By: 21 September 2020
Surgeon in Focus – William Barrett

Dr William Barrett is a board-certified and fellowship-trained orthopaedic surgeon, who specialises in primary and revision hip and knee replacement at Valley Medical Center in Renton, WA in the USA. He has been active in the American Academy of Orthopaedic Surgeons Continuing Medical Education programmes. He is the past chairman of the Education Committee for the American Association of Hip and Knee Surgeons. Dr Barrett has been involved in the design of some of the most commonly used hip and knee replacement systems used in joint replacement surgery.


Q: As a leading orthopaedic surgeon, could you tell us more about your experience and training background in this field?

A: I graduated from the University of Southern California School of Medicine in 1980. I then went to Seattle, WA for my orthopaedic residency at the University of Washington and did my fellowship training in arthritis surgery and joint reconstruction at Brigham and Women’s Hospital, Harvard Medical school.

Every year, I perform around 500+ joint replacements and am actively involved in clinical research on anterior approach total hip replacement and total knee replacement.


Q: What drove you to choose surgery as a career – and hip and knee surgery in particular?

A: In medical school, I was attracted to surgery as a specialty and orthopaedics specifically because of the ability to fix acute injuries and fractures, and eventually hip and knee replacement to correct the problems associated with end stage arthritis. The satisfaction of eliminating pain and loss of function due to arthritis is tremendous.


Q: How has your job changed since the onset of the Covid-19 pandemic?

A: We took two months off, March and April, and started back in mid-May. I am slowly working my way through my backlog of 120 patients whose surgeries were cancelled during that time. We operated at 150 per cent of normal capacity for the first two months back, now our schedule has normalised. Like many places we have had to adapt and embrace new technology and innovations to support our patients.


Q: Do you think it is safe to reschedule surgeries now? What steps have you taken to safely prepare for reopening?

A: Yes, I believe it is safe to resume surgery for most patients. It’s important for me to listen to each patient to evaluate their needs and determine what’s right for them. For certain patients, surgery may not be appropriate. While hip and knee surgeries are considered elective, they are many times truly necessary for patients to improve their quality of life. The patients who need these surgeries are dealing with issues such as chronic pain or limited mobility and ultimately will need an elective surgery to get back to living their lives. It’s important for me to consistently work closely with and listen to my patients to evaluate their needs to determine what’s right for them.

Hospitals are doing everything they can to keep patients and clinicians safe. Everyone in the hospital always has to wear a mask. We’ve made changes to patient flow in the hospital and visitation restrictions. Most hospitals are allowing a family member to accompany a surgery patient into the hospital but limiting the time of the visit. We have also adopted telehealth to decrease the number of unnecessary clinic visits, and that’s become a mainstay of our pre-op business and now our post-op visits.


Q: How are hospitals increasing procedure efficiency?

A: We have increased our use of telehealth and different technologies to try to improve efficiencies and adjust for a reduced staff. Tools like Patient Path are assisting with the pre-op phase and allowing us to connect with patients ahead of surgery while KINCISE™ and VELYS™ Hip Navigation are beneficial in planning for joint replacement. Digital surgery tools are helping us to better plan, analyse and automate hip surgery, in order to deliver a high standard of care and increase efficiency before, during and after surgery.


Q: How has the industry adapted and evolved to assist surgeons and surgery?

A: Looking back on my 30+ years of experience as an orthopaedic surgeon, I reflect on how things have been and where they are going. If I go way back, before I was a surgeon, back to when I was born, doctors made house calls. They would bring their black bag, take the patient’s history, examine the patient, develop a plan, and then on the spot decide what they were going to do; and what they were going to do was in their little black bag. That was the level of technology at that point in time.

Fast forward 60 years, we do the same thing. We take the patient’s history and do an exam. It may or may not be physically with the patient, it may be remote. We develop and execute a plan but now we have all these tools at our fingertips, so that while we’re talking to the patient, a history and a medical record can be generated. We have imaging that we never thought was possible 60 years ago, and so we take all this information and we condense it into an action plan that has changed the way we deliver care. I think along those lines, we look at some of the healthcare apps and some of the new technology available. Now with machine learning, that information can be accrued in a minute or two and you can develop a plan and use this technology to optimise the patient, to understand the risk for that patient and determine where’s the best location for that patient to be successful with their outcome as far as hip and knee replacement.


Q: Should this continue where possible?

A: Absolutely. What we’re seeing now with artificial intelligence and machine learning would often take an individual person years to learn and accomplish and we can now harness this knowledge in hours or minutes. Some of the technological changes that I’ve seen in my lifetime, for example electronic medical records, have some good and some bad. However, for the most part, we have technology in the operating room that allows us to analyse the position and precision of how we place our implants. So, it’s had a tremendous impact not only on the procedure itself, but what goes on before the procedure and the aftercare – the ability to monitor patients remotely.


Q: How has COVID-19 changed the way we see our doctors, such as using telemedicine pre-surgery and automated and digital surgery technology?

A: I think COVID-19 has made telemedicine and digital surgery technology more essential. The uptake of technology in healthcare has probably been a little bit slower than it’s been in the rest of sectors of our society, but COVID-19 is forcing us to quickly adapt these technologies in order to minimise contact and increase efficiency.

Technologies such as telemedicine and patient engagement apps have allowed me to connect virtually with patients for post-op rehab without face-to-face interaction, limiting exposure and saving time. These services have quickly become common practice for lots of orthopaedic surgeons and have been very useful in making our patients feel like they’re being accompanied along their journey.


Q: In your opinion, what are the main do’s and don’ts for people as the world begins to open everything back up again?

A: We are all learning to adapt to the “new normal” and new technologies. As physicians, it is important we embrace new innovations to make sure our patients are getting the care they need. Also, it’s our job to clearly educate patients on the measures we are taking to keep them safe during surgery and we all have patience with each other as we learn to adjust.


Q: How do you think the future looks in the field of orthopaedic surgery?

A: While there are so many things that are uncertain right now, it’s also happens to be a very exciting time for innovation to provide better patient care, better surgeon education and improved hospital safety.