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2024 ePoster 2nd Place Dr. Brian Gladnick · AHF Podcast

• 0:05
  Joseph M. Schwab: Hello and welcome to the AHF podcast.
• 0:08
  Joseph M. Schwab: I'm your host, Joe Schwab.
• 0:10
  Joseph M. Schwab: Our guest today is Dr.
• 0:11
  Joseph M. Schwab: Brian Gladnick of the Carrell Memorial Clinic in Dallas, Texas.
• 0:15
  Joseph M. Schwab: Dr.
• 0:16
  Joseph M. Schwab: Gladnick's study,"Mitigating Calcar Fracture Risk with Automated Impaction During Total Hip Arthroplasty", took second place at the most recent AHF meeting.
• 0:25
  Joseph M. Schwab: Dr.
• 0:26
  Joseph M. Schwab: Gladnick, welcome to the AHF podcast.
• 0:29
  Brian Gladnick: Joe, thanks for having me.
• 0:30
  Brian Gladnick: Honored to be here.
• 0:30
  Joseph M. Schwab: So first of all, tell me a little bit about yourself, a little bit about your background and your practice.
• 0:36
  Brian Gladnick: I'm here at the Carrell Clinic in Dallas, Texas.
• 0:39
  Brian Gladnick: We are one of the oldest clinics really in the south and really even in the country.
• 0:43
  Brian Gladnick: We're 100 years old.
• 0:45
  Brian Gladnick: We were, our clinic was actually started in 1921, by a guy, W.
• 0:49
  Brian Gladnick: B.
• 0:49
  Brian Gladnick: Carrell, who started out as a, proponent of, pediatric deformity and fracture care.
• 0:54
  Brian Gladnick: He was actually one of the founders of the Scottish Rite Hospital, orthopedic hospital here in Dallas as well.
• 0:58
  Brian Gladnick: And so, over the last hundred years, um, what started out as a very small, uh, children's orthopedic clinic has, uh, grown into a specialty orthopedic hospital.
• 1:07
  Brian Gladnick: We have all service lines, spine, sports, total joints, foot and ankle, hand, all that stuff, of course.
• 1:13
  Brian Gladnick: Um, and, uh, we have a very, very busy total joints department here.
• 1:16
  Brian Gladnick: I joined the faculty, uh, about almost six years ago.
• 1:19
  Brian Gladnick: Um, and, uh, we do about, gosh, 22, 2400 joints a year in this hospital between, we have, uh, five fellowship trained, um, total joints doctors, um, that do that.
• 1:29
  Brian Gladnick: And, um, so we, uh, got a very busy revision service.
• 1:33
  Brian Gladnick: We started a fellowship, um, at, uh, kind of that whole process began a couple years ago.
• 1:37
  Brian Gladnick: We're just actually graduating our first fellow this year.
• 1:39
  Brian Gladnick: In recent years, we got we have a 501 c3 Charitable foundation, so we got approved for REDCap and we were able to start our institutional registries about five years ago based on That so it's really improved our ability to put out good quality research.
• 1:53
  Joseph M. Schwab: Where did you do your residency and your fellowship
• 1:56
  Brian Gladnick: Yeah, I trained at HSS for residency, graduated from there in 2015, uh, did my, uh, my fellowship at OrthoCarolina in Charlotte, uh, graduated from there in 2016, um, and, uh, spent some time traveling around a little bit, went to Switzerland at the Schulthess Klinik and saw Michael Leunig and those guys for a little bit, went down to, uh, Austin saw Tyler Goldberg operate and I've been trying something I've been trying to do now every year is take a couple days off and just sort of travel around the country and watch other people operate.
• 2:22
  Brian Gladnick: I think it's a really valuable thing to do.
• 2:24
  Joseph M. Schwab: Is, uh, ortho Carolina where you were exposed to anterior approach, or was that with Michael Leunig?
• 2:29
  Brian Gladnick: Well, even when I was so I when I graduated HSS 2015, it was it was HSS at that point was still very dogmatically posterior approach, but there was starting to be some some, uh, people dipping their toes in the water.
• 2:40
  Brian Gladnick: Mike Alexiades had been doing it for decades, really, at that point.
• 2:43
  Brian Gladnick: So, but there was some other people kind of starting to get into it.
• 2:46
  Brian Gladnick: So there's still some experience.
• 2:47
  Brian Gladnick: I did see some anti approach there.
• 2:49
  Brian Gladnick: Um, but yes, going to Switzerland and see Michael Leunig, operate was just an eye opening experience for me and, watching him do what he does.
• 2:55
  Brian Gladnick: He's one of the most outstanding surgeons, technically I've ever seen operate.
• 2:59
  Brian Gladnick: And, um, so then kind of coming back, I really wanted to be at a, a anterior specific, uh, fellowship, which is why I went to OrthoCarolina, which is an incredible experience.
• 3:07
  Brian Gladnick: And probably the, the, one of the few years of my training, uh, that I ever said, gosh, I would, if I would do that again in a heartbeat, if I could.
