Ljiljana Bogunovic, MD, is an orthopedic surgeon whose areas of interest include sports related injuries of the shoulder, hip, knee, foot and ankle.
Dr. Bogunovic sees patients at two convenient locations:
Washington University and Barnes-Jewish Orthopedic Center, 14532 S. Outer 40 Drive, Chesterfield, MO 63017
Center for Advanced Medicine – South County, 5201 Midamerica Plaza, St. Louis, MO 63129
PLEASE CALL 314-514-3500 FOR AN APPOINTMENT
What happened in the course of schooling to influence you to choose your specialty?
Early in medical school I decided to go the surgical route. I enjoyed splitting my week between taking care of patients in the operating room and seeing them in clinic.
It is satisfying to see a patient with a problem in the clinic, make a diagnosis, fix it mechanically with your hands in the operating room and be able to make the patient better.
The patient population you see in orthopedics sports medicine is generally young and active. These are individuals who are motivated to get better in order to get back into the game.
Sports and activities are a huge part of my life -- being active helps me maintain my sanity. I can understand how frustrating it can be when that is taken away from you. To be able to play a role in helping somebody get back to doing something they love to do is very satisfying. That is ultimately how I picked orthopedics.
The experience of tearing my ACL has given me a better appreciation for what it means to have an injury that takes you out of something you like to do. It makes it easier to relate to my patients as I walk them through the process. I tell them the physical and mental components of going through surgery and that rehab will be a challenging road, but eventually we will get them back to doing the things they like to do.
What brought you to Washington University?
When I was a medical student, I did a rotation here with orthopedic hand surgeon, Dr. Martin Boyer. I absolutely fell in love with the place. I’m originally from the Midwest, but did my medical school training in New York. The opportunity to come back was appealing.
The orthopedic department here is fantastic – it is very collegial and everybody is committed to excellence, not only in patient care, but teaching medical students and residents.
I had a great experience as a resident here, and given the opportunity to come back as faculty, it was something I couldn’t pass up. I absolutely love my job. I love the patients that I’m taking care of, the partners I’m working with, and the opportunity to teach medical students and residents as they come through the program. It has been very satisfying.
Did you have a mentor?
During residency my primary mentor was Dr. Rick Wright, who was our program director at the time. He was very helpful throughout my residency in terms of guiding me, not only on the sub-specialty I ultimately chose, but navigating the field of academics. I also looked to him to learn the skills on how to train residents.
As a young faculty member and I incredibly lucky to have multiple mentors including my sports partners Drs Matt Matava, Rick Wright, Rob Brophy and Matt Smith. We work as a team to deliver the best possible sports medicine orthopedic care to our patients.
Which aspect of your practice is most interesting?
I love taking care of athletes. I share the disappointment with them when they have an injury and I’m sorry for the fact that they have to take time off from their sport.
I treat injuries of the shoulder, hip, knee, foot and ankle. Right now in my practice, the majority of what I see is knees. It’s a common injury in a variety of different sports -- basketball, football, soccer, dancing, running – the knee is probably one of the most common injured joints.
The satisfaction of being able to help them through their injury and get them back to doing the thing they love to do is probably the best part of my job.
ACL tears can be a repeat performance. Can you explain why?
When you tear your ACL you are at a risk of tearing it again. With an ACL reconstruction, we make a new ACL. We make it as strong as it was before -- but we don’t necessarily make it any stronger.
Recent data, including that performed at our institution indicates that ACL retears result from multiple factors. These include patient activity level, patient age, surgical technique and graft choice. Post-operative rehabilitation is also important to preventing repeat injury.
With physical therapy, we teach our patients to avoid the positions and movement patterns that may place them at an increased risk for a repeat injury in the future.
What new developments in your field are you most excited about?
We are beginning to better able to understand the process of arthritis and the different ways to prevent it from occurring.
Unfortunately, once arthritis has begun, we are somewhat limited in our ability to stop it. Once you have an arthritic joint, you’ve essentially worn away all the cartilage at the end of your joint. One of your only remaining options is to have a joint replacement.
