Recording - 10-23-2024 09:40:04

00:02 This is Mark Swiontkowski coming to you from Montreal. And we are at the 40th anniversary of the orthopedic Trauma association meeting, and it's my distinct honor to do the first interview with Professor Rudolph Poolman from Amsterdam, who is a renowned orthopedic surgeon and trialist as a, participated in and led many, many, many important clinical trials in orthopedics so it's going to be the first conversation, and maybe you could just start by saying, how did you get involved in orthopedic trauma surgery? What was the event? How did it lead you to.

00:47 It was during my residency that I got interested in trauma surgery, and there was, I did a clerkship at Harborview Medical center back in. It was, I think, 98. Yeah, it was 98. And Professor Rene Marty was working with him, so he sent me, you should go to the states, and you should visit Harborfield Medical center. And that's where I got into orthopedic trauma. And the first study, actually, we did a transatlantic interobserver variation study on scaphoid fractures.

01:31 Ah, yes.

01:32 There's a difference.

01:33 Yeah.

01:35 And so that was the first study I did on orthopedic trauma internationally. And so I made a lot of friends there, and it run off from there.

01:46 That's great. Rennie was a really good friend and great surgeon. Gifted surgeon, I would say. Absolutely. And made a lot of contributions. I can think about his contributions in hip fracture surgeries and osteonecrosis. Very important work. So you got involved with the trial there. Did you do formal training in clinical research?

02:13 Not at that time, but it was just embedded in the department, and MRT was very much connected also to the department of clinical epidemiology. So they helped out there. And so in Amsterdam, there was a good link between the departments, and so that's why on the road, I got my training, and then I did my residency, and I got connected with Mo Bandari. I was reading one of his ephemeral papers in JS at the time, and I sent him an email, not expecting a reply, and in 4 hours, I got a reply. And then we started discussing trial methodology and stuff like that. And so he said, well, are you doing trial right now, or are you doing studies right now? So let's work together. Let's collaborate. And I said, yes. And then we started working together and looking at the quality of medical reporting in orthopedics. And then I got that to the end of my residency, and then he asked, what are you going to do following your residency? And I said, well, I'm still thinking about stuff. And he said, well, you should come to Canada. And that's how I came to Canada and did my fellowship. I was the first fellow of Mo, and I got to in 2006. I was doing my fellowship there and did trauma combined with research at McMaster, and that was the basis for my PhD thesis. And so I wrote my thesis there, and Rene Marty was my supervisor together with Mo.

04:06 That's a. That's a great story. So the Netherlands seems to be, you know, as the editor emeritus now of JBJs, I'm fairly well informed about the hotbeds, if you will, of clinical trial work in the world. And the Netherlands seems to be a real leader. What do you owe that tradition to, if you will? Has it been ongoing forever, or did it really?

04:35 I think, well, we like to do good science. I think that, of course, we're a small country. If you compare two sizing in the US, the square mileage is about the same size as Los Angeles and also the amount of inhabitants. So it's actually more like a big us city you can pair it with. And so there's lots of universities. So the research comes from, I think, and the trials, we like to collaborate because if you do just single center retrospective studies, it doesn't give the answers. And so I think the. And we're Dutch, so we don't want to spend too much money. So there's always an incentive to do trials, and there always needs to be an economic evaluation alongside the trials to see if the intervention is actually cost effective. So it should be clinically effective, of course. And then the cost effectiveness is mandatory to also do. If you got a government funding for a trial, you always need to do cost effectiveness analysis. So I think that's to see if it's cost effective. That's one of the reasons we're doing so many trials.

06:01 Right. That's an excellent model. It's one that should be followed in many other countries, that there needs to be a product of the research that actually informs decision making on the part of the government and funding agencies. That's a wonderful model. So we're here at the orthopedic Trauma association meeting. When was the first time you came to one of these meetings?

06:29 I think it was in 2006, during my fellowship here in Canada. I can't remember which place it was.

06:38 Then.

06:40 And I didn't go every year because flying across the pond is not cheap, not cheap. And it needs to be a good reason. I've got a bit of my back problem, so sorry about that. I just twisted my back when I got into the cab on the way to the hospital, to the airport. I looked like an old mandeh.

07:07 Yeah, you're young in reference to this person, so it will subside.

07:14 So just keep going. So sometimes I make a bit of strange noises, maybe, but I'll be fine. So I don't go every year, and I was a member, but then I didn't go every year, so I thought, well, there was also a cost effectiveness analysis there.

