Orthopedic surgeon Dr. Kyle S. Nuland joined University Orthopedics’ Joint Replacement Center last month. Nuland comes to the practice after completing an adult reconstruction fellowship at Columbia University and a residency program at Albert Einstein College of Medicine at Montefiore Medical Center in New York. In addition to joint replacements, Nuland’s specialties include minimally invasive knee surgery and hip and knee disorders.
PBN: Why did you decide to make the move to University Orthopedics?
NULAND: University Orthopedics is an extremely impressive collaboration of not only highly accomplished surgeons but our associated researchers, professors, medical students, residents, and staff. The organization is incredibly well run, which allows me to focus a significant amount of time on performing surgery and caring for patients. Health care in general has become an ever-increasingly complex structure, and having a team to help navigate the large picture puts me in a position to be the best surgeon I can.
PBN: What kinds of minimally invasive surgery do you perform, and what sort of patients are these procedures best suited for?
NULAND: The two types of minimally invasive surgery I perform are partial knee replacements, and anterior total hip replacements. Partial knee replacements are an excellent solution for certain patients with isolated knee arthritis. The incision and surgical field is significantly smaller than a normal total knee replacement, and it allows the patient to retain more of their natural structures, such as their cruciate ligaments. Anterior total hip replacement is also considered a minimally invasive approach using a specialized table. This approach is a “muscle-sparing” approach, which allows me to replace a hip by spreading different groups of muscles apart rather than cutting them. It also allows me to use a live-time x-ray machine to ensure that the components are in the position I’m aiming for. Hip replacements are best suited for individuals with significant hip pain that emanates from their joint surface.
PBN: On the other side of the spectrum, what types of joint procedures are the most complicated, and is there any new technology on the horizon to shorten surgery or recovery times?
NULAND: The most complicated procedures I perform are usually revisions of previously done total knees or hips. Sometimes over time these implants break down, or loosen, and require revision. These are more complex as scar forms around the previous surgical site, and the normal anatomic landmarks are no longer available. Additionally taking out old replacement parts can sometimes take significant time. The technology to help us improve on these techniques has taken the form of both better implant designs and materials, as well as newer instruments that help us take out the older components. Robotics and three-dimensional printing have also started to become key players in both planning these complex surgeries, and making real-time decisions with the aid of newer technology.
PBN: Can most or many of your patients expect to eventually return to their usual activities after undergoing joint replacement or reconstruction?
NULAND: Joint replacement is an incredibly impactful procedure in restoring someone’s quality of life. The vast majority of patients return to their preoperative level of functioning, or even surpass their preoperative level of functioning. This is especially true for hip replacements, where often-times people are leaving the same day and walking out of the hospital. I do like to take the time and explain the expectations to patients however. Every patient has a different level of pre-operative functioning, and it’s important to clarify what they can expect in the post-operative period and down the road.
PBN: Is there a certain type of joint disorder or problem that you tend to see most frequently?
NULAND: Osteoarthritis is by far the most common joint disorder that I see and treat. This is the term we use for the breakdown of cartilage that is not secondary to another process, such as inflammatory arthritis (such as rheumatoid or psoriatic arthritis), or previous trauma. I also frequently see patients with different types of dysplasia, which is a congenital or developmental issue where a particular joint does not develop normally. This usually results in a joint that is not perfectly congruent, and this can lead to early-onset arthritis.
Elizabeth Graham is a PBN contributing writer.
