“Highly accomplished,” “Consequential” and “Key Opinion Leader” are just some of the apt descriptions of Antonia F. Chen, M.D., M.B.A., director of Research, Arthroplasty Services at Brigham and Women’s Hospital, and associate professor of orthopedic surgery at Harvard Medical School.
The consummate clinician-scientist, Dr. Chen has also served as the Associate Director of Research at the Rothman Orthopaedic Institute in Philadelphia, an Associate Professor at Sidney Kimmel Medical College, and the Director of Medical Education Curriculum, Musculoskeletal Studies at the Sidney Kimmel Medical College and Thomas Jefferson University.
Antonia Chen earned a B.S. from Yale University and an M.D. from Robert Wood Johnson Medical School, and simultaneously obtained an M.B.A. from Rutgers Business School. She completed her orthopedic residency at the University of Pittsburgh and her fellowship in hip and knee arthroplasty at the Rothman Orthopaedic Institute.
Given that she has written over 300 publications, 45 book chapters, and 4 books, OTW wanted to check in with Dr. Chen about her research efforts and thoughts on the field. And there IS a “first” …
“Currently I’m working on a prospective randomized controlled trial which compares low versus high dose vitamin D supplementation prior to total joint arthroplasty,” said Dr. Chen. “There have been lots of studies looking at total joint replacements and vitamin D deficiency and the evidence is that vitamin D deficiency may be problematic in terms of complications after surgery.”
“In our new study, we’re randomizing to low versus high dose vitamin D. No one to date has conducted a prospective randomized trial on this subject. The previous studies have been retrospective trials which, by design, are not able to control for different factors.”
“Whether or not a person got vitamin D or didn’t get vitamin D is probably related to other factors. So, if we can control the factors using the design of a prospective randomized study, we hope to make a difference in our understanding of the benefits of Vitamin D.”
Frustration Leads to a Deeper Dive
“Our prior interim analysis showed that there’s really no difference between patients who take vitamin D and those who don’t,” said Dr. Chen to OTW. “Although that was shocking and frustrating, at the same time I think more and more patients are coming in now on vitamin D supplementation. That’s a possible confounding factor, which led to our interest in designing a prospective randomized study where we are gathering data from patients taking low versus high dose vitamin D.”
“We expected that high vitamin D patients would have fewer reoperations, fewer readmissions, and fewer complications. Patients in the high dose supplementation group continue on 800IU daily after the high dose supplementation is completed, and we do at least three months of follow up on their vitamin D levels. We check the level before surgery, on the day of surgery, and three months after surgery. We’re looking at three months out because infection is highest in the first 90 days. While infections are our primary end point, we’re looking at all complications and all revisions. We hope to have final results in 1-2 years.”
Periprosthetic Joint Infections—Not Just an Ortho Problem
When OTW asked about the state of periprosthetic joint infection (PJI) treatment, Dr. Chen commented, “The hardest problem I see is that infection is so multifactorial that until we get all those factors under control, we will still have a problem on our hands. This is NOT just an orthopedic issue. Surgical site infections or hospital acquired infections are something that are hugely problematic for our society as a whole. I wish infections were a never event, but we aren’t there yet.”
Periprosthetic joint infection is causing headaches for patients, surgeons, and hospitals, says Dr. Chen. But it is receiving more attention than ever.
As former president of the Musculoskeletal Infection Society (MSIS), Dr. Chen said, “I sometimes joke that PJI is finally becoming a sexy topic. When I was a resident, I got interested in studying infection by accident. I was looking for a research project and someone had written a project called, ‘The Pittsburgh Experience, Periprosthetic Joint Infection’. I didn’t know much about publishing, then, but realized that ‘Pittsburgh experience’ was hard to generalize as a research topic.”
“However, I took that retrospective data that was collected and found that patients who were malnourished had an increased rate of infection. This was presented at the first MSIS meeting that I attended. While this conclusion may not seem groundbreaking now, it was still very good information, and this got me very interested in studying infection.”
PJI Gets Award for Persistence
“I think it’s something that we want to work hard to eradicate, but we haven’t done it yet. It is prominent now because the biggest problems in orthopedics are slowly being whittled away by one by one—yet PJI persists.”
“Implants are improving. There are fewer dislocations because of technology. Implant materials are getting better. So, why are total knees or hips failing today? The reasons they were failing 10 years ago are not why they’re failing now. Infection has risen to the top and is probably the number one reason that these knee or hip replacement surgeries fail.”
“What is the ‘good’ news? There will always be work to do in the infection space. The bad news? We will always have work to do in the infection space.”
The AI Revolution
Regarding this unprecedented digital era of artificial intelligence (AI), machine learning and the like, OTW wondered about Dr. Chen’s thoughts on the future of orthopedics. How meaningful could these new technologies be?
“To put it mildly, they will be very relevant. From a clinical perspective, for example, I can envision batch processing of images to make diagnoses. Currently, as a clinician, I make a judgment call whether or not a patient would be a good candidate for surgery by using an X-ray and grading the joint, for example, Kellgren-Lawrence grade 4. That’s what I dictate and that’s what the insurance companies see, which is what reimbursement is based on.”
“With AI, however, you can tell you exactly what the radiographic classification is and a patient can be denied surgery based on this AI read alone. Thus, AI can potentially make clinical decisions on behalf of surgeons, which obviously is a scary and potentially dangerous thing.”
When OTW asked if these new tools, in moving us towards more precision medicine, may mean that physicians won’t have to fall back on so much defensive medicine, Dr. Chen noted, “Hopefully so, but it’s really going to depend on insurance companies. There will always be an element of defensive medicine, I would say, but I hope that AI makes decisions more data driven. On the flip side, data analytics may predictably tell you what the perfect, patient-specific surgical parameters should be for each surgical case and at what optimal time surgery should be performed. However, we’re probably a long way from that.”
“The hard part is that there is variability in the data,” said Dr. Chen. “We don’t know which perioperative factors predict postoperative outcomes. For example, two patients with the same demographic background and preoperative deformities may have very different results. AI and machine learning have the potential to identify these factors and guide us to provide the best care for our patients, and I do believe that AI will fundamentally revolutionize research and clinical practice.”
In the Spotlight
Dr. Chen’s clinical and research efforts have been rewarded many times throughout the years. With her talents evident from an early point in her career, Dr. Chen was awarded The American-British-Canadian Traveling Fellowship, an international tour focusing on leadership in orthopedics and the exchange of ideas internationally. In addition, she received The John Insall Traveling Fellowship, a knee-specific award that focused on knee arthroplasty at various centers throughout North America.
From the lab to the human side of things, Dr. Chen does it all. Not only does she use her undergraduate degree in Molecular, Cellular and Developmental Biology every day, but she uses her human skills as well—as one of the most essential and consequential opinion leaders in the musculoskeletal world.
