By: 3 May 2021
Surgeon in focus – Professor Roger van Riet

Professor Roger van Riet is a world-renowned elbow surgeon. He is a pioneer in arthroscopic surgery of the elbow and has treated elbow injuries in many international athletes, including Olympic and world champions. He is well recognised for the development of his technique to repair and reconstruct the unstable elbow as well as tendon repairs around the elbow. He has travelled the world as a teacher of elbow surgery. He is a visiting professor at the University Hospital Antwerp and has published extensively. He is currently involved in the development of a new elbow prosthesis. As the fellowship director of AZ Monica in Antwerp, he has been involved in the training of many young colleagues. He was the first president of the Belgian Shoulder and Elbow Surgeons Society and has been the chair of the rehab committee and a member of the executive board of the European Society of Shoulder and Elbow Surgeons.


OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?

RvR: My initial dream was to become a professional cyclist, and I was able to combine this with studying physiotherapy. Unfortunately, I fractured both my shoulder and elbow in different cycling crashes and had to have surgery myself. I guess that was my first introduction to orthopaedic surgery. After that, as part of my internship as a student physio I was able to observe several surgeries at the Leicester General and then I knew I wanted to become an orthopaedic surgeon. After qualifying as a physiotherapist, I worked as a physio for a year, before starting medical school. Most holidays I still worked as a locum physiotherapist in several hospitals in the UK.


OPN: It is clear that the healthcare industry has been greatly impacted by the Covid-19 pandemic, what has been the greatest impact within the orthopaedic industry?

RvR: Initially, all elective surgery had to be postponed causing patients to suffer longer from their orthopaedic conditions. Many problems deteriorated as a result. Other patients were afraid to come to hospital and this sometimes caused a delay in diagnosis and treatment. As patients got used to the pandemic and were more familiar with safety and health guidelines, trust was restored and the biggest part of our practice returned to near normal. At the moment the main difference in my practice is the decrease of sports injuries. Recreational sports have not yet returned to normal and this reflected in that part of the patient population.


OPN: As a surgeon, how do you embrace new technologies to ensure the best patient experience, management strategies and surgical outcomes?

RvR:We are always trying to improve the outcome for the patient. The most important aspect of this is to evaluate the result of the technique used. This often leads to small changes that may have a large impact and sometimes this leads to new techniques. This has helped us to pioneer some of the techniques currently used by many colleagues. Especially in the field of arthroscopic surgery there has been an enormous growth in indications and some of the things that were thought to be impossible have now become routine for experienced elbow surgeons. Another field that has seen a revolution is the use of 3D imaging and preoperative planning for fractures that have healed in the wrong position. This is a good example of where technology helps the surgeon to perform a procedure with more accuracy and a decreased risk of complications.


OPN: Are you attending any orthopaedic events this year?

RvR: At the moment most events are virtual but hopefully we will be allowed to travel again soon. Since the travel ban, I have presented at two or three virtual meetings a month. This month, for example, I will be presenting on elbow surgery topics at an international meeting organised in India and another one organised in Egypt. Later in the year, I have live meetings planned in the UK, Netherlands, USA, Croatia, Poland, Spain, Belgium and South Africa. Fingers crossed the world will be more normal again soon.


OPN: What’s the best part of your job?

RvR: When a patient tells me that the surgery changed their live.


OPN: … and the worst?

RvR: The absolute worst is when there is a complication. I spend quite some time to council the patient before surgery and tell them what the risks are. Despite that, it is always very disappointing for both me and especially for the patient when a complication occurs.


OPN: What has been the highlight of your career so far?

RvR: That is a difficult question. I am proud of my career and have had lots of wonderful moments. I still feel there is room to grow and develop. Once I reach a goal I am usually already working on the next. I have treated many international athletes and immediately become a fan and am always proud of their achievements. In 2016, we organised the largest elbow course to date in Antwerp, Belgium, but if I have to pick one moment, I will probably choose the time that I was invited to be an invited guest lecturer at the Mayo Clinic Elbow Course. In 2001 I was a research fellow at the Mayo Clinic and was allowed to attend the elbow course for the first time. In return I was helping in the lab and literally had to clean the floors. Since then, I had been back nearly every year as an instructor in the lab but in 2018, I was featured as the guest lecturer as a member of the Mayo Elbow Club. That was a moment where I suddenly realised what had happened between mopping the floors and being the guest lecturer that year.


OPN: Are you currently involved in any scientific research within your work?

RvR:Yes, I have published over 100 peer reviewed papers on elbow surgery, approximately 50 book chapters and have presented over 500 times in national and international meetings. I am a guest professor at the University of Antwerp and fellowship coordinator. Our research is ongoing and we are constantly evaluating our results. At the moment we have projects on elbow arthroscopy, prosthetic replacement, biceps tendon repair, tendonitis and nerve compression, just to name a few.


OPN: If you weren’t an orthopaedic surgeon what would you be?

RvR: I cannot imagine doing something else. I love my job and still feel challenged to get better nearly every day.


OPN: What would you tell your 21-year-old self?

RvR: Do not crash your bike so often! Try using the brakes every once in a while.


OPN: If you were Health Minister for the day what changes would you implement?

RvR: In my opinion, so called quality control mechanisms have become a goal in their own instead of a means to improve quality. The environment that has been created favours ticking boxes, instead of letting highly trained healthcare professionals think for themselves. This has the opposite effect of what it is trying to achieve. Nursing staff, doctors and everyone involved in healthcare spend a significant amount of their time on administrative tasks. This is time that cannot be spend on patient care. That would be the first thing I would try to change.


OPN: Away from the clinic and operating theatre – what do you do to relax?

RvR: Spending time with my family is very important to me.  I still love sports, and try to ride my bike when I can.


OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2021 and the next decade?

RvR: The future looks great. We will have so many innovations and the increased use of artificial intelligence in imaging, planning and printing will improve patient care. This will happen gradually as safety is obviously our first concern. The surgeon is responsible and should not let the computer decide just yet. Patient specific implants will become more common and maybe hospitals will be able to print these on site. For 2021, I am less ambitious. Hopefully, we will gradually return to pre-Covid ‘old-fashioned’ orthopaedic patient care, research and international exchange of knowledge and ideas.