“Performing” Surgery

"Performing" Surgery

Appreciation for the arts and cutting-edge surgery skills seem worlds apart. But Dr. David LaVelle (Martin ’75, Health Science Center ’79) easily connects the dots. Once a cast member on the stage of UT Martin’s Vanguard Theatre, this talented orthopedic surgeon is equally comfortable discussing plays or describing an innovative surgical hip-repair procedure he performs at Campbell Clinic in Memphis. Besides relieving his patients’ pain, LaVelle is teaching the next generation of surgeons at one of the world’s foremost orthopedic clinics.

LaVelle, whose father is Dr. Herman LaVelle (Health Science Center ’51), a retired Memphis ear, nose, and throat physician, was destined for a medical career. He arrived at Martin focused on academics, but at the urging of some favorite professors, he pursued new interests that continue to influence his life. Although he never played a major role, he performed in Vanguard Theatre plays and completed additional hours in English. He credits this broadening educational experience for developing the communications skills necessary to work with patients.

LaVelle became interested in orthopedics while attending the UT Health Science Center. As he worked in emergency rooms, he noticed that orthopedic surgeons “universally seemed to enjoy what they were doing.” He saw patients arrive in great pain and gain immediate relief after treatment. Also, orthopedic tools resembled the hand and power tools he had learned to use in his dad’s woodworking shop, so his affinity for “fixing things” fit perfectly with the specialty.

LaVelle graduated from medical school in 1979 and entered a residency at Campbell Clinic, which serves as the UT College of Medicine Department of Orthopedic Surgery. As a specialist in adult reconstruction and trauma surgery, he was asked to join the clinic staff in January 1985. The clinic’s specialties include sports medicine, pediatric orthopedics, and joint replacement.

His trauma surgery expertise set the stage for his subsequent work with joint replacement. “Trauma surgery requires the most creativity and innovation of any area of orthopedics,” he said. “If you learn trauma surgery well and perform it well, the rest of the orthopedic specialties use those same skills.” When he joined Campbell Clinic, the Regional Medical Center in Memphis–known as “the Med”–opened to offer the first Level 1 trauma center in that area. The opportunity allowed him to spend his first 7 years in practice treating trauma cases.

Now, more than 20 years later, LaVelle has learned an innovative procedure called “the Birmingham hip resurfacing system.” British orthopedic surgeons Derek McMinn and Ronan Treacy, using a device from Smith & Nephew, developed the procedure. LaVelle works with Smith & Nephew to develop orthopedic products and has traveled around the world lecturing about the use of selected devices.

Using a model of the hip joint, LaVelle compared traditional hip-replacement surgery and the new procedure. In simple terms, the hip joint is a ball-and-socket joint, and arthritis occurs when the cartilage between the ball and the socket wears out. The traditional way to treat a severely arthritic hip is to remove the ball and insert a stem with a ceramic or metal ball into the marrow cavity of the femur. The hip socket is then opened, and a titanium shell with an ultrahigh-molecular-weight polyethylene liner is placed in the socket. The hip is then assembled by “reducing,” or setting the prosthetic ball into the plastic socket.

The new procedure preserves much more bone through resurfacing and covering the ball with a metal cap. The result is a metal-on-metal bearing surface that simplifies any future surgery. LaVelle said the new procedure also offers advantages for mobility compared with traditional hip replacement. The new surface is more durable, and the larger ball used with the Birmingham hip offers a wider range of motion and is less likely to pop out of the socket, the major complication of traditional surgery.

Permanent restrictions exist with standard hip replacement, he added. For example, patients can no longer squat; also, the leg cannot be turned inward after surgery, a motion that can cause the ball to pop out of the socket. But with the new implant, there are few restrictions because of the ball’s larger size. The procedure is so promising that professional cyclist Greg Landis had it in October at another clinic.

As with almost any medical procedure, LaVelle noted some cautions for potential patients. For example, the best candidates are people younger than 60 years old who have hard bone and are highly active. And he advises that wear occurs no matter what material is used in the replacement joint. “When a metal-on-metal bearing surface wears, it releases metal ions,” LaVelle said, adding that metal ions released into the bloodstream, especially chrome and cobalt, elevate over time. “We don’t think that causes any problems, but for that reason, we don’t recommend this surgery in women of childbearing years, and we don’t recommend this surgery in people who have kidney disease.”

Then there’s the question of cost. Several large insurance companies have not approved the surgery, although the Federal Drug Administration has. The reason, in LaVelle’s opinion, is the expense–the new implant costs as much as three times more than the traditional implant. “So I have not been able to do this operation on a lot of people who need it simply because their insurance company’s not willing to pay for it,” he said.

But LaVelle remains enthusiastic about the new procedure and his work in general. He says that experience has made him a better surgeon, a skill he shares with others through teaching. His workload includes six to eight “big cases” per week, and he always teaches as he operates. With support personnel and medical students, LaVelle’s operating-room “audience” can number as many as 12 people.

“My operating room is what the Europeans would call ‘a teaching theater,'” he said. “I’ve traded the Vanguard Theatre for a teaching theater in an operating room.”

David LaVelle’s acting days might have ended, but his outstanding performance in the operating room continues. Expect rave reviews from future patients and the next generation of orthopedic surgeons.