Appreciation for the arts and cutting-edge surgery skills seem worlds apart. But, Dr. David LaVelle (UTM ’75, UTHSC ‘79) easily connects the dots. Once a cast member on UT Martin’s Vanguard Theatre stage, this talented orthopaedic surgeon is equally as comfortable discussing plays as he is describing an innovative surgical hip procedure that he now performs at Campbell Clinic in Memphis. Besides bringing joint-pain relief to his patients, LaVelle is teaching the next generation of surgeons at one of the world’s foremost orthopaedic clinics.
LaVelle, whose father is Dr. Herman LaVelle (UTHSC ’51), a retired Memphis ear, nose and throat physician, was destined for a medical career. He entered UT Martin focused on academics, but at the urging of others, he soon pursued new interests that continue to impact his life. At least two professors, William Snyder and Ted James, became unlikely mentors as LaVelle explored college life beyond the classroom.
Snyder, longtime Vanguard Theatre director, encouraged LaVelle’s participation in plays and creative writing. Although he never held a major role in a play, the experience changed his life. “I was a science-oriented guy, but he (Snyder) helped encourage me to look at the world through the eyes of a writer or an actor or an artist, and it was just awesome,” LaVelle said.
The late Dr. Ted James of the biological sciences faculty made his own impression on LaVelle. “He (James) also looked at the students and was interested in developing more than just the one-dimensional side of their lives,” LaVelle added. “He was interested in pre-med students getting a taste of the arts, and he encouraged me to become involved in Vanguard and to get involved with the English program and so forth. I actually had as many English hours as I did biology hours when I graduated.”
This broad educational experience has paid dividends for LaVelle in unexpected ways. “It’s enriched my life greatly, because I still appreciate reading literature and a good book, but it also helped my ability to communicate,” he said.
LaVelle became interested in orthopaedics while attending UT-Memphis (now the UT Health Science Center). As he worked in emergency rooms, he noticed that orthopaedic surgeons “universally seemed to enjoy what they were doing.” He saw people arrive in great pain and gain immediate relief after treatment. Also, orthopaedic tools resembled the hand and power tools that he learned to use in his dad’s woodworking shop, so his affinity for “fixing things” fit perfectly with the specialty.
LaVelle graduated from medical school in 1979 and entered a residency at Campbell Clinic, which serves as the UT College of Medicine Department of Orthopaedics. Specializing in adult reconstructive and trauma surgery, he was asked to join the clinic staff in January 1985. Founded in 1909 by Dr. Willis C. Campbell, the clinic is aptly described on its Web site “as a world leader in sports medicine, pediatric orthopaedics, joint replacement” and other related specialties.
His trauma surgery expertise set the stage for his subsequent work with joint replacement. “Trauma surgery requires the most creativity and innovation of any area of orthopaedics,” he said, adding, “If you learn trauma surgery well, and if you can do trauma surgery well, then all of the rest of the orthopaedic specialties utilize those same skills.” As he joined Campbell Clinic, the Regional Medical Center in Memphis, known as The Med, opened to offer the first Level 1 trauma center in this part of the country. The opportunity allowed him to spend his first seven years in practice treating trauma cases.
Now, more than 20 years later, LaVelle has learned an innovative procedure known as the Birmingham Hip Resurfacing System (BHR). The procedure was developed by British orthopaedic surgeons, Derek McMinn and Ronan Treacy, using a device sold by Smith & Nephew. LaVelle works with Smith & Nephew to develop orthopaedic products and has traveled around the world lecturing about the use of selected devices.
Using a model of the hip joint, LaVelle described traditional hip replacement surgery and the new procedure. In simple terms, the hip joint is a ball-and-socket joint, and arthritis occurs when the cartilage wears out between the ball and socket. The traditional way to treat arthritis is to remove the ball and insert a stem with a ceramic or metal ball into the marrow cavity. The hip socket is then opened, and a titanium shell with an ultrahigh molecular weight polyethelene liner is placed in the socket. The hip is then assembled by “reducing” or setting the prosthetic ball into the plastic socket.
“Over the years, we have tried to develop a technique of doing a resurfacing of the hip without having to take as much bone out or putting in as large an implant,” LaVelle said. “And as early as the 1970s, other orthopaedic surgeons around the country have tried to develop that type of surgery, but up until this point, it’s been unsuccessful primarily because of the socket. The original resurfacing hip replacements had a plastic socket, but the socket was real thin, and so it didn’t stand up, it didn’t bear up, and so it fell apart.”
The new procedure preserves much more bone through resurfacing and covering the ball with a metal cap. The result is a metal-on-metal bearing surface that simplifies any future surgery. LaVelle said that the new procedure also offers advantages for mobility compared to traditional hip replacement. The new surface is more durable, and the larger ball used with the Birmingham hip offers a wider range of motion and is less likely to pop out of socket, the major complication of traditional surgery.
Permanent restrictions exist with standard hip replacement, he added. For example, patients can no longer squat; also, the leg cannot be turned inward after surgery, a motion that can cause the ball to pop out of the socket. But, with the new implant, there are few restrictions because of the ball’s size. The procedure is so promising that professional cyclist, Floyd Landis, had the procedure performed last October at another clinic.
As with most any medical procedure, LaVelle noted some cautions for potential patients to consider. For example, the best candidates are persons less than 60 years old, who have hard bone and are highly active. And, he advises that wear occurs no matter what material is used in the replacement joint. “When a metal-on-metal bearing surface wears, it releases metal ions,” LaVelle said, adding that metal ions released into the bloodstream, especially chrome and cobalt, elevate over time. “We don’t think that that causes any problems, but for that reason, we don’t recommend this surgery in women of childbearing years, and we don’t recommend this surgery in people who have … kidney disease.”
Then there’s the question of cost. Several large insurance companies have not approved the surgery although the Federal Drug Administration has. The reason, in his opinion, is the expense: the new implant costs up to three times more than the traditional implant.
This issue aside, LaVelle remains enthusiastic about the new procedure and his work in general. He says that experience has made him a better surgeon, which he shares with others through teaching. His workload includes six to eight “big cases” per week, and he always teaches as he operates.
“My operating room is what the Europeans would call a teaching theatre,” he said. “I’ve traded a Vanguard Theatre for a teaching theatre in an operating room.”
David LaVelle’s acting days might have ended, but his outstanding performance in the operating room continues. For this, expect rave reviews from future patients and the next generation of orthopaedic surgeons.
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