- Complex primary hip and knee replacements
- Minimally invasive hip and knee replacements
- Partial knee replacements
- Revision hip and knee replacements
- Birmingham hip resurfacing
- Treatment of hip and knee infections
- Fracture care
- Orthopaedic Surgery
Clinical Associate Professor, Orthopaedic Surgery
Honors & Awards
Academic All-America Springboard Diving Team, National Interscholastic Swimming Coaches of America (1994)
Chevron Science Scholar, Chevron (1994-1998)
King Leaders Scholar, Sigma Chi Fraternity (1998)
Balfour Award, Sigma Chi Fraternity (1998)
Medical Society Scholar, Monterey County Medical Society (2001-2004)
Investment in Community Scholar, Clark Foundation (2003-2004)
Alpha Omega Alpha Member, Boston University School of Medicine (2004)
Anthony L.F. Gorman Prize in Physiology, Boston University School of Medicine (2004)
Cum Laude, Boston University School of Medicine (2004)
Chief Resident of the County Hospital Award, Santa Clara Valley Medical Center (2009)
Medical Education: Boston University School of Medicine (2004) MA
Residency: Stanford University Orthopaedics (2009) CA
Board Certification: American Board of Orthopaedic Surgery, Orthopaedic Surgery (2012)
Fellowship: Rush University Medical enter (2010) IL
Internship, Stanford University- Orthopaedics, CA (2005)
Undergraduate Degree, Stanford University, CA (1998)
Current Research and Scholarly Interests
My current research interests include operative and non-operative treatment of arthritis, minimally invasive techniques for hip and knee replacement, clinical outcomes of joint replacement surgery, and the design of hip and knee implants and instrumentation.
Posterior cruciate ligament-retaining total knee arthroplasty in patients with rheumatoid arthritis: a concise follow-up of a previous report.
journal of bone and joint surgery. American volume
2011; 93 (22): e130 1-6
7We previously reported the minimum eight-year follow-up results of cruciate-retaining total knee arthroplasty in a consecutive series of seventy-two knees in patients with rheumatoid arthritis. In the present study, we evaluated the longer-term outcomes after twenty to twenty-five years of follow-up. Since the publication of our original study, ten knees have been revised: three because of periprosthetic fracture, three because of infection, two because of patellofemoral failure, and two because of posterior instability. The rate of implant survival at twenty years after surgery was 69% (95% confidence interval [CI], 56% to 79%) with revision for any reason as the end point, 81% (95% CI, 69% to 89%) with femoral or tibial component revision for any reason as the end point, and 93% (95% CI, 83% to 97%) with posterior instability as the end point. These long-term results demonstrate that posterior cruciate ligament insufficiency with instability was rarely the cause of failure following cruciate-retaining total knee arthroplasty in patients with rheumatoid arthritis.
