Inside the World of Orthopedic Surgery: An Expert Interview with Dr. Cătălin Prescură

Hello, Dr. Cătălin Prescură and thank you for sharing your experience with us!

1. Hip arthroscopy is known to be a particularly difficult field. What initially led you to specialize in this field, and what has motivated you to continue to improve over the years?

Hip arthroscopy is the field that has seen the greatest increase in terms of the number of cases operated on in the last 15 years, compared to arthroscopic operations on the knee and shoulder. It is indeed the most technically difficult to perform, as it requires dedicated technology and instrumentation, and the surgical techniques used to approach the joint have the highest variability and complexity of all arthroscopically assisted procedures.


Being passionate about sports traumatology and having an inclination towards arthroscopically assisted knee and shoulder surgeries, I have encountered in my practice several hip joint pathologies of impingement type that had surgical indications but had no treatment solutions in the country, this being a field less approached in Romania. I had the chance in 2017 to meet Prof. Dr. Stefan Fickert (Sporthopaedicum, Germany), a European authority in this field, and specialize in his clinic on arthroscopic hip surgery techniques. Once I managed to master and follow a surgical routine completely different from other procedures, the complexity of the cases I addressed increased. This forces you as a surgeon to be in a continuous learning process, to increase your level of training and improvement, and to always be up to date with modern international studies and techniques. 

2. Given the growing interest in minimally invasive surgery, how do you see the future development of arthroscopy, and what advances are you most excited to implement in your practice?

Currently, minimally invasive surgery is the "gold standard" in most orthopedic surgeries, whether for sports trauma, prosthetic surgery, or fractures. Studies have clearly shown that the complication rate increases with the procedure's exposure and invasiveness. 

Strictly related to arthroscopic interventions, I believe that the success of a procedure does not only consist in the advancement of technology or a new and innovative implant, but rather in the correct determination of the indication, the optimal time to perform the surgery and, last but not least, the degree of correct information given to the patients.

The future of arthroscopy, I believe, lies more in repairing the structures themselves than in replacing them. At present, we can "repair" a torn meniscus or ligament, which implies surgical suture techniques with natural healing potential.

These structures can no longer be repaired if the lesion is diagnosed later. Still, they must be reconstructed (replaced) with tissues that do not have the original native properties, which is why the result may not be exceptional.

In conclusion, the future of arthroscopy does not lie in miracle implants but in a precise, rapid, and correct approach to the lesions. In arthroscopic surgery, waiting and delaying the operation often decreases the efficiency and the potential for natural healing of the injured structures. 

The future of surgery is centered around robotic-assisted techniques, which increase the precision of surgical gestures and outcomes. In arthroscopic techniques, I believe that robots will be a real benefit, as software is already being developed with applications in knee and hip arthroscopy that allow us to perform maneuvers in very tight spaces where it is technically very difficult to work. 

3. How has your international experience influenced your practice in Romania, and what unique techniques or knowledge have you brought back to the country for the benefit of your patients?

International experience is vital in a surgeon's career, as all medical innovations are driven by the results of multi-center studies, studies that involve massive work and investment from technology manufacturers, or educational funding/research grants. 
On the other hand, any study must also be backed up by the experience of the top international surgeons with whom we consult and interact in our practice. I perform hip arthroscopy, minimally invasive hip surgery (prosthesis), and robotic-assisted knee surgery in my practice, and I believe these techniques are of great benefit to the patient.

4. How do you think the availability of free prostheses under the National Health Program will impact patients needing hip and knee replacements?

In recent years, at the national level, there has been an increase in the volume of total hip and knee arthroplasty operations, up to about 20,000 operations/year. Considering the fact that life expectancy has increased in the last 15-20 years, I expect this volume of cases to increase further, following the international trend.

On the other hand, compared with a European country such as Sweden, which has half the population of Romania, the number of surgeries, according to the Swedish National Arthroplasty Registry in 2022 is 21,000 hip replacements and 16,000 knee replacements, i.e., a total of 37,000 implants per year.

Extrapolated to our population, this means a volume almost 4x higher. I want to believe that we are healthier than the Swedes, but the differences are based on other reasons, such as organization and trust in the national health system, patient information, quality of life, etc.

The availability of free implants through the existence of the National Health Programme is a real benefit, and I would like to see these allocations increase exponentially, as many patients have an indication for joint replacement and are waiting for the allocation of funds, which have proven to be insufficient, leading to waiting lists that can reach 9-12 months or even longer.

5. What steps are you taking to ensure that more people benefit from these advances?

In order to increase the volume of operations at the national level and help as many patients as possible, I believe that a collective effort is needed on the part of us orthopedic surgeons to raise awareness of the procedure, which today is one with minimal risks and optimal results, increases the quality of life and helps us return to most of the activities we want to do, practically to a normal life without pain. In Romania, there is still a lot of reluctance on the part of patients towards joint replacement surgery, which is why I believe it is our role to promote the procedure and the optimal results and to popularize as much as possible an intervention that, in most Western countries is routine for the patient. 

6. Access to detailed imaging data is crucial for orthopedic surgeons. How has imaging technology influenced your ability to diagnose and treat complex hip and knee conditions?

In our specialty, the diagnosis of an orthopedic condition is established both based on a clinical consultation (in the office) and documented by relevant imaging investigations. These may consist of routine investigations (X-rays or ultrasound), which are often performed ad locum, or more complex investigations (MRI with or without contrast, direct MRI arthrography, computer tomography with 3D reconstruction, scintigraphy, or Pet-CT in tumor pathologies). 

