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Focus on Robert Barrack, MD

Robert Barrack, MD, is the Charles F. and Joanne Knight Distinguished Professor of Orthopedic Surgery. He is the orthopedics chief of staff and chief of adult reconstructive surgery. His areas of specialty are adult hip and knee reconstructive surgery.

Dr. Barrack sees patients at:

The Center for Advance Medicine, Orthopedic Surgery Center, 4921 Parkview Place, 6th floor, Suite A, St. Louis, MO.

Washington University Orthopedics, 14532 South Outer Forty Drive, Suite 210, Chesterfield, MO.


What happened in the course of schooling to influence you to choose orthopedic surgery as your specialty?

Working with different groups of patients and doctors during my medical school rotations at Vanderbilt helped me find the environment where I was most comfortable. Orthopedics was the best fit for me because the patients had problems that could be made significantly better in almost every instance. There weren’t many frustrating chronic issues, but rather conditions for which there were good answers, such as fractures, ligament injuries or arthritis.

With one intervention, like a hip or knee replacement, you can dramatically alter the life of someone with arthritis who is not able to walk without a lot of pain or difficulty. The results are very tangible and I think that is what attracts so many medical students to this specialty.

Dr. Robert Barrack and his family

Did you have a mentor that influenced you?

I was fortunate to have many excellent role models and mentors during my training and beyond. During my internship at Portsmouth Naval Hospital, the Chief of Orthopaedics, Captain Ted Dupuy, went out of his way to help me get a deferment and find the best civilian residency we could, which turned out to be Tulane University in New Orleans, LA. I was fortunate to benefit from training with a number of talented, unique individuals – Ray Haddad and Tom Whitecloud at Tulane, John Roberts at Children’s Hospital of New Orleans, and Jack Hughston and Jimmy Andrews in Columbus, Georgia. The most influential individual in my development as a total joint surgeon, however, was Dr. William Harris at Massachusetts General Hospital and Harvard Medical School under whom I studied as a fellow over 20 years ago. He has continued as a valued mentor and supporter throughout my career.

What brought you to Washington University?

Richard Gelberman, MD, chairman of orthopedic surgery, called and asked me to come to St. Louis to consider the position. I had been on the faculty at Tulane for about 13 years, and was not really looking to move.

Coincidently, the person who used to sit in this office was a good friend of mine – Bill Maloney, MD. He left to become the chairman of orthopedic surgery at Stanford, and that created an opening here.

I had never been to St. Louis, but I was pleasantly surprised by the livability of the city, the friendliness and work ethic of the people, and the excellence of the medical school, the hospital, and foremost the Department of Orthopaedic Surgery.

Which aspect of your practice is most interesting?

It’s very rewarding to perform a procedure, like a hip or knee replacement, that has a dramatic positive impact on such a high percentage of patients; not only relieving their pain, but returning the vast majority to the activities in life that are most important to them.

I also enjoy teaching residents, fellows, and medical students.

In addition, we are a center for clinical studies to document the value of new techniques and devices, and I find that research very rewarding as well.

What new developments in your field are you most excited about?

We’ve been leaders in evaluating many new procedures and technologies. After hip resurfacing received FDA approval in 2006, the first approved resurfacing was performed here. We’ve had some dramatically good results with that procedure that we’ve documented in clinical studies that have been published.

Right now we are evaluating new technology in a randomized study to determine if custom cutting guides generated from MRI are beneficial in total knee replacement.

There is another promising new imaging technology we are examining. It allows us to take three-dimensional images of patients while they are standing. It’s like a weight-bearing CT scan, but it only takes about 30 seconds. It’s very exciting because there’s about 100 times less radiation exposure than a CT and 5 to 10 times less than a standard X-ray.

Also, we’re one of the centers in the country that is evaluating new technology to prevent blood clots after hip and knee surgery with a portable compression device. It seems to be as effective as strong blood thinners, but with far fewer risks and less cost.

Can you explain that blood-clot prevention technology?

The most immediate life-threatening complication after hip or knee replacement surgery is a blood clot that can lead to a pulmonary embolism. While somewhat uncommon, it can be quite serious, so we have to take steps to minimize the risk. All of our patients are treated with either a drug or a compression device to try to minimize the risk of blood clots.

