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More personalized, accurate knee surgery with robotics

ROSA provides surgeons with scientific data and precision that leads to improved outcomes for patients who undergo total knee replacement. (photo courtesy of Vail Summit Orthopaedics & Neurosurgery)
ROSA provides surgeons with scientific data and precision that leads to improved outcomes for patients who undergo total knee replacement.
Photo courtesy of Vail Summit Orthopaedics & Neurosurgery

Vail-Summit Orthopaedics & Neurosurgery has always been a leader in cutting edge surgery, and now it’s providing more personalized and even more accurate total knee replacements with its Zimmer Biomet Robotic Surgical Assistant (ROSA). 

Increased precision and data

Dr. Nathan Cafferky recently published a paper highlighting the benefits of using ROSA in the peer-reviewed journal “Case Reports in Orthopedics.” His study, which included five total knee replacements, showed how ROSA allows surgeons even more precise knee implant positioning by using real-time, scientific data to guide the accuracy of the surgeon’s work. For instance, ROSA lets surgeons know that the tension they place on each of the ligaments is exact and helps them make more pure bone cuts. Before ROSA, surgeons used their medical expertise to determine if ligament tension was appropriate.

“Historically, surgeons have relied on their training, and have used a more subjective artistic approach to evaluation the ligamentous tension,” Cafferky said. “ROSA provides the surgeon with real-time objective data on the ligamentous balancing and gives the surgeon scientific confidence that the knee replacement is well balanced and personalized to each individual patient.”

“Conventional and robotic total knee replacement surgeries are very good at restoring alignment, but total knee replacement is functionally a soft tissue balancing surgery, so it comes down to what the surgeon feels is acceptable. Each surgeon’s assessment of a knee may feel different during surgery, but with robotics, we’re putting numbers on that feel,” Cafferky said. “I think that has been the missing link in total knee replacement surgery.”

Better patient outcomes

Prior to surgery, ROSA converts x-rays — rather than an expensive MRI or a high-radiation CT scan — into a three-dimensional representation of the knee. This allows physicians to map out a patient’s exact, and unique, anatomy before operating. 

The robotic data is especially important for patient satisfaction. Though most patients do very well with total knee replacements, nationwide, about 15% to 20% express pain, discomfort, mechanical sensations or stiffness. Granted, only about 10% of VSON patients express such dissatisfaction, but with ROSA, that number is expected to decrease.

Cafferky notes that ROSA helps provide a more scientifically balanced total knee, leading to highly satisfied patients who are able to successfully return to the activities they love, like skiing, hiking and cycling.

“Our patients already do better than national outcomes, but with robotics, we’re looking to do even better,” Cafferky said. “We’re seeing patients recover faster with less soft tissue trauma and not as much bleeding. Patients have a faster get up and go, faster range of motion improvements and less need for post op manipulations. They appear to be performing better than conventional total knee replacements and have a better quality of life, as far as athletics.”

So far, short-term recovery seems faster and patients appear more satisfied long term, but Cafferky will continue to follow up with long-term outcome studies.

“We’ll probably see faster recovery short-term, and more reproducible long-term outcomes, meaning a higher percentage of patients get back to a more satisfying lifestyle. However, prospective studies (are necessary) to see if we have scientific, statistically significance comparing conventional total knee replacement patients to ROSA assisted total knee replacement surgeries, because we are only a year into our study right now,” he said. “I’m actively involved in multi-center studies, looking at our patients’ outcomes.”

Leading the development of innovative surgical technology

Dr. Cafferky has been on the cutting edge of robotic surgical assistant technology; even before the FDA cleared it for use in total knee replacements in January 2019. He is a consultant for Zimmer Biomet and helped Zimmer Biomet evaluate the safety and accuracy of the ROSA total knee replacements through cadaveric studies and evaluations, which ultimately led to FDA approval in January of 2019. 

“ROSA was initially designed to be used in neurosurgery, due to its very small — 0.5 millimeter — margin of error, meaning that it is very safe,” he said. “My job in the early phases of cadaveric evaluation was to try to turn a Neurosurgery Robotic Arm into an Orthopaedic Robotic Arm. With great success, the FDA approved the ROSA in January 2019, and thus our patients at Vail Summit Orthopaedics and Neurosurgery are benefiting from this technology.”

