Joint adventure

In the North State, as in other areas nationwide, joint replacements represent an expanding field in medicine. Chico orthopedists—including a transplant from Paradise—have come together to meet the need through the Total Joint Replacement Program at Enloe Medical Center.

Dr. Brock Cummings, the aforementioned Paradisian, was recently selected as the program’s medical director. He joins fellow doctors Kirk Granlund, Stephen Morris, Bill Watson and Charles Wilhite as surgeons performing joint replacements through the Enloe program.

“It’s growing rapidly,” Cummings said of the specialized field of joint replacement. “Certainly the aging population, the baby boomer generation, is coming through the arthritis age, and that growing population of people is driving the majority of the increased utilization. But the components, the materials that we’re using, are longer-lasting, so we’re feeling more comfortable about putting them into younger patients.

“Traditionally we’ve said, ‘Come back when you’re 60 for a joint replacement.’ But young people have had motor vehicle accidents or other traumas involving their joints, and they’ve had dramatic arthritis at a younger age, and nowadays we can consider joint replacement and get them back to a more active lifestyle.”

Cummings has been part of a busy orthopedic practice on the Ridge for 10 years. More and more, he found himself performing hip and knee replacements. A member of Enloe’s medical staff since 2009, he will continue to see his Paradise patients, but the Chico office he recently opened will concentrate on joint-replacement patients.

“I’m excited about Dr. Cummings’ expanded role,” said Dr. Marcia Nelson, Enloe’s vice president of medical affairs as well as a family physician in private practice in Chico. “Having a medical director just doing joint replacements really highlights the importance of this service line to Enloe and the community. It also allows us to have dedicated resources to create a uniform offering for all the patients who receive joint replacements at Enloe.”

Nelson has seen Cummings in action and came away “really impressed with what I saw,” she said. “The operating-room environment was orderly, efficient, calm, focused. Everybody knew the role they played and worked well as a team, because he’s really tried to create a good team performance.”

That’s a key characteristic for his role as medical director, as Cummings forges a team with other experienced physicians.

“It’s not a one-man show—there’s depth to the bench,” Nelson said. “We have a number of orthopedists who have shown they provide quality, volume and cost-efficient care.”

Cummings enjoys partnering with them in the joint-replacement program.

“I’ve been pleased with the cooperation and the willingness to work together,” he said. “We’re in the early stages of this, and I think things will continue to be more cohesive and collaborative as we continue putting this program together.”

Unlike other physicians who’ve taken a beeline to medical school, Cummings went on a more circuitous route. He was raised in Ukiah and graduated from Pacific Union College in the Napa Valley. He’d completed pre-medicine requirements, but unsure as to what career he should pursue, he went to work for a contractor, building custom homes.

A few years later, he said, “I decided I needed to get on with life, and I have a real love for children, so I went into elementary education.” He taught fourth-graders in Southern California for five years, including one year in which he had students spanning 11 languages.

It was a challenging assignment, though “I didn’t feel I was being challenged the way I wanted to be. I was complaining to my wife about the job, and she said, ‘Well, you can always go back to medical school …’—so that’s what I did.”

Cummings enrolled at Loma Linda University, just a few miles from where he was teaching. He aimed to become a pediatrician, but his surgical rotation in residency sparked a new interest, and he trained in orthopedics.

“I found my home,” he said. “One of the things I like about orthopedics versus some other specialties in medicine is there’s a defined problem and a defined solution. I’m of the mentality that, ‘OK, here’s a problem, here’s a solution, you’re fixed—job accomplished’; as opposed to managing diabetes or managing hypertension, where you’re just keeping them going along.”

Cummings moved to Paradise in 2003. Over the past decade, he has received additional training in joint-replacement surgeries, particularly procedures that are minimally invasive and require less recovery time.

One such advance is the anterior approach to hip replacements. Rather than detach muscles, the surgeon works between muscle groups—“parting the curtain rather than taking it down,” Cummings explained.

Another breakthrough is patient-specific instrumentation. Physicians administer detailed scans of patients’ joints, and a manufacturer uses those measurements to create cutting guides for the surgeon. In addition, the orthopedist can use the three-dimensional scans to determine which piece of hardware will best work for a particular patient’s anatomy “before the scalpel ever touches skin.”

Ten years ago, Cummings never imagined he’d be preparing for surgeries using virtual 3D. Technology is just one way the field of joint replacement is burgeoning.

“Joint-replacement surgery really has so much to offer to keep vital, active people having the quality of life they want,” Nelson said, “so joint-replacement surgery will just have a larger presence in terms of need, not just for the North State area but also for the United States as a whole.”