Dr. William Pennington is an inventor. Some might call him revolutionary.
For some behind-the-scenes photos of Dr. Pennington at work, check out our photo gallery.
Dr. William Pennington. By Adam Ryan Morris
An orthopedic surgeon with 12 years experience, he’s one of just two surgeons nationwide performing a radically new kind of operation. It all started with one of his periodic trips to the Naples, Fla., headquarters of Arthrex, a company that develops tools and implants for orthopedic surgeries. As one of their idea men, he works on projects for years at a time, developing tools and procedures. “You can come up with ideas and work on them, and they’re very supportive,” says Pennington, who practices at Midwest Orthopedic Specialty Hospital in Franklin, among other locations.
For years, he tried to perfect an arthroscopic procedure that would completely replace the shoulder bone with artificial parts. In doing so, however, his mind wandered to another possibility: “You know what would be cool?” he thought. “Not putting metal and plastic in but using human cartilage and bone.” He ran with it, developing an alternative shoulder replacement that is both biological and arthroscopic. “You’re not changing anything in the shoulder,” he says. It’s all natural, from a donor. No metal. No plastic. And no muscle cutting. Pennington and one other surgeon in Ohio have been the only two performing this arthroscopy for the past year. Another doctor in Chicago is learning the method as well.
A look around the Milwaukee area yields a whole crop of innovators like Pennington, discontent with the norm. They’re testing out new options, opening specialized centers, embarking on clinical trials, and venturing to labs, meetings and conferences to brainstorm the previously unthinkable. These are some of the town’s best doctors, and they are changing the world of medicine one patient at a time, right here in Milwaukee.
With innovation on the brain, a local surgeon invented a groundbreaking procedure.
Bill Pennington didn’t dream of becoming a doctor. As a junior at UW-Madison, a time when many doctor hopefuls are charting out their next steps, Pennington was chugging along in pharmacy school. But memories of a high school injury set him on another path: He tore a quad muscle in his senior year on the football field. “That was what touched me,” he says. “A lot of us sports docs will tell a story like that: ‘I tore this, and that’s what inspired me to get into the game of medicine.’ ”
Once he decided to switch to medicine, Pennington knew exactly what kind: treating shoulders and knees. The South Milwaukee native attended the Medical College of Wisconsin, also doing his residency in orthopedics there, before taking a fellowship in shoulder and knee reconstruction in San Francisco.
While in California, he worked under mentor Dr. Eugene Wolf, who was actually at the meeting 30 years ago where the arthroscope was first introduced. “It was a great yearlong experience about how to do the cases arthroscopically and be minimally invasive,” Pennington says. “But I also learned how to innovate.”
Operating room conversations would turn from arthroscopic how-to lessons to idea sessions. Soon after the surgery, Wolf would be drawing the idea for a new tool on a napkin and faxing it to a company. “Within about four days, we’d get a prototype instrument,” Pennington says. This stuck with him. Soon, he was following in his mentor’s footsteps.
In Europe, arthroscopic full shoulder replacement is done using artificial parts, an approach the federal Food and Drug Administration has not approved in the United States, where full shoulder replacements are done with conventional surgery and artificial parts. This was what Pennington was trying to improve upon when he created his revolutionary approach: Arthroscopic biological resurfacing of the humeral head, as it’s called, replaces a patient’s humeral head (the ball of the shoulder) with one from a donor, as well as donated cartilage. It can also sub in for the old method of a conventional full shoulder replacement, which uses a metal ball and a plastic cup. It took Pennington several years to research tools and get them constructed, receive FDA approval and operate on more than 30 cadavers, perfecting the procedure. After that, Pennington was simply waiting for the perfect patient – something he doesn’t take lightly.
“Orthopedists are a little bit different than other doctors; we’re all gadget guys,” he says. “That’s good, and that’s bad. It’s good if you know how to use those gadgets.” But it’s bad for patients if you don’t.
In 2009, in walked a patient named Debbie Berland, now 46, a special education aide from Oak Creek. Young and active, Berland was an exceptional case. Cortisone shots, physical therapy and arthroscopic scopes to remove scar tissue didn’t have a lasting effect. “I felt like I was 100 years old getting out of bed,” Berland says. “As time went on, it was getting worse and worse.”
