Post on 07-Jul-2020
UNMC ORTHOPAEDIC BIENNIAL REPORT 1
08/09 BIENNIAL REPORT
DEPARTMENT OF ORTHOPAEDIC SURGERY AND REHABILITATION
PERF
ORM
ANC
EIN
MO
TIO
N
4
MES
SAG
E FR
OM
TH
E C
HA
IR
6
SEC
TIO
N 1
| D
EPA
RTM
ENT
IN M
OTI
ON
O
ur M
issi
on in
Mot
ion
8
O
lym
pic
Swim
Tria
ls A
war
d
16
Blue
Dis
tinct
ion
Cen
ter
17
M
eet t
he F
ull-T
ime
Facu
lty
18
O
pera
tion
Wal
k–N
ebra
ska
24
Le
ndin
g a
Hel
ping
Han
d in
Hai
ti 28
32
SE
CTI
ON
2 |
RES
IDEN
TS IN
MO
TIO
N
A
bout
the
Prog
ram
34
Resi
dent
Life
in O
mah
a
36
Neb
rask
a O
rtho
paed
ic A
lum
ni
38
Mee
t the
Res
iden
ts
40
Re
cent
Pos
t-G
radu
ate
Fello
wsh
ips
42
44
SE
CTI
ON
3 |
RES
EARC
H IN
MO
TIO
N
U
tiliz
ing
Out
com
es &
Clin
ical
Stu
dies
46
Bi
omec
hani
cs L
abor
ator
y
50
Nan
o-Bi
otec
hnol
ogy
Labo
rato
ry
53
Scie
ntifi
c A
bstr
acts
56 8
2
SEC
TIO
N 4
| P
EOPL
E IN
MO
TIO
N
V
isiti
ng S
peak
ers
84
Hon
or R
oll o
f Con
trib
utor
s
87
Gra
nts,
Fun
ds a
nd E
ndow
men
ts
88
Full-
Tim
e Fa
culty
Act
iviti
es
92
D
epar
tmen
t Life
98
TAB
LE O
FC
ON
TEN
TSTH
E U
NIV
ERSI
TY O
F N
EBRA
SKA
MED
ICA
L C
ENTE
R D
EPAR
TMEN
T O
F O
RTH
OPA
EDIC
SU
RG
ERY
AN
D R
EHA
BIL
ITA
TIO
N R
EPO
RT
LEA
DIN
G IN
NO
VA
TIO
NS
IN O
RTH
OPA
ED
IC R
ESE
AR
CH
AN
D C
AR
E
PE
RFO
RM
AN
CE
IN M
OTIO
N4
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T5
AT T
HE
DE
PAR
TMEN
T O
F O
RTH
OPA
ED
IC S
UR
GER
Y A
ND
RE
HA
BIL
ITA
TIO
N, O
UR
MIS
SIO
N IS
TO
IMPR
OV
E TH
E Q
UA
LITY
O
F O
RTH
OPA
EDIC
CA
RE T
HRO
UG
H S
TATE
-OF-
THE-
ART
PAT
IEN
T C
ARE
, SU
PERI
OR
EDU
CAT
ION
AN
D IN
NO
VATI
VE
RESE
ARC
H.
ME
SS
AG
E F
ROM
TH
E C
HA
IR
DR
. KEV
IN G
ARV
IN
We
are
build
ing
a w
orl
d-c
lass
rese
arch
pr
ogra
m in
our
Nan
o-Bi
otec
hnol
ogy
and
Biom
echa
nics
labo
rato
ries,
whe
re w
e ar
e pe
rfor
min
g cu
ttin
g-ed
ge re
sear
ch to
cre
ate
“sm
art”
impl
ants
that
last
long
er a
nd p
erfo
rm
bett
er, a
s w
ell a
s in
nova
tive
wor
k on
wea
r te
stin
g of
join
ts th
at is
hel
ping
to s
et n
atio
nal
and
inte
rnat
iona
l sta
ndar
ds fo
r tes
ting
of
knee
repl
acem
ent s
yste
ms.
Con
tinui
ng to
be
at th
e fo
refr
ont o
f ort
hopa
edic
rese
arch
and
te
chno
logy
ens
ures
that
we
can
prov
ide
a su
perio
r edu
catio
n to
our
resi
dent
s, a
s w
ell a
s of
fer t
he la
test
tech
niqu
es a
nd m
ost a
dvan
ced
diag
nosi
s an
d tr
eatm
ent t
o ou
r pat
ient
s.
Con
stan
tly s
triv
ing
to e
xcel
in a
ll as
pect
s of
ou
r mis
sion
als
o in
evita
bly
brin
gs g
row
th.
We
are
exci
ted
to a
nnou
nce
that
we
have
re
crui
ted
two
new
phy
sici
ans
to o
ur te
am. D
rs.
Beau
Kon
igsb
erg
and
Cur
tis H
artm
an, w
ho
both
spe
cial
ize
in a
dult
reco
nstr
uctiv
e su
rger
y,
have
join
ed o
ur fu
ll-tim
e fa
culty
. You
can
le
arn
mor
e ab
out e
ach
of th
em in
the
‘Mee
t th
e Fu
ll-tim
e Fa
culty
’ sec
tion
of o
ur re
port
.
