Marc Swiontkowski, M.D., a professor in the Department of Orthopedic Surgery at the University of Minnesota Medical School, has been honored with the 2020 Kappa Delta Ann Doner Vaughn Award from The American Academy of Orthopaedic Surgeons (AAOS). The award was announced as part of the Academy’s virtual annual meeting experience. Dr. Swiontkowski has received this award “…for his research in the operative management of hip fractures, which identified the optimal surgical approach. The Kappa Delta Awards recognize research in musculoskeletal disease or injury with great potential to advance patient care.”
In 2008, Dr. Swiontkowski, principal investigator Mohit Bhandari, M.D. and their colleagues turned their attention to a common orthopedic problem—femoral neck fractures. Their efforts gained traction, over time expanding to include more than 366 orthopedic surgeons from 81 facilities in 8 countries. Their project was given the title, “Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH).”
Dr. Swiontkowski told OTW, “While internal fixation is the standard of care for undisplaced fractures, there are serious potential complications, including avascular necrosis, early implant failure and nonunion. Such difficulties often result in revision procedures and may frequently involve high morbidity and mortality.”
As FAITH progressed, the researchers saw that a particular type of device was promising. “Our early data indicated that cancellous screws did a better job of preserving blood supply and sliding hip screws featured improved biomechanical stability,” said Dr. Swiontkowski to OTW.
Their work continued and in 2017 the team published a study on patients with low-energy hip fractures, comparing the effectiveness of a sliding hip screw versus cancellous screws on the risk of reoperation and other key outcomes.
“We found absolutely no benefit to the sliding hip screw in terms of reoperation at 24 months for both displaced and non-displaced fractures,” stated Dr. Swiontkowski. “Avascular necrosis was more common in the sliding hip screw group than in cancellous screws group (9% vs. 5%, respectively). While overall, we found no real impact of comorbidities, smokers and patients with displaced fractures or fractures at the base of the femoral neck had better outcomes with a sliding hip screw.”
Pointing to the power of numbers, Dr. Swiontkowski noted, “In standard cohort studies, people hold to their biases. However, with a large trial such as FAITH, the truth emerges.”
“Multiple screws should be reserved for a truly undisplaced fracture,” said Dr. Swiontkowski. “For all other fractures not being addressed with arthroplasty, a sliding hip screw is in order.”
Also noteworthy was the team’s December 2019 publication in which they compared patient outcomes between hemiarthroplasty and total hip arthroplasty (THA) for displaced femoral neck fractures (1,495 patients). Called the HEALTH trial, (hip fracture evaluation with alternatives of total hip arthroplasty versus hemiarthroplasty), the study revealed that among patients with displaced femoral neck fractures, revision procedures between those randomly assigned to the THA group and those in the hemiarthroplasty group did not differ significantly.
If 1,495 patients are excellent, then 3,000 patients are superb. “Going forward, we will utilize the award funding to pursue an even larger, international cohort study that includes 3,000 subjects in each treatment category. We will compare the best implant approach for fixation of femoral neck fractures with the best arthroplasty approach. To date we have been contacted by centers in China and India that would like to participate. Our goal is to conduct the research as efficiently as possible so that in the meantime, other things involved with treating patients don’t change.”
Dr. Swiontkowski, orthopedic department chair at the University of Minnesota Medical School from 1997–2007, was previously awarded the Orthopaedic Research and Education Foundation (OREF) Clinical Research Award in 1997 for the development of a musculoskeletal extremity health status instrument; the 2003 Kappa Delta Ann Doner Vaughn Award for the study of limb salvage or amputation after severe lower extremity trauma; and the OREF Clinical Research Award in 2010 for research titled “Setting a New Benchmark for Collaborative Trials in Trauma: The Rationale, Design, and Execution of the Study to Prospectively Evaluate Intramedullary Nails in Tibial Shaft Fractures (S.P.R.I.N.T.).”
He serves on the Board of Directors of the Mid America Orthopaedic Association, is the past president of the American Orthopaedic Association and Orthopaedic Trauma Association, Director Emeritus of the American Board of Orthopaedic Surgery and the American Board of Medical Specialties, and is Editor-in-Chief of the Journal of Bone and Joint Surgery.
Congratulations Marc! This is an honor well deserved!! Do you have been tireless in your pursuit of excellence in orthopedics and I greatly respect you and your work!
Sincerely,
Michael Thorpe MD
Your former intern!