Dr. Juliet DeCampos is a sports physician and orthopedic surgeon who rose to national prominence as the surgeon who reattached the arm of Jesse Arbogast, a young boy whose arm was bitten off by a shark at a Pensacola beach. In addition to her newsworthy experience in trauma care, Dr. DeCampos is a well-respected shoulder and knee surgeon, a specialist in sports medicine, and a team doctor for the Pensacola team of the National Women’s Football Association. She was among the first physicians trained in the use of Carticel®, a significant new treatment in knee surgery.
Knee1: We noticed in looking over your CV that in college you completed a triple-major, in exercise physiology, biology, and sports journalism. That’s an accomplishment in and of itself. Then you continued on and received a Master’s degree in exercise physiology, which is a fairly unusual background for an orthopedist.
Dr. DeCampos: What’s really helped me in sports medicine is the physiology of exercise, because I had a more cellular-level approach. And if I had chosen [a research] route, I think that would have been more my research emphasis.
Sports medicine doctors can do themselves a disservice. You can know how to do a procedure, and therefore do it for any diagnosis. But I think that what makes you an expert in a procedure is realizing who and when: if it’s even the best procedure for the patient, and what the alternatives are.
Knee1: Was there a point in your life when you knew you wanted to go into sports medicine?
Dr. DeCampos: Yes, when I was ten. I wanted to go into sports medicine because I was a football fan. When I was a ten-year-old girl I saw the University of Southern California-UCLA game—I’m a Trojan—and I watched a big play with a now-unpopular guy who was then the Heisman trophy winner, O.J. Simpson. I said, "Dad, what kind of doctor gets to be at these games?"
My dad was a general practitioner, a family doctor with a big practice, who saw everybody for everything. Girls weren’t doctors back then, but as one of seven daughters, he never said to me, "You should be a nurse, or a teacher." So when I wanted to be a doctor, he never said, "Women don’t do orthopedics." I actually never had anybody tell me that I shouldn’t go into orthopedics until I was interviewing for medical school. I had interviewers who said, "Oh no, you shouldn’t do orthopedic surgery." But my dad was very supportive. I can’t remember ever wanting to be anything else than a doctor, and I think that having that focus probably helped me later on.
Knee1: How many of the people in your medical school class were women?
Dr. DeCampos: Twenty-five percent of my class. In my orthopedic surgery internship, there was one woman in the program when I applied, but there were three in my class, and seven out of total of 55. At the time we had blacks and women and Asians when no one else did. We had a very forward-thinking chairman, Augusto Sarmiento, MD, who was a foreign medical graduate (from Columbia, South America), and he was committed to having a very diverse residency.
I am the President of the FORUM, an elite group of invited fellowship-trained female orthopedists. We talk about the pressure on you when you represent "all women to everyone." Being the only woman is a very common scenario. People say, "I had a woman in my residency, and she did this, so that must be how all women are." But in our program, we had a huge variety of different people, and the women in the program were not singled out.
In my orthopaedic fellowship at the Kerlan-Jobe Orthopaedic Clinic, they had had no women in the fellowship, ever, until two years before me. Then they had Lynn Scovazzo who was the best resident in her year at Pittsburgh, and they decided that they could take women. Every one of my fellowship classmates has gone on to take care of high level professional athletes. But, as a woman, I knew that I would be unlikely to get the opportunity to be a doctor for professional basketball or football at the NBA or NFL level.
Knee1: You are a team doctor for the National Women’s Football Association, is that correct?
Dr. DeCampos: Yes, I am a team doctor for professional football now, but it’s not the same level of pressure as the NFL. The NWFA woman players are excellent athletes, who have always wanted to play football and were always denied that opportunity. They literally started out as professionals, but that’s a very loose term. They’re very dedicated athletes, but they all have to work at other jobs. I am very proud that my team, the Pensacola Power, is the pre-eminent team in the league; and of the nine athletes that had ACL reconstructions, all returned to play the next season – a success ratio I doubt any NFL surgeon enjoys!
Knee1: Let’s return to talk a little bit about your experience in trauma care. One of the greatest associations with your name is the unbelievable story of Jesse Arbogast, which made national news a few years ago. Did your background in trauma care help you at that time?
Dr. DeCampos: Jesse Arbogast was a boy who was at Pensacola Beach on a day when I was on call, which is one out of four days. As you know from the recent attack in Hawaii where the surfer had her arm bitten off, the most common scenario is: shark bites you; it swims off with whatever body part it has; you die. So, for example, for this girl to survive is tremendous, but of course they didn’t catch the shark. The story about Jesse is catching the shark, getting his arm, and then putting his arm back on.
There are two stories that I think are more significant than the arm attachment, and the first story is that, when he was brought to the emergency room of our center, they resuscitated this boy who was essentially exsanguinated. And the second story is that his uncle literally pulled the shark to shore, and they were able to extract the arm.
My experience in trauma was extremely helpful. When I was in it, the University of Southern California program covered the L.A. County University of Southern California medical center, one of the pre-eminent trauma centers in the world, by volume if not by reputation. We literally had a replant team, and as a senior resident you serve on the team, primarily putting on fingers and hand parts that had been amputated by table saws; things like that. Being on a replant team, you had to learn the process of limb salvage, from packaging the limb to delivery: how to evaluate the limb to see if it’s replantable, how you evaluate the residual limb. So I was able to activate that system for myself even though I hadn’t been involved in a replant for years. Then I was able to contact a microvascular surgeon who lived in this area and was willing to come in and do the microvascular part of the reattachment.
