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(L to R): Scott Wolfe, M.D., Hospital for Special Surgery, Robin Queen, Ph.D., Virginia Tech, Henrik Malchau, M.D., Ph.D., Harvard Medical School, and Matthew Dobbs, M.D., Washington University in St. Louis

Musculoskeletal Research: The Kappa Delta/OREF Awards

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, April 18th, 2017

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This year’s recipients of the prestigious Kappa Delta Sorority and the Orthopaedic Research and Education Foundation (OREF) awards have been announced. The awards shine a light on the complexity of the wrist joint, the gait mechanics of the ankle, personalized medicine for clubfoot, and impact of global arthroplasty implant registries. The awards were presented at the recent annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).

The 2017 Kappa Delta Elizabeth Winston Lanier Award was presented to Scott W. Wolfe, M.D., chief emeritus of hand surgery and attending orthopedic surgeon at the Hospital for Special Surgery (HSS) in New York City, for his research titled "Kinematics of the normal and injured wrist: the importance of the midcarpal joint." The research was co-authored by Joseph J. (Trey) Crisco, III, Ph.D., Henry F. Lippitt professor of orthopaedics and professor of Engineering (Research) at Brown University.

Dr. Wolfe commented to OTW, “The list of prior Kappa Delta award recipients is staggering—a virtual ‘who’s who’ of orthopedic giants who have built the foundations of scientific knowledge upon which all current clinical practice is built. While always a dream of ours, winning the Kappa Delta award seemed unattainable. Receiving this award is a validation of the importance of our work to the greater orthopedic community, to orthopedic science, and most importantly, to our orthopedic patients. More importantly, this award represents an enormous incentive to press on, to think outside of the current boundaries of clinical care and to reach higher, towards innovative solutions to help patients with debilitating wrist arthritis.”

Dr. Crisco told OTW, “The wrist is arguably the most complex joint in the human body, capable of moving in multiple directions and throughout a nearly hemispherical range of motion. Made up of eight oddly-shaped small bones whose motion is coordinated by dozens of surrounding ligaments, wrist motion can be broadly described in terms of microkinematics—that describe the motion of each individual bone—or macrokinematics—that describe the motion of the whole wrist, as the hand moves in relation to the forearm.”

“From the outset of our work together, our goal has been to measure—for the first time ever—the micro- and macrokinematics of the wrist in motion, that is, in live subjects, in three dimensions and during the performance of functional activities. The barriers to this were enormous, and required complex computer algorithms and customized software, as live motion analysis in the upper extremity had never been accomplished. Our pioneering efforts adapted existing computer software that was developed to track and identify high-speed military aircraft as they approached U.S. airspace and combined it with newly developed software that was used to track the beating heart!”

“After tackling the ability to independently identify and measure each carpal bone, we were poised to attempt macrokinematics during functional activities. Using 10 high-speed cameras in the HSS Leon Root motion analysis laboratory, we adapted techniques used in the gait laboratory to the wrist to successfully reach our goal. In 2014, we published the first of several scientific manuscripts that described wrist motion during eight common household, recreational and occupational tasks, including pouring from a pitcher, throwing a baseball, hammering, and throwing a dart. The future of non-invasive motion analysis is even brighter—we are now on the threshold of high-speed analysis of both microkinematics and macrokinematics, simultaneously using state-of-the-art techniques at Brown University’s biplanar radiography laboratory.”

“This has the capability of comparing the uninjured wrist to the surgically reconstructed wrist, and even a wrist replaced with a prosthetic arthroplasty. For the future, we have already applied for funding from the National Institutes of Health to design, build and implant an instrumented total wrist arthroplasty, which has the capability of transmitting live motion and load-transmission data from within the patient’s wrist during normal and sporting activities, with the goal of building more durable solutions to wrist arthritis—a condition that affects an estimated 4.8 million people in the United States alone.”

The 2017 Kappa Delta Young Investigator Award was presented to Robin Queen, Ph.D., F.A.C.S.M., associate professor of biomedical engineering and mechanics at Virginia Tech in Blacksburg, Virginia, and associate professor of orthopedic surgery at Virginia Tech Carilion School of Medicine for her research on the impact of ankle osteoarthritis and total ankle replacement on gait mechanics and balance.

Dr. Queen told OTW, “In order for surgeons to begin to take a more holistic approach to treatment and recovery we as researchers need to provide evidence and justification that will demonstrate the short and long-term benefits to patients. We have to be able to demonstrate to the surgeons that using a more holistic approach to treatment and care that their patients have improved patient reported outcomes and satisfaction as well as improved long-term joint function and mobility.”

“This award is a culmination of a decade of work in a patient population that is understudied and a validation that the work I have been doing is high quality and impactful. The recognition has given me a renewed sense of purpose to continue working to improve the lives of patients through research and integration of these findings into clinical care.”