Foot pumps to prevent blood clots have been in use for many years. The drawback was that the pumps were attached to a heavy power unit with tubing that went to the calf device. Whenever the patient needed to get out of bed, the tubes would have to be disconnected from the pump and then reconnected when the patient got back into bed.

A small company developed a portable device that has a compact battery unit and once the pumps are put on, they can stay on. The patient can get up and do therapy, or go to the bathroom without disconnecting and reconnecting, which improves compliance and effectiveness.

The new portable pump also has more advanced technology that monitors the exact number of hours it is being used and a sensing device that times the pumping with a patient’s respiratory cycle. When someone breathes in and out, the resistance to blood flow changes dramatically. It’s much more efficient if the pump inflates against low resistance.

This pump has been found to be as effective as any powerful drug – with none of the bleeding complications. Recently, the American College of Chest Physicians (ACCP) validated our enthusiasm for this device by stating in their latest recommendation that this is the only compression device they recommended.

Do you see hip resurfacing as eventually replacing hip replacements?

Hip resurfacing is for a relatively small percentage of patients with hip arthritis. It’s best suited for young active patients who want to return to very high activity levels. The average age of a hip resurfacing patient is 50, and over 90% of them are male. Most hip resurfacing patients are going back to very demanding occupations or sports that involve running, jumping or quick changes in direction. I have a patient who had hip resurfacing in 2010 and just qualified as a 9th degree black belt in Japan.

There are certain very high level activities that most American surgeons discourage total hip replacement patients from doing. The surgeons’ reasons include fear of the hip dislocating or concern that the forces on the device could be counterproductive. With hip resurfacing, there’s been a long track record of allowing patients to do virtually unrestricted activities including martial arts, running, yoga, or heavy lifting.

Total hip replacement is so successful at relieving pain and returning patients to normal activities that there’s really not a reason to do a hip resurfacing unless a patient has the need or desire to do extreme activities.

Where are you from?

I grew up in Oak Ridge, a small town in east Tennessee known as the Atomic City. It was the location of the Manhattan Project and where the first atomic bombs were assembled. Most people who lived there had families associated with one of the nuclear plants in town. There was a high concentration of PhDs and a lot of nuclear physicists -- making it a unique place to grow up.

My parents still live there. My mother taught at Oak Ridge High School for 40 years and my father was a patent attorney for the Atomic Energy Commission, that later became the Department of Energy.

Is there a particular award or achievement that is most gratifying?

When my son, Adam, was in 5th grade, I was named “His Most Important Person”. He wrote an essay and drew a picture of us playing basketball together. I was a giant and he drew himself about a third my size. Now he’s taller than me and I’m looking up to him.

What is the best advice you’ve received?

In the words of Yogi Berra, the great baseball philosopher (and St. Louis native), when you come to a fork in the road, take it. It might sound silly, but in my career, I took a lot of forks. After college, I went to Nashville for medical school, and then to the Navy for my internship, I spent an extra year in an orthopedic materials lab before starting my residency in New Orleans.

Even at the end of my residency I wanted to get more experience before I returned to the Navy, so I went to New England Baptist Hospital in Boston for additional training in joint replacement. After my naval service, I returned to Boston for a fellowship at Massachusetts General before returning to New Orleans and finally here to St. Louis.

While many professionals spend all or much of their career in one location, I experienced a different setting each step of the way. All those diversions are what made the big difference in my career.

If you weren’t a doctor, what would you like to be doing?

My first love was always sports, but unfortunately my size and skill level didn’t quite match my passion. I really liked literature, history, and writing, so I might have ended up as a lawyer if medical school hadn’t panned out.

What do you enjoy doing in your free time?

We’ve become big Cardinals fans (after being long-suffering Saints fans). Since we’ve moved here, the Cardinals have been to the World Series three times and won two. It’s been fun to follow.

We also enjoy traveling with our sons. This year we’ll be doing college tours throughout the country with our younger son, Toby.

We’re also excited about going to see our older son, Adam, compete on the Purdue Crew team. His team will be in my home town of Oak Ridge, TN for a regatta on Melton Hill Lake, which coincidently is two miles from where I grew up. His grandparents still live in that same house, so it will be a family reunion.

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Copyright 2015 Washington University School of Medicine