By: 6 October 2022
Surgeon in Focus – Alexander Sah

Alexander Sah is an orthopaedic hip and knee surgery specialist, based in California, with expertise in minimally invasive anterior hip replacement and partial and total knee replacement, outpatient joint replacement, as well as complex hip and knee revision surgeries.

He in on leadership committees for the American Academy of Orthopedic Surgeons and for the American Association of Hip and Knee Surgeons. He presents research at national meetings annually and teaches surgeons on advancing techniques in the field of joint replacement. Dr Sah has recently been at the forefront of the shift to ambulatory surgery centers (ASCs) and is a strong proponent of the benefits that serve the patient, the provider, and the payer.


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

AS: My father was a head and neck surgeon. Growing up seeing the impact his career had on the community clearly left an impression on me. To this day, patients of his, that are now patients of mine, tell me how appreciative they are to have had him as their doctor and their surgeon. We, as surgeons, are privileged to perform procedures for patients that can dramatically improve their quality of life, with long-lasting benefits. Orthopaedic surgery has always been an interest of mine because of the immediate impact the surgeries can have to improve patient function and outcomes.


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?

AS: The pandemic has greatly impacted the way that healthcare is delivered, and how it is perceived by physicians and patients. At the height of the pandemic, orthopaedic surgeons were faced with delivering only the most essential procedures and doing so in the most efficient and safe way possible. Suddenly, the healthcare industry, as a whole, was re-evaluating how to best deliver care in the worst of times. The migration to the Ambulatory Surgery Centers (ASC) is only one example of a major change in orthopaedics. Second, patients’ expectations of healthcare began to evolve as inpatient beds were no longer available. Expectations of recovering after surgery in a hospital were shrinking, and patients became more accepting of recovering at home, and changing the traditional expectations after surgery.


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

AS: Establishing relationships with our patients is by far the most rewarding part of our profession. It doesn’t even feel like a job when you can come to work and meet with patients that have new leases on life because of their new joint replacement. You get to know them like family, and they share the activities they can now do, the places they have gone, the adventures they have planned, all because they have regained their mobility and function. There is nothing more gratifying than to hear these patients say that their joint replacement surgery was the best thing they have ever done, and they wish they had done it sooner.


OPN: … and the worst?

AS: I went into medicine to help people and to form long-lasting relationships, like my father did with his patients. We simply want to help people improve their quality of life, regardless of who, where, or why. The increasing barriers from insurance carriers and payors is affecting patient access to care. The paperwork and hurdles that are required to deliver high quality care can certainly distract from the fundamental medical treatments that we prefer to focus on.


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

AS: I have been fortunate to participate in leadership roles for our national orthopaedic associations, and to teach techniques and to present research at a high level. I have been recognised by organisations like Becker’s and been a member of the esteemed AAOS Leadership Fellows Program, which are all incredible honours. Yet the greatest highlight of my career is that conversation with a patient or family when they tell us that while they couldn’t be happier with their joint replacement, and they can do everything that they want to and more, and that they are equally appreciative of the personalised care our team has provided. From the person answering the phone to nurse to surgeon to therapist to the person bringing the food- the patient sees that every staff member loves their job, and puts the patient first. From the personal phone calls, the check-ins, the immediate response to questions- the patients feel comfortable and fully taken care of. They tell us that the entire experience was better than anything they could have imagined, then I know that we have done it right.


OPN: Originally thought to be fuelled by the pandemic, the growth of the ASC market in the US is proving to be more than a temporary trend. Could you share your insight as to where the ASC industry is heading?

AS: The movement of elective hip and knee replacements to the ASC will continue. The pandemic sped up an already increasing migration of surgeries out of the hospital and into ASC. This is due to a combination of necessity, surgeon comfort in the change, and patient acceptance of same-day discharges. Due to financial savings and incentives, improved outcomes and patient satisfaction, this trend will continue.


OPN: What could this mean for the patient experience, management strategies and surgical outcomes looking forward?

AS: In many cases, the patients find an improved patient experience, as these ASCs can act as specialty hospitals to focus on the fine details of the patient surgical experience. Better outcomes and more personalised care can lead to greater patient satisfaction. ASCs will need to prepare for this increase in demand, by accommodating higher case volumes.


OPN: Are you planning to attend any orthopaedic events this year?

AS: I will attend AAHKS, AAOS, WOA, COA meetings.


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

AS: I would be a physician, and likely a surgeon. If not orthopaedics, perhaps ENT like my father. I would find a profession to work and help people somehow through the medical field.


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

AS: I would remind my younger self to be prepared for a long journey, but to enjoy the process. It goes quickly, and as hard as the process is, it is still one of the most rewarding professions possible.


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

AS: Access to health care for all. Fewer restrictions due to insurance barriers would allow patients to see physicians that they prefer. There is need to reassess declining physician reimbursement, as continued yearly reductions in reimbursement undermine the quality of care that can be provided.


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

AS: I enjoy time with family, and my three sons. I enjoy sports, the outdoors, travel and photography.


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?

AS: The future remains bright, with continuous improvements and technological advances to provide better and more efficient care for patients. The pandemic showed that the demand for orthopaedic care remains consistent, even during the most difficult times for the healthcare system, and may be increasing, as people live longer and remain more active.


OPN: With expertise in outpatient procedures, you are on the faculty for the AAOS Outpatient and Rapid Recovery course this November, and will also be speaking at the MicroPort Orthopaedics Medial-Pivot Symposium. Can you give us a sneak peek into some of the insights you will be sharing at these upcoming events?

AS: This will be my fourth year as faculty for the AAOS Outpatient and Rapid Recovery course this November 2022. It is always a pleasure to present with other national leaders on the advances in outpatient joint replacement surgery. Protocols and techniques continue to improve each year, and at this meeting I look forward to learning from my peers, as much as I look forward to educating attendees. The focus of my presentations this year will be on the importance of preop education for patients and caregivers to have a successful outcome. With faster discharges and less time for teaching, more work is required on the frontend to prepare patients for recovery at home. I will also present on essential steps for the surgeon just beginning outpatient discharges for the first time. Rather than starting from scratch, this presentation will review some of the common pitfalls encountered and some of the tips to achieve success.

In September, I am thrilled to be participating in the inaugural Medial-Pivot Symposium in Chicago. This meeting will be a unique opportunity to discuss the history and potential advantages of the medial-pivot knee design, and to learn from peers about their experiences with this implant. The industry has migrated towards some version of this medial-pivot design, but truly understanding its rationale and the techniques to optimise its outcomes is important. I have been tasked to speak about the patient’s direct role in managing their postoperative recovery. I will speak about cryotherapy and other pain management strategies, and how the patient must take an active role in navigating their recovery successfully. I will present on tips to transition total joints to the ASC and the many options available to optimise postoperative pain management.