In April 2019, Vail Health purchased the Zimmer Biomet ROSA, making it one of the first in the nation to acquire the technology. By the first week in May 2019, Cafferky had successfully completed his first robot-assisted total knee replacement. 

About Nathan Cafferky, M.D. FAAOS

As a total joint surgeon who specializes in adult reconstruction, Dr. Cafferky focuses on hip and knee replacements at Vail-Summit Orthopaedics & Neurosurgery. A native of Portland, Ore., Dr. Cafferky attended medical school at Loma Linda University School of Medicine in Southern California and completed his residency and fellowship training in joints and adult reconstruction at the University of Colorado Anschutz Medical Campus. He serves as a U.S. Ski Team physician and a Team Summit Colorado physician.

“I was one of the first users in the country, and world, to adopt this technology and have been seeing our patients benefit since,” Cafferky says. “Other surgeons from around North America, and around the globe are also seeing the benefits, and many visiting surgeons are coming to Vail to learn how we are improving our patient experience with ROSA.”

Cafferky has trained surgeons from across the United States and around the globe as they launch ROSA technology in their communities.

“It’s been a great privilege and experience to get to interact and train surgeons from around the world. Not only do I get to teach others, but these surgeons also get to teach me something as well,” he said.

ROSA, which is comprised of a base unit with a robotic arm, can position cutting guides for the most accurate bony cuts, and provide objective information on the ligamentous balancing at each step, but Cafferky is still doing and performing the surgery. Cafferky likens surgery before and after ROSA to “going from paper maps to GPS.”

“The most exciting aspect is the objective data I get during surgery,” he said. “The experience is much more streamlined, scientific, and more personalized. Now I can tell a patient with confidence that ‘your knee is scientifically balanced and personalized for you’. I have scientific evidence to support that.”

The Movie Guru: “Raya and the Last Dragon” satisfying but misses its message

"Raya and the Last Dragon" hits theaters and Disney+ Premiere Access on Friday. (Disney)

The protagonists may change, but the Disney formula for a successful movie never does.

That formula is on display once again in “Raya and the Last Dragon,” which hits theaters and Disney+ Premiere Access on Friday. The movie has all the essential elements — a spunky protagonist on a quest, a beautifully animated world for them to explore, plucky sidekicks, a cute animal or fantasy creature as a companion and an inspirational message for the protagonist to learn. Other elements have proven to be purely optional, including a love interest, but Disney rarely if ever misses one on the essentials list. It’s a formula people continue to like.

In “Raya,” our spunky protagonist is a survivor of a broken world. After a heartbreaking, apocalyptic betrayal, Raya and her trusty roly-poly undertake a quest to wake a sleeping dragon, put a pearl back together, and save the world. On the way, they meet a strange and often hilarious group of individuals eager to help them on their journey.

As far as heroic journeys go, this is a satisfying one. Raya is easy to like, though hot-tempered and (understandably) slow to trust, and her companions are all funny and charming even when they’re causing trouble. Their adventures offer just the right amount of excitement and danger, and when the stakes get higher at the end you care enough about the characters to be genuinely worried for them.

There’s also some wonderful things to look at. Though there’s been some debate as to whether the salad bowl of South Asian cultures counts as good representation or not, the result is a gorgeous, beautifully detailed world easy to get lost in. The character animation is also well-done, with some good facial variety and beautiful costuming. Though the quality of the dragon’s design was another source of debate, Awkwafina’s boisterous performance makes her entertaining to watch.

The movie’s message of unification and healing is also well-meant, and more welcome than ever during the multiple levels of crisis we’ve also lived through this past year. It’s overly simplistic, particularly on a political level, but the movie’s heart is clearly in the right place.

When it tries to talk about trust, however, the message is both overly simplistic and self-contradicting. The basic theme seems to be to trust blindly and everything will work out in the end, but the movie also shows multiple times that showing that kind of trust in people can and will get you killed. The main focus of this trust message is the movie’s functional antagonist, a young woman named Namaari, and a lot of the film’s impact depends on having faith in her despite all evidence to the contrary.

