According to the National Institutes of Health, “hip and groin pain is a common complaint among athletes of all ages and accounts for approximately 5% to 6% of all sports injuries.” There are many causes of hip and groin injuries, but it typically involves bones and areas around the hip joint, including potential genetic dispositions towards hip abnormalities. In the past, many hip injuries in athletes were neglected, but recent developments in magnetic resonance arthrography, hip arthroscopy, and biomechanics have led to an increase in understanding of the hip and groin areas and advances in research and diagnosis and treatment of hip and groin conditions, especially as it relates to young athletes.
I had the opportunity to interview Dr. Andrew Jimenez, Orthopedic Surgeon and Assistant Professor at Yale University, on some of the cutting edge research he’s performing on hip arthroscopy. Our discussion covered his background and journey in the medical field, his work, and his general advice on how best to pursue a career in orthopedics and sports medicine.
How long have you been an Orthopedic Surgeon?
I’m early in my career, and I just started working at Yale University earlier this year. It was a long road including college, medical school, orthopedic surgery and residency. I also completed two Fellowships, one in Sports Medicine at the University of Connecticut and the other in hip preservation at the American Hip Institute.
What Sparked Your Interest in Sports Medicine and Hip Arthroscopy in particular?
I was an athlete throughout high school and college, and my teammates and I experienced a number of sports-related injuries. During the treatment and recovery process, I worked with therapists, athletic trainers and orthopedists, which gave me insight from the patient’s perspective and sparked my interest in orthopedic surgery. I developed an interest in hip arthroscopy because it’s a relatively newer field. There has been a lot of work done in sports medicine on the shoulder and the knee, but the hip is the next frontier. There is currently a lot of research and development surrounding hip arthroscopy, and that has resulted in significant innovation in that area, so it’s a pretty exciting time to be a part of the work and to contribute as much as I can to the literature.
What kind of patients do you see on a day to day basis? Do you see mostly athletes or elderly patients?
I see all types of patients – both athletes and older patients. Although I've done a lot of research on hip arthroscopy in athletes, hip impingement and labral tears affects people of all ages. Younger athletes do tend to have a higher rate of hip impingement probably because of the high demands they are putting on their hips.
I understand that hip impingements develop because of a misshapen femoral head. What causes the femoral head to be misshapen, is it caused by trauma or genetics?
There’s been a lot of research on that but the answer is not always perfectly clear. Sometimes it can be a result of trauma, but sometimes it could be due to genetics. There is a growth plate that goes along the femoral head neck junction, and researchers think that the growth plate may lay down over an extra bone that causes a bump to form on the femoral head which ultimately can cause hip impingement.
What does a typical day/week of work look like for you?
As an orthopedic surgeon, I perform surgeries in the operating room a few days a week. I’m also in the clinic a few days a week where I see patients in an office setting. These are typically either new patients or postoperative patients that I check on to see how they are doing after surgery. There are also the educational aspects where I meet with some of the residents and medical students at Yale and provide lectures and discuss educational topics to help with their learning and development. One day a week, I go to the training room to see athletes to see how they are doing and treat them accordingly.
Can you describe specifically what you do in the training room?
The training room is a collaborative environment where the athletes are also working with their athletic trainers and physical therapists who show them exercises and activities they can do to get better from a non-operative standpoint. My role is to assess a patient with an injury, or to see how they are doing after surgery, or see how they are progressing with their non-operative treatment.
What is the most rewarding aspect of orthopedic surgery?
It’s definitely the relationship with the patient. You see a patient come in with certain goals they want to accomplish, and the ability to get the patient back to that level of function whether it’s an athlete that wants to get back to sports competition or someone that just wants to get pain-free motion of their extremity or joint. The gratification of helping that person accomplish their goal is the biggest reward.
What is the most challenging aspect of your job?
The research aspect, which I really love, is the most challenging aspect because every day you’re working on how you can make treatment or procedures or recovery processes better for injuries. It’s a challenge to stay on your toes and to try to keep pushing the envelope in terms of innovation and improvements in patient care, in order to try to get the best outcomes that we possibly can.
Can you describe your background and what motivated you to go down this path?