What really helped was my trauma training, because my practice does not involve microsurgical limb reattachment at all. My practice involves shoulder surgery and knee surgery. I’m a specialist in that I only do sports medicine in my private practice, but I’m a generalist in that I have to take one in four orthopedic trauma calls, so I do hip fractures and femur fractures and multiple trauma and put arms back on kids that got bit off; things like that. That’s the small-town orthopedist experience.
Knee1: Then let’s talk a little bit more about your practice. What are your current interests in research and patient care?
Dr. DeCampos: Currently I only do clinical research, because I am a private practitioner with no fellows, residents, or university affiliation. I am in the directory as providing Carticel®, autologous cultured chondrocytes. I was the first woman trained in that. I believe they trained twenty, and everyone else was an academic. At the time I was the number one arthroscopist in downtown L.A.; that’s how they chose me.
Since my fellowship, all my research has been clinical. I brought Carticel® to the panhandle when I came from L.A. No one was doing it. My then-partner became trained in it, and within three years we had done twenty procedures with really excellent results. It was great to come to a new area and institute a relatively new treatment for the benefit of the patients.
Knee1: Could you tell our readers a little more about that treatment?
Dr. DeCampos: Carticel® was initially a proprietary method developed by Genzyme Biosurgery. Usually, I link it to in vitro fertilization, where someone wants to have a baby but can’t without advanced technology. In this case, someone wants to use their own cells to salvage a knee, in order to avoid the possibility of rejection. It’s a great technology.
Currently it’s a two-step process. We harvest grown-up cartilage cells, which are called chondrocytes, from their knee; then we send a small sample to Genzyme. They expand the cell volume by de-differentiating them, making them into baby cells, and growing them into 12 million cells. Then we perform another surgery with a larger incision, and prepare the bone bed and insert the cells. There’s a very specific rehab protocol. Just like in vitro fertilization, there’s a nine to ten-month period that’s watchful waiting, during which you try to get the cells to re-differentiate and essentially start re-forming cartilage back in the knee.
In somebody who has worn a hole in their knee or knocked a hole in their knee — not arthritis all over the knee, but just one localized area, or two or three localized areas — you can literally resurface the knee with their own cartilage, using biological technology that stands the test of time. Fifteen-year studies in Europe and 10-year studies in the U.S. have shown that this provides a durable repair and essentially gives the patient a normal knee function.
Knee1: Do you find the small-town experience more rewarding than working in a major center of academic medicine like Boston?
Dr. DeCampos: No, absolutely not. If I were single and childless, then I’d be the chairman of a program at an all-academic center, pouring out research. When I left L.A., I had been a physician at the Olympics, which was one of my goals. I was at the ‘96 Atlanta games, and I had to leave a four-month old son with my husband and go be a doctor for two weeks, and I was literally FedExing breast milk across the country. I said to myself, I’m never going to be the world’s most famous orthopedist; but I could be a good mom if I concentrate on that; so we moved.
I just talked to a well-known woman orthopedist yesterday, who was doing exactly what I would be doing if I was still in L.A., and we were sharing that though. She just had her third child, and is covering Division 1A games, and she’s not happy. She doesn’t see her kids or her husband. She’s much more famous than I ever was — in terms of orthopedics, not the fifteen minutes of fame [that I had] — and she’s going to downsize. It’s interesting. If you don’t have children, and you do have a very supportive spouse, women can have everything and more. But they can’t rise as far up academically unless they sacrifice family, or choose not to have one. I think the trend overall is for more doctors to be women.
Fewer women are going into orthopedics. Few women choose the most time-intensive specialties; instead they choose hand surgery or pediatric orthopedics. With pediatric orthopedics, for example, you’re with pediatricians, many more of whom are women; and they are very open to the demands of family. By and large women avoid things that are physically demanding over the long haul, or where they have to take a lot of trauma calls. Given that medical school classes are now 50% women, I think by sheer numbers there will be more women orthopedists, although the percentage may be smaller.
Knee1: What do you feel is your greatest contribution to orthopedic surgery?
Dr. DeCampos: Being involved with Jesse Arbogast was able to give me wide exposure, so people were able to see that there was a woman orthopedic surgeon who was involved in the care of this case: "Wow, the doctor who put that arm on is a woman." Day in and day out, I think my most significant contribution has been my ability to interact with young athletes, and have a positive impact on their lives.
Knee1: How do you expect your practice to be different in five years?
Dr. DeCampos: One, I will start to teach again. I had put that on hiatus, teaching physicians and medical students. I think that teaching enhances my knowledge of what’s new and at the forefront. The second thing is that I will be in a group, and I think that will afford me more time to concentrate on some more clinical research which is actually publishable.
Knee1: Are there specific advances or changes in your field which you hope to see in the next five or ten years?
Dr. DeCampos: There will be a lot more genetic biotechnology, replacing some of the more onerous surgery we do right now. For example, we’re using biological bone substitutes to enhance initial fixation. In terms of sports medicine, I think that the difference in the etiology of women’s knee injuries and treatment — I think those differences will be more carefully thought out; there will be more of an algorithm for treatment in those situations.