Unfortunately, the movie fails to give the audience any glimmer of hope that she is capable of making the right decision. This is mostly because all we see of her character is a series of wrong decisions that betray characters the movie makes us do a better job of caring about, barely offering any nuance or reasoning behind those decisions. A journey that might have been profound in another studio’s hands falls flat under the Disney formula.

In the end, “Raya and the Last Dragon” is a good story. But there’s a part of me that wishes someone else had been the one to tell it.

Raya and the Last Dragon

Rated PG for some violence, action and thematic elements

Screenplay by Qui Nguyen and Adele Lim, story by Paul Briggs, Don Hall, Adele Lim, Carlos López Estrada, Kiel Murray, Qui Nguyen, John Ripa, and Dean Wellins

Directed by Don Hall and Carlos López Estrada (co-directors Paul Briggs and John Ripa)

Starring Kelly Marie Tran, Awkwafina, Izaac Wang, Gemma Chan, Daniel Dae Kim, Benedict Wong, Jona Xiao, Sandra Oh, Thalia Tran, Lucille Soong and more

Grade: Two and a half stars

Jenniffer Wardell is an award-winning movie critic and member of the Denver Film Critics Society. Find her on Twitter at @wardellwriter or drop her a line at themovieguruslc@gmail.com.

Success through clear leadership

Vail-Summit Orthopaedics & Neurosurgery CEO John Polikandriotis is scheduled to speak at a national online conference for the American College of Healthcare Executives alongside major figures in the health care space, including Dr. Anthony S. Fauci.

The healthcare industry has one of the highest burnout rates in the nation, but CEO John Polikandriotis has bucked that trend at Vail-Summit Orthopaedics & Neurosurgery (VSON) through clear, authentic leadership. Now, he’s teaching others how to lead with “deliberate clarity.”

In March, he speaks at a virtual national conference for the American College of Healthcare Executives about how to achieve success when old methods don’t work anymore. He will be speaking alongside major figures in the health care space, including Dr. Anthony S. Fauci.

Polikandriotis understands the classic grind: “overwork, attain, intermission and repeat,” which ultimately leads to exhaustion and burnout.

Rather than chasing never-ending goals imposed by others, he advocates taking time to define what truly brings you joy. He also points out that anything worth pursuing requires sacrifices: Most people see the “shiny ball” of wealth, fame or other success leaders possess without knowing about the relationships, time, energy or money they put in to achieve their status, he said.

“Leading can be all-consuming and highly stressful, especially when you do it for a company and employees that you care so much about,” he said. “Great leaders have to sacrifice personal agenda for the good of others and their organization.”

Although leadership has a cost, it’s also quite rewarding. 

“It teaches you priority management, relationship management and communication skills,” he said. “And at the end of the day, nothing is more rewarding to me than to see dedicated employees overcoming challenges, growing, learning and doing amazing fulfilling work.”

In his four years at VSON, Polikandriotis has focused on four core values: compassionate care, innovation, teamwork and community.

“John has trust in his staff, trust in the process,” said Megan Buhler, director of operations. “John has strength in leadership and brought a new presence to the CEO office when he joined the organization.”

His strength started with a clear vision of where VSON needed to go, and how to get there. He ensured all employees understood what the company stands for, where it’s going and why.

“John has brought a business perspective to VSON that incorporates intimate knowledge of the local healthcare environment with a national perspective into the business of healthcare,” said Dr. Erik Dorf, a shoulder, hand, elbow, wrist, knee and orthopaedic trauma surgeon. “Through his guidance, VSON has been able to maintain our market share and develop a growth strategy focused on aligning world-class orthopaedic surgeons throughout Colorado. John is a visionary in his field. We are blessed to have him on our team.”

Vail-Summit Orthopaedics & Neurosurgery CEO John Polikandriotis.

Polikandriotis understands that success isn’t linear: Solving one problem just leads to other questions and problems.

“Success is an action, not a destination,” he said. “Today’s solutions will always lay the foundation for tomorrow’s problems.”

The choice: Either stop solving problems or realize that a meaningful life involves solving problems. Afterall, careers in healthcare — and plenty of other areas — revolve around solving challenges.