• 3:13
  Joseph M. Schwab: What prompted you to want to study this automated impaction concept in total hip arthroplasty?
• 3:20
  Brian Gladnick: This started at the study that we had at the AHF, Was really started out as kind of an observation that we had seen over years.
• 3:26
  Brian Gladnick: And so, um, when I first started using the device, like I said, I had some brief exposure to it when I was in Virginia back in, like, 2016.
• 3:32
  Brian Gladnick: But then I started using it in earnest when I came to Dallas in 2019.
• 3:36
  Brian Gladnick: And so, um, when I first started using it, um, I was just kind of blindly just on power everything.
• 3:44
  Brian Gladnick: So broaching on power.
• 3:46
  Brian Gladnick: Stem goes down on power, impact the head on power.
• 3:49
  Brian Gladnick: And the thing is, it's calibrated for the same amount of newtons of force that you want to engage the trunnion.
• 3:53
  Brian Gladnick: I remember when they first came out with this thing, it was a lot of the messaging from the companies was, um, this is a, uh, a panacea for fractures.
• 4:01
  Brian Gladnick: You know, you'll never break anybody with this thing.
• 4:02
  Brian Gladnick: It's calibrated, it's safe, you're in line.
• 4:05
  Brian Gladnick: And my experience was that that was clearly not the case that every once in a while we were, we were having a fracture.
• 4:11
  Brian Gladnick: just as you would if you're broaching by hand every once in a while, you're gonna have a fracture if you're doing enough hips.
• 4:15
  Brian Gladnick: Um, and so we went back and looked.
• 4:17
  Brian Gladnick: And in fact, when we looked at that study, you know, if you ever look at our overall rate, I think it was something like almost 1600 hips.
• 4:22
  Brian Gladnick: We had like 17 fractures as rate of like 1.1%.
• 4:25
  Brian Gladnick: was clear to me that there was, it's not a, it's not a panacea, but it's not, it's didn't seem much different than, than mechanical or handheld broaching.
• 4:32
  Brian Gladnick: And it's just that it's, you know, there's certain patients are going to have, have, have fractures.
• 4:37
  Brian Gladnick: Um, but one thing that did become clear to me, you know, as we use this thing more and more was that there were certain situations in which I was just naturally saying, uh, that's a case.
• 4:47
  Brian Gladnick: I'm not going to put the final stem down.
• 4:50
  Brian Gladnick: By hand.
• 4:50
  Brian Gladnick: And I know.
• 4:51
  Brian Gladnick: And so we know it's very early on.
• 4:52
  Brian Gladnick: It seems like all of our fractures were occurring, not with the broach itself, but with the final stem.
• 4:57
  Brian Gladnick: Um, so I would be, you know, and I was ruthlessly aggressive with this thing, just like full auto, just Wedging these stems in super tight on then say, okay, it looks great.
• 5:06
  Brian Gladnick: I'd take the end, take the broach out and then when we, and then you put the stem down, but every once in a while you'd have a fracture you go geez, gee whiz, we were, you know, like I said, ruthlessly aggressive with these broaches, but then all of a sudden we put the stem down, we have a crack.
• 5:17
  Brian Gladnick: Why did that happen?
• 5:19
  Brian Gladnick: Um, and one thing we started to notice was that.
• 5:22
  Brian Gladnick: In situations in which you imagine when you have that final broach in there and we just look at it, and if there was a rim, like a sort of a cushion of cancellous bone surrounding the outside of the broach, that was situation, I was pretty comfortable saying, okay, it's almost like a cushion, right?
• 5:35
  Brian Gladnick: We're going to, it's going to, you know, uh, be a safe situation to impact that stem by power.
• 5:40
  Joseph M. Schwab: So what did your study actually find?
• 5:41
  Joseph M. Schwab: What were the results?
• 5:42
  Brian Gladnick: it brought our fracture rate down from like 1.2 to 0.6 by going, by being, going that selective.
• 5:49
  Brian Gladnick: And I will say.
• 5:50
  Brian Gladnick: It was certainly clinically significant to me to see a, basically a, a 50% reduction in fractures.
• 5:55
  Joseph M. Schwab: Were you using a consistent stem throughout the entire time?
• 5:58
  Joseph M. Schwab: Were you using a mixture of stems?
• 6:00
  Joseph M. Schwab: Tell me a little bit about that.
• 6:02
  Brian Gladnick: Yeah.
• 6:02
  Brian Gladnick: I mean, I use, I'm pretty consistent with my stem.
• 6:04
  Brian Gladnick: I mean, I use a triple tapered collared HA-coated stem in virtually almost everybody.
• 6:08
  Brian Gladnick: Um, I excluded patients that we cemented or certainly any kind of conversions, revisions, things like those were all excluded.
• 6:15
  Brian Gladnick: So the only people that were allowed to be included in the study were primary triple tapered stems.
• 6:20
  Joseph M. Schwab: Based on what you found, what advice would you give to surgeons who are using automated impaction?
• 6:27
  Brian Gladnick: First thing I would tell him is to go for it.
