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VOL. 128 | NO. 42 | Friday, March 1, 2013

Campbell Clinic’s Mihalko Keeps Athletes in the Game


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“There’s nothing better than getting someone who can’t do their sport back to succeeding in what they want to do.”

–Dr. Marc Mihalko
Campbell Clinic

Competitive athletes face tough choices when it comes to fixing worn-out joints and no one knows that better than another competitive athlete.

Dr. Marc Mihalko, a triathlete and orthopaedic surgeon for Campbell Clinic, uses new technological innovations to help other athletes remain in the game.

“There’s nothing better than getting someone who can’t do their sport back to succeeding in what they want to do,” said Mihalko, who has been with Campbell Clinic for the last 15 years – five as a resident and 10 on staff.

Mihalko is originally from New Jersey but moved to Nashville with his family during high school and went to college at the University of Tennessee at Knoxville. He stayed with UT for medical school and was hired by Campbell Clinic immediately after his residency.

Choosing orthopaedics as a specialty came with immediate professional gratification.

“With orthopaedics, there are a lot of things you can actually fix,” Mihalko said. “With some medical problems it’s an ongoing problem that never really gets cured. With orthopaedics you can really see someone get better.”

Because he works in Campbell Clinic’s Southaven location, which is smaller than its other three locations, Mihalko’s patients are not specialized. He sees children injured in accidents, seniors whose joints are wearing out, as well as athletes.

He himself is a lifelong jogger who started swimming competitively for the first time about nine years ago. Friends then convinced him to compete in triathlons and he’s been doing it ever since. He also enjoys skiing and snowboarding with his two sons.

Professionally, he’s fascinated by the hip joint.

“I’m really interested in hips and I do a lot of hip replacements,” Mihalko said. “I’ve been branching out into a new field on the sports medicine side of hip surgery. There are patients who 10 years ago we’d have told them we don’t have anything to offer you. Now we do.”

Specifically, hip preservation techniques have developed in the last 10 years largely due to improvement in surgical equipment. Some hip replacements can be delayed for years or prevented altogether by less-invasive surgeries.

“We’ve found that there are a lot of conditions, which if left untreated, wind up going on to have a hip replacement,” Mihalko said. “These are people very young in their lives so to have a hip replacement is devastating. You have to tell people that they have to change their activities for the rest of their lives.”

Usually joint pain occurs when the cartilage, which cushions the bone parts of a joint, tears or becomes damaged. Sometimes this happens because of abnormalities in the bones structure like a burr grinding against the cartilage, a condition called Femoroacetabular impingement or FAI.

Mihalko operates arthroscopically using a tiny camera to guide the shaving of the bones and the sewing of the cartilage. Sometimes arthroscopy is not possible and a more invasive incision is necessary, but it still avoids a full hip replacement.

That’s important because full replacements come with limitations to mobility that may prevent athletes from being able to compete. Mihalko said that youth sports are becoming more and more competitive, the injuries are occurring younger, and the surgeries are becoming more common.

Mihalko performed about 20 of the surgeries in 2011 and 50 of them in 2012.

“They still might get to a replacement, but our hope is that we can delay that at the worst and hopefully one day prevent it,” Mihalko said.

Rehab takes three to four months and patients are followed closely for a year. Now that hip preservation has been around for more than five years, the long-term effects can be studied more closely.

Mihalko and Dr. Bill Mihalko, also of Campbell Clinic but not related, are working together on research to determine the impact of hip preservation on bone stability.

“We’re making some deeper layer incisions in the hip joint,” Mihalko said. “And we’re trying to figure out how that affects the stability of the hip. If I cut this much, is that going to change how stable or how much mobility is in your hip. We’re doing a cadaver study to see how it changes people’s hips.”

Mihalko has also written chapters on his research in a Campbell Clinic textbook published earlier this year titled “Campbell’s Operative Orthopaedics.” The book is sold around the world in seven languages.

Educating doctors and the public about these processes is now key to the research, he said.

“Usually people have seen several doctors before they get to us,” Mihalko said. “People aren’t aware of these processes. Even we didn’t know 10 or 15 years ago.”

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