For me, I had medicine in my family. My father was in medicine so that had an impact on me. Besides that, I was involved in athletics my whole life. I grew up in Tampa, FL and was involved in wrestling, I really enjoyed the sport and it meant a lot to me. It became part and parcel of who I was. As I got older, I wanted to be involved in taking care of athletes because I understood where they were coming from and how much it meant to them to get back to competing. The ability as an orthopedic surgeon to help people, work with them and help them overcome challenges is what pushed me to consider doing orthopedic surgery.
Also, a lot of it comes down to mentors, early on, my father was a mentor of mine, and when I got to college, I had mentors there. I went to medical school at the University of Cincinnati and I had a mentor there, Dr. Crawford, who is a long time Orthopedic Surgeon at University of Cincinnati. I started shadowing him in my first year of medical school. He took me under his wing and provided guidance and mentorship and as a result, I decided to pursue orthopedics.
What are some valuable skills you’ve gained throughout your journey?
Obviously you gain surgical skills, but the biggest skills I’ve learned are the interpersonal skills and the ability to see a patient, listen to them and understand their goals and help them get the best outcomes possible.
How do you communicate bad news to a patient if a surgery doesn’t go as planned?
I’m still early in my career so I haven’t had to do that yet. However, in general, I think the best approach is to be open and honest with the patients. For example you can say something like . . . “Our goal was to do x, we weren’t able to get it done, here are our options and next steps . . . “ I think the biggest thing is to be honest with patients about (a) what you think the surgery can do for them and (b) what their options are and it really is a discussion between the surgeon and patients to identify the best next steps for the patient. You want to try to be as helpful and to problem solve as much as possible.
Can you discuss the work life balance challenges?
Definitely, the journey, medical school and residency are challenging. I think that the field of medicine in general is getting better about understanding work life balance as opposed to what it used to be in the past. It is important for every person and surgeon to find that balance and also find time to take care of yourself. If you don’t take care of yourself and have a good, stable home life, it will be difficult to excel in your career. Your family and those closest to you are the most important things in your life and that deserves adequate attention and respect. There can still be long work hours and challenging schedules, but in general, the medical field has gotten a lot better with work life balance.
Do you have any Dos and Don’ts to prevent injuries?
I’ve gotten injured myself, and I think it all comes down to warming up and stretching. When I was younger doing wrestling, I would just start wrestling without warming up and that is really not the best approach because the stiffer you are, the more prone you are to injury. It’s important to warm up before working out, stretch before and after workouts and cool down after the workout help you to avoid injury.
What are some cutting-edge developments or technologies that really spark your intellectual interest?
In hip arthroscopy, there’s a lot of work going into 3D modeling and 3D reconstruction of people’s bone anatomy. I think that’s been very helpful in trying to visualize a complex 3 dimensional structure and figuring out the best way to correct it. In addition to that, there have been some developments in biologics, like PRP or bone marrow injections and the use of that to help heal damaged cartilage. A lot of work still needs to be done on that but some of the early results are promising and deserve greater attention.
How are computers utilized in orthopedic surgery?
It depends on the field of orthopedic surgery, for instance, for hip and knee replacements, there’s robotic-assisted orthopedic surgery that basically helps you make very precise cuts and helps you plan the surgery ahead of time. For me, I perform hip surgeries so I get a CT scan or scan of the hip prior to surgery, and in the surgery, the computer assisted system will be able to help make different measurements on the X-rays and that helps me make very precise cuts to help the patient get the outcomes they need. In addition, there’s a lot of computerized software that’s available that helps you plan your surgery ahead of time before you even set foot in the operating room based off your CT scan so by the time you’re in the operating room, the surgery’s already been planned digitally so you know exactly what you’re trying to accomplish.
Do you have any advice for a young student interested in a career in orthopedics? What can they do to prepare?
Yes. I would say do well in school, keep studying, work hard, and I think the biggest thing is to find a mentor because it’s a tough road and it can be intimidating to navigate. I think if you have someone that can give you advice or recommendations and help guide you along the way, it can make the journey a lot easier.
Do you have any recommendations for an undergraduate major if someone wants to pursue a career in orthopedics?
I have a Biology degree but looking back, something like mechanical engineering or biomedical engineering would make a lot of sense because orthopedics is very similar to mechanical engineering. Beyond that, anything that peaks your interest and anything you’re passionate about is what you should pursue as you are likely to excel at what you enjoy.
https://pubmed.ncbi.nlm.nih.gov/19361671/
Comments