A Look at the Center for the Intrepid with Joseph F. Alderete, MD

Col. Christopher J. Roach, MD, FAAOS – the chair of the Department of Orthopaedics at the San Antonio Military Medical Center – presented on the Center for the Intrepid (CFI) at the Texas Orthopaedic Association’s 2018 Annual Conference.

Click here to view Dr. Roach’s PowerPoint presentation from the conference.

The following is a Q&A that TOA performed with Joseph F. Alderete, MD.

TOA: Why was the CFI created?  What makes it different from existing centers?  

 Joseph Alderete: In the spring of 2005, Arnold Fisher and the board of directors of the Intrepid Fallen Heroes proffered a rehabilitation facility. Secretary of the Army Harvey accepted the proffer, and funds for the facility were received from over 600,000 Americans. Ground was broken for the four-story, 65,000 square foot outpatient rehabilitation facility and two new 21 handicap accessible suite Fisher Houses on 22 September 2005. The ribbon cutting for the CFI and the new Fisher Houses was held on 29 January 2007 and patient care began in the facility on 15 February 2007.

The threefold mission of the CFI is to provide rehabilitation for OIF/OEF casualties who have sustained amputation, burns, or functional limb loss, to provide education to DoD and Department of Veteran’s Affairs professionals on cutting edge rehabilitation modalities, and to promote research in the fields of Orthopaedics, prosthetics and physical/occupational rehabilitation. The staff and equipment for the building were selected to provide the full spectrum of amputee rehabilitation, as well as the advanced outpatient rehabilitation for burn victims and limb salvage patients with residual functional loss.

Through the collaboration of a multi-disciplinary team, we will provide state-of-the-art amputee and limb salvage care, assisting our patients as they return to the highest levels of physical, psychological and emotional function.

The Intrepid is so special because it is run by a partnership of Orthopedic Surgeon and Physical Medicine and Rehabilitation doctors, and employs the most experienced prosthetists, physical therapist, occupational therapist, and behavioral health providers to facilitate optimal care in targeted medicine.

TOA: Many of the trauma cases that you witness in the military are different than what an orthopaedic surgeon in the civilian world may encounter.  What lessons have you learned from military orthopaedic trauma cases that could translate to civilian trauma cases?  

JA: We have set the bar for limb salvage in massive trauma by incorporating advanced resuscitation, tissue regeneration and regenerative medicine to facilitate limb salvage. The IDEO, or Intrepid Dynamic Exoskeletal Orthosis, was designed and is manufactured at the Intrepid to offload arthrosis, skin or skeletal defect, or neuropathic pain making limb salvage easier. When limb salvage is not possible, we have learned the most optimal amputation techniques for facilitating high levels of function to include advanced tissue myodeses, targeted muscle reinnervation for both neuromotor control of prosthetics, as well as relief of neuroma related pain, and finally Osseointegration.

TOA: What new research is being conducted at the CFI?

JA: We are looking at the use of artificial intelligence through Department of Energy supercomputing capability to interpret raw clinical data made pre-hospital, en-route care, initial resuscitation, and then transport through the echelon continuum of care to predict life threatening medical conditions or en-route complications in evacuation to a military treatment facility.

  • Define the relationship between functional outcomes and amputation type and/or length.
  • Use artificial intelligence to predict who would best benefit from an amputation versus limb salvage.
  • We participate in the DOD/VA Osseointegration program studying the effects of skeletal integration to prosthesis and accompanying rehabilitation.
  • We are looking at the long-term effects of amputation versus limb salvage and mitigating factors that we can manipulate in rehabilitation.
  • We are also looking at advanced rehabilitation in the special operations community incorporating high intensity interval training to return the elite warrior athlete to optimal function.
  • We are studying effective particles and nontraditional techniques to obviate long term opiate use and chronic pain.

TOA: If orthopaedic surgeons wanted to visit the Intrepid to learn more about what you are doing, would it be possible for orthopaedic surgeons to visit you?

JA: Absolutely, please reach out to joseph.f.alderete.mil@mail.mil or snjalderete@gmail.com. I would be happy to arrange a tour and we welcome military-civilian collaboration in forwarding the science of Orthopaedics and Trauma care.

Joseph F Alderete MD
LTC, MC
Chief, Orthopaedic Oncology
Surgical Director, Center for the Intrepid San Antonio Military Medical Center
Office 210.916.7627 Pager 210.513.9797