This
yea
r we
have
em
bark
ed o
n a
new
jo
urne
y th
roug
h a
won
derf
ul o
rgan
izat
ion
calle
d O
pera
tion
Wal
k. D
r. La
wre
nce
Dor
r, O
pera
tion
Wal
k’s fo
unde
r, in
spire
d us
with
a m
otiv
atin
g ac
coun
t of h
is v
olun
teer
ex
perie
nces
dur
ing
last
yea
r’s g
radu
atio
n ta
lks.
In th
e fa
ll of
this
yea
r, O
pera
tion
Wal
k–N
ebra
ska
will
trav
el to
Ant
igua
, G
uate
mal
a, o
n ou
r firs
t mis
sion
. To
get
read
y fo
r thi
s m
issi
on w
e re
cent
ly jo
ined
D
r. D
orr a
nd h
is te
am o
n O
pera
tion
Wal
k–V
ietn
am. B
e su
re to
read
abo
ut o
ur
rew
ardi
ng a
nd u
plift
ing
expe
rienc
e in
the
artic
le ‘O
pera
tion
Wal
k–N
ebra
ska’
.
In ‘L
endi
ng a
Hel
ping
Han
d in
Hai
ti’, D
rs.
Mig
uel D
acca
rett
and
Sea
n M
cGar
ry s
hare
ex
perie
nces
from
thei
r rec
ent t
rave
ls to
H
aiti.
The
impa
ct o
f thi
s di
sast
er o
n th
e or
thop
aedi
c co
mm
unity
wor
ld-w
ide
rival
ed
any
in re
cent
his
tory
. The
dev
asta
ting
eart
hqua
ke, a
nd th
e ty
pe o
f inj
urie
s it
caus
ed,
crea
ted
an im
med
iate
and
des
pera
te n
eed
for o
rtho
paed
ic a
nd tr
aum
a su
rgeo
ns. W
e ar
e pr
oud
of th
e ef
fort
s th
at h
ave
been
m
ade
loca
lly b
y ou
r ow
n su
rgeo
ns a
nd
orga
niza
tions
, as
wel
l as
effo
rts
mad
e na
tiona
lly, e
spec
ially
by
our f
riend
s an
d co
lleag
ues
at th
e A
mer
ican
Aca
dem
y fo
r O
rtho
paed
ic S
urge
ons
( AA
OS)
, who
mai
ntai
n on
goin
g ef
fort
s to
sup
port
the
Hai
tian
peop
le
in th
e w
ake
of th
is h
orrib
le tr
aged
y.
We
exte
nd a
sin
cere
than
k yo
u to
eve
ryon
e w
ho m
ade
priv
ate
cont
ribut
ions
to th
e de
part
men
t dur
ing
the
2008
– 200
9 ca
lend
ar
year
s. P
leas
e m
ake
sure
to s
ee th
e ‘H
onor
Rol
l of
Con
trib
utor
s’ w
e ha
ve p
ublis
hed
to s
how
ou
r app
reci
atio
n fo
r the
se g
ifts,
whi
ch p
rovi
de
vita
l res
ourc
es fo
r the
con
tinue
d su
cces
s of
our
dep
artm
ent’s
resi
denc
y ed
ucat
ion
prog
ram
, res
earc
h pr
ojec
ts, a
nd m
uch
mor
e.
We
will
con
tinue
to k
eep
you
abre
ast
of
futu
re c
hang
es a
nd n
ewsw
orth
y ha
ppen
ings
in
the
depa
rtm
ent.
Hop
eful
ly y
ou w
ill e
njoy
pe
rusi
ng th
e re
port
, and
take
hea
rt in
kn
owin
g th
at it
is th
e su
ppor
t of o
ur a
lum
ni
and
frie
nds
of th
e de
part
men
t tha
t hel
ps u
s co
ntin
ue to
fulfi
ll ou
r mis
sion
of e
xcel
lenc
e in
pa
tient
car
e, re
side
nt e
duca
tion,
and
cut
ting-
edge
rese
arch
.
Tha
nk
you
fo
r yo
ur
sup
po
rt!
KEV
IN G
ARV
IN, M
.D.
Prof
esso
r & C
hair
PE
RFO
RM
AN
CE
IN M
OTIO
N4
YOU
R FE
EDB
AC
K C
OU
NTS
. . .
The
UN
MC
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n is
list
enin
g to
you
. You
r fee
d-
back
is im
port
ant t
o us
. Sim
ply
go to
ww
w.U
NM
CO
rtho
InM
otio
n.co
m a
nd c
ompl
ete
our b
rief s
urve
y. Th
is in
form
atio
n w
ill h
elp
us im
prov
e ou
r com
mun
icat
ions
and
pro
vide
you
with
mor
e va
luab
le re
sour
ces.
DEP
ART
MEN
T O
F O
RTH
OPA
ED
IC S
UR
GE
RY
AN
D R
EH
AB
ILIT
ATI
ON
Your
feed
back
cou
nts.
