The fundamental question?
Dr. Quinn: “Ultimately, we want to know, ‘What project is the highest priority given our limited resources…and which would be most appealing to researchers? We need to look at what kinds of things that entities such as the National Institutes of Health (NIH) and the Department of Defense (DOD) are likely to fund. After much work, we provide a short list of options to OREF.”
“At this point, we have three potential projects. The first is a study examining the efficacy of biologics for the treatment of orthopedic diseases, with a particular focus on platelet rich plasma and growth factor injections for full-thickness rotator cuff tears and osteoarthritis of the knee. The second study will be a review of the existing clinical research on the effects of tobacco, vaping, and/or marijuana use on postoperative outcomes for total joint arthroplasty. The third proposed project is an examination of the effectiveness of antibiotic bone cement for the prevention of periprosthetic joint infections.”
Conflicts of Interest
“We take biases and any conflict of interest very seriously, from the manuscript submission to everyone who participates in the CPG [Clinical Practice Guidelines] process. As for industry, we may work with them if they approach us in the following manner: ‘We want to fund research on bone cement. We’ll give you $1 million and you decide how to funnel it. We are out of the process.’”
Looking Forward
Dr. Quinn and his team have submitted their suggestions to OREF and are now awaiting finalization of the list.
“Over the next 6-12 months I think we will have enough funding for one pilot project that will then hopefully attract other, matching funding. And we are fortunate that a lot of orthopedic surgeons donate to OREF and can earmark specific areas that they want to support.”
And sometimes Dr. Quinn has to make his colleagues take their medicine.
“I call the whole quality initiative or evidence-based medicine push the ‘eat your spinach’ directive. Most practitioners take offense a la, ‘How dare you use big data and other avenues to tell me how to practice medicine?’ I tell them, ‘Eat your spinach. It’s good for medicine and good for you if we can do it in a way that we end up following the best evidence.’ Many people forget that one of the biggest complaints orthopedic surgeons have is that our products don’t contain the highest levels of evidence.”
Kristy Weber: “This collaboration draws strength from OREF’s grant expertise and AAOS’ ability to identify clinical gaps and to market to the entire field. We were fortunate to have the input of Michael Parks, M.D., past president of OREF, who was critical to this process.”
Dr. Parks: “There are fundamental challenges facing orthopedic researchers, one of which is the extreme variations in treatments. Specifically, there are so many biologic treatments involving injections in the knee, stem cells and other formulations and they are being done by different types of healthcare providers. Another challenge is that patients frequently come in asking about the value of XYZ treatment and sometimes there is just not enough data to provide them with solid answers.”
The COVID-19 Wrench
“With the COVID-19 pandemic, the funding ‘pie’ has shrunk significantly,” states Dr. Parks. “Just as everything else in this country has been slowed down since March, our program will be slower to ramp up. However, there is a significant interest particularly among patients and caregivers to know more about biologics. Because of this high level of interest, people will donate and earmark those funds for this research.”
“OREF is grounded in the belief that it is well-researched knowledge that will advance orthopaedic practice,” said Richard F. Kyle, M.D., OREF president. “This collaboration with the AAOS will go a long way toward funding investigational grants that will catalyze research and help drive effective patient care.”
