Javad Parvizi is an American Board Certified, fellowship trained, orthopaedic surgeon and the Director of Clinical Research at the Rothman Orthopaedic Institute. He has been at Rothman since 2003. He holds the James Edwards Professor Chair of Orthopaedics at Thomas Jefferson University. He specialises in the management of young patients with hip disorders such as dysplasia, femoroacetabular impingement and other complex hip and knee conditions.
OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?
JP: When I was a child, I witnessed my grandfather perform surgery on a man’s leg. It fascinated me and from that moment I knew I would pursue a career as a surgeon. After a brief stint working in cardiothoracic surgery in the UK, I joined the Mayo Clinic, and under the leadership of Dr. Bernie Morrey, I focused my career on orthopaedic surgery.
OPN: It is clear that the healthcare industry has been greatly impacted by the pandemic, what has been the greatest impact for you within the orthopaedic industry?
JP: The biggest impact for patients here in the US was the delay in treatment. Here our patients usually only wait days or weeks for elective procedures. During the pandemic, that timeline significantly increased. These Covid-related delays provided me with a perspective on other countries with socialised medicine where these delays are commonplace. Witnessing the suffering of patients here in the US waiting for total hip arthroplasty (THA) was hard to watch.
The other major impact of Covid was our migration toward digital health. We witnessed several post-operative follow-up services conducted via digital or telehealth channels. We were encouraged to learn that even our elderly patients were able to use the digital platforms to access telehealth services.
OPN: What’s the best part of your job?
JP: My greatest satisfaction is helping a patient improve their quality of life by eliminating or reducing pain. In particular, THA, and other orthopaedic procedures, can deliver immediate improvements in mobility, pain reduction, and quality of life. It is extremely rewarding helping individuals to walk without pain, and, in some cases, resume running and other athletic pursuits.
For the past 25 years I have been researching the reduction of post-operative orthopaedic infections. It has been extremely rewarding helping to reduce post-op infection in the orthopaedic patient populations.
OPN: … and the worst?
JP: For me, and most healthcare providers, the worst feeling is doing our best with the best technology and still falling short. The worst part is when we lose the battle. Primarily when a joint replacement procedure results in a post-op infection and we are forced to perform a salvage procedure, such as fusing a joint or amputation.
OPN: What has been the highlight of your career so far?
JP: Being selected to serve on a team of American, British and Canadian travelling Fellows in 2005. This prestigious Fellowship enabled me to travel around the world for five weeks with five other professionals.
Based on my research passion, I am proud of having the opportunity to serve as a servant leader or various organisations like the Musculoskeletal Infection Society (MSIS), the Eastern Orthopedic Association and the American Association of Hip and Knee Surgeons. I am also very proud to be named James Edwards Professor Chair of Orthopedics at Thomas Jefferson University.
Another rewarding aspect of my career has been the research into aspirin as the gold-standard treatment for the prevention of venous thromboembolism after orthopaedic procedures. I should mention Paul A. Lotke, MD and Eduardo A. Salvati, MD, whose path I followed in this work.
OPN: You have agreed to participate in an FDA IDE Pivotal Study with Hip Innovation Technology (HIT) and their Reverse Hip Replacement System, can you tell us more about it?
JP: Hip Innovation Technology, LLC recently received FDA (Food and Drug Administration) Investigational Device Exemption (IDE) approval to initiate a pivotal clinical study to further evaluate the company’s Reverse Hip Replacement System (Reverse HRS) for use in primary THA.
The clinical study objective is to evaluate the safety and effectiveness of the Reverse HRS in patients undergoing THA. Safety will be assessed through the collection of device-related adverse events and patient quality of life metrics. Effectiveness will be evaluated using clinical, radiologic, and patient-reported outcomes.
One of the most common debilitating side effects of THA is dislocation. This trial will further evaluate the benefits of the Reverse HRS to reduce dislocation versus standard THA implants.
OPN: What potential advantages does the Reverse Hip Replacement System (Reverse HRS) offer to patients over typical hip implants on the market?
JP: The Reverse HRS, as the name implies, is a reverse geometry hip prosthesis designed to improve stability throughout functional ranges of motion, reduce prosthesis impingement and reduce the risk of dislocation. Dislocation continues to be one of the most common complications of conventional total hip systems and one of the most frequent indications for patients requiring re-operation.
The Reverse HRS consists of a cementless acetabular component that uniquely has a central taper into which the ball seats.
Importantly, the articulation surface is still a ball against a polyethylene liner, however, the system is reversed with the ball now associated with the acetabular component and the liner being associated with the femoral component which appears to facilitate key product features including improved stability, reduced impingement and reduced dislocation.