07:33 Because you're Dutch?

07:34 Because I'm Dutch. Should I pay for something where I'm not going every year? But I'm still a member of the AAOS and so it was a choice to make which society to be an international member from.

07:50 Right, yeah.

07:51 But still, I've got good friends here and I like to come to see what's happening and where everybody's working on and I think these personal interactions are the most important. Just listening to another retrospective series that's.

08:10 Yeah, it's not really helpful, not so interesting. But to maintain the personal connection is worth the trouble of getting here.

08:21 Absolutely, yeah. It's far better than being on a Zoom call and it's better to be in personal connection.

08:30 Right. So what clinical problem are you working on next?

08:36 Yeah, so what? We just got funding from the dutch arthroplasty registry, or it's actually the dutch orthopedic intervention registry is the new name and they have also funding for studies and we're setting up, actually in collaboration with Nathan O'Hara and with Shira Spark and also with Matt Costa from Oxford, Nils Heiler from Sweden. We're setting up a platform for platform trials. So with the white trials in the UK, with the master protocol, and then we do separate arms and what we're looking at is filled hip arthroplasties, that's our theme. And one of the themes there is that prostatic fractures, because we see a rise on pair prosthetic fractures and that's where I think we need to focus on with our new research, because the hip fractures, well, we're getting more knowledge there and it's still. Not all the answers are there, but still think periprostatic fractures. There's a lot of open questions that needs to be answered.

09:54 Like.

09:55 Like, for instance, if you. The question always is if they're fixed or loose. So if you can start with diagnostic trials, of course, that's. I think we need to do more diagnostic trials, because when you do a diagnostic test, the diagnostic intervention cascade starts rolling and then I think it's important to do more diagnostic tests, because if you want to start this diagnostic cascade rolling, or you just don't get it rolling, it makes a difference. And so, for instance, one of the questions is, if the implant is loose or fixed, and then the next question is, should you revise or should you fix it? And then the question is, if you revise it, should you revise, for instance, for hip fractures, should you revise the complete system? So, including the cup or just the stem, which were usually the fracture, is, because we know that if you have peripheral fracture and you have a revision, the chances of a dislocation following the surgery is quite high. So one of the other studies we're doing right now, we're just, just had our over a thousand inclusions. It's the Readap study where we did dual mobility cups versus unipolar cups to see if it prevents dislocation. So a question like that can be also answered in the revision cases, of course, because it's. So if you look at the literature, there's actually no real experiments, just observational data on whether there's a couple. One, I think at this meeting, there's for knee periprosthetic knee fractures, there's a paper now on if you need to nail them or if you need to plate them, but there's not many real trials out there, so the causal inference is quite hard to make. I think that's still critical that we can make also inferences based on our studies, and that really informs our practice. So one of the questions also is, so should you, if you do a whole system revision, so including the cup, or just leave the cup in place, because that's, of course, there are frail patients you actually justified to do a complete revision or just do the more simple femoral roficinomi.

12:36 Right. And complete, as always, with a cost effectiveness and.

12:41 Yeah, absolutely.

12:42 Impact on health related quality of life and.

12:44 Yeah, yeah, yeah, that's important, of course. And that's interesting. That was one of the issues with revision surgeries, I think, is we're very proud of our registry data, but if you start looking at registry data, then the revision of revision cases, that's complicated, because I think that's a bothersome outcome, because sometimes the patients are too frail to have another revision or the implant is too fixed, but the outcome is not good to do a revision, so there's no options left. And so then the outcome of a revision as an endpoint may not be the best endpoint. That's why we need to look at different endpoints there.

13:29 That's very interesting and complex issues and sounds like lots of work to do for the next decade, at least. So you seem to be still very energetic and enthusiastic about your work as a trauma center, trauma surgeon and researcher. Would you recommend this type of career for a young person going into surgery?

13:55 Yeah, if you're curious, then it's good to follow this path, I think, and it's always good to you can do in surgery. There's still always ways to be creative and find new solutions for problems that exist. And sometimes you just have to be thinking outside of the box or without a box at all. Just be creative. And if you're. I think that's it's just fun. And if you're having fun, you have a good life.

14:29 That's great.

14:30 Yeah.

14:31 Well, I appreciate very much you taking the time to be interviewed for this OTA event, and we will be posting this soon and enjoy the rest of the meeting. And thank you very much. Have a great, great flight back home where you have lots of research work and patient care work waiting for you.

14:49 Thank you.