Cornstarch and Volcanic Ash=Orthopedic Healing?
While it sounds like something a 7-year-old might concoct from the fridge and the playground, a new plastic just might help in healing orthopedic injuries. Researchers from Beaumont Health in Royal Oaks, Michigan, have put together a new material made of cornstarch and a volcanic ash compound (Montmorillonite clay). Kevin Baker, Ph.D., director of the Beaumont Orthopaedic Research Laboratories, worked on the study with Rangaramanujam Kannan, Ph.D. of Johns Hopkins University. Dr. Baker tells OTW, “The idea for this project actually began as a conversation between our late chairman—Harry Herkowitz, M.D.—and me regarding the need for a synthetic graft material that could replace the use of autologous iliac crest bone graft. The material needed to be highly porous like native bone, but also be able to withstand significant biomechanical loading. Dr. Kannan (then at Wayne State) was leading the field in the development of polymer nanocomposites for primarily non-medical applications. We discussed the project with Dr. Kannan and he felt that his supercritical CO2 processing would be an excellent match.”
“We started the initial work in 2007 and found that we were able to significantly increase the compressive strength of resorbable polymers (poly-d-lactide) by adding organically-modified Montmorillonite clay and processing the mixture in supercritical CO2. So we ended up with a synthetic, resorbable construct that looked like bone and behaved mechanically like bone. And it dissolves in the body within 18 months.”
The material is still in the research phase, say the researchers, and likely won’t be available to patients for several years. “It’s always important to know the limitations of the material. First of all, we are still quite a ways away from seeing this in human patients. There is a strict FDA pipeline for this type of technology, though we are using constituents that have FDA approval for other uses (PDLA [polylactic acid] is an approved polymer used in medical applications; Montmorillonite clay is used in pharmaceutical and cosmetic applications). Second, we believe that the supercritical CO2 process will allow for the incorporation of growth factors and small osteoinductive molecules which can be slowly released from the constructs upon implantation. Most other porous polymer technology relies on the use of volatile organic solvents which have the ability to denature proteins, and stimulate an inflammatory response. Since we are using CO2 for processing, we avoid these issues.”
“We were fortunate that the translational aspects of our research were funded by a Seed/Starter research grant from the Cervical Spine Research Society. And to honor Dr. Herkowitz, we have dedicated the manuscript to him.”
SF-36 MCS Does Not Predict Functional Outcome After Ankle Arthritis Surgery
Does mental health status point towards certain outcomes after surgery for ankle arthritis? A team of American and Canadian researchers wanted to find out. Stephen Kennedy, M.D. is a hand and upper extremity surgeon in the Department of Orthopaedics and Sports Medicine at the University of Washington in Seattle. He tells OTW, “This study was prompted by discussions at orthopedic grand rounds about the role of psychosocial factors on outcomes in orthopedics. Researchers and health care organizations are increasingly demonstrating that psychological factors like depression and anxiety can predict functional outcome after surgery. For example, the World Health Organization has found that depression better predicts general health status than angina, asthma, diabetes, or arthritis. We were interested in whether there was an effect on ankle osteoarthritis surgery.”
The researchers gathered preoperative and postoperative patient scores on the SF-36 MCS and Ankle Osteoarthritis Scale questionnaires from the Canadian Orthopaedic Foot and Ankle Society (COFAS) End-Stage Ankle Arthritis Database. “We reviewed 337 surgeries (95 arthrodesis and 242 arthroplasties) and found, surprisingly, that the pre-operative SF-36 MCS doesn’t actually predict functional outcome after surgery for ankle arthrodesis or arthroplasty, at least not at the two-year mark or the five-year mark. Based on the existing literature in other areas supporting a link, we thought there might be an effect. However, although depression, anxiety, and other factors can have an impact on function, pain, and wellbeing, this impact may dissipate with time after the underlying biomedical problem improves. It probably effects how patients perceive pain and function in the present, but may not be as helpful at predicting the future response to medical treatments. In the long run, the benefits of ankle arthroplasty or arthrodesis surgery, as measured by Ankle Osteoarthritis Scale, are not limited by the pre-operative MCS.”
“For the day-to-day work of orthopedic surgeons, this means that mental health scores may not be helpful in determining whether a patient will benefit from either ankle arthrodesis or ankle arthroplasty. It may influence their experience of their osteoarthritis, or coping around the time of the actual surgery, but it likely has little or no effect on the long term benefit of the surgical procedure. Of course, there are limitations to the study, and more studies are needed. Future studies will need to be prospective, use better validated measures of psychosocial factors, and have a design that follows patients through multiple time points in their recovery.”
John Feagin, Jr., M.D. Wins Dr. Ernst Jokl Sports Medicine Award
Dr. John A. Feagin, Jr. has been honored with the 2015 Dr. Ernst Jokl Sports Medicine Award by the United States Sports Academy. A former West Point athlete who was commissioned to the Artillery Branch of the U.S. Army, John Feagin rose to become a peerless leader in the field of sports medicine. The award Dr. Feagin is receiving is named for Ernst Jokl, M.D., a former Olympic athlete, international sports medicine scholar and Director of the University of Kentucky Rehabilitation Center.
Following graduation from Duke University in 1961, Dr. Feagin returned to active duty, and then began a residency at Walter Reed Army Medical Center. He would go on to participate in the founding of a number of orthopedic organizations, including the Society of Military Orthopaedic Surgeons, the American Orthopaedic Society of Sports Medicine, and the International Society of Knee Surgery and Arthroscopy.
Later on, Dr. Feagin returned to Duke University, and spent 10 years leading and following his own personal star of excellence. Over the years he has worked closely with Blue Devils basketball coach Mike Krzyzewski, and became team physician. Dr. Feagin gave so much to the university that Duke’s Sports Medicine Leadership Program is named after him.
Asked what this honor means to him, Dr. Feagin told OTW, “I met Dr. Jokl one time. He was a giant of a man. I learned of his life’s work, reputation and accomplishments from his son Dr. Peter Jokl an orthopaedic colleague on the faculty at Yale. That was early in my sports medicine career and it gave me a sense of what could be accomplished even in the face of adversity. To be honored for contributions to Sports Medicine by the U.S. Sports Academy, in the name of Dr. Jokl, makes the work of a career especially meaningful.”
Asked about the most important areas being explored in sports medicine, Dr. Feagin told OTW, “The STOP program instituted by Dr. Andrews and the American Orthopaedic Society for Sports Medicine is our most important work because it emphasizes prevention of injury early in sports. The concussion work is also important. A review of rule change opportunities in the collision sports at the level and with the import that President Theodore Roosevelt accomplished many decades ago is a must. The game has changed and so must the rules.
“Lastly, the value of sports to our country, to the family and individually needs to be revisited. The work of Dr. Bruce Ogilvie, a sports psychologist at San Jose State, was seminal and every parent should have a grasp of what sports can mean in a young life. The good and the not so good, and the critical role of coaching the young athlete.”
“The role of sports and sports as a business has grown exponentially in my lifetime. The leadership requisite to this development in business, on the field, philosophically and physiologically is critical if we are to preserve the values we knew and believed. Coach Krzyzewski is a great example of what that leadership can accomplish. The U.S. Sports Academy is a degree-granting institution with the same commitment as our Duke Leadership Program.”
