Kevin L. Kirk, DO is a board-certified orthopedic surgeon specializing in disorders of the foot, ankle and lower leg. Although he treats all general orthopedic conditions, he has a special interest in foot and ankle joint replacement, arthroscopy, reconstruction and trauma surgery.
Dr. Kirk received his Doctor of Osteopathic Medicine from the Philadelphia College of Osteopathic Medicine in 1999. He completed an internship in General Surgery and subsequent Orthopedic Surgery Residency at Walter Reed Army Medical Center in Washington, DC. He then went on to complete a fellowship in Foot and Ankle Surgery at Johns Hopkins University/Union Memorial Hospital in Baltimore, MD.
After completing fellowship, he was appointed the Chief, Foot and Ankle Surgery at Brooke Army Medical Center. In 2010, he became the Chief, Orthopedic Surgery Service at San Antonio Military Medical Center serving in that position until his retirement from the Army in 2013. He has recently relocated his practice from the University Orthopedic Associates in New Jersey where he was an orthopedic consultant to the athletic programs at Rutgers/Princeton and Rider Universities.
Dr. Kirk is a highly experienced orthopedic surgeon and a veteran of two deployments with forward surgical teams to Afghanistan in 2005 and 2011. He remains active in the orthopedic academic community. He has served on the faculty of the Uniformed Service University of Health Sciences, Baylor College of Medicine and Rutgers/ Robert Wood Johnson Medical School.
TOA: How did practicing orthopaedics in the military setting different from practicing in the civilian arena?
Due to the high energy mechanism of injury coupled with the “up-armored vehicles” later in the conflicts led to severely comminuted fractures of the foot and ankle. Oftentimes in civilian practice, you will have more isolated severe fractures, such as calcaneus or pilon fractures, whereas in the military the fractures would be in combination (for example comminuted calcaneus, talus and tibia fractures coupled with spine injuries and possible closed head injuries). The severity of these fractures often led to posttraumatic arthritis in active young patients.
The onset of arthritis at such a young age caused an interesting dilemma. In most patients with arthritis of the foot or ankle, total ankle arthroplasty or fusions are usually a good option; however, these patients are often much older and less active. In the military population of active young patients with the same severity of post-traumatic arthritis, fusions are usually the only option. The decreased mobility of the ankle or foot after fusion often led to the inability to run which many of the soldiers equated to their full recovery, i.e., “being healed.” Since they were not able to run, and having seen their buddies with amputations being able to run, caused a high number of delayed amputations, approximately 15 percent.
TOA: Foot and ankle is one of your specialties. What are some of the most exciting advances in foot and ankle that you have witnessed over the past few years?
TOA: You have taken a particular interest in osteoporosis.
Kevin Kirk: This may take a while … I attended the American Orthopaedic Association Meeting in Boston while I was a resident and walked into an Own the Bone Symposium. I really did not know much about osteoporosis and why orthopedic surgeons would be interested in this topic. I did not think much more about it during my time in the military since most patients were younger and injuries were mainly due to war trauma.
After my retirement from the Army in 2013, I took a job at Rutgers/University Orthopedic Associates in New Jersey where they had a robust osteoporosis screening and secondary fracture prevention program. I started to rekindle my interest in the Own the Bone program/osteoporosis and secondary fracture prevention.
From my deployment experiences, you returned changed and want to serve your patients better and have better treatment of diseases. I felt that this would be my way to make a lasting impact on my community and hospital system. So when I returned to join The San Antonio Orthopaedic Group in 2014, there were only a few surgeons ordering Dexa scans or referring for osteoporosis care. I saw the opportunity to develop a program within our group and within the Baptist Healthcare System. At the time I started to take general orthopaedic call as well and really saw the impact of osteoporosis and geriatric fractures.
According to the National Osteoporosis Foundation, an estimated 10 million adults in the US have osteoporosis and over 43 million have low bone mass. Osteoporosis is a silent disease often resulting in fractures from ground level falls so a patient doesn’t know that they have a problem until they fracture. Over 1 million fractures occur annually, which is a much higher annual incidence than new strokes, heart attacks or breast cancer combined. Once a patient fractures, there is a 30 percent mortality rate within the first year, and 50 percent typically do not return to their prior level of ambulation/function.
As orthopaedic surgeons, we would typically treat the fracture and never treat the underlying cause. Thereby the patient would be at a 40 percent risk of another fracture within the year following if the osteoporosis is left untreated. As orthopaedic surgeons we are the “tip of the spear” when it comes to identifying fractures related to poor bone quality. It is with those facts, I petitioned our TSAOG Executive Committee to start a secondary fracture prevention program.
I currently supervise the nurse practitioner for our Bone Health Institute, and her volume has steadily increased since starting the program. In addition, I have become the physician champion for the Own the Bone/ Secondary Fracture Prevention program at Mission Trail Baptist Hospital on the southside of San Antonio. We are currently in the process of seeking Joint Commission credentialing as a certified Osteoporosis/ Fragility Fracture program. My hope is that we can serve a model for the other programs within our system and duplicate the program at other facilities within the Baptist System.
TOA: Why do you think it is important for orthopaedic surgeons to engage in the public policy process with organizations like TOA and AAOS?
Kevin Kirk: If you are not at the table you are on the table: Physicians and surgeons are reluctant leaders. I think that it is critical that surgeons to remain active in organized medicine to assist policymakers with decisions that affect our patients and their care. We are the frontline of healthcare and truly understand the needs of our patients and the impact policy decisions can have on the delivery of that care. Therefore, we need to be at the table.
Mil Med. 2010 Dec;175(12):1027-9.
Prevalence of late amputations during the current conflicts in Afghanistan and Iraq.
Stinner DJ1, Burns TC, Kirk KL, Scoville CR, Ficke JR, Hsu JR; Late Amputation Study Team.
After identifying this as a problem, since this rate was three times greater than civilian trauma patients, our group set out to find a solution. The solution was the Intrepid Dynamic Exoskeleton Orthosis (IDEO). This innovative orthosis allowed patients with fused ankle to return to running and helped decrease the late amputation rate.
Comparative effect of orthosis design on functional performance.
Patzkowski JC, Blanck RV, Owens JG, Wilken JM, Kirk KL, Wenke JC, Hsu JR; Skeletal Trauma Research Consortium.
J Bone Joint Surg Am. 2012 Mar 21;94(6):507-15.
Management of posttraumatic osteoarthritis with an integrated orthotic and rehabilitation initiative.
Patzkowski JC, Owens JG, Blanck RV, Kirk KL, Hsu JR; Skeletal Trauma Research Consortium.
J Am Acad Orthop Surg. 2012;20 Suppl 1:S48-53
Can an integrated orthotic and rehabilitation program decrease pain and improve function after lower extremity trauma?
Bedigrew KM, Patzkowski JC, Wilken JM, Owens JG, Blanck RV, Stinner DJ, Kirk KL, Hsu JR; Skeletal Trauma Research Consortium (STReC).
Clin Orthop Relat Res. 2014 Oct;472(10):3017-25
Fortunately the success of the IDEO has translated to the civilian side and now is commercially available through Hangar Prosthetics as the Exosym brace. In fact, I have been able to get this type of brace for Workers’ Compensation patients with good results. It is actually a part of the ODG for Worker’s Comp. Well, that is all I have to say about that!