Marcus Milderman, MD
@marcusmilderman
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Following
436
Media
260
Statuses
1,332
Hip and knee replacement surgeon in Eugene, Oregon. closet Justin Bieber fan. views are my own and not necessarily my practice's.
Oregon, USA
Joined January 2014
Don't wanna be here?
Send us removal request.
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They ran out of normal gloves and only had 7.5 weird green ones, so...
HULK HANDS
#orthotwitter
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Surgeon here. For the record, im literally scared all the time.
Brock Purdy today: "One thing that I've learned for sure is to try to take out fear, throw it out the window, and play clear-minded — play like a surgeon."
Origin story, also released today:
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Doctor PSA of the day:
DONT TELL A PATIENT THEY NEED A PROCEDURE DONE THAT YOURE NOT GOING TO DO YOURSELF.
thank you.
#orthotwitter
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New favorite way to annoy the OR staff AND make surgeries more epic:
Add descriptive nouns to the tools.
"Cobb of courage please"
"Lamina spreader of wisdom"
"Scalpel of destiny"
#orthotwitter
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Got to meet a real life celebrity last night!
So cool to meet the funny, generous, and witty
@LGlaucomflecken
and some other random dude she was with. Apparently goes by the name
@DGlaucomflecken
, which is kinda weird.
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I will be starting a GoFundMe account to help the poor and probably hungry surgeons at Mayo so that they might be able to pay their research assistants.
#sendingthoughtsandprayers
#alsotriscuits
#orthotwitter
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Because 'bringing coffee for the staff' sounds better than 'dosing my assists with stimulants so they perform better.'
#orthotwitter
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Alright who do I kiss for doing the work to publish this
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Was looking at a femoral head after reaming it out for autograft and here we are.
Also, never realized how branded our hoods are. Touché on product placement Stryker, touché.
#MedTwitter
#orthotwitter
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I submit for
#orthotwitter
approval.
The taco 'bell' is the right amount of version/inclination for cups.
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Was at an Ortho conference and took my teenage daughter through the exhibit hall, and later she referred to it as an "orthopedic farmers market".
#orthotwitter
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can we agree that if you put on your website that you have less complications than your orthopedic peers, you're kind of super douchey?
#orthotwitter
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Son: "so this podcast, it's for the young arthroplasty group?"
Me: "yeah"
Son: "and you're in it?"
Me: "yeah"
Son: "so... shouldn't it be called... the middle-aged arthroplasty group?"
@AAHKS_YAG
@ACR_MD
@DrChadKrueger
@LeonardBullerMD
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Thankful for porous metal, flexible osteotomes, TXA, and (yeah I'm gonna say it) anesthesia.
#orthotwitter
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Asked chatbot to give me a total knee op report in the form of a rap...
Mind. Blown.
#orthotwitter
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Okay so I did a thing. God save the monomer monarchy.
The mono-marchy.
@ACR_MD
@WessexOrtho
@DrAntoniaChen
@KneeUnit
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@LadyInterlocks
And maybe even from decisions that you don't make! It's like a big blue ocean of complication possibilities.
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So every now and then my medical assistant will send me mugshots of my patients.
And it just sorta warms my heart to know that somewhere out there, there's a total knee that's doing well enough to commit armed robbery.
#orthotwitter
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Reading this morning about surgeons advertising new approaches do the same thing as everyone else is doing, so... I'd like to add the: Piriformis Elevating, Non Invasive Surgery for hip replacement.
I'll be publishing data on the
#PENIShip
soon.
#orthotwitter
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"Why did I put this in? Because I looked good"
Best slide of
#aahks2023
goes to
@JuliusOni
. you're a beautiful man and look great.
#SelfiesofAAHKS2023
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Forgive me
#orthotwitter
, for I have sinned.
I tried to press fit a hemi, promptly broke the calcar and then cabled /cemented it.
#onlyatwofbombcase
#NeverAgain
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What goes through my mind when signing up a patient that just looks like a dislocation waiting to happen.
