Randall Talks Rich AAOS 2022 Program, Packed With Engaging Discussions

R. Lor Randall, MD

The American Academy of Orthopaedic Surgeons (AAOS) 2022 Annual Meeting is being held March 22 to 26 in Chicago, Illinois and is filled with an educational agenda that includes plenty of room for practice-changing discussions in orthopedic oncology, according to R. Lor Randall, MD.

“Its functionality is the stewarding of clinical care of orthopedic surgeons, clinical care of patients by orthopedic surgeons in terms of making sure that orthopedic surgeons are up to date with the latest clinical aspects of orthopedic care,” Randall, who was heavily involved in this year’s meeting, said.

In an interview with OncLive^®, Randall, who is the David Linn Endowed Chair for Orthopaedic Surgery and professor and chair of the Department of Orthopaedic Surgery, University of California Davis Health, discussed the takeaways from this year’s meeting.

OncLive^®: Please provide some background to the AAOS meeting.

Randall: This is the largest orthopedic meeting in the world. It's here in Chicago this year; it was in San Diego last year and it was reasonably well attended as an in-person meeting last year, given all that was going on [with the COVID-19 pandemic]. It's better attended this year, but it's still not back up to full capacity.

While it's called the American Academy of Orthopedic Surgeons, it is really a “world congress.” It's exciting to reconnect with my colleagues from all different disciplines. As we've discussed in the past, orthopedic oncology is a very small section of orthopedics. In general, we make up probably about 1% to 2% of the person force in orthopedics. However, we're certainly one of the most transdisciplinary collaborative group of surgeons, just by the nature of our practice.

As you can appreciate, we are more of a disease-focused group, whereas much of orthopedics is anatomically or demographically focused like a hip surgeon, a knee surgeon, or a pediatric orthopedic surgeon. We take care of patients of all ages in orthopedic oncology, and we operate all over the body and in some cases, even in non-orthopedic realms.

Therefore, it's always fun to come to this meeting as an orthopedic oncologist because in our field, because of the nature of being a disease focus, as opposed to an anatomic or demographic focus, we take knowledge from all the different sub specialists. I learned from a pediatric orthopedist, I learned from joint reconstruction surgeons, and I learned from spine surgeons.

In addition to that, we also have the privilege to educate them about our niche. Many orthopedic surgeons are understandably very anxious about stumbling upon a patient with a potential malignant diagnosis, right? This is because they don't feel trained in it. They want to do right by their patients. Therefore, when they see something funny on a radiograph, x-ray, scan, [it's a moment of], "Could this be cancer? How do I treat it? What do I do?"

We gave an instructional course lecture [at the meeting] this year. Colleagues from Harvard, Rush, and then myself from UC Davis, gave an instructional course lecture to general orthopedists on tumor and tumor-like conditions of which every orthopedic surgeon should know. It was very well attended—it was standing room only, which was just terrific to see that people wanted to have a bird's eye view of orthopedic oncology and how it would impact their practice.

We gave an overview of establishing a differential diagnosis that was given by my colleague from Harvard, and then I was moderating. Then, I talked about how patients with orthopedic tumors might present in the emergency room; for example, they might show up because they have a pathologic fracture from metastatic carcinoma to bone, or they might present with a primary mass. An orthopedic surgeon who's on call for the emergency room might then be faced with the situation before them.

I went through the algorithm of how you would triage this appropriately, when to call your orthopedic surgeon, what tests you order up front. Then, I then went on to talk about pediatric tumors; pediatrics is a big part of what I do and is a particular passion of mine.

I spoke about both benign and malignant conditions. A colleague of mine came forward and talked about how it might present to a sports physician. A sports physician sees a lot of swollen joints and younger, athletic people, and sometimes those are injury related, but sometimes their conditions such as tenosynovial giant cell tumor [TGCT] or other benign conditions, and the sports surgeon who sees the MRI for a TGCT is immediately concerned. Could this be something other than TGCT? Could this be cancerous? What do I do if it's not cancerous and if it is truly TGCT, what do I do?

There are pseudo tumors that present after some types of joint replacements, the body reacts to prosthesis and creates these pseudo tumors that can look like a cancer. [One of my colleagues went] through on how you determine that. Finally, one of our other colleagues spoke about spine tumors; he talked about both benign and malignant conditions of the spine, both primary tumors that arise from the spine, and then carcinomas and things that involve the spine.

Then, we had about a 15-to-20-minute question and answer session. It was nice to see a bunch of general orthopedists come to the microphone and ask us about scenarios that they had either experienced or were anxious about that they might experience. [It ended up being] a 90-minute session.

Beyond that, there is a variety of other instructional course lectures that my orthopedic oncology colleagues are presenting, and some of them more are more specialty focused. The instructional course I just discussed was meant for the general orthopedist, but we also do give instructional courses to our peers. Someone might be particularly experienced in it in a certain type of sarcoma, and they might give an instructional course lecture on that disease entity to bring other orthopedic oncologists up to speed who might not be quite as experienced in that realm.

Therefore, it's been a great meeting. All of the different subspecialties within orthopedics have a date concentrated to their own discipline. We have the Musculoskeletal Tumor Society Specialty Day; that is a great program. I'm moderating one of the sessions about the latest emerging technologies in orthopedic oncology. I have a few colleagues from around the country that will be presenting, and then I'll be moderating and asking, hopefully, provocative or interesting questions of them as we get the audience engaged. It's just a wonderful experience.

What are the important takeaways from this meeting for medical oncologists?

It is important for the medical oncologists to know that, like all disciplines, medical oncology has its clinical oncology meetings, but then there are some general internal medicine meetings that they might attend as well. Obviously, when you're an [oncologist], you have to worry about all the organ systems. Staying up to date on things beyond cancer is pretty relevant; I don't think that's naïve of me to say that.

Therefore, what we are doing here is educating our general orthopedist. Then, we are reaffirming our knowledge base with orthopedic oncologist in that we are stewarding our responsibility for cancer care in the musculoskeletal system. Medical oncologists sometimes may have an orthopedic oncologist immediately available to them if they're at a major center. Now, there are probably many medical oncologists out there that don't have an orthopedic oncologist; they have a general orthopedist who might manage their metastatic carcinoma to bone.

There is real applicability to this mission as relates to cancer care. In the United States, as we talked about previously, skeletal-related events in cancer make up about 20% of the cancer care economy. That's a large portion of the pie. Therefore, all these medical oncologists will invariably have some patients who have musculoskeletal involvement.

What has the experience been like to regroup with so many of your colleagues since the COVID-19 pandemic?

It's been very positive. One thing is that as nice and fast as the Omicron variant came on, it also fell off [just as fast]. This was fortuitous in terms of the timing. We have had to show our documentation of our vaccination status and fill out a survey to make sure that we have no symptoms. The event itself is mask optional, but many people still wear their masks. Most people when they're presenting will take their masks down, so their voice can carry better.

However, there is definitely a great sense of gregariousness to be able to shake someone's hand, and to give a genuine hug to some of my colleagues I haven't seen in 2 years except through the screen. It instills me with optimism and rejuvenates my vigor to do the best I can as a professional as well as a fellow human being.

Is there anything else you would like to add?

I'd also like to give recognition to the Orthopaedic Research Society, which is much more of our science, mechanistic, and translational science venue. It's also a very large congress from around the world. It's held at a different time and a different location, it used to piggyback on the AAOS, but people realized that that was just too long [of a meeting], so they split them up. I would like to recognize that the ORS is also again, an important part of what we do as orthopedic surgeons from a research perspective.