Developments have roots in OREF-funded studies

In the past 50-plus years, the orthopaedic specialty has changed dramatically, with new techniques and innovations that advance not only the way orthopaedists practice, but also improve the lives of the patients they treat. With donor support from AAOS members and industry, the Orthopaedic Research and Education Foundation (OREF) has funded the beginnings of many of these advancements.

“Fundamental research has potential clinical implications,” said OREF grant recipient Harlan C. Amstutz, MD, of the University of California, Los Angeles (UCLA), who is best known for his work on total hip replacements and for founding the Joint Replacement Institute. “So many research activities have down-the-line implications for clinical practice and pave the way for advances in medicine and orthopaedic surgery. Without research, you don’t go anywhere.”

Treatment techniques
Research funded by OREF led to the discovery of growth factors that interact with one another, resulting in a new treatment technique for patients with skeletal growth deficiencies. OREF funding also led to hip prosthetics that are less likely to loosen once implanted, thus helping to reduce postoperative injury and the need for revision surgery.

“Research supported by OREF improves patient care by giving surgeons a better sense of key factors for stabilizing hip fractures and a better understanding of the effects of internal fixation and trauma,” said Marc F. Swiontkowski, MD, of the University of Minnesota. “OREF funding provided me with key resources to learn clinical and basic science research techniques, which have been the foundation of my academic career.”

Current projects funded by OREF may lead to additional discoveries that strengthen and improve orthopaedic techniques. Ongoing OREF-supported projects include research on biofactors that could lead to better tendon-to-bone healing and on improved scaffolds to ensure the durability of meniscus replacement.

“Many of the things I do every day seem to work in clinical practice, but I don’t really understand them,” said Cristin Ferguson, MD, of Wake Forest University Health Sciences, and the recipient of a 2007 OREF Clinician Scientist Award for her work on biologic meniscus replacement. “I’d like to understand why people tear their menisci. I’d like to understand why the meniscus wears out. Research allows me to ask these questions, and, over time, answer them. I think the ultimate goal is to expand our knowledge so we can better treat patients.”

All orthopaedic patients, especially those with spinal diseases and injuries, stand to benefit from a study that OREF clinician scientist Francis H. Shen, MD is conducting. Dr. Shen, of the University of Virginia Health System, is investigating the possibility that spine surgery might be replaced by injections that induce fusion with less pain and risk than traditional grafting.

“In our lab, everything we do contributes to improving the quality of life for our patients—and ourselves because we will all be patients one day, as will our kids and our grandkids,” said Dr. Shen. “That’s why the research that OREF funds is so important. Our profession—and our personal quality of life—depend on research.”

Cancer and its complications are also being addressed with OREF-supported studies on how to target the path of metastasizing kidney cancer to prevent it from entering and destroying bone.

“We are really just trying to make a small step forward in improving our patients’ lives. We’re tying to stop some of the suffering due to bone metastasis,” said Kristy L. Weber, MD, of Johns Hopkins. “The OREF/Zimmer award was one of the first grants I received for the bone metastasis research, which has become the main focus of our laboratory. Without that support, we wouldn’t be going forward as we are.”

Screens and monitors
Innovations in orthopaedics are not limited to treatment technique. Preventive improvements can be realized through screening and monitoring. The importance of monitoring the size of rotator cuff tears to prevent further damage and the need for repair techniques to strengthen the tendon and prevent further injury better than either arthroscopic or open methods were demonstrated with OREF-funded research.

Patients at risk for scoliosis may be able to learn how great their risk is and, if diagnosed, have therapy tailored to their individual situations. OREF-funded investigations contributing to the growing base of knowledge on scoliosis screening include studies by Nancy H. Miller, MD, who received a 2001 OREF Career Development Award and funding from the National Institutes of Health, and by Philip F. Giampietro, MD, PhD, and Cathleen L. Raggio, MD, who were supported by a 2007 OREF Research Grant.

“To be a better clinician, you need a foundation in orthopaedic research,” said Dr. Miller, of the University of Colorado. “Patients have become much more knowledgeable regarding their conditions and current research efforts. They are going to make choices, influenced by how much their surgeons know.”

Learning curve
Improvements in patient care also require that orthopaedists continue to learn new techniques from their peers. OREF funding helps enable this continuing education process.

An OREF educational grant provided funding for a searchable database containing the pathology of bone, cartilage, and soft-tissue diseases, giving orthopaedists information to help them make better treatment decisions.

“It really is necessary to understand the nature, the character of, and the possible problems that can arise from a disease,” said Henry J. Mankin, MD, of Harvard Medical School and Massachusetts General Hospital. Dr. Mankin received an OREF educational grant to develop a computerized orthopaedic pathophysiologic teaching system. “What I want is something that is logical and sensible for people to use for education and research. If physicians who care for patients with connective tissue disorders know more about the disease, the patients will live better and longer.”

Above and beyond
Best practices have also emerged from OREF-funded projects. OREF-funded research led to new legislation that improved coding changes to increase reimbursement for total joint revisions. Laminar air-flow became standard practice in operating rooms, in part because of research funded by OREF.

“The OREF grant was one of the first we received and a catalyst that allowed us to begin to assess the reduction of organisms in the operating room following installation of a laminar flow system,” Dr. Amstutz explained. “This study proved that laminar flow was a step toward eliminating intraoperative infections.”

For more information on OREF, visit www.oref.org or contact Ed Hoover, vice president, development at hoover@oref.org or (847) 384-4354.

Amy Kile, OREF publications manager, can be reached at kile@oref.org