Many Swedes have left their mark on science, and you can now add Dr. Mathias Bostrom to the list. Born in Sweden, Dr. Bostrom, now a hip and knee specialist at Hospital for Special Surgery (HSS) in New York, was raised in the Virginia suburbs of Washington, D.C. “Being first generation immigrants, my parents held education in high regard and stressed hard work. My dad, an economist with the World Bank, would always say, ‘There are a lot of opportunities in this country; once you have an education you can do whatever you want.’ My mom stayed at home to help ensure that I made the most of those opportunities.”
Yet another set of watchful eyes helped keep a young Mathias Bostrom on the right path.
Whenever I walked into my ninth grade science class, I was met with an unusually qualified instructor…an NIH researcher. As you can imagine, he was intellectually rigorous and didn’t tolerate sloppy thinking.
Before jumping into the medical school applicant pool, Mathias Bostrom dove into another kind of pool. “I attended the University of Virginia, where I was a physics major and swam competitively. Being involved in such a focused, goal oriented activity was powerful, and helped focus my thinking about other areas of my life.”
Finding Perfection in Orthopedics
On the early admissions track at Johns Hopkins Medical School, the soon-to-be Dr. Bostrom had a bit of flexibility on his hands. “Because I was admitted to Hopkins in my third year of college, I was fortunate to have the freedom to pursue other avenues and indulged my interests in music and art history. When I arrived at medical school and saw all of the options, I just wasn’t sure which specialty to select. While I considered cardiothoracic surgery, once I did my orthopedic rotation and they let me put a screw in a fractured ankle in the middle of the night, I thought, ‘I can actually make a living doing this?’”
With his heart set on orthopedics, he looked for a school where hazing wasn’t part of the daily ritual. “I completed medical school in 1989 and thought that I would remain at Hopkins or go to the University of Pennsylvania. I had never seriously considered New York, but when I interviewed at HSS, I was hit over the head with all they had to offer. Not only was there this critical mass of people doing cutting edge work, but I could see that the facility had a humanistic approach to education, meaning that there was no ‘let’s beat up the residents mentality.’”
But those not interested in perfection need not apply. “During my HSS residency I spent a year in the lab with Dr. Joseph Lane, a true gentleman and an incredible thinker. He was doing work in the emerging field of healing bone with BMPs…I was at the right place at the right time. I got to learn from a master. He also gave me the wisdom to see that if something is going very well, I should ride the wave because those are the things that change the field. Indeed, this work is the basis of what I do now, i.e., the biology of bone healing and trying to achieve improved osseointegration for implants. Another guiding light for me was Dr. Eduardo Salvati, a superb technical surgeon who was constantly on a quest to do the operation perfectly. He would say, ‘OK isn’t good enough.’”
Able to meet the standards of a perfectionist mentor, Dr. Bostrom stayed on at HSS. “I undertook an arthroplasy fellowship with Dr. Salvati, and was then asked to remain on staff. Much of my time over the next four years was spent in the lab, where I continued to work with BMPs and other systemic agents that could potentially improve bone healing.”
And he found growing into a “real” orthopedist was unnerving at times. Dr. Bostrom:
During the first couple of years in practice, you develop a profound respect for what you don’t know. I recall some tough revision cases my first couple of years, some of which were in the middle of the night when there was no backup.
Building His Own Practice
But those must have been good practice because Dr. Bostrom has developed a thriving arthroplasy practice with a specialization in complex revisions. “The most difficult surgeries are around the hip joint on the acetabular side where a good part of the pelvis is gone…and once you get to your fifth or sixth revision there is not a lot of bone to work with. Also dicey is when there is an infection and/or when the patient is immunocompromised, has diabetes, etc. And sometimes we can’t fix them perfectly, and we’re just happy to have saved a leg and saved a life.”
“Some of the most exciting situations, ” says Dr. Bostrom, “involve big acetabular cases or those where we must replace the entire femur with metal and perform a total knee and hip replacement all at the same time. Those are fun in part because we often do custom implants on the socket side and then a total femur…we have suddenly recreated half of the patient’s leg.”
Researching Bone Biology
Dr. Bostrom is good at creating…now if he can just get bone and metal to cooperate. “My primary research focus at present is how to enhance the healing of bone to metal implants, especially in the knee. Most hip replacements are done without cement, but during knee replacements, we still use cement. If we can get the implant to osseointegrate then we can increase the likelihood that the implant will last longer.”
Yes, he said, “if.” “The primary obstacle to osseointegration is the quality of the bone. We are trying to understand when bone is compromised, how we can get implants to heal in quickly and stay strong. This is where there is an overlap between the world of metabolic bone, osteoporosis and orthopedics. There are a lot of very interesting compounds available, many of which can be used to get bone to heal into implants.
“My colleagues and I now have a rabbit model where we are looking at osseointegration in a loading environment—as opposed to in a smaller animal that doesn’t come close to human anatomy. One thing we are seeing is that we can use Forteo, a parathyroid hormone, to dramatically increase the healing of the implant to the bone. In the foreseeable future this could be used in clinical settings to improve implant fixation. In the end, it’s all about what the body is ready to do…once you get integration then the patient’s normal biology has to kick in.”
Looking forward, Dr. Bostrom notes, “I see major strides in osseointegration over the next five to ten years. I predict that we will move away from metal implants and will be much more precise in terms of what kind of weight bearing and loading we’ll subject a limb to. The number of knee replacements is expanding exponentially and that won’t slow down regardless of what happens with healthcare. While at present we don’t have the right surfaces, designs or biology to achieve proper osseointegration, we are on the right track.”
To stay on that track, funds are needed. Dr. Bostrom: “I would like legislators to understand that we must know more about the biology around the joint. More funding for research means that we can get more people mobile and pain free—and their care will be less expensive. We have a long way to go in terms in understanding how to get artificial joints to function perfectly. The same can be said of what it will take to finally ‘convert’ from metal to biological joints. This is where the research funding should go.”
Teaching Future Orthopedists
Hanging onto his every word about these and other matters are the HSS residents. Dr. Bostrom, once honored with the Philip D. Wilson, Jr. Teaching award, now runs the residency program. “Our goal and obligation is to ensure that the next generation of doctors is better trained than we were. I try to take a humanistic approach, meaning that while they need to work hard in training, they also have a lot of support and resources.
“One of the things we have done is instead of having shift breaks, physicians assistants (PAs) having been coming in at night so that our residents only need to spend two nights a week at the hospital. The most important part of leading a fellowship is teaching by example. If you round and see patients every day, then they see that as the appropriate way to care for patients. On the other hand, if you let your PA round for you, that hidden message is not lost on the residents.”
So he does it all—well, most of it—himself. And when Dr. Bostrom needs a bit of repose, he picks up some rocks. “My whole family loves the beach. My wife of 20 years, along with our two children, enjoy going sailing and taking in the scenery. Because sailing is my passion and my escape, I have a little boat that I tinker around with. In the summer I head to the boat, get a cup of tea, spread out my grant papers, and throw some rocks in the water. This time enables me to look at the big picture issues as opposed to the day to day challenges of keeping my desk clear of paper. For example, I consider ways to improve myself as a surgeon, ponder the fundamental biology of hip arthritis, ask myself if we are doing right by our younger patients who get hip resurfacing, etc.”
