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Texas Orthopedics, Sports & Rehabilitation Associates

Wednesday, September 18, 2013

Doctor of the Week

Dr. Brendan MacKay is our Doctor of the Week!

Brendan J. MacKay, MD is a Board Eligible Orthopaedic Surgeon and Fellowship trained Hand Surgeon. Dr. MacKay is Board Eligible by the American Board of Orthopaedic Surgery and is a Candidate Member of the American Society for Surgery of the Hand. He has an interest in minimally invasive/endoscopic carpal tunnel surgery, complex hand reconstruction including microvascular and peripheral nerve surgery, sports injuries, joint replacement, and orthopedic trauma treatment.
Dr. MacKay is a native of Long Island, New York. He graduated Magna Cum Laude from the University of Notre Dame with a Bachelor of Science in Premedical Studies and Economics. Dr. MacKay attended the Northwestern University Feinberg School of Medicine and completed his residency in orthopaedic surgery at the New York University Langone Medical Center Hospital for Joint Diseases. He was selected as an Executive Chief Resident in his final year of training by Dr. Joseph Zuckerman, past President of the American Academy of Orthopaedic Surgeons. After graduating from residency, he completed a fellowship in hand, microvascular, and peripheral nerve surgery at The Hand Center of San Antonio and the University of Texas Health Science Center under the auspices of Drs. David P. Green and William C. Pederson, internationally recognized authorities in hand surgery.
Dr. MacKay has co-authored several peer reviewed scientific articles and has presented at national orthopaedic meetings, including the American Academy of Orthopaedic Surgeons and the American Society for Surgery of the Hand.
He currently serves as team physician for the McNeil High School football team and participates in the care of the American Hockey League Texas Stars.
In his free time, Dr. MacKay enjoys traveling to pursue downhill skiing, scuba diving, and golf.

Tuesday, September 17, 2013

What is the Societal Value of Total Knee Replacement?

Post provided by American Academy of Orthopedic Surgery

With all the attention on the cost of health care, an important factor is being overlooked: the impact on society resulting from the treatment of a particular condition. Comparing that impact when both surgical and nonsurgical treatments are available is particularly important in a specialty such as orthopaedics, which focuses on restoring mobility and health.

“A number of studies have already looked at the cost-effectiveness to individual patients for certain orthopaedic procedures, including total hip and total knee arthroplasties,” said AAOS Past President John R. Tongue, MD. In outlining the goal behind “The Direct and Indirect Costs to Society of Treatment for End-Stage Knee Osteoarthritis,” a study published in the Aug. 21 issue of the Journal of Bone & Joint Surgery, Dr. Tongue noted, “We wanted to examine the cost-effectiveness of orthopaedic procedures from a societal point of view.

“For example, if you’re a 55-year-old teacher and you need a total knee arthroplasty (TKA) to keep teaching, and you undergo the procedure, you’re going to continue to work; you’re going to continue to pay taxes. If you don’t, you’re more likely to sit around, developing other comorbidities, gaining weight, having poor quality of life, and collecting disability.”

Applying a new model
Inspired by published research that attempted to quantify the societal impact of deaths and injuries from roadway trauma, Dr. Tongue contacted an economist friend to see if it might be possible to similarly quantify the impact of orthopaedic procedures.

The economist, John Duffield, PhD, proposed conducting a literature search to identify previous work that may have covered similar ground, then building on that research to develop a new methodology that could be applied to specific medical conditions. To carry out this objective, AAOS engaged KNG Health Consulting, LLC, and its research partners at IHS Global, Inc., and Duke University.

$12 billion in savings
To estimate the societal value of TKA, the research team generated results based on adults age 40 years or older who underwent TKA during 2009. According to the authors, the study population accounted for 99 percent of all TKAs performed in the United States that year.

The researchers calculated direct costs, quality-of-life, and most importantly the lifetime indirect cost of TKA. These indirect costs components capture the effects of surgery on a patient’s ability to work, patient earnings, disability payments, and missed work days. For modeling purposes, the researchers conservatively assumed that all patients retire at age 75.

The research team found that, compared with nonsurgical treatment, undergoing TKA increased direct costs per patient by an average of $20,635 (based on 2009 dollars). Those costs were offset by societal savings of an average $39,565 per patient based on reduced indirect costs, producing an estimated $18,930 in lifetime savings to society per patient.