• 6:29
  Brian Gladnick: It's a, I think it's a real, um, benefit to the surgeon themselves.
• 6:34
  Brian Gladnick: And we actually, we have an ongoing, a couple of manuscripts in publication right now, but a, um, ongoing, uh, multi centered RCT, uh, prospective RCT looking at a variety of different things, not just, you know, accuracy of, of, of component placement, but also things like operative time, um, broaching time, uh, fracture rate.
• 6:53
  Brian Gladnick: Um, and also biometric data looking at the, the burden of effort on the surgeon themselves.
• 6:58
  Brian Gladnick: So they had all the surgeons in the study wearing a biometric vest with real, real time EMG data.
• 7:03
  Brian Gladnick: So looking at your muscle activation, your deltoids, your biceps, your pecs, things like that.
• 7:08
  Brian Gladnick: It's a lot less wear and tear on your body.
• 7:10
  Brian Gladnick: And so I think, you know, we'll be operating longer and more comfortably with these devices as we go forward.
• 7:15
  Brian Gladnick: Um, Number two, I think we're doing a better job putting these, these stems in, you know, I think if anyone who uses the device and it's hard to quantify in the study, but there's something very palpable about when you broach with automation that the consistency of your broach envelope is just much more pleasing to the eye and pleasing to the feel of your hands than when you're doing it by hand.
• 7:34
  Brian Gladnick: Um, I think ergonomically it's easier to control the broach.
• 7:37
  Brian Gladnick: Think about a really tight muscular patient or you know how these, you know, think about a patient who, you know, as you go, you know, As you grow larger and larger in your broach size, how sometimes the anatomy will force you into that and increase an inversion.
• 7:48
  Brian Gladnick: You're trying so hard to resist that, but you're fighting a belly or fighting their their their musculature, and it's kind of forcing your hand out.
• 7:54
  Brian Gladnick: It's much easier in my mind to resist that using automation.
• 7:57
  Brian Gladnick: It's not a panacea for fractures.
• 7:59
  Brian Gladnick: You can definitely still crack somebody with these things.
• 8:01
  Brian Gladnick: Um, but there's, if you, uh, if you pay very close attention to the relationship between the broach and the calcar, if there is a full circumferential cushion of cancellous bone between your final broach and the calcar, go ahead and put it down by power.
• 8:16
  Brian Gladnick: But if there's any part of your broach that's directly contacting that calcar, just be safe, tap out the stem and put it down gently by hand.
• 8:22
  Joseph M. Schwab: Any advice that you would give surgeons who aren't using automated impaction, would this be a, an indication to consider using it or what's your advice there?
• 8:30
  Brian Gladnick: You know, I think if you've been broaching by hand for 20 years, you're very used to the pitch changes and the, the, the feel of a stem as it engages, um, you know, the proximal bone or distal bone, you know what that feels like.
• 8:40
  Brian Gladnick: Um, it feels different when you use automated impaction.
• 8:43
  Brian Gladnick: And, uh, and there's some just things where you have to just use it to get used to those things.
• 8:47
  Brian Gladnick: Um, but the learning curve for it is very, is very easy.
• 8:50
  Brian Gladnick: I mean, we, we train our fellows on it.
• 8:51
  Brian Gladnick: They have it within like a week or two.
• 8:52
  Brian Gladnick: They, they got it, you know, it's not, it's not terribly difficult.
• 8:56
  Joseph M. Schwab: So is it going to give you an extra 10 years on your practice?
• 8:58
  Joseph M. Schwab: Do you think?
• 8:59
  Brian Gladnick: I hope so.
• 8:59
  Brian Gladnick: I'm going to, my, plan is to work until I drop dead.
• 9:01
  Brian Gladnick: So that's the,
• 9:03
  Joseph M. Schwab: Hopefully not anytime soon.
• 9:05
  Brian Gladnick: that's right.
• 9:07
  Joseph M. Schwab: Um, well, you know, we really appreciate you submitting your poster to the AHF this year.
• 9:12
  Joseph M. Schwab: We congratulate you on your victory.
• 9:13
  Joseph M. Schwab: It was, uh, uh, an excellent poster.
• 9:16
  Joseph M. Schwab: It had great scores from the scientific committee and we look forward to you submitting, uh, further research in the future.
• 9:23
  Brian Gladnick: Well, thank you, Joe.
• 9:23
  Brian Gladnick: Yeah, we were, we were honored to have that, um, to have that recognition and, um, yeah, hopefully, uh, much more coming forward.
• 9:29
  Joseph M. Schwab: Thank you for meeting with me today, Brian.
• 9:31
  Brian Gladnick: Thank you.
• 9:32
  Brian Gladnick: Thank you for your time.
• 9:34
  Joe Schwab: thank you for joining me for another episode of the AHF podcast.
• 9:38
  Joe Schwab: If you want more information, you can check us out on Facebook, LinkedIn, or X, or you can visit us at our website, anteriorhipfoundation.
• 9:47
  Joe Schwab: com.