Department of Orthopaedic Surgery

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    Improved Tissue Repair in Articular Cartilage Defects in Vivo by rAAV-Mediated Overexpression of Human Fibroblast Growth Factor 2
    (Elsevier, 2005-08-01) Cucchiarini, Magali; Madry, Henning; Ma, Chunyan; Thurn, Tanja; Zurakowski, David; Menger, Michael D.; Kohn, Dieter; Trippel, Stephen B.; Terwilliger, Ernest F.; Orthopaedic Surgery, School of Medicine
    Therapeutic gene transfer into articular cartilage is a potential means to stimulate reparative activities in tissue lesions. We previously demonstrated that direct application of recombinant adeno-associated virus (rAAV) vectors to articular chondrocytes in their native matrix in situ as well as sites of tissue damage allowed for efficient and sustained reporter gene expression. Here we test the hypothesis that rAAV-mediated overexpression of fibroblast growth factor 2 (FGF-2), one candidate for enhancing the repair of cartilage lesions, would lead to the production of a biologically active factor that would facilitate the healing of articular cartilage defects. In vitro, FGF-2 production from an rAAV-delivered transgene was sufficient to stimulate chondrocyte proliferation over a prolonged period of time. In vivo, application of the therapeutic vector significantly improved the overall repair, filling, architecture, and cell morphology of osteochondral defects in rabbit knee joints. Differences in matrix synthesis were also observed, although not to the point of statistical significance. This process may further benefit from cosupplementation with other factors. These results provide a basis for rAAV application to sites of articular cartilage damage to deliver agents that promote tissue repair.
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    Indiana Orthopaedic Journal, Volume 1
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2007) Feinberg, Judy R.; Roberts, Donna L.
    Inaugural edition (volume 1) of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana Orthopaedic Journal, Volume 2
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2008) Feinberg, Judy R.; Roberts, Donna L.
    Volume 2 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana Orthopaedic Journal, Volume 3
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2009) Feinberg, Judy R.; Roberts, Donna L.
    Volume 3 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Indiana Orthopaedic Journal, Volume 4
    (Indiana University School of Medicine Department of Orthopaedic Surgery, 2010) Feinberg, Judy R.; Roberts, Donna L.
    Volume 4 of the Indiana Orthopaedic Journal. The intent of this publication is to provide an annual report of activities in the Indiana University School of Medicine's Department of Orthopaedic Surgery for alumni and friends, and to share research, accomplishments, and other useful information.
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    Lumbar extraforaminal decompression: A technical note and retrospective study looking at potential complications as an outpatient procedure
    (Elsevier, 2011) Miller, Justin W.; Sasso, Rick C.; Department of Orthopaedic Surgery, IU School of Medicine
    BACKGROUND: Lumbar disc herniation and stenosis that results in compression of a nerve root lateral to the foramen is defined as extraforaminal. In recent years the recognition of such pathology has increased with technology and greater awareness. Various approaches and techniques have been developed for extraforaminal decompression in the lumbar region. The purpose of this study was two fold: 1) Determine the safety of treating patients operatively via a paramedian muscle splitting approach on an outpatient basis, and 2) Highlight the technical aspects of the approach to the extraforaminal region. METHODS: One hundred consecutive extraforaminal decompressions were performed from 1992 to 2007 by a single surgeon. A retrospective review was performed consisting of chart reviews. Summary statistics and the Pierson Chi-square test were used to analyze the data. The primary outcome measure was the need for hospital admission or readmission following surgical decompression. RESULTS: Seven of 100 patients (7%) were required to remain in the hospital for twenty-three hour observation due to Medicare requirements. Five (5%) of the patients originally scheduled for an outpatient procedure were converted to inpatient status due to postoperative pain. All were released within 2 days (average 1.25 days). Only one (1%) patient was readmitted for urinary retention that resolved without incident. There was no significant difference (P = 0.137) in complication rate between our control and those that underwent extraforaminal decompression. CONCLUSIONS: Extraforaminal lumbar decompression as an outpatient procedure can be done safely without the need for hospital admission.
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    A comparison of the shock-absorbing properties of cervical disc prosthesis bearing materials
    (Elsevier, 2011) Dahl, Michael C.; Jacobsen, Stephen; Metcalf, Newton; Sasso, Rick; Ching, Randal P.; Department of Orthopaedic Surgery, IU School of Medicine
    BACKGROUND DATA: Cervical arthroplasty offers theoretical advantages over traditional spinal fusion, including elimination of adjacent segment disease and elimination of the risk of pseudoarthrosis formation. Initial studies of cervical arthroplasty have shown promising results, however, the ideal design characteristics for disc replacement constructs have not been determined. The current study seeks to quantify the differences in the shock absorption characteristics of three commonly used materials in cervical disc arthroplasty. METHODS: Three different nucleus materials, polyurethane (PU), polyethylene (PE) and a titanium-alloy (Ti) were tested in a humidity- and temperature-controlled chamber. Ten of each nucleus type underwent three separate mechanical testing protocols to measure 1) dynamic stiffness, 2) quasi-static stiffness, 3) energy absorption, and 4) energy dissipation. The results were compared using analysis of variance. RESULTS: PU had the lowest mean dynamic stiffness (435 ± 13 N/mm, P < .0001) and highest energy absorption (19.4 ± 0.1 N/mm, P < .0001) of all three nucleus materials tested. PU was found to have significantly higher energy dissipation (viscous damping ratio 0.017 ± 0,001, P < .0001) than the PE or TI nuclei. PU had the lowest quasi-static stiffness (598 ± 23 N/mm, P < .0001) of the nucleus materials tested. A biphasic response curve was observed for all of the PU nuclei tests. CONCLUSIONS: Polyurethane absorbs and dissipates more energy and is less stiff than either polyethylene or titanium. LEVEL OF EVIDENCE: Basic Science/Biomechanical Study. CLINICAL RELEVANCE: This study characterizes important differences in biomechanical properties of materials that are currently being used for different cervical disc prostheses.