#orthotwitter
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And to think this whole time I've been squeezing my cement gun trigger manually, like a peasant
#orthotwitter
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I'm sitting next to a urologist dictating a case and I have never felt more uncomfortable.
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Definitely wins best suit.
Dr Lombardi giving a talk on why he hasn't adopted technology while wearing a Bluetooth earpiece is what the kids call a "flex".
#AAHKS2023
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So what are we doing with press fit TKAs.
1) Believing the Australian data that says it's worse,
2) the ajrr data that says it's better, or
3) Dr. Nams study that says the Stryker one lasts forever and cleans your teeth while you sleep
#orthotwitter
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@LindaSuleimanMD
giving a great talk on acute tha in the setting of fracture. And from a fashion standpoint, crushing the lipstick/jacket color combo. 10/10.
@aahks2023
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Patient quote of the day.
Me: How's the your hip replacement?
Patient: Great! Except I gained 10 pounds. My new hip made it easier to get up and walk to the fridge.
#orthotwitter
#medtwitter
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The incomparable
@DrAntoniaChen
getting the well deserved WIAEA award. Which coincidentally sounds like an island in Hawaii we should have the conference at one year.
No matching green lipstick, BUT, University of Oregon green. Still 10/10.
#AAHKS2023
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@jointdocShields
I had a patient a week out say:
So, I hope my hip is stable because my boyfriend is coming over tonight and it's ... gonna get freaky.
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Since we don't have solid research on the best protocols for pji, I give you things that probably don't have any less data than the things we believe work. A list from someone doing 3 pji cases today.
#orthotwitter
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I hope that when I die, the homies pour out a little dilute betadine in my memory during a washout.
#orthotwitter
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You've heard of elf on the shelf, but have you heard of
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An
#orthotwitter
rant, post scramble.
Tl,dr: if you're hiring for an "orthopedic research fellowship year", pay the A. Fucking. Living. Wage.
Okay let's go.
You KNOW that the applicants didn't get in to residency and are desperate for any kind of Ortho experience.
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I need one of you academic types to do an aahks symposium on press fit TKAs
Who should get them, when to bail, how to work up a painful one, what lucencies are worrying at what time, when to revise it, revision tricks, etc
I feel like it's kinda the wild west.
#orthotwitter
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Made a bet with a hand surgeon I could beat her in a marathon.
Unfortunately my total joint colleagues may not appreciate my new bumper sticker...
#orthotwitter
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Doing a triflange today and had a bad dream last night that when we dislocated the current hip, the ENTIRE leg just fell off. No bleeding or anything, just fell off.
First thought: wow, exposure is gonna be great now.
Second thought: I...should call vascular.
#orthotwitter
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As a way to illustrate a intra-prosthetic dislocation radiographically, I submit for validation:
The upside down taco bell sign.
#orthotwitter
#dualmotility
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In adult reconstruction, we do like 4 surgeries.
If you're on the podium, literally ANY financial disclosure you have is relevant to the talk you're about to give.
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Great talk from from Josh Bingham out of mayo Arizona on antibiotic mixtures in spacers.
What to mix, how to mix, when to mix.
#orthotwitter
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Rep: "Okay, So there's not like a +5mm augment button, I'm going to click 10 times and then cut, and then click back 10 times, and do then again on the next augment. Let's all count together, 1,2..."
#orthotwitter
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Favorite new operating room protocol:
During closure of the last case of the day, a show tune shall be played. Singing along is not optional.
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I'm not surprised tech doesn't improve outcomes. Not sure what they're hoping to improve upon. All my patients do perfect.
#exceptthatonepatient
#andthatotherone
#ohandtheresTHATone
...
More technology to use during
#TKAs
, more precision in the operating room, but still no improvement in short-term patient outcomes.
@AAHKS
@DrChadKrueger
with the VA
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@_NancyMD
@mymomthesurgeon
@Ortho_doc
@jointdocShields
@MHPoison1
@OrthoThompson
@AlexAndersonMD
@DrDonnica
We lost power once this winter. My daughter said she was glad it happened so she could see what it was like when I was growing up. I'm 37.