View details for DOI 10.2106/JBJS.J.01695
View details for PubMedID 22262390
Restoration of Knee Volume Using Selected Arthroscopic Releases
AMERICAN JOURNAL OF SPORTS MEDICINE
2010; 38 (11): 2288-2293
Inflammation and subsequent fibrosis, adhesions, or plicae may limit normal capsular compliance and decrease volume capacity of the knee.Patients with fibrosis, anterior interval scarring, adhesions, or palpable painful plicae will have decreased knee volumes when compared to controls, and selective arthroscopic releases will restore volume to normal levels.Descriptive laboratory study and cohort study; Level of evidence, 2.In part I, knee volume and pressure were recorded in 14 fresh-frozen human cadaveric knees, and the maximum volume capacity was identified before capsular disruption. In part II, 49 patients undergoing arthroscopy were divided into 2 groups based on intraoperative volume assessment at 50 mm H(2)O pressure: group 1 (n = 20) with normal volume (<1 standard deviation below the mean established in part I) and group 2 (n = 29) knees with deficient volume (>1 standard deviation below mean). Group 2 underwent volume-changing procedures such as lysis of adhesions, anterior interval release, and plica resections, while group 1 underwent volume-neutral procedures including meniscal or chondral surgery. The knee volume was then reassessed after arthroscopy.The average volume capacity of the knees in the cadaveric study was 87.5 ± 21.7 mL (range, 50-120 mL). There was no statistical difference between the presurgical (98.9 ± 29.8 mL) and postsurgical volumes (99.4 ± 29.1 mL) in group 1; P = .65. The presurgical volume in group 2 (46.1 ± 13.0 mL) was significantly lower than group 1 (P = .001). The group 2 volume increased to 78.5 ± 24.2 mL after surgery (P = .001), with an average change in volume of 75.5%. The mean change in volume after surgery was significantly greater in group 2 (32.3 mL) versus group 1 (0.45 mL) (P = .001). At 1-year follow-up, the mean Tegner score in the volume-compromised group 2 increased from 2.0 ± 1.4 preoperatively to 4.0 ± 2.0 postoperatively (P = .01), the Lysholm score increased from 45.0 ± 24.0 preoperatively to 76.8 ± 25.4 postoperatively (P = .003), and the average Short Form-12 quality of life score increased from 32.4 ± 8.7 preoperatively to 45.0 ± 11.0 postoperatively (P = .005).The average volume of the human knee in this study was between 65 and 110 mL (±1 standard deviation of mean of 87.5 mL). Although patients with chronic knee pain may have pain from multiple sources, some may have diminished knee volume, and selected arthroscopic releases can restore knee volume to near-normal levels.
View details for DOI 10.1177/0363546510378074
View details for Web of Science ID 000283348600023
View details for PubMedID 20807861
Influence of team composition on turnover and efficiency of total hip and knee arthroplasty.
The bone & joint journal
2021; 103-B (2): 347–52
AIMS: Surgical costs are a major component of healthcare expenditures in the USA. Intraoperative communication is a key factor contributing to patient outcomes. However, the effectiveness of communication is only partially determined by the surgeon, and understanding how non-surgeon personnel affect intraoperative communication is critical for the development of safe and cost-effective staffing guidelines. Operative efficiency is also dependent on high-functioning teams and can offer a proxy for effective communication in highly standardized procedures like primary total hip and knee arthroplasty. We aimed to evaluate how the composition and dynamics of surgical teams impact operative efficiency during arthroplasty.METHODS: We performed a retrospective review of staff characteristics and operating times for 112 surgeries (70 primary total hip arthroplasties (THAs) and 42 primary total knee arthroplasties (TKAs)) conducted by a single surgeon over a one-year period. Each surgery was evaluated in terms of operative duration, presence of surgeon-preferred staff, and turnover of trainees, nurses, and other non-surgical personnel, controlling cases for body mass index, presence of osteoarthritis, and American Society of Anesthesiologists (ASA) score.RESULTS: Turnover among specific types of operating room staff, including the anaesthesiologist (p = 0.011), circulating nurse (p = 0.027), and scrub nurse (p = 0.006), was significantly associated with increased operative duration. Furthermore, the presence of medical students and nursing students were associated with improved intraoperative efficiency in TKA (p = 0.048) and THA (p = 0.015), respectively. The presence of surgical fellows (p > 0.05), vendor representatives (p > 0.05), and physician assistants (p > 0.05) had no effect on intraoperative efficiency. Finally, the presence of the surgeon's 'preferred' staff did not significantly shorten operative duration, except in the case of residents (p = 0.043).CONCLUSION: Our findings suggest that active management of surgical team turnover and composition may provide a means of improving intraoperative efficiency during THA and TKA. Cite this article: Bone Joint J 2021;103-B(2):347-352.
View details for DOI 10.1302/0301-620X.103B2.BJJ-2020-0170.R2
View details for PubMedID 33517742
- Osteonecrosis of the Hip www.orthoinfo.org, Your Orthopaedic Connection 2011