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Pain Meds and Hearing Loss in Women; Houston Methodist’s New Biomechanics Lab; Implant Corrosion Update

Elizabeth Hofheinz, M.P.H., M.Ed. • Wed, January 4th, 2017

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Extended Use of Pain Meds Associated With Hearing Loss in Women

Could the familiar medications ibuprofen and acetaminophen be having yet another drawback? Yes, says new work appearing in the December 14, 2016 edition of the American Journal of Epidemiology. The research, which involved more than 54, 000 women in the Nurses’ Health Study, was led by scientists from Brigham and Women's Hospital. The scientists found that women who use pain relievers for an extended amount of time are at risk for a higher risk of hearing loss.

"Hearing loss is extremely common in the United States and can have a profound impact on quality of life, " said senior author Gary Curhan, M.D., S.C.D., a physician in the Channing Division of Network Medicine at Brigham and Women's Hospital, in the article. "Finding modifiable risk factors could help us identify ways to lower risk before hearing loss begins and slow progression in those with hearing loss."

First author Brian Min-Hann Lin, M.D. told OTW, “Hearing loss is common among U.S. adults and is associated with decreased quality of life. Despite this, there are limited prospective studies on potential modifiable risk factors for hearing loss. We are interested in identifying potential modifiable risk factors for hearing loss, which includes over the counter analgesics.”

“We found that there is an increased risk of hearing loss with regular acetaminophen and regular NSAID [nonsteroidal anti-inflammatory drugs] use. We suggest that people who are taking these medications regularly have a discussion with their care provider to see if they need to be taking these medications.”

Houston Methodist: New Orthopedics Biomechanics Research Laboratory

Houston Methodist Orthopedics & Sports Medicine and Biomechanical Environments Laboratory at Texas A&M University has opened a new laboratory designed to advance orthopedics research from the bench to the bedside. The initiative is known as the Orthopedic Biomechanics Research Laboratory (OBRL).

Kevin Varner, M.D., chair of Houston Methodist Department of Orthopedics & Sports Medicine, told OTW, “When I became chairman of the Department of Orthopedics & Sports Medicine, it became clear to me that we needed to bring more of our research collaborations in-house to increase involvement from our physicians and have closer working ties between them and our scientists.”

Michael Moreno, Ph.D. is a Texas A&M assistant professor of mechanical and biomedical engineering and Houston Methodist Orthopedics & Sports Medicine director of biomechanics research and engineering. He commented to OTW, “Following a successful collaboration on a project with members of the Houston Methodist Research Institute, I had the opportunity to meet Kevin Varner, M.D., chair of the Houston Methodist Department of Orthopedics & Sports Medicine, in 2014.”

“Our meeting was timed well, as Dr. Varner was working to develop a robust research program that included engineering expertise. We believe that multidisciplinary research teams are the key driving force behind the current technological revolution. Engineers possess the means and expertise to design devices and technologies that perform critical functions, whereas clinicians and surgeons possess the unique insight necessary to define the functions that must be performed.”

“For biomedical engineers, working closely with clinicians and surgeons provides a wealth of opportunity to develop novel technologies that solve important problems in medicine. For the clinicians and surgeons, working with engineers provides a means to realize their ideas and substantively advance the quality of care that can be provided.”

Patrick C. McCulloch, M.D., John S. Dunn Chair of Orthopedic Surgery Research at Houston Methodist Hospital added, “While the Texas Medical Center is the largest in the world and is a center for medical care and research, Houston Methodist is unique in that we have partnered with a famous engineering school in Texas A&M University to create a world-class orthopedic biomechanics laboratory.”

“Having surgeons, engineers, exercise physiologists and physical therapists working together will lead to greater innovation and translate to improved care for our patients as we pursue a wide range of research in orthopedics and sports medicine including: medical device design and performance; surgical tool design; post-operative clinical outcomes; human performance; multi-scale biomechanical analysis; and cell, tissue, organ, and whole body biomechanics.”

“Each member of our team approaches the research from their unique perspective—biomechanical, clinical, physiological, surgical, engineering—not many research teams have such varied areas of expertise.”

Asked about the equipment, Bradley S. Lambert, Ph.D., Houston Methodist Orthopedics & Sports Medicine director of human subjects research and Texas A&M TEES [Texas A&M Engineering Experiment Station] research scientist told OTW, “One key advantage of pursuing the OBRL as a collaborative venture between Houston Methodist and Texas A&M was the access to Texas A&M’s existing biomedical research infrastructure, including a wide range of mechanical testing devices and the capabilities to design new types of technologies for almost any mechanical testing situation. This allowed for the OBRL facility at Houston Methodist to focus on clinical and human subject research and acquiring equipment that would be compatible with and complementary to the equipment already available in Dr. Moreno’s Texas A&M lab.”

