Dr Stephen S. Tower

Dr. Tower is an all-around orthopedic surgeon whose special interest lies in primary and revision hip, knee and shoulder surgery, in addition to general orthopedics and trauma care. A lifelong Alaskan, Dr. Tower has provided orthopedic care in Anchorage since 1992. 

 

"Too often," Dr. Tower says, "patients are pushed into surgery when other treatments that are less invasive make more sense. I work closely with my patients to decide the best options, giving careful consideration to individual preferences and current research."

 

Dr. Tower believes that high quality orthopedic care is always in the best interest of the health and well being of the patient, and should be thoughtful, compassionate and scientifically based.

Dr.  Tower received his medical degree from the University of Washington, in Seattle, and completed his internship in Internal Medicine at Dartmouth Hitchcock Medical Center in Lebanon, NH. He served 4 years in the U.S. Public Health Service as a General Medical Officer for Indian Health. He completed his residency training in Orthopedic Surgery at the Oregon Health Sciences University in Portland. 

 

Dr. Tower has practiced orthopedic surgery in Anchorage since 1992 and is an Affiliate Professor of Medicine at the University of Alaska. He enjoys an academic collaboration with Dartmouth Biomedical Engineering Center on research to understand the reasons why hip replacements fail. He is a member of the American Academy of Orthopaedic Surgeons and a board member of Health Watch USA.

 

Dr. Tower is an avid cyclist who can occasionally be seen commuting by bicycle to work and between Anchorage hospitals.

EXPERIENCE COUNTS

Dr. Tower’s training, experience, research, and patient advocacy make him one of the leading arthroprosthetic surgeons in the country.

 

Dr. Tower first observed a hip replacement as a first year medical student in 1979. When he turned to share his enthusiasm with a classmate, he found that the classmate was on the floor. At that point, Dr. Tower felt destined to be a joint replacement surgeon. Dr. Tower served as an assistant surgeon in orthopedics for the Indian Health Service from 1983 through 1986, at which time he began his orthopedic residency at the Oregon Health Sciences University.

 

In Portland, Dr. Tower researched the difficult problems that are occasionally encountered after hip or knee replacement. This work won the Alonzo Nuffield Award for the best submitted research paper to the 1992 annual meeting of the Western Orthopedic Association and was published soon thereafter.(1)

 

Dr. Tower returned to Anchorage in 1992. Joint replacement had been commonly performed in Alaska for a decade and some of these joints had worn out and were requiring revision surgery. Revision joint replacement is often more involved than a primary, first-time replacement operation. Few surgeons in Alaska at that time had either the training or the interest to take on these complex procedures. Dr. Tower was willing and was well trained to tackle these challenging cases.

 

In private practice, Dr. Tower continued joint replacement quality improvement and research through a collaboration with the Dartmouth Biomedical Engineering Center  (DBEC). When he revises a joint replacement, the failed parts are sent to DBEC, with the patient’s permission, to determine whether the implant materials or design contributed to the failure of the joint.

 

Dr. Tower's efforts in this regard have identified a major problem with the plastic hip socket liners used in most hip replacements over the past decade. Dr. Tower and DBEC were the first to recognize that if a plastic socket liner is made too thin in order to accommodate a larger diameter femoral head, then the insert might crack, causing the hip to fail within several years rather than within several decades. This work prompted an industry-wide redesign of hip socket liners. (2)

 

More recently, Dr. Tower and DBEC were the first to recognize that excessive wear of metal-on-metal hips (a chrome-cobalt ball rubbing on a chrome-cobalt socket) could not only result in failure of the replacement because of damage to the tissues about the hip, but they also might result in cobalt poisoning (cobaltism). (3,4) This finding contributed to the removal from the market of almost all metal-on-metal hip designs and to the formal recall of Johnson & Johnson’s ASR hip. This work has also helped develop protocols for monitoring the numerous Americans that were implanted with metal-on-metal hips. (5)

 

Presently, Dr. Tower and DBEC are studying why corrosion of chrome-cobalt alloy hip implants occurs and how often this leads to hip tissue damage or to cobalt poisoning/cobaltism. A large number of the hips implanted in the United States over the past 20 years have utilized chrome-cobalt parts. There are a large number of Americans who presently may be at risk for corrosion of their chrome-cobalt hip implants.(6)

Dr. Tower has been recognized as an experienced leader in the field of safe joint replacement by Consumer Reports, Consumers Union, and Health Watch USA. He is committed to improving the practice of joint replacement beyond his own patients.

HIS PERSONAL EXPERIENCE WITH HIP ARTHRITIS AND HIP REPLACEMENT

Doctors put drugs of which they know little into bodies of which they know less for diseases of which the know nothing at all.”  - Voltaire, 1715

 

There is little doubt that medical therapeutics and the knowledge of human physiology and pathology have progressed since 1715 but it is likely that there is no better way for a physician to understand an ailment and the risks associated with its remedy than to experience both first hand.

 

When I elected to have my hip replaced in 2006, I had twenty years of experience scrubbing in on that operation. I also had contributed to improving hip implant design and to optimizing the treatment of femur fractures that can complicate hip or knee replacement. (1,2)

 

I had followed the same advice that I give my younger patients about the timing of joint replacement. For a decade I had been modifying my fitness activities until cycling was the only means I had to maintain my fitness. Once that activity became limited to a 6-mile commute home from the hospital, I signed up for the operation that I knew best and most enjoyed performing.