“Don’t hope for a life without problems,” he said. “Hope for a life full of problems you are passionate about solving.”

And, as a leader, realize that trying to fix every problem will probably lead to burnout. Polikandriotis takes two approaches: delegating and knowing what he can and cannot control.

“John trusts you to do your job,” Buhler said. “He doesn’t feel he has to be involved every step of the way. That’s why we’ve gotten so much done in the last four years. He trusts that I can do my job and he’ll do his job and things will just get done.”

When things like, say, a global pandemic come his way, he focuses on things he can control.

“I think it is an easy tendency to become paralyzed focusing on things that you can’t control or change,” he said. “Great leadership is about training yourself to separate what you cannot control from what you can control, and then focusing exclusively on the latter. Mindful leaders control how much they learn, how much they listen, how hard they work, and which inspiring people to surround themselves with. This choice to focus on things we can control can increase our endurance to be able to withstand and adapt to anything this constantly everchanging world throws at us.”

Such leadership skills require not only cognitive intelligence, but also emotional intelligence — the ability to be an authentic human being, connect with others, manage stress, show humility and empathy and be honest.

“High IQ makes sense, but we’re starting to live in a world where emotional intelligence trumps IQ,” he said. “If you want to win over hearts and minds, you have to lead with your authentic heart and mind. Leaders don’t tell people what to do; they have open conversations about what their team wants.”

In other words, they provide directions and intent — not orders. They provide an overall vision and goals with clear expectations.

“I’ve only been at VSON for a year, but I already feel like a stronger marketer thanks to John’s leadership,” said Rachel Follender, director of marketing and communications. “When I present a new opportunity to him, he doesn’t tell me ‘yes’ or ‘no.’ He always asks ‘what do you think?’ and encourages me to make a decision based on my expertise in marketing, as well as knowledge of our industry and organizational needs. When you work for John, he doesn’t just give you a list of things you have to do. He pushes you to develop that list yourself, and own the intention behind it. John doesn’t strive to be a boss — he strives to be a mentor and business partner.”

Most of all, great leaders care for, and support, their team members.

“Empower and educate others to work at their highest level,” Polikandriotis said. “The upper limit of what’s possible will increase only with each collaborator you empower.”

“Let’s be honest: orthopaedic surgeons are independent minded physicians,” Dorf said. “John has been able to align the varying perspectives of the VSON partners toward common goals and a long-term vision. Without his guidance, we would not be where we are now.”

As each empowered person passes on his or her enthusiasm and expertise to other colleagues, it creates a domino effect of vitality and success that ultimately serves the organization’s clients — in this case, VSON’s patients.

Holy Cross Energy’s journey toward 100% renewable energy

HCE former CEO Ed Grange. To learn more about Ed’s story, visit HolyCross.com/the-co-op-that-climbed-mountains/
Holy Cross Energy’s Journey to 100%

Learn more about our Journey to 100% at www.holycross.com/100×30.

At Holy Cross Energy (HCE), our legacy remains rooted in the original ranchers and farmers who called our valleys home in the late 1930s. It is because of their commitment to bring electricity to the Eagle and Roaring Fork River Valleys that we are able to provide safe, reliable, affordable, and sustainable energy and services for our members and their communities today. As HCE embarks on its ambitious goal to bring 100% renewable energy to our members and communities by 2030, we honor our remarkable past.

Thank you for being part of our Journey to 100%.

Below, former HCE CEO Ed Grange discusses how bringing electricity to a new ski area called Vail in the 1950s almost didn’t happen:

This article originally appeared in Rural Electric Magazine in November 2020. Written by Frank Gallant.

Ed Grange grew up on an unelectrified ranch high in the Rocky Mountains of western Colorado. He watched his mother pump water by hand and cook on a wood stove. Late in life, he could still hear the “god-awful” noise made by the gasoline-powered washing machine on the front porch.

“In the winter, we had to bring it into the kitchen and run the exhaust pipe outside. The noise filled the house,” he recalled in a March 2019 newspaper interview.

Grange didn’t want that kind of a life for himself, so with his Italian immigrant parents’ blessing, he went to college and then graduate school, expecting to get a job teaching mathematics.