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@Pman_delivers
Completely agree. Surgeons should do their own FMLA paperwork for surgery.
And honestly this applies to other surgeons just as much as non-surgical providers.
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Less than a week till
#aahks
. Im so excited to be on stage again!
Not actually giving a talk or anything, it's at the
@AAHKS_YAG
karaoke night. but still.
#orthotwitter
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Asking
#orthotwitter
:
Would you use adipose or bone marrow derived stem cells to treat this?
I hear adipose are better for varus/valgus instability?
#itsajoke
#usingamnioticonesofcourse
#alsojoke
#mometalmoproblems
#probsstillgonnainvolvestems
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Look at my new toys!! Extracting all the things!
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Had a new response to the 6 week post tka question "how's the knee doing?"
"Went Bear hunting".
This is now an objective measure in clinic as to how patients are doing with recovery. This overtook the previous top response of "waterskiing".
#orthotwitter
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I'd like to make a motion that the use of the phrase "joint guys" results in a mandatory dollar donation to the
@RJOSociety
.
#imighthavedoneittoday
#orthotwitter
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@JArthroplasty
@womenAAHKS
@NaanDerthaal
@BoneDocMMD
@CenterRotation
@jointdocShields
@eglieberman
Counterpoint: rates of revision are going to be going up too, so... Job security.
Now let's get those revision codes paying what they're actually worth.
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Kind of an interesting case.
Intra prosthetic dislocation of a constrained loose component with florid metallosis.
So a head that's detached from the trunnion that's detached from the liner that's detached from the cup that's detached from the pelvis.
#orthotwitter
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@kimtuckinAZ
It warms my heart to know that if we ever come across a civilization of lilliputians, we got them covered from a joint arthroplasty perspective.
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@ArthroToday
@ExeterHipUnit
@timpetheram
@generalorthomd
It's the curse of productivity and the incentive that it provides. We can do more cementless per unit time. And as much as we say that that stuff doesn't factor into decision making, we ALL know that's false.
I don't know the answer other than cement HAS to be taught and used.
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Happy Thanksgiving everyone!
Thankful for the learning, commiserating and connections built on
#orthotwitter
.
May your implants be well fixed, your knees stable in flexion and your patients not asking "WHy CaNt I HaVe aN AntERIor APpRoACh"
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One of the more memorable moments from from spring
#aahks
meeting for me:
Someone asked
@M_BolognesiMD
a question, and the response was that he was too conflicted to given unbiased answer, so would refrain from answering.
I can't tell you how much I appreciate this response.
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When you're doing a knee revision and waaaaay too much bone comes out with the implant.
#orthotwitter
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(having difficulty getting a constrained poly out of a pinnacle cup)
"The one time I DO want it to dissociate... AMIRITE???"
The Depuy rep did not laugh.
#orthotwitter
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When you don't medialize all the way to the floor, do you rationalize it by thinking you're saving more bone for the potential acetabular revision?
#ido
#justarthroplastythoughts
#orthotwitter
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@ACR_MD
@aschwartz45
@jointdocShields
@NaanDerthaal
Okay hear me out. Three contestants. They all have buzzers. Different categories.
Implant Jeopardy.
I'm going to guess a lot of people would actually kind of like to see some of the historical implants at aahks?? I personally think it would be enjoyable to watch.
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@ACR_MD
@AlexisGaskin32
@kimtuckinAZ
@jaimelbellamyDO
@eglieberman
@JennaBernstein7
@CourtneyBellMD
@djschuett
@LadyInterlocks
@orthogal21
@janicebonsuMD
@marykmulcaheymd
@LindaSuleimanMD
@generalorthomd
@jointdocShields
@DrChadKrueger
@hugortopedista
@DrAntoniaChen
I got to be part of a badass
@AAHKS_YAG
podcast, accumulated at least 4 points in the
#HeForShe
award, standardized ASC tka implants among 7 providers and also ate an entire bag of Takis blue heat.
