Thesis Day / Senior Thesis Day
Brigham & Women’s Hospital, Bornstein Amphitheatre
Friday, June 22, 2007

Senior Resident Thesis Presentations

Introduction  •  First Session  •  Second Session  •  Third Session  •  Fourth Session
Osgood Lecturer
James F. Kellam, MD
Harry E. Rubash, MD
Second Session
Moderator: Harry E. Rubash, MD

Howard B. Yeon, MD, JD Chris Chiodo, MD
Asset Protection for Orthopaedic Surgeons
Howard B. Yeon, MD, JD
Discussor: Chris Chiodo, MD
Advisor: James H. Herndon, MD, MBA

Dr. Yeon presented his original work that combined his dual training in medicine and law. He reviewed existing forms of asset protection and the methods suitable for use by the majority of Orthopaedic surgeons. The goal was to assess whether asset protection is a practical complement to medical malpractice insurance for most Orthopaedic surgeons. He consulted practicing attorneys in Massachusetts, New York, New Jersey, Connecticut, and Florida to assess the current utilization of asset protection devices. He explained how the current insurance and legal systems coincide to increase the cost of medical malpractice settlements, at the peril of the practicing surgeon.

He concluded that asset protection is a practical means of supplementing medical malpractice insurance and that broad adoption of asset protection as an alternative o medical malpractice insurance may result in inadequate funds available to injured patients. The discussor, Dr. Chiodo, and the moderator, Dr. Rubash, both applauded his work and suggested that Dr. Yeon bring his ground-breaking work to a broader audience.

Alexander P. Sah, MD Thomas S. Thornhill, MD
Dislocation Rate after Conversion of Hip Hemiarthroplasty to THA – Greater than First-time Revision THA
Alexander P. Sah, MD
Discussor: Thomas S. Thornhill, MD
Advisor: Daniel Estok, MD

Revision hip arthroplasty continues to have 3 to 5 times greater dislocation rates than primary hip replacement. The purpose of Dr. Sah’s study was to determine whether conversion surgery carries the same or greater dislocation risk than revision total hip replacement. Dr. Sah summarized a retrospective series of conversion total hips, from hemiarthroplasties performed for fracture. He found a significantly higher rate of subsequent dislocation in these patients compared to primary THA and compared to hips revised for other reasons. He postulated that the relative stability of the very large endo head means that hemiarthroplasty patients become accustomed to a much larger stable range than is possible after a total hip replacement. Several arthroplasty surgeons in the audience added that for this and other reasons, they are increasingly likely to perform primary THA for their patients who present with femoral neck fracture.

Dr. Thornhill pointed out that Dr. Sah’s work was an important piece in a long-standing debate on the role of hemiarthroplasty today. He then inquired as to whether Dr. Sah’s data could shed any more light on the subject of the proper treatment of femoral neck fractures. Dr. Sah responded that this was another piece of evidence that for younger patients (less than 80 years old) a THA may be a more viable alternative. He emphasized that femoral downsizing would still be an important parameter to keep in mind.

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