Recent research suggests that there may we can do to get in the way of the body’s response to injury in order to prevent arthritis from occurring in the future.
I am hopeful that in the next 10-15 years, preventing arthritis is the area where we will have the biggest advances in the field of orthopedics.
If you tear an ACL, your knee takes a hit, and in an instant that injury sets the tone for arthritis in the future. Even if you have an ACL reconstruction, you are at a slightly increased risk of developing arthritis down the road, just by the fact that you had an injury.
We are learning about the different inflammatory processes that happen after a knee injury. If we can alter or interfere with those, it is possible to prevent the progression of arthritis in the knee in the future.
Can you define arthritis?
The articular cartilage is basically the “white stuff” you see at the end of a chicken bone -- it is the lining of your joint. Think of it like the tread on your tires. When that lining wears away or that tire tread is gone, that is essentially arthritis.
Arthritis can occur in varying degrees. With mild arthritis, that means the lining has just started to wear away. With complete loss of the lining, or bone-on-bone arthritis, you have completely lost that white layer and it is essentially bone on either side of the joint.
Because arthritis is a progressive disease, there are many non-operative options to minimize the progression in order to keep the patient comfortable. Physical therapy to strengthen muscles -- the glutes, quads and core – will minimize the forces across the knee.
Maintaining a healthy body weight is also critically important. The impact is magnified across the knee, so even a one to two pound decrease in body weight translates to a significant decrease in force placed on the knee.
Anti-inflammatory medications such as ibuprofen or naproxen can be used to decrease the inflammation. Because arthritis is an inflammatory process, if you decrease the inflammation, you decrease the swelling and you decrease the pain. Cortisone and hyaluronic acid injections are other options for treatment.
There is also new data to suggest that platelet rich plasma (PRP) may play a role in helping patients reduce arthritic pain.
Joint replacement is the surgical option for end -stage arthritis, if non-operative treatments fail to help.
The Center for Advanced Medicine – South County is opening an injury clinic in September 2017, what can you tell us about it?
The Department of Orthopedics is looking forward to the opening of our new South County Injury Clinic (link here), similar to the one we have at our Chesterfield location. The injury clinic will be open Monday to Friday, noon to 8 pm -- no appointment needed.
The walk-in clinic will be staffed by orthopedic surgeons and nurse practitioners -- patients will have access to x-ray, splinting and full-service casting.
The whole process is streamlined to help patients avoid going through multiple steps and office visits. It is essentially one-stop shopping for orthopedic injuries.
Where are you from?
I’m originally from southeast Wisconsin, a small town called Mukwonago.
For someone visiting Wisconsin, there are a lot of great places to see. A trip to Lambeau field is probably #1 on the list, especially if you can make it to a Packer’s game. It is probably one of the highlights of the state.
We also have many beautiful parks, rivers and lakes that growing up, I had the opportunity to spend time exploring.
Are you a big Packer’s fan?
It’s a requirement as a Wisconsin resident. My uncle had season tickets. It was fantastic -- sitting outside in the freezing cold, covered in your deer hunting clothes, hugging people you don’t even know when the Packers scored.
Which particular award or achievement is most gratifying?
As a resident, I was fortunate enough to win the resident teaching award. It is given to one of the orthopedic residents by the current medical school class.
I went into academics because I enjoy teaching. I look forward to the opportunity to continue to teach the medical students as well as the residents. It is satisfying, but it’s also very challenging. It was very gratifying to have won that award.
What is the best advice you’ve received?
The best advice I’ve ever received was probably from my parents. They emigrated here from Serbia and the opportunities weren’t available to them that I had available to me. Their advice to me was “You can do whatever you want to do, as long as you put in the hard work and effort towards it.” I am where I am today because of them.
If you weren’t a doctor, what would you like to be doing?
If I wasn’t a doctor I would probably be doing something active that also involved teaching. Ski instructor or crossfit coach. I am passionate about my sports and I love getting others active and interested in them as well.