Give this Surgeon a Hand
by Eve Jacobs

MaryEllen Russel, medical secretary, Shirley hall, executive secretary Joseph Benevenia, MD, vice chair and associate professor, Kathleen Beebe, MD, musculoskeletal oncology fellow, Monica Harduby, MS, PA-C, Kara Winslow, RN, clinician, all in the NJMS division of musculoskeletal oncology

He maintains it is the blending of his scientific and artistic talents that allows him to give his patients — who frequently travel long distances to see him despite being debilitated —something very special, and oftentimes unique.

He remembers himself as a child who was “intrigued with discovering the inner workings of anything, everything — a lamp, a machine, a living creature.” He had a passion for science and for mechanics and obviously a fair amount of natural ability in that area. During his growing-up years, photography, painting and playing bass guitar in a rock and roll band complemented his technical/scientific leanings.

“I have always loved working with my hands,” says the surgeon.

In fact, Benevenia chose a field that demands artistry, inventiveness and mechanical aptitude, as well as an exquisite flair for hand-crafting. He describes what he does as “customizing surgeries for cancer patients with unique problems.”

During his undergraduate years at St. Louis University, he discovered a natural affinity for organic chemistry, usually the bane of every pre-med student’s life. “You have to imagine molecules in space coming together to produce reactions. You have to visualize it,” he contends. “For me that was natural.”

Medical school was another eye-opener for him. At NJMS, he fell in love with anatomy during his first year. “Once I got into the gross anatomy lab, I knew I was home,” he says.

“It was like being an explorer, all the muscles, nerves, bones, ligaments, joints — all marvels. The majority of the body is musculoskeletal anatomy. It’s vast.”
It was then that Benevenia decided he “had to do surgery. You have to get in there with your hands — this was the specialty for me.”

But it was not until several years later, when he was doing a surgery rotation at the Veteran’s Administration Medical Center in East Orange that “everything really came together.” A general surgeon mentioned his love for sculpture (he was not a sculptor) because it reminded him of surgery, and a bulb lit up in the young Benevenia’s brain.

“I was experimenting with sculpture at the time,” he says, “and suddenly I understood that I could bring my love for anatomy and surgery together with my love for sculpting.
I made my choice of profession right then.”

Over the years, orthopedic surgery has proven to be a good fit: “I can create an operation by developing a scientific approach and then put spatial geometry from sculpture and art into the scientific database.”

Benevenia’s art and science have as their goal the replacement of bones, muscles, tendons and joints that have been so ravaged by cancer, or less frequently by trauma or infection, that they can no longer sustain their function as part of the human body’s framework.

“Orthopedics is a specialty that’s highly variable and demands flexibility,” he says. “You could go from working on a hand to a pelvis to a leg to a hip. And while the surgery requires great delicacy when working on soft tissues, you need the toughness and resilience of power tools when fixing bones.”

He feels that doctors should not be too overly specialized and narrow in their approach to surgery. “An understanding of all specialties is required in this field,” he contends.

“I’m a doctor first,” he states, “then I’m a surgeon, then an orthopedic surgeon, then a specialist in oncology.” He tells residents that there is a progression to their education for a reason and that all of their stepwise learning comes into consideration when treating a patient.

Benevenia points out that when you superimpose oncology on top of orthopedics, you get “layer upon layer” of complexity and intricacy that “calls upon a tremendous breadth of creativity to accomplish what the patient needs.”

What the patient most often needs is a surgeon who is a master rebuilder. That rebuilding could involve autografts (the patient’s own tissue from another part of the body), allografts (tissue from a bone bank), metals, plastics, ceramics, or most probably, a combination of some or all of these.

While restoring function and mobility are generally the goal of such surgeries, Benevenia says he is always driven to accomplish more. “Function is critical,” he admits, “but I think it’s a sterile measure of success.”

The surgeon says that he always looks at the results through his patients’ eyes. “It’s not a question of the physician being happy with the results. What matters is if the patient is happy when he looks in the mirror,” he states.

Those who have worked with him closely have described his ability to see beyond the disfigured body lying in front of him — to visualize what that arm or leg or hip could look like — as central to his success. And it is this extraordinary “gift” for visualizing in a three-dimensional space that allows him to be creative. “I tailor the reconstruction to the patient,” he says.

While using a person’s own healthy tissue (such as a fibula with its blood supply and cartilage) to replace what has been ravaged by disease (a wrist, for instance) is always preferable, Benevenia turns to the Musculoskeletal Transplant Foundation when an autograft is not possible. It is the largest nonprofit tissue bank in the U.S., says the surgeon who serves on its board of directors, and it’s located in New Jersey, but few people are aware of its existence.

Benevenia says that last year more than 200,000 individuals received allografts provided by the Foundation, 60 percent for spinal surgery and the other 40 percent for
orthopedic oncology, sports medicine and other hip and knee procedures.

Cancer’s destructive course in the body often demands more than autografts and allografts. Then the surgeon chooses from a rapidly expanding armamentarium of “hardware” and “software,” including novel materials such as tissue-engineered polymers and growth factors, customized modular implants designed jointly by implant engineers and surgeons, and even a new generation of expandable implants that “grow” with a child, making repeated surgeries to replace inert implants passé.

“You need to push the envelope to make progress,” Benevenia says. “This is what I always tell my students.”

“And then I say to them, ‘Don’t allow yourself to get pigeonholed or to give up if you seem to hit a wall. You need to be bold and creative. Muster all your courage and move things forward. Your patients are counting on you.’”