Then the direction of his life changed. Home for the summer in 1950, he took a part-time $1.15-an-hour job with Holy Cross Electric Association that grew into a 60-year career.

Vail, the early years

Holy Cross Electric emerged in 1939 after the federal Rural Electrification Administration (REA) recommended that two groups of farmers and ranchers who wanted to organize a co-op—one from the Eagle River Valley in Vail and the other from the Roaring Fork Valley in Aspen—band together if they hoped to get a loan. A county extension agent suggested the incorporators name the co-op after the Mount of the Holy Cross, a local landmark.

REA approved a loan for $119,000, and Holy Cross Electric started building lines in the two valleys. The first line was energized in September 1941, bringing the comforts of central station power to 175 rural families.

By the time Grange came along, Holy Cross Electric was expanding up side valleys and along the main streets of mountain villages in both directions. The acquisition of two small utilities, Eagle River Electric Company and Mountain Utilities, further enlarged the co-op’s service territory.

Then around 1962, the ski industry—and the co-op—took off like a downhill racer. Aspen, Vail, Snowmass, Buttermilk, and other ski resorts were developed. Holy Cross Electric nearly quadrupled in size between 1962 and 1971, growing from 2,300 consumers to 8,700.

Grange saw the boom coming in the late 1950s when many resorts still used noisy diesel engines to power ski lifts. He noticed that a number of large sheep ranches near what would become Vail had changed hands, from the original local owners to a Denver-based buyer named Transmontane Rod and Gun Club. This didn’t make sense because back then, no one bought land in Gore Valley for hunting and fishing preserves.

He investigated and discovered that Transmontane Rod and Gun Club was a front for an investment group headed by Pete Seibert, a former U.S. Ski Team member, and Earl Eaton, a local mountaineer, who wanted to build a world-class ski resort.

Vail Gondola, 1962

“Seibert and Eaton knew that if they said they were planning to build a ski area, land prices would soar,” Grange told the Post Independent in Glenwood Springs, where the co-op has its headquarters. “So over the next few years, they acquired practically all of the land from the bottom of Vail Pass down to where Vail exists now. Some parcels were hard to get because some ranchers didn’t want to sell, but Seibert and Eaton eventually got everything.”

Busy running a growing utility, Grange and his boss, cigar-chomping George Thurston, Holy Cross Electric’s first general manager, didn’t pay much attention until they started seeing publicity about the new ski area. One day in April or May 1962, Seibert drove down to Glenwood Springs to talk to them.

He said Public Service of Colorado officials had laughed him out of their offices. They said his plan was a pipe dream; Gore Valley was too far from Denver to attract enough skiers to keep him in business.

“So Pete tells us, ‘I don’t have any more money. I spent most of what I had on the gondola. … Could you give me some help? Could you take it to your board and see if maybe they would be willing to build me a line up there so I could get open? Our targeted opening day is December 15th.”

All seven board members were ranchers. They didn’t know much about skiing, let alone big ski resorts. But they trusted their general manager’s judgment when he said the co-op shouldn’t pass up this opportunity to build membership in Gore Valley. Grange said it was clear to him Thurston would be out looking for work if the project flopped.

Both Thurston and Grange gulped when Siebert said, a few days later, “You’ve got to put everything underground that serves the lodges and the housing.”

Snowmaking in Vail

Holy Cross Electric had only scant experience with underground construction—one subdivision in Aspen. The co-op hired an outside engineer to lay out the distribution system and an outside contractor to build the overhead lines to the lifts.

Fortunately, 1962 was a dry year and not as cold as usual, allowing the work to proceed without delays.

“We just barely made the December 15th opening day deadline,” Grange said.

There was little snow at first and few skiers, but a few weeks later, the mountain got into its January rhythm of adding a few inches almost every day, and Vail was on its way.

“Never in the history of U.S. skiing has a bare mountain leaped in such a short time into the four-star category of ski resorts,” Sports Illustrated said of Siebert and Eaton’s dream in 1964, when Vail was becoming one of the most popular snow-sports destinations in the United States, welcoming thousands of visitors to its slopes every winter.

