Dr. Paul Lichstein, an orthopedic surgeon and researcher at Novant Health Orthopedics & Sports Medicine - Salisbury, specializes in “adult reconstruction,” treating patients with serious orthopedic conditions. Lichstein often cares for complex cases in which other doctors have sometimes tried but were unable to control infection, rebuild a knee or repair a broken pelvis. Patients can be frightened and wonder: Will I ever recover?
Lichstein understands better than most of us.
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In May 2007, he had just finished his first year of medical school at Wake Forest University. The program required four weeks at a community practice. His family has roots in Ashe County, with a farm that dates to 1773. Lichstein loved it there and arranged to do his rotation in the emergency room at a hospital in Galax, Virginia, near the North Carolina border.
It hadn’t rained in a month when Lichstein was driving back from his shift that night. A freak thunderstorm slickened the roads. His car skidded on a patch of oil as he navigated a curve, hydroplaned and collided head-on with an 18-wheeler.
After physicians at Ashe County Memorial Hospital stabilized his dislocated hip, Lichstein was flown to
Wake Forest Baptist Medical Center in Winston-Salem for emergency surgery. He needed three surgeries that summer for pelvic and hip injuries. Lichstein returned to medical school for his second year, but had to take the entire next year off for still more surgery. He was in pain and didn’t know if he could finish medical school.
From eastern N.C. to Harvard
Before completing his orthopedic surgery residency at Stanford and his fellowship at Harvard, Lichstein was just a kid growing up in eastern North Carolina. His grandfather, Dr. John Gamble Jr., was a general surgeon who served in a MASH unit during the Korean War. Gamble opened his own hospital in the small town of Lincolnton northwest of Charlotte and “would sometimes accept payment in deer meat because people would not have enough money,” Lichstein said. “He was a pillar of the community. So I grew up understanding what you could mean to a community as a surgeon."
Gamble went on to serve in the N.C. House of Representatives and helped submit legislation to open East Carolina University’s medical school. Lichstein’s parents are both doctors, too, practicing internal medicine.
Maybe all that illustrious history and expectation to go into medicine is what led Lichstein to earn his undergraduate degree at UNC Chapel Hill and spend the next four years fishing. He guided fly fishing trips around the world. When he was ready to pursue medicine, he realized, “I’ve really got to build up my resume, because if I show up and say, ‘I’ve been catching fish for the past couple of years,’ it probably wasn’t going to showcase my commitment to medicine.” He earned a master’s in physiology and biophysics at Georgetown before entering medical school.
"My whole life just got turned upside down," he said. "It gave me a real appreciation for not only how disruptive these cataclysmic life events could be to one's plans, but also the power of good support. Because I don't know what would have happened if my family, friends, and the medical community wasn't there."
Lichstein graduated from medical school in 2011. He went on to pursue years of rigorous training, including an orthopedic surgery residency at Stanford University School of Medicine in 2017, followed by an orthopedic surgery/adult reconstruction fellowship at Harvard Medical School.
At one time, he would have considered the prospect of focusing on knee and hip surgeries “really boring,” he said. But after his accident, he realized he wanted to treat disability – “to effectively intervene in a definitive way that would cause real change that was immediate and long-lasting." Treating patients who come to the hospital in a wheelchair and leave under their own power is “immensely rewarding.”
The family business is medicine. Lichstein’s wife, Dr. Margaret Greven, is a retina surgeon who he met at medical school. When they aren’t treating patients, they’re busy at home with daughter Kathryn, 2 1/2, and their golden retriever, Sadie.
Physicians with Lichstein’s academic pedigree and interest in research often choose to live in major cities. He pondered whether to teach on the faculty at a prestigious university. But he decided the best use of his skills was to return to North Carolina and provide the same quality of care available in a bigger city.
He appreciates the relationships he can build in a smaller community. “There's something about having a patient come in your office and tell you that they're there because they have spoken with their friends, and their friends have said what you've done for them."
Patients like the young man he was, driving home from work, when life took a turn.
Leading research on hip replacements
Dr. Paul Lichstein participated in his first research project during his year off from medical school. He later spent a year at the Rothman Orthopaedic Institute in Philadelphia, conducting hip and knee research. He loved this different way of figuring out complicated medical puzzles. Several of his papers are frequently cited in orthopedic literature. One reason he chose to join Novant Health is the ability to continue leading research.
Recently, Lichstein served as principal investigator on research that considered best practices to repair broken bones around a hip replacement. The project sought to determine whether the type of surgeon made a difference in producing better outcomes. The question has taken on greater urgency as the number of total hip replacements has grown in the U.S.
Lichstein formed a consortium of institutions to compile their data on past surgeries of this type and long-term results, including Harvard, Stanford, Emory, University of Virginia, University of Washington and others. Data from more than 600 patients suggests that it’s best for a joint replacement specialist to conduct this kind of surgery, compared to an orthopedic trauma surgeon or a general surgeon.
The study is expected to be published in a medical journal later this year. Lichstein also hopes to create a U.S. registry for periprosthetic fractures – fractures that occur close to artificial joints and other implants – building knowledge through thousands of cases. Lichstein says it would “give us the ability to do prospective studies to really hash out the fine details and give high-level recommendations,” helping to improve patient care nationwide.