Surgery had become inevitable. But the conventional option was problematic. “You take a person her age, and the timer starts ticking. She’ll outlive this,” Pennington says, holding a metal and plastic replacement. Odds are the artificial parts will need to be replaced in 20-30 years with another operation. “To me, that’s not acceptable,” he says.
The conventional approach, moreover, uses typical surgery, not arthroscopy, meaning doctors would open up Berland’s shoulder and cut into her muscles. Pennington explained his alternative procedure, that he had only performed it on cadavers, and he encouraged her to seek another opinion. Berland did and decided to chance it, placing her shoulder in Pennington’s care. Two weeks after the surgery, she was in the swimming pool.
Of course, there’s no guarantee the biological alternative will last longer than the conventional one. But the operation is much less intrusive. “Worst-case scenario, that wears out, and you put more cartilage in maybe 10 or 20 years down the road, or she turns into a 60-year-old woman, and we do [a traditional replacement] for the first time,” Pennington says.
And he still does these traditional replacements all the time. Sitting in his Franklin office, Pennington pulls up a video of a patient post-surgery. She’s smiling big, full of energy, with a wonderful sense of humor, moving her reworked shoulder and “drinking arm,” singing the names of the physical therapy exercises in the process. Pennington’s smile is just as big, like a proud parent showing off a picture of his kid. “There’s no more gratifying patient than somebody who isn’t able to do what they want to do, and you restore that,” he says. “There’s nothing more fulfilling.”
Restoring function was critical in the case of Chellsie Memmel, a West Allis native and Olympic gymnast. In 2006, Pennington repaired tears in her rotator cuff and labrum. Within six months, she was back at the gym. “I was able to get back to my highest level of competition,” she says. In 2011, he operated on Memmel again, this time on her biceps tendon. Now, she’s determined to be ready for Olympic trials this summer.
Pennington performs about 1,000 surgeries a year, everything from full shoulder replacements (biological and conventional) to repairing tears arthroscopically. It’s a constantly changing field. “Shoulder replacements have really advanced in the last 10-20 years,” he says. Only 12 years ago when Pennington started, doctors weren’t doing a lot of arthroscopic rotator cuff repairs. Now, it’s the most common surgery he performs. From first incision to final stitch, it can take Pennington as little as 20 minutes. “It’s just like playing a video game.”
On an early November morning, nurses, assistants, an anesthesiologist and Pennington are preparing to do just that – repair a torn rotator cuff. Moments before 7 a.m., the patient is wheeled in and put under smoothly, covered with a blue tarp with nothing but one arm visible and extended toward the ceiling. Video screens are positioned throughout the room, and a table set with instruments stands just behind the doctor.
Pennington proceeds methodically, making small half-inch incisions and inserting an arthroscope (a video camera) into the shoulder to see the tear. The damage is evident, including the tear itself, bone spurs and floating scar tissue. He sucks out the scar tissue, removes the spurs, scrapes at the healthy bone so the repair will take, stitches the tear, creates a hole in the bone and hammers in the anchor, completing the repair.
Once he turns off the pump, which flushes sterile fluid through the shoulder during surgery, bone marrow should appear on the screens, indicating a successful procedure. He does so, and everyone waits. Silence. The seconds tick by. And then there it is, bubbles of bone marrow start rolling across the screen. A sense of relief runs through the room as Pennington, who seemed quite confident all along, describes what we’re seeing: “You’re watching her start her healing process right there.”
The Cutting Edge
How four other innovative doctors are changing the world of medicine.
By Evan Solochek
Dr. Timothy Fenske
Every year, more than 100,000 people in the United States are diagnosed with various forms of blood cancer. And every year, as many as 160 of those patients come to The Blood and Marrow Transplant Program at Froedtert & The Medical College of Wisconsin in search of hope.
They’re suffering from leukemia, lymphoma or multiple myeloma and are in need of an innovative blood stem cell transplant procedure. And Froedtert is the only place in southeastern Wisconsin that does it.