When Ed Grange went to work for Holy Cross Electric in 1950, seven employees served 700 consumers. Today, 158 employees serve more than 55,000, from major ski areas to farms, ranches, and rural communities.Grange retired in 2011. Colorado Country Life, the statewide co-op magazine, reported he was still skiing in 2019 at age 84, though he no longer made the rounds to the ski areas to read the meters on the lifts, a task he happily completed into the mid-1990s.

This Week Outdoors: Where to go and what to do

Editor’s note: For a list of more sport and outdoor activities as well as other events happening around the valley, visit http://www.vaildaily.com/calendar. Events are subject to change.

Wednesday, Aug. 26

Free Nature Walk with Vail Nature Center: Join a naturalist for a free educational hike with the Vail Nature Center. No reservations are required. Hikes on Mondays and Tuesdays are from 9 to 10 a.m.; hikes on Wednesdays through Fridays are from 11:30 a.m. to 12:30 p.m.

***This event happens daily

Saturday, Aug. 29

Camp Hale Half Marathon: The Vail Rec District’s Trail Running Series continues with the Camp Hale Half Marathon. This race begins 8 a.m. and is open to all abilities. Participants must pre-register. For more information, visit www.vailrec.com. Race organizers have adjusted certain protocols for safety.

Garden Tours at Betty Ford Alpine Gardens: Starting at 10:30 a.m., tours of the Betty Ford Alpine Gardens in Vail explore alpine flora, mountain environments, history and more. Spots are limited, and participants are asked to arrive several minutes early. Register online at bettyfordalpinegardens.org.

Tuesday, Sept. 1-2

Davos Dash mountain bike race: The Vail Rec District’s Mountain Bike Series concludes Sept. 1-2 with the Davos Dash. There are categories for all ages and abilities, and racers are spaced out across two days to help keep with social distancing guidelines. For more information on the series, visit www.vailrec.com. Races go from 4 to 8 p.m. on both Tuesday and Wednesday of race days.

Outdoor yoga class at Beaver Creek: This free, 90-minute outdoor yoga class takes place Tuesdays and Wednesdays at Beaver Creek from 9 a.m. to 10:30 a.m. Visit www.beavercreek.com.

Family guided activities with Betty Ford Alpine Gardens in Vail: Children and families can discover the great outdoors with some hands-on learning on Tuesdays and Wednesdays with the Betty Ford Alpine Gardens. Cost is $10 per child and activities are best suited for ages 5-12 and are from 10:30 a.m. to noon. Visit https://bettyfordalpinegardens.org/.

Saturday, Sept. 12

EverGold trail running race at Beaver Creek: The Vail Rec District’s Trail Running Series continues with the EverGold 10K and 5K at Beaver Creek. This race begins 9 a.m. and is open to all abilities. Participants must pre-register. For more information, visit www.vailrec.com. Race organizers have adjusted certain protocols for safety.

Saturday, Sept. 19

Vail Health’s annual Hike, Wine & Dine event goes virtual: On Saturday and Sunday, Sept. 19-20, Vail Health is celebrating the spirit of togetherness by taking its annual Hike, Wine & Dine event virtual, allowing people to participate wherever they are located and share their experiences with the event group through Strava Club as well as Facebook and Instagram. Registration is $50 and all proceeds support the operating expenses of Jack’s Place and Shaw Cancer Center, services of Vail Health. Register online at http://www.shawcancercenter.org.

Sunday, Sept. 20

Vail Health’s annual Hike, Wine & Dine event goes virtual: On Saturday and Sunday, Sept. 19-20, Vail Health is celebrating the spirit of togetherness by taking its annual Hike, Wine & Dine event virtual, allowing people to participate wherever they are located and share their experiences with the event group through Strava Club as well as Facebook and Instagram. Registration is $50 and all proceeds support the operating expenses of Jack’s Place and Shaw Cancer Center, services of Vail Health. Register online at http://www.shawcancercenter.org.

Saturday, Sept. 26

Boneyard Boogie trail running race in Eagle: The Vail Rec District’s Trail Running Series concludes with the Boneyard Boogie in Eagle. This race begins 9 a.m. and is open to all abilities. Participants must pre-register. For more information, visit www.vailrec.com. Race organizers have adjusted certain protocols for safety.