 

My rationale for selecting my particular implant seemed sound, particularly in light of my research on the shortcomings of thin plastic hip socket liners. (2) Despite an academic interest in hip implant materials and design and 14 years of experience replacing hips in private practice, I was unaware that my particular implant, like most hip implants available in the United States, had only a cursory pre-market review by the FDA. My accelerated return to endurance cycling competition reinforced my impression that I had made an optimal selection. My own experience led me to choose an implant with flawed technology into some (fortunately only 6) of my younger, more active patients.

 

Over 42 months, my replaced hip became painful to the point that I was again limited to a 6-mile bike ride. More concerning, I had also developed sleep disturbance, mood instability, imbalance, tinnitus (ringing in the ears), retinopathy, and stiffening of the heart (diastolic cardiomyopathy).

 

When my hip was finally revised, a crankcase of metallic sludge was found which had irreparably damaged the ligaments about the hip that provide stability. This deficiency resulted in 10 dislocations of the revised hip. Thankfully, the pain at the hip largely resolved, as did my cardiomyopathy, disordered mood sleep disturbance, hearing issues, imbalance, and vision issues.

 

Before the revision operation, the cobalt concentration in my blood was found to be 120 times that which is thought to be safe for cobalt-exposed workers and my cerebrospinal fluid (CSF) cobalt level became the third highest reported in the literature at that time.

 

The publication of my experience, combined with that of one of my patients, was the first time that systemic cobalt poisoning/cobaltism was noted as a potential complication of metal-on-metal hip replacement. (3) This was initially felt to be an extraordinarily rare occurrence. (4) Over time, additional cases were reported and cobaltism became noted to be one of the complications of metal-on-metal hip replacement, which led to its commercial demise. Additionally, it led to the concept that patients implanted with metal-on-metal hips ought to be monitored for systemic cobalt poisoning/cobaltism in addition to being screened for damage to the tissues around the hip implant. (5)

Of all of the metal-on-metal hips implanted, only 93,000 were formally recalled, leading to concern that numerous patients might be at risk for developing cobaltism/systemic cobalt poisoning.

SOURCES

1.Beals RK, Tower SS. Periprosthetic fractures of the femur. An analysis of 93 fractures. Clin Orthop Relat Res. 1996(327):238-46. Epub 1996/06/01. PubMed PMID: 8641069.

 

2.Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am. 2007;89(10):2212-7. Epub 2007/10/03. doi: 10.2106/JBJS.F.00758. PubMed PMID: 17908898.

 

3.Tower SS. Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am. 2010;92(17):2847-51. Epub 2010/11/03. doi: 10.2106/JBJS.J.00125. PubMed PMID: 21037026.

 

4.Tower S. Arthroprosthetic cobaltism: identification of the at-risk patient. Alaska Med. 2010;52:28-32. Epub 2010/11/12. PubMed PMID: 21066926.

 

5.Kwon YM, Lombardi AV, Jacobs JJ, Fehring TK, Lewis CG, Cabanela ME. Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society. J Bone Joint Surg Am. 2014;96(1):e4. Epub 2014/01/03. doi: 10.2106/JBJS.M.00160. PubMed PMID: 24382732.

 

6.Gessner BD, Steck T, Woelber E, Tower SS. A Systematic Review of Systemic Cobaltism After Wear or Corrosion of Chrome-Cobalt Hip Implants. J Patient Saf. 2015. doi: 10.1097/PTS.0000000000000220. PubMed PMID: 26076080

SOURCES

1. Tower SS, Beals RK. Fractures of the femur after hip replacement: the Oregon experience. Orthop Clin North Am. 1999;30(2):235 -47. Epub 1999/04/10. PubMed PMID: 10196425.

 

2. Tower SS, Currier JH, Currier BH, Lyford KA, Van Citters DW, Mayor MB. Rim cracking of the cross-linked longevity polyethylene acetabular liner after total hip arthroplasty. J Bone Joint Surg Am. 2007;89(10):2212-7. Epub 2007/10/03. doi: 10.2106/JBJS.F.00758. PubMed PMID: 17908898.

 

3.Tower SS. Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty: a case report. J Bone Joint Surg Am. 2010;92(17):2847-51. Epub 2010/11/03. doi: 10.2106/JBJS.J.00125. PubMed PMID: 21037026.

 

4. Jacobs JJ. Commentary on an article by Stephen S. Tower, MD: "Arthroprosthetic cobaltism: neurological and cardiac manifestations in two patients with metal-on-metal arthroplasty. a case report". J Bone Joint Surg Am. 2010;92(17):e35. Epub 2010/12/03. doi: 10.2106/JBJS.J.01657. PubMed PMID: 21123606.

 

5. Kwon YM, Lombardi AV, Jacobs JJ, Fehring TK, Lewis CG, Cabanela ME. Risk stratification algorithm for management of patients with metal-on-metal hip arthroplasty: consensus statement of the American Association of Hip and Knee Surgeons, the American Academy of Orthopaedic Surgeons, and the Hip Society. J Bone Joint Surg Am. 2014;96(1):e4. Epub 2014/01/03. doi: 10.2106/JBJS.M.00160. PubMed PMID: 24382732.

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