Overall, the researchers found that 85 percent of the societal savings were associated with increased employment and earnings. The remaining 15 percent were linked to fewer missed work days and lower disability payments.

Based on the more than 600,000 TKAs performed in the United States during 2009, the study authors estimated a lifetime societal savings of approximately $12 billion for the single year studied.

“When we submitted the study, there was some concern among reviewers that the findings could be interpreted as, ‘everyone should get surgery,’” said Dr. Koenig. “It’s important to understand that is not the conclusion of the study. The conclusion is that, for the cohort of people who have surgery, there are—on average—societal savings. For many reasons, some patients don’t undergo surgery. Our analysis was based on the cohort of patients who actually underwent surgery.”

Further research
The TKA study is the first of five similar research papers planned for publication, each examining the value of a different orthopaedic procedure.

“We chose a variety of conditions based on high economic impact and to demonstrate the breadth of our specialty,” said Dr. Tongue. “We have already submitted for publication papers on rotator cuff repair and anterior cruciate ligament repair, and two more studies—one looking at hip fracture and one on lumbar diskectomy—are in the works.”

“What I find most exciting about this research,” said Dr. Tongue, “is that it changes the conversation from how expensive orthopaedic procedures are, to how valuable they are. You don’t have to try to stretch any estimates, because the value for each procedure is tremendous.”

Tuesday, September 10, 2013

Doctor of the Week

Dr. Greg Westmoreland is our Doctor of the Week! Watch the video to learn more about Dr. Westmoreland.

Tuesday, September 3, 2013

Knee Replacement Surgery: New Health Economics Study Highlights Societal Benefits

Cost Savings are Good News as Aging Population Rapidly Increases
Demand for Relief from Chronic Knee Pain

The full impact of knee replacement surgery on both patients’ lives and on society includes significant overall cost savings, according to a new study published in the Journal of Bone and Joint Surgery
(JBJS). Researchers found that for the average patient undergoing knee replacement surgery, the expense of surgery is offset by indirect savings of nearly $40,000. This translates to an average lifetime societal benefit of $10,000-$30,000. Most of the societal savings come from the patient’s ability to maintain employment and increase earnings over a longer time in the workforce. The study also found benefits from fewer missed worked days and lower disability payments.

As an aging population stays in the workforce longer and obesity rates continue to climb, demand for total knee replacement surgery is expected to exceed 3 million by the year 2030 – up from 600,000 in 2009. Now with a new way of comparing direct and indirect costs between surgical and non-surgical treatments, patients suffering from end-stage osteoarthritis of the knee are able to get a quantitative look at the overall cost benefits of knee replacement surgery relative to the societal and economic savings.

“We know that when a knee replacement is done on patients at the appropriate time, it adds tremendous value to their lives. It gets them back to work and back to their families. It improves their quality of life and allows them to be productive and active again,” said John R. Tongue, MD, American Academy of Orthopaedic Surgeons(AAOS) past-president. “But until now, that value has been hard to quantify. This study allows patients to see the big picture of the effect on their daily lives and in the long term.”

Dr. Tongue adds, “Demographics of knee replacement patients have dramatically changed as baby boomers age. They want and need to stay active but their joints can’t always keep up. In this economic environment, this study provides a new way of looking at cost that offers perspective to this growing population.”

Total knee replacement (or total knee arthroplasty (TKA)) is one of the most successful and life-enhancing surgical procedures. It significantly relieves pain for 90 percent of the patients who have the procedure, allowing them to return to work and tremendously improving their quality of life.

The fullstudy is available at Video and audio pertaining to this news can also be found at

Doctor of the Week

Dr. David Savage is our Doctor of the Week! Watch the video to learn more about Dr. Savage.

FREE Joint Replacement Seminar on Thursday

Learn more about non-surgical arthritis treatment options as well as total hip and total knee replacement surgery at Arthritis Camp! Refreshments are served. Bring your friends and family!

Date: Thursday, Sept 5th 
Time: 5 PM to 7 PM
Location: Northwest Austin, 4700 Seton Center Pkwy, Ste. 200, Austin, 78759
Speaker: Marc DeHart, MD

Please RSVP by registering online or call 439-1176. If you can't make this seminar, plan to attend our next seminar on Thursday Oct 3rd