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    The Epidemiology and Demographics of Legg-Calvé-Perthes' Disease
    (Wiley, 2011-09-05) Loder, Randall T.; Skopelja, Elaine N.; Orthopaedic Surgery, School of Medicine
    The etiology of Legg-Calvé-Perthes' disease (LCPD) is unknown. There are many insights however from epidemiologic/demographic information. A systematic medical literature review regarding LCPD was performed. The incidence ranges from 0.4/100,000 to 29.0/100,000 children <15 years of age. There is significant variability in incidence within racial groups and is frequently higher in lower socioeconomic classes. The typical age at presentation ranges from 4 to 8 years (average 6.5 years), except for children from the Indian subcontinent (average 9.5 years). There is a mild familial component. The children demonstrate impaired growth in height, skeletal age, and birth weight. This impaired growth coincides with an age appropriate reduced somatomedin A activity and decreased levels of IGF. LCPD can be associated with abnormalities in the coagulation cascade, including an increase in factor V Leiden mutation, low levels of protein C and/or S, and decreased antithrombin activity. There is decreased turnover in type I collagen and synthesis of type III collagen, as well as reduced levels of urinary glycosaminoglycans in the active phases of the disorder. Subtle abnormalities in the opposite hip and other minor/major congenital defects are reported. Children with LCPD are active and score abnormally in certain standardized psychological tests.
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    The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis
    (Wiley, 2011-09-21) Loder, Randall T.; Skopelja, Elaine N.; Orthopaedic Surgery, School of Medicine
    The etiology of slipped capital femoral epiphysis (SCFE) is unknown with many insights coming from epidemiologic/demographic information. A systematic medical literature review regarding SCFE was performed. The incidence is 0.33/100,000 to 24.58/100,000 children 8 to 15 years of age. The relative racial frequency, relative to Caucasians at 1.0, is 5.6 for Polynesians, 3.9 for Blacks, and 2.5 for Hispanics. The average age is 12.0 years for boys and 11.2 years for girls. The physiologic age when SCFE occurs is less variable than the chronologic age. The average symptom duration is 4 to 5 months. Most children are obese: >50% are >95th percentile weight for age with average BMI is 25-30 kg/m(2). The onset of SCFE is in the summer when north of 40°N. Bilaterality ranges from 18 to 50%. In children with bilateral involvement, 50-60% present with simultaneous SCFEs and those who present with a unilateral SCFE and subsequently develop a contralateral SCFE do so within 18 months. The age at presentation is younger for those who present with a unilateral SCFE and later develop a contralateral SCFE. The age-weight, age-height, and height test are useful to differentiate between an idiopathic and atypical SCFE.
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    The Epidemiology and Demographics of Hip Dysplasia
    (Wiley, 2011-10-10) Loder, Randall T.; Skopelja, Elaine N.; Orthopaedic Surgery, School of Medicine
    The etiology of developmental dysplasia of the hip (DDH) is unknown. There are many insights, however, from epidemiologic/demographic information. A systematic medical literature review regarding DDH was performed. There is a predominance of left-sided (64.0%) and unilateral disease (63.4%). The incidence per 1000 live births ranges from 0.06 in Africans in Africa to 76.1 in Native Americans. There is significant variability in incidence within each racial group by geographic location. The incidence of clinical neonatal hip instability at birth ranges from 0.4 in Africans to 61.7 in Polish Caucasians. Predictors of DDH are breech presentation, positive family history, and gender (female). Children born premature, with low birth weights, or to multifetal pregnancies are somewhat protected from DDH. Certain HLA A, B, and D types demonstrate an increase in DDH. Chromosome 17q21 is strongly associated with DDH. Ligamentous laxity and abnormalities in collagen metabolism, estrogen metabolism, and pregnancy-associated pelvic instability are well-described associations with DDH. Many studies demonstrate an increase of DDH in the winter, both in the northern and southern hemispheres. Swaddling is strongly associated with DDH. Amniocentesis, premature labor, and massive radiation exposure may increase the risk of DDH. Associated conditions are congenital muscular torticollis and congenital foot deformities. The opposite hip is frequently abnormal when using rigorous radiographic assessments. The role of acetabular dysplasia and adult hip osteoarthritis is complex. Archeological studies demonstrate that the epidemiology of DDH may be changing.