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Only true orthopods will get it. Like
@LadyInterlocks
.
#orthotwitter
You've heard of elf on the shelf
Now get ready for
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@jointdocShields
@AshleyGWinter
I wrote orders for a patient to be toe touch weight bearing.
On bilateral lower extremities.
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@jointdocShields
@RiveraSurgical
I mean, I pulled a cemented attune tibial tray in like 2 minutes, so... Not sure what the big deal is.
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@ArthroToday
@AAHKS
@EdinburghKnee
@DrChadKrueger
@CenterRotation
@LindaSuleimanMD
@AlexisGaskin32
Ive personally noticed a big difference since starting to use a robot. Mostly that my tib ant is more sore from repeated clicks of the foot pedal. Maybe we could study that??
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@JArthroplasty
@womenAAHKS
@BrdgPlt2Nowhere
@alexusmcooper
@DrPeterGold
@kimtuckinAZ
@CenterRotation
@KevinWeiszMD
@Ortho_Deck
Still waiting for that 601% improvement in outcomes study...
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One of the my favorite feelings is before surgery when a patient will smile and proudly tell you they quit smoking and are ready for their tja.
#orthotwitter
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@ACR_MD
@hugortopedista
@_NancyMD
@djschuett
@NaanDerthaal
@DrLeeRubin
@FixnBones
@generalorthomd
@drericksonspine
@AlexisGaskin32
@Dr_Stambough
@lisacannada
@jaimelbellamyDO
@mymomthesurgeon
Wait, so
@ACR_MD
, you want me to photoshop you, but didn't say anything about inviting me...
I feel like the nerd that the jock asks to do their homework while the cool kids go out and party.
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Fun fact: William Stewart Halsted, inventor of the surgical residency program. Believed immersion with unlimited work hours in the field gave a better education.
Fun fact
#2
: also chronically addicted to cocaine.
#orthotwitter
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@prem_ramkumar
No one cares if you want to do hip resurfacing. It's when you do shady things like tag Smith and Nephew in your post, or make dubious and unfounded claims about how andy would have done worse with a THA that make you seem like a biased and compromised source.
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@ArthroToday
@CenterRotation
@kate_wynne
@BrianChalmersMD
@NuelleSportsMD
I would love to know the mechanism of a robot having a lower UTI rate.
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I never know where we're at with irrigation solutions, but dr. Fehring showed pretty incredible success rates with one stages using this, albeit short term results.
On a side note, yellow tie was prominent without being loud. 8.5/10.
#AAHKS2023
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@aJohnTimperley
@ExeterHipUnit
If you compare any hip replacement to one with a wired troch osteotomy, loose poorly cemented femoral stem w/high hip center, it's gonna be better.
All for new technologies and all that but let's not pretend that the mako and spaire got you the better result.
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@woyskiortho
@jointdocShields
@BoneJointJ
@Dr_Stambough
@JArthroplasty
@ArthroToday
@BrianChalmersMD
@DrChadKrueger
@DrLeeRubin
@jaimelbellamyDO
@djschuett
@blakepetersonMD
@BoneDocMMD
Don't lament the cement!
Yes I just made that up and I'll be showing myself out.
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@NaanDerthaal
@CenterRotation
@orthotraumamd
@LeonardBullerMD
@txsportsdoc
@rkh_md
@jointdocShields
@RafaSierra5
@EdinburghKnee
@FixnBones
@BennerKneeMD
Old fellowship attending used to call the patella the canary in the mineshaft. If it's not tracking right something is really, really wrong.
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Yesterday:
Patellofemoral joints put in: 2
Patellofemoral joints taken out: 2
Patellofemoral joints left unresurfaced: 2
I have a weird relationship with the patellofemoral joint.
#facebookrelationshipstatusitscomplicated
#orthotwitter
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If you're using the demayo, the green coban is far superior to the normal coban.
I will not be answering further questions at this time.
#orthotwitter
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