The gold standard in hip or knee joint imaging is the MRI investigation, which gives us all the anatomical elements, representing practically a photograph of the structures in our joint. We must understand that however complex the MRI investigation is, it does not diagnose or establish the treatment; it is done exclusively by the orthopedic specialist, who interprets the appearance and the MRI images in a clinical context. The orthopedic surgeon will never operate the medical imaging report, but the clinical expression that this appearance gives, not all lesions and changes described miss or are pathological. 

7. Why do you think access to imaging data is important for orthopaedic surgeons? 

Imaging technology helps us plan our surgery as accurately as possible and reduces the chance of being surprised intraoperatively with lesions that, in the absence of an MRI, we would not be able to anticipate. The patient should also be informed as accurately as possible before the operation about surgical planning, which often modifies the recovery protocol.
The orthopaedic surgeon's access to imaging data is not only important, I would say it is vital, and I believe that there must be good collaboration between the orthopaedic surgeon and the imaging physician, so that the quality of the images and the interpretation of the imaging report is as conclusive and focused on the pathology we are looking for. 

At the same time, overspecialization in orthopedics by practice area is increasing, and it is ideal to share our medical casework with colleagues who more often address that pathology and have more treatment expertise.

Dr Cătălin Prescură

A good surgeon is a surgeon who knows very well his qualities as well as his limitations, which is why when you are addressing a surgical case where you may not have enough experience, you would want to refer the patient to a specialized colleague, sending directly the imaging you have through a simple link or electronic medical file.

Digitization in medicine has this great advantage: we can access imaging investigations from a doctor's account, both from the hospital office and from my personal laptop, which greatly streamlines my time and medical decisions. 

About Dr. Cătălin Prescură:

Dr. Cătălin Prescură is a specialist in orthopedics and traumatology. With over 15 years of experience in the field, he specializes in hip/knee arthroplasty, performing total and partial knee replacements, including OXFORD knee unicompartmental replacements and custom CT/MRN replacements.
He is passionate about rapid recovery from joint sports injuries, so he performs knee, hip, and ankle arthroscopies. He is also dedicated to regenerative medicine and prearthrosis, performing tibia/femur corrective osteotomies, artificial meniscus transplants, and articular cartilage reconstructions.

 

 

FAQs

What does an orthopedic surgeon specialist do?

An orthopedic surgeon, also known as an orthopedist or orthopedic doctor, is a medical professional specializing in diagnosing, treating, and managing conditions related to the musculoskeletal system. This system includes bones, joints, muscles, ligaments, tendons, and nerves. Orthopedic surgeons address various musculoskeletal issues, ranging from joint pain and arthritis to back pain and injuries.

Their primary role involves performing orthopedic surgery to correct deformities, treat injuries, and alleviate pain. They are skilled in various surgical procedures, including spine surgery and foot and ankle surgery. These specialists often work closely with other healthcare providers, such as primary care doctors and physical therapists, to develop comprehensive treatment plans tailored to individual patient needs.

Education and training for an orthopedic surgeon include completing medical school, followed by a residency program in orthopedic surgery, which typically lasts five years. Some may also pursue additional fellowship training in specific areas of the field of orthopedics, such as sports medicine or pediatric orthopedics.

Orthopedic surgeons play a crucial role in pain management and the overall treatment of musculoskeletal conditions. They utilize a combination of surgical and non-surgical approaches, including medication, physical therapy, and lifestyle modifications, to help patients recover and maintain their quality of life.

Whether addressing common issues like arthritis and joint pain or complex cases requiring advanced surgical intervention, orthopedic surgeons are essential in restoring function and alleviating pain for individuals suffering from musculoskeletal problems.

What is done in orthopedic surgery?

Orthopedic surgery, performed by an orthopedic surgeon or orthopedist, involves various surgical treatments aimed at addressing issues related to the bones, joints, and overall musculoskeletal system. The goal of orthopedic surgery is to correct deformities, treat injuries, and alleviate pain, often resulting from sports injuries, orthopedic trauma, or degenerative conditions.

Orthopedic doctors undergo extensive medical training, including medical school, followed by a residency program in orthopedic surgery and often additional fellowship training in specialized areas such as sports medicine or spine surgery. This rigorous training equips them with the expertise to perform a wide range of procedures.

In orthopedic surgery, several specific procedures are commonly performed:

  1. Joint Replacement Surgery: Replacing damaged joints, such as the hip or knee, with artificial implants to relieve pain and restore function.

  2. Arthroscopy: A minimally invasive technique used to diagnose and treat joint problems using a small camera and specialized instruments.

  3. Spine Surgery: Procedures to treat conditions affecting the spine, such as herniated discs, spinal stenosis, or scoliosis.

  4. Fracture Repair: Surgical fixation of broken bones using plates, screws, or rods to ensure proper healing.

  5. Ligament and Tendon Repair: Reconstructing torn ligaments and tendons, often due to sports injuries, to restore stability and function.

  6. Orthopedic Trauma Surgery: Addressing severe injuries resulting from accidents or falls, including complex fractures and dislocations.

Orthopedic care also encompasses post-operative rehabilitation to ensure successful recovery and regain strength and mobility. This often involves working with physical therapists and other rehabilitation specialists to create tailored recovery plans.

In summary, orthopedic surgery involves a variety of surgical treatments performed by highly trained orthopedic surgeons to address and manage conditions affecting the musculoskeletal system, with a focus on restoring function and alleviating pain through both surgical and non-surgical approaches.

 

About the author - Andra Bria

Andra Bria is a marketing manager at Medicai. She is interested in health equity, patient experience and value-driven care pathways. She believes in interoperability and collaboration for a more connected healthcare industry.