Orthopedic revisionist ‘a little bit of a carpenter’

By: Jane Heilmann .

Dr. Sekundiak joint revisionist
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FARGO, N.D. —  When hip or knee joint replacements fail or wear out over time, it’s Todd Sekundiak’s job to put them back together again.

Sekundiak, M.D., is Sanford Health’s newest specialist in Fargo, North Dakota. Born and raised in Winnipeg, Canada, just 200 miles north of Fargo, Dr. Sekundiak attended medical school at the University of Manitoba, completed a residency in orthopedic surgery in British Columbia and did arthroplasty fellowships in Phoenix and Chicago.

Choosing orthopedics as his specialty wasn’t a sure thing, at first. “I was fortunate to have some great mentors in orthopedics. If you look at my hands, I’m a little bit of a carpenter, and orthopedics is a lot of problem-solving with physical equipment and physical problems and mobility, and I do love all that.”

As for specializing in revisions, “it was a necessity, really. Initially, when physicians started doing joint replacements, they were putting in primary implants. Those are now failing. Again, it’s problem-solving — putting people back together like Humpty Dumpty. It’s exciting for me to make people better.”

After practicing for 15 years at Creighton University in Omaha, Nebraska, Dr. Sekundiak was looking for a new challenge. With his talents in demand, he intended to head somewhere warm or the East Coast, but there were things calling him to Fargo, and he jokes that it wasn’t the geography or climate. “There was the need — obviously, a growing medical population for this service. There was also potential — the great group of orthopedic surgeons already here, the orthopedic residency program starting this year, the possibility of adding fellowship training for people specifically who are interested in doing what I do, and the research aspect.”

Joint “revision” surgery has been around for a while and continues to grow rapidly. Overall success rates for joint replacements are high over 10 to 20 years, but at a million joints replacements per year in the U.S., revision rates are growing by 50 percent per year. Half of these are due to underlying health problems, such as infections or diabetes.

While many orthopedic surgeons dabble in revisions because they want to take care of their own patients, they often refer to a revisionist when it becomes complex. “Ultimately, that’s one of our goals,” Dr. Sekundiak said. “To be a referral center for other doctors and orthopedic surgeons who might not want to take care of these complex issues themselves.”

When an implant fails, the patient loses bone stock, which means the surgeon has less bone to work with. “Again, I do equate it to the Humpty Dumpty thing,” he said. “There are more pieces, more problems, and the bone is more fragile. From a physical perspective, it’s harder to put people back together when you’re dealing with eggshell bone, and you expect them to get up and walk on it right away.”

In addition to being more complex, joint revision surgery is often risky for patients with associated medical issues such as infection or diabetes. Surgeons strive to do minimally invasive surgery, even on revisions, but they have to be prepared to do whatever it takes to make the patient better. “That’s a juggle sometimes,” Dr. Sekundiak said. “You plan and want to do the least amount, but it can be a lot worse than it appears on the X-ray.”

Fortunately, advanced techniques and newer materials that actually incorporate and reconstitute bone are aiding in the process. There are also newer and more robust implants that can substitute for bone, and tendons, ligaments and bones can be transplanted. Stem cell therapy is another option showing promise in the research area. Sanford Health also employs computer navigation, is pursuing robotic options and  partners with manufacturing companies to look at new materials and new implants to improve success rates.

Today, there really is no age limit to joint replacements, which is why rates of joint replacement are still going up, not down. “Our society is so active,” Dr. Sekundiak said. “As we age, we want to maintain mobility. Fifty-year-olds are now getting total joint replacements. When I was training 25 years ago, that was unheard of. You have to be 65 or older. We now can operate on people over 100, understanding the risk, of course.”

Dr. Sekundiak stresses the importance of regular follow-ups after joint replacement. “We’re always concerned about implants failing. We still want to see patients year after year so we can spot problems before they get bad. It’s like getting your car serviced. If we see your brakes are failing, it’s much easier to put in new brake pads before your brakes totally fail. If we can get to the problem early, it’s easier to fix. “

As for athletes, the only ones he usually sees are those who are “over the hill.” Most young athletes are managed by sports medicine physicians who do everything possible for joint preservation with cartilage transplants, ligament repairs and more. “They are trying to put me out of business,” he joked. “It’s not cookbook. Each case is different. Every patient is specific. The way the joint fails is specific and how to reconstruct it is specific.”

Dr. Sekundiak typically performs 600 to 700 hip and knee cases per year, half of them revisions, and he plans to meet or exceed that at Sanford Health. He’s excited to get back into a routine and be a part of the large ortho team and help it succeed.

“Being a veteran in orthopedics and coming into a new system is a bit scary. The cool thing is seeing physicians doing things differently and better, and learning from them, and hoping they learn from me,” he said.

When he’s not at work, Dr. Sekundiak is a “yard guy” who likes to get his hands dirty with planting, weeding and trimming. “I never thought I’d be living and working in Fargo. It was a tough decision, but it was my family who really wanted to live here.” He finds Fargo has a homegrown feel and good people. He’s also grateful to be closer to family in Winnipeg.

“In your life, you want an easy commute, friendly people and a good team to work with. I’m glad to be here.”