Dr. Andrew Freiberg: Advances in OA and Biomaterials
October 17, 2008
Dr. Andrew Freiberg is the current Arthroplasty Service Chief at Massachusetts General Hospital and an Associate Professor of Orthopaedic Surgery at Harvard Medical School. His education and training include an undergraduate degree from Northwestern University followed by medical school at the University of Cincinnati College of Medicine. He then completed general surgery and orthopaedic training at the University of Michigan Hospitals in Ann Arbor, MI. Dr. Freiberg then completed an adult reconstructive surgery fellowship at Massachusetts General Hospital. His clinical and research interests include minimally invasive hip and knee arthroplasty, partial knee replacement, and complex revision surgery. The research program at MGH has a long interest in the development and study of new bearing surfaces that can be used in arthroplasty.
Knee1: What made you choose the field of orthopedics?
Dr. Freiberg: I am fortunate to have orthopaedics in my family. I am the only fourth generation orthopaedic surgeon in the U.S. and am proud to be a member of our profession. Orthopaedic surgery is an amazingly diverse specialty and offers a lifetime of challenges and opportunities in patient care.
Knee1: How big a problem in your opinion is osteoarthritis (OA) and are there special populations who are more at risk?
Dr. Freiberg: Osteoarthritis is a major health problem in the U.S. It seems that patients who are overweight with a BMI greater than 30 seem to be a bigger risk for OA than those who are thinner and active. People who have sports injuries are also at greater risk of OA, but they usually do not need joint replacement for decades.
Knee1: What are the warning signs of OA that are most often missed?
Dr. Freiberg: One of the most commonly-missed signs is that of referred pain from an arthritic hip manifesting as knee pain. Also, hip OA can seem like a groin pull. X-rays to evaluate a painful or stiff joint are extremely valuable in diagnosing OA. Joint pain that does not resolve with simple conservative management such as rest and short-term use of an oral anti-inflammatory should be evaluated by your physician.
Knee1: What is the treatment management plan that you recommend as the disease progresses?
Dr. Freiberg: As OA progresses, weight loss when indicated can dramatically improve pain. Every step we take, our hips and knees see 4 – 5 times our body weight, so even small changes in weight can really decrease forces on our joints. Initial management, of course depending on each patient's individual medical condition, usually consists of an over the counter anti-inflammatory and/or use of arthritis strength acetaminophen combined with a gentle exercise program. Formal physical therapy is more useful for early knee OA than it is for hip OA. A cane can be used for longer walks as the disease progresses. For some forms of knee OA an "unloading" brace can be used for walks or activities like golf or tennis. Some patients benefit from oral glucosamine/chondroitin sulfate preparations.
Knee1: How are advances in technology changing treatment management?
Dr. Freiberg: There are a number of advances in technology that include newer medications, arthroscopic surgical techniques, improved joint replacement materials and more minimally invasive surgical techniques.
Knee1: What are the key things that everyone suffering from OA should know?
Dr. Freiberg: Osteoarthritis usually progresses slowly and patients have plenty of time to make informed decisions about their treatment. Stiffness is a part of joint deterioration and usually improves after joint replacement.
Knee1: Why did you decide to focus on arthroplasty?
Dr. Freiberg: It's a great sub-specialty within orthopaedics because of the tremendous positive effects it can have on our patients. I also enjoy complex reconstructions or doing minimally-invasive procedures that are more technically challenging.
Knee1: In which types of cases do you recommend arthroplasty?
Dr. Freiberg: Patients with advanced osteoarthritis, rheumatoid arthritis, post-traumatic arthritis, or arthritis from osteonecrosis.
Knee1: Are you seeing an increase in younger patients requiring this type of procedure?
Dr. Freiberg: Absolutely
Knee1: Can you talk a little about the Knee Biomechanics and Biomaterials Laboratory?
Dr. Freiberg: Our lab investigates how normal knees work and we try to study the motions of patient's knees who have had reconstructive procedures. The goal is to make our surgical procedures and implants restore normal function and range of motion in patients.
Knee1: Do you find patients coming in and expecting better outcomes? Also, do you sometimes find that the outcome they expect is not realistically possible to deliver based on their condition?
Dr. Freiberg: What patients expect is complex and we try to understand each person’s goals. At times, people have unrealistic goals, but we can achieve excellent functional results that most of our patients are pleased with.
Knee1: Do you find that patients coming in are more educated, and if they are more educated, how much does that help with them getting better treatment outcomes?
Dr. Freiberg: Being educated doesn't necessarily improve outcome. There is a lot of confusing and contradictory information available to our patients. Some of this material is just "information marketing" and not very relevant. The best advice I can give is to find a surgeon you trust and try to learn about the treatment options that are available and that work in his or her experience.
Knee1: Is there any advice you would give to someone experiencing knee pain?
Dr. Freiberg: Go and see an orthopaedic surgeon!
Last updated: 17-Oct-08