In addition, the reverse hip was shown to be very forgiving with regard to cup placement in cadavers. Even with gross misplacement of the acetabular component of the hip in cadavers, the reverse hip was stable. This is critical as many patients with coexistent spine and hip arthritis, are at higher risk of dislocation of the hip. The placement of the acetabular component in an optimal position in these patients can be challenging as hip replacement is performed when patients are lying down and the spine-hip relationship changes when the patient stands.
I have been working on the Reverse HRS for more than six years now and am excited to participate in the clinical trial of this device.
OPN: Has the Reverse HRS ever been clinically implanted in any patients?
JP: There is an ongoing radiostereometric analysis (RSA) clinical study in Canada evaluating the safety and effectiveness of the Reverse HRS in patients undergoing primary total hip arthroplasty (THA) with an additional specific focus on acetabular and femoral component fixation. This study’s RSA results demonstrated excellent fixation to bone with minimum migration at 24 months for both the acetabular and femoral components.
Initial RSA results are predictive for long term fixation, and the study data predicts the HIT Reverse HRS to be at a low risk for aseptic loosening and revision at 10 years. As a result, based on similar patient populations, our expectation is that the U.S. pivotal study will observe similar results to the ongoing Canadian clinical trial.
OPN:What could your clinical research mean for the patient experience, management strategies and surgical outcomes looking forward?
JP: We hope our participation in the clinical research of the Reverse HRS contributes to answering unmet medical needs that improve stability throughout functional ranges of motion, reduce prosthesis impingement and reduce the risk of dislocation.
By alternating the placement of the ball onto the acetabular cup instead of the femoral stem, the ball maintains constant contact with both the acetabular component and the femoral component. As a result of this constant contact, the Reverse HRS can maintain stability of the hip at extended ranges of motion and thus minimise the risk of dislocation.
This design improvement should also reduce high contact stresses across the hip joint, thereby distributing wear evenly across the contact surface of the polyethylene liner and at the same time, minimising edge loading. In addition, because the polyethylene liner is composed of highly cross-linked polyethylene (HXLPE), the risk of osteolysis and aseptic loosening due to wear debris generation is further reduced.
OPN: What’s the next step in your clinical research?
JP: Our primary research goal right now is to enrol and complete the Investigational Device Exemption (IDE) pivotal clinical study to further evaluate the company’s Reverse Hip Replacement System (Reverse HRS) for use in primary total hip arthroplasty (THA).
OPN: Are you planning to attend any orthopaedic events this year?
A: Yes. I attended the AAOS meeting in Chicago and have plans to attend the Spring 2022 meeting of the American Association of Hip & Knee Surgeons, The Musculoskeletal Society meeting, and I plan on attending quite a few international orthopaedic meetings.
OPN: If you weren’t an orthopaedic surgeon what would you be?
JP: A pilot. I love air travel and exploring the world.
OPN: What would you tell your 21-year-old self?
JP: Do exactly what I have done. Immigrate to America and pursue a career in orthopaedics in this amazing country.
OPN: If you were the FDA or Health Minister for the day what changes would you implement?
JP: I have been a clinician in many places in my life. From the UK to Switzerland to the U.S. No system is perfect. These government agencies are there to protect the patients and for the most part they do that. They have an extremely hard job balancing the protection of patients and facilitating the progress of new technologies.
To keep that balance is difficult. I believe that the FDA has been very receptive to the need of patients and the medical community for the most part. I know that the agency is reviewing current issues related to the clearance of anti-infective technologies and other innovations that require large scale clinical trials that are sometimes prohibitively difficult to conduct.
OPN: Away from the clinic and operating theatre – what do you do to relax?
JP: I golf with my family, I read, I listen to music, and I travel.
OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2022 and the next decade?
JP: Front and centre, we expect that THA will be impacted by the advent of the reverse hip replacement system.
Further, we can expect to see incredible advance in the field of precision medicine, individualised medicine and genomics.
Unfortunately, the demand for orthopaedic services has resulted in a simultaneous reduction in available reimbursement. We hope these market dynamics won’t discourage young people from pursuing orthopaedic surgery.
We can also expect to see great strides in understanding the genetic basis for degenerative diseases such as osteoarthritis of the knee and hip joints. The science to explore the genetic aspects of these diseases could potentially revolutionise how we treat these debilitating orthopaedic diseases.
We can see a future where biological interventions supersede orthopaedic surgical interventions. So, in the 10-20 years we expect to see a shift away from metals and plastics to the use of biologics to prevent and treat these diseases.