The 2017 Kappa Delta Ann Doner Vaughn Award was presented to Matthew Dobbs, M.D., for his research on advancing personalized medicine for clubfoot. Dr. Dobbs is the Dr. Asa C. and Mrs. Dorothy W. Jones professor of orthopedic surgery at Washington University in St. Louis. The research was co-authored by Christina Gurnett, M.D., Ph.D., professor Department of Neurology and Division of Pediatric Neurology at Washington University School of Medicine.

Dr. Dobbs commented to OTW, “Winning the Kappa Delta Award is special in the sense that it validates my clubfoot research efforts over the years. It is a true honor to be recognized by my peers as this award is truly considered the ‘Nobel Prize’ of orthopedics.”

We asked Dr. Dobbs about the challenges in developing this algorithm and he told us, “Investigating the etiology of clubfoot while at the same time improving the clinical management of clubfoot posed many challenges. Our research has led to the discovery of the first genes for isolated clubfoot and based on these genetic findings we are developing personalized treatment strategies for patients with clubfoot. This is important as all clubfeet are not the same and therefore different approaches are necessary for better treatment outcomes.”

“We were also able to modify the Ponseti Method of clubfoot casting to successfully treat clubfoot patients with associated neuromuscular disorders as well as older patients who had received no treatment or who were treated previously with surgery. Successful treatment with this minimally invasive approach avoids the need for more extensive surgery and provides better long-term outcomes.”

“Another milestone in our clubfoot research was publishing the negative long-term effects of more extensive surgery on clubfoot patients in terms of foot function and pain. This led to the widespread adoption of the Ponseti Method of clubfoot casting.”

The 2017 OREF Clinical Research Award was presented to Henrik Malchau, M.D., Ph.D., professor of orthopedics at Harvard Medical School and vice chief orthopedics and co-director of the Harris Orthopaedic Laboratory Massachusetts General Hospital in Boston for his research on the impact of arthroplasty implant registries throughout the world. The research was co-authored by Daniel Berry, M.D.; Charles Bragdon, Ph.D.; Göran Garellick, M.D., Ph.D.; William H. Harris, M.D., Sc.D.; Peter Herberts, M.D., Ph.D.; Johan Kärrholm, M.D., Ph.D.; David Lewallen, M.D.; Lars Lidgren, M.D., Ph.D.; and Otto Robertson, M.D., Ph.D.

Dr. Lidgren told OTW, “This award is a recognition of successful research by groups in Sweden and U.S., which I am proud to be part of, publishing 1,800 per reviewed studies over 5 decades with the overall goal to improve the outcome of joint replacements.”

Dr. Berry commented to OTW, “The award is a terrific acknowledgement of the role National and Institutional Joint registries have played over the last 30 years in moving the field of joint replacement forward. During that time joint replacement has moved from a new procedure with much potential to a much more mature procedure with a very high rate of success and reliability. The data provided by Joint Registries has been instrumental to the iterative cycle of improvements that have characterized, and continue to characterize, joint replacement.

When we asked Dr. Berry about his other, related work, he added, “We will continue to use existing Joint Registries to identify the most successful implants and the most successful techniques, and also to identify unexpected problems. Increasingly, joint registries collect comorbidity data and patient reported outcomes and can report these back to stakeholders to allow them to use risk adjusted data to compare outcomes, make modifications in practice where appropriate, and thereby further improve operative outcomes.”

“The United States is now fortunate to have its own national joint registry, the American Joint Replacement Registry (AJRR), which just entered its one millionth joint replacement. As more and more U.S. hospitals and surgeons join the AJRR and enter their data, we will increasingly have a comprehensive system that identifies most successful implants used in North America, identifies best operative and perioperative practices in North America, provides feedback to users, and serves as a trip wire to identify unexpected problems as early as possible when they arise.”

Co-author William Harris, M.D. told OTW, “Clearly, the recognition of all the work of all the authors as well as the inherent recognition of all registry efforts by others is a welcome acceptance of these critical endeavors.”

“However, far more important is the message to the entire orthopedic community of how valuable registry data have been and will be in the progress of total joint surgery. It is only through registry type data that further improvements can be documented, and indeed also further distinction can be made between just change and true progress. All innovative ideas are best evaluated both rapidly and thoroughly, across age groups and disease types as well as across national and cultural differences by grouping big data, i.e., registry data.”

“Our program is deeply committed to assessing both past failures, such as the metal on metal experience, and future possible major advances, such as the ability to deliver antibiotics from polyethylene, pain medicine from polyethylene and further innovative materials and design concepts for total joint surgery.”

In its March 16, 2017 news release, Kappa Delta said, “In 1947, at its golden anniversary, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopedic research. The first annual award, a single stipend of $1,000, was made available to the Academy in 1949 and presented at the AAOS meeting in 1950. The Kappa Delta Awards have been presented by the Academy to persons who have performed research in orthopaedic surgery that is of high significance and impact.”

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