“Some items from the first round of acquisitions included: 12 camera Motion Analysis System for biomechanical analysis of human movement patterns and muscle activation, Vicon motion capture system, 16 channel Myon wireless EMG, and four AMTI 2kN force plates.”

Joshua Harris, M.D., a Houston Methodist orthopedic surgeon, added, “The Gait Lab is an important part of the OBRL and has phenomenal capabilities. We now have the capability to perform enhanced evaluations of certain types of athletes and dancers using motion capture force plates and DEXA [dual-energy x-ray absorptiometry]. We can evaluate particularly complex motions to analyze for injury risk factors, performance improvement areas, and to evaluate the effectiveness of various rehab strategies should they get injured.”

“Recently completed and ongoing studies are looking at clinical pain assessment; effect of a physical therapist’s experience on designing treatment programs; functional effects and physiology of new therapies and treatments; biomechanical and physiological analysis of dance and sports movements in various professional and collegiate team sports, fitness sports and dance; and 3D printing technology to aid in surgical management. We have several studies challenging current concepts regarding clinical outcomes.”

Rush Advancing Joint Failure Analysis With First-in-U.S. Technology

Patients who suffer from arthritis and must undergo joint replacement surgery would prefer that their implants last.

While in the vast majority of cases this is not a problem, says Robin Pourzal, Ph.D., a materials scientist in the Department of Orthopedic Surgery at Rush University Medical Center, the issue of corrosion raises its ugly head enough times to be a real problem. Dr. Pourzal told OTW, “Joint replacement is generally considered to be a slam dunk.”

“Given the high volume of these surgeries, corrosion is a problem in approximately 2-3% of cases. This means that there are approximately 4, 000 patients in the U.S. per year who deal with the effects of this complication—sometimes that means pain, swelling, and eventual revision surgery.”

Dr. Pourzal, who is impressed with the multidisciplinary aspect of the research being conducted at Rush, indicates that he and his colleagues can take advantage of a unique combination of expertise in several relevant fields, the availability of advanced material testing and characterization tools, as well as close collaboration with clinicians. “Tackling this problem at Rush means that we can do so from several angles: clinicians, research engineers, and biologists have come together to solve this problem of corrosion. If we only focus on one aspect of the problem, then we won’t solve it.”

To that end, Dr. Pourzal and his colleagues have undertaken a retrospective study of nearly 500 retrieved implants. “Because corrosion is not often recognized as the cause for revision, we do not have much published information on implant failures due to corrosion. We have known since the late ’80s that corrosion can be a problem. However, there have been other problems with joint replacement since then such as polyethylene wear.”

“Many of these problems have been addressed with great success thanks to the efforts of the orthopedic research community, so now we are focusing on corrosion. Interestingly, corrosion is often misdiagnosed as inflammation or infection. Thus, often surgeons may see a problem and do an intervention but don’t necessarily know how to diagnose it as corrosion-related.”

“One of my Rush colleagues, Craig Della Valle, M.D., is looking into the clinical aspects of how biomarkers determine corrosion. The goal is to be able to diagnose the patient before doing the intervention. He is studying blood samples from revision patients with elevated levels of metal ions. His aim is to determine what metal ion level would indicate whether a patient was at risk of corrosion-induced failure.”

“The question for research is, ‘Why is corrosion happening in the first place?’ Along with my colleagues Drs. Hannah J. Lundberg and Mathew T. Mathew, we recently received a substantial grant from the National Institutes of Health and we already made the interesting observation that there are inconsistencies in implant alloys that impact how these materials degrade. These alloys are standardized by the American Society for Testing Materials, but each manufacturer has different processes in terms of the thermos-mechanical treatment. Our hope is that we can create some awareness and that maybe in the long run contribute to the improvement of these standards.”

“We are fortunate to have a new technology known as The OrthoLux 5. This unique coordinate measuring machine is one of only a few in the United States. It allows us—in under 10 minutes—to make digital 3D copies of the joint surface and evaluate how much material has been removed. Most importantly, we can image the damaged areas and then determine what mechanisms led to the degradation. Then, we can correlate the findings to specific implant design features, implant alloy metallurgy, surgical alignment, and patient factors (such as body mass index, gender, activity level). Then we can make recommendations to implant manufacturers and to surgeons about how to prevent corrosion.”

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