Once admitted to the BMT program, a patient is given a transfusion of donor stem cells (just as if he was receiving a blood transfusion). These cells find their way into the bone marrow, where they start multiplying and producing blood cells. Simply put, the procedure replaces the patient’s blood – and immune system – with that of a donor. For instance, if a male donor receives a transplant from a female, after the procedure, the male’s blood won’t have any Y chromosomes.
“About 30 days out, more than 90 percent of the blood cells mark like the donor,” says Dr. Timothy Fenske, medical oncologist at Froedtert & MCW.
Cancer cells have a unique resistance to their host’s immune system, so replacing it with the donor’s immune system dramatically increases a patient’s chance of survival. According to Fenske, for large-cell lymphoma, the most common type, traditional chemotherapy offers a 15-20 percent success rate. A stem cell transplant pushes that as high as 50 percent. For other forms of lymphoma, it has a success rate as high as 60-80 percent.
Dr. Grace Janik
Teleconferencing is nothing new – Skype and FaceTime have brought that technology to our fingertips. But Dr. Grace Janik, co-director of minimally invasive surgery and infertility at Columbia St. Mary’s, did something altogether groundbreaking in November.
While the American Association of Gynecologic Laparoscopists conference was taking place in Florida, Janik was in Milwaukee performing an endometriosis. But using a brand-new device called VisitOR1 – basically a small, ceiling-mounted robot that can move around the operating room with a camera hooked up to the laparoscope – Janik could perform the surgery while allowing some 2,000 people at the conference to not only watch, but communicate with her.
The purpose is education. Endometriosis – when the lining of uterus grows into the pelvis and causes pain and infertility – is a very common disease, but it’s wildly undertreated because the surgery is so complex. In the past, doctors looking to learn a new procedure would often have to fly somewhere to take a course and get hands-on training. Now that instruction can take place without leaving their office.
Drs. Tanvir Bajwa and Daniel O’Hair
Every year, around 100,000 elderly Americans are diagnosed with aortic stenosis – a narrowing of the heart valves that can lead to severe shortness of breath, heart palpitations and, if untreated, death within two years for up to 40 percent of patients. The traditional treatment for this debilitating disease involves cracking the sternum and doing a heart and lung bypass, followed by weeks of recovery. But roughly one-third of those who develop it are deemed too weak for the highly invasive open-heart surgery.
At Aurora Health Care, Dr. Tanvir Bajwa, a cardiologist, and Dr. Daniel O’Hair, a cardiovascular and thoracic surgeon, are participating in a nationwide clinical trial for a new technique called CoreValve that is giving those too-fragile patients a new lease on life.
“We see a lot of people that are told there is no treatment, and they’ve just given up hope,” says O’Hair. “They think there isn’t an option out there, but there is.”
With this new technique, a 2-centimeter incision is made in the patient’s groin, and the replacement valve is threaded through the femoral artery all the way to the heart. The new valve (made out of pig tissue) is deployed and “basically pushes the old one out of the way,” says O’Hair. The procedure is done in about an hour and a half, and after two days of observation, the patient is free to go home. In the United States, the first one was done more than a year ago in California. The first such operation in Milwaukee was just this past summer.
Milwaukee Magazine has published its definitive guide to area doctors six times before: 1987, 1991, 1996, 2000, 2004 and 2008. To construct this year’s list, we sent surveys to 3,700 doctors and 1,300 nurses from the five-county metro area, yielding a pool of 5,000 area medical professionals. We asked them to nominate three “top” physicians in 33 different specialties. The number of times a particular doctor has made our list is indicated by the number of stars: Zero stars means this is the doctor’s first time, while six stars indicates the doctor has made our list each of the previous six times we’ve published it. The top choice of nurses is also indicated where applicable. Contact information and professional affiliations are provided by the physicians. Finally, we screened our list to eliminate any doctors who had complaints against them with the Department of Regulation and Licensing (drl.wi.gov) during the last five years.
To purchase a copy of our 2012 Top Doctors listing, please contact the circulation department at 414-287-4333 or at firstname.lastname@example.org.