Getting Patients Back to Normal: Orthopaedic Surgeon Victor Hugo Hernandez
Dr. Hernandez talks about his work using advanced technologies to improve surgery plans and post-operative patient pain and establish an ideal pace for recovery.
Victor Hugo Hernandez, M.D., is chief of the Division of Joint Replacement in the University of Miami Miller School of Medicine’s Department of Orthopaedics. He’s been researching ways to refine hip and knee replacements, including post-surgical care, to improve patient recovery. He and his team are also studying the physical demands orthopedic surgeons face.
Why did you decide to specialize in orthopedic surgery?
Since I was a kid, I’ve always loved to fix things. My father is an orthopedic surgeon and he has been quite successful at fixing people. I wanted to do that, too.
Joint replacement is one of the unique fields in medicine where we can really help people with serious and limiting physical problems get back to normal lives. People have hip or knee problems that limit their activities. Within a couple of hours after surgery, they can walk and go home and enjoy a new life. These procedures help people overcome pain and keep them independent, and I love that.
How has the field changed since you started?
Technology and other advances have changed the field a lot during the last 10 years. Today, we have robotics, as well as virtual/mixed/augmented reality, wearable devices and new surgical and pain management techniques.
We’re having a lot of success with robotics and mixed reality during hip and knee replacements. We translate scans into 3D holograms or images. We can perform the procedure virtually and develop a unique surgical plan for each patient.
—Dr. Victor Hugo Hernandez
We approach hip replacements through the front now, which makes things much easier on patients. We used to cut muscles and tendons. Now, we know how to avoid that, which allows patients to go home the same day. We also have better materials and devices. It’s constant change.
These changes have huge impacts on a patient’s quality of life. Ten, 15 years ago, we’d advise people to wait until the pain was unbearable before having surgery. Now, we can better predict the right time to do their surgery, and that really benefits patients.
What are some specific technologies you’d like to call out?
We’re having a lot of success with robotics and mixed reality during hip and knee replacements. We do a CT scan before the surgery, and we translate those scans into 3D holograms or images. So, we can perform the procedure virtually and develop a unique surgical plan for each patient. I just have to perform the plan, using advanced technology, to make it perfect.
One of your research projects is focused on helping patient recovery.
We used a wearable device with a gyrometer and accelerometer, which read patients’ steps, range of motion, exercise, temperature and healing. With this information, we can guide patient recovery. Also, patients can interact with me through their phones and send pictures of the wound, their pain scores and other information.
Through this process, we can predict optimal activity ranges for them to be successful. If their activity is too low, it slows recovery. On the other hand, patients who are overachievers can go really fast at first, but eventually crash, causing pain, swelling and inflammation. We help them find the ideal pace.
Tell us about your current study on glucose control and surgery.
We’re outfitting patients with wearable glucose monitors to study how their blood sugar behaves following the stress of surgery and how medication can change those results. If someone has high glucose during recovery, it can delay their healing and increase the risk of infection. We’re hoping to reduce infection rates and other potential complications.
What other projects are you overseeing?
These are physically demanding surgeries and around 15% of surgeons retire early because of work-related injuries. We are trying to teach our colleagues about different ways to improve their ergonomics and other factors to make it easier to perform these procedures.
Before, we had to use a mallet to place a hip prosthesis. Sometimes we would hit it over 50 times during one surgery, and we might have three or four procedures that day. We now have a pneumatic hammer that alleviates some of the physical strain.
There’s also mental strain and we’re giving surgeons cognitive tests after procedures to see how that affects them. We want to understand how people of different sizes and genders respond to the stress and how robotics and other technologies can support their mental and physical well-being.
Tags: AI, artificial intelligence, augmented reality, Department of Orthopaedics, Dr. Victor H. Hernandez, Orthopaedic surgery, total hip replacement, total knee replacement