Sim
ply
go to
ww
w.U
NM
CO
rtho
InM
otio
n.co
m
SEC
TIO
N
01
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T9
OUR
MIS
SION
IN
MO
TIO
N:
LIN
KIN
G P
ATIE
NT
CA
RE, E
DU
CAT
ION
AN
D R
ESEA
RCH
,
IS T
HE
KEY
TO E
NSU
RIN
G T
HAT
WE
CO
NTI
NU
E TO
OFF
ER T
HE
BEST
AN
D M
OST
INN
OVA
TIV
E C
AR
E
FOR
OU
R PA
TIEN
T’S
MU
SCU
LOSK
ELET
AL
PRO
BLEM
S,
PRO
DU
CE
THE
BEST
AN
D B
RIG
HTE
ST O
RTH
OPA
EDIC
SURG
EON
S O
F TH
E FU
TURE
, AN
D D
EVEL
OP
NEW
CLI
NIC
AL P
ROC
EDU
RES
AND
SU
RGIC
AL
TEC
HN
IQU
ES
THRO
UG
H C
UTT
ING
- ED
GE
RESE
ARC
H. H
OW
EVER
,
AT T
HE
DEPA
RTM
ENT
OF
OR
THO
PAED
IC S
UR
GER
Y
AN
D R
EH
AB
ILIT
ATI
ON
, WE
FEEL
TH
AT JU
ST
TREA
DIN
G T
HE
BEAT
EN P
ATH
IS N
OT
ENO
UG
H. E
VERY
DAY
OU
R G
OA
L IS
NO
T TO
SIM
PLY
AP
PLY
EAC
H O
F
THES
E O
BJEC
TIVE
S, B
UT
TO E
XC
EL IN
EAC
H A
T SU
CH
A L
EVEL
TH
AT O
NE
PUSH
ES T
HE
OTH
ER T
O R
ISE
TO
A H
IGH
ER S
TAN
DA
RD
, CRE
ATIN
G A
CO
NTI
NU
OU
SLY
EVO
LVIN
G C
YC
LE O
F E
XCE
LLE
NC
E.
IN A
CA
DEM
IC C
ENTE
RS A
ROU
ND
TH
E W
ORL
D IT
’S K
NO
WN
AS
THE
“3-L
EGG
ED S
TOO
L” A
ND
IT E
MBO
DIE
S TH
E M
ISSI
ON
AN
D V
ISIO
N
OF
UN
MC
’S D
EPA
RTM
EN
T O
F O
RTH
OPA
EDIC
SU
RG
ER
Y. EA
CH
LEG
IS V
ITA
L FO
R TH
E SU
CC
ESS
OF
NO
T O
NLY
OU
R AC
AD
EMIC
MIS
SIO
N,
BUT
ALS
O V
ITA
L TO
TH
E SU
CC
ESS
OF
THE
TWO
OTH
ER L
EGS.
PATI
ENT
CA
RE
RESE
ARC
HED
UC
ATIO
N
TO IM
PRO
VE T
HE
QU
ALI
TY O
F O
RTH
OPA
EDIC
CA
RE
THRO
UG
H T
HE
FUSI
ON
OF
STA
TE-O
F-TH
E-A
RT
PATI
ENT
CA
RE,
SUPER
IOR
ED
UC
ATIO
N A
ND
INN
OV
ATI
VE R
ESEA
RCH
.
DE
PA
RTM
EN
T IN
MO
TIO
N
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T11
PATI
ENT
CA
RE:
PRO
VID
ING
STA
TE-O
F-TH
E-A
RT O
RTH
OPA
EDIC
C
ARE
FO
R PA
TIE
NTS
AFF
LIC
TED
WIT
H
MU
SCU
LOSK
ELET
AL
DIS
ORD
ERS
At t
he D
epar
tmen
t of O
rtho
pa
edic
Surg
ery
and
Reh
ab
ilita
tion
at t
he U
nive
rsity
of
Neb
rask
a M
edic
al C
ente
r we
offe
r the
re
sour
ces
of a
larg
e, u
nive
rsity
-rela
ted
hosp
ital
with
the
pers
onal
car
e an
d at
tent
ion
of a
sm
alle
r dep
artm
ent..
Our
team
of d
edic
ated
, ca
ring
heal
th p
rofe
ssio
nals
spe
cial
izes
in th
e pr
even
tion,
dia
gnos
is, a
nd tr
eatm
ent
of m
uscu
losk
elet
al d
isor
ders
in c
hild
ren,
te
enag
ers,
and
adu
lts. O
ur d
epar
tmen
t pr
ovid
es q
ualit
y, co
st-e
ffec
tive
care
to
mor
e th
an 3
5,00
0 pa
tient
s ea
ch y
ear f
rom
N
ebra
ska,
the
Mid
wes
t, an
d ar
ound
the
wor
ld. S
ever
al o
f our
phy
sici
ans
are
reco
g-ni
zed
each
yea
r on
the
annu
al “B
est D
octo
rs
in A
mer
ica”
list
and
man
y se
rve
the
prof
es-
sion
as
lead
ers
in lo
cal,
stat
e, n
atio
nal a
nd
inte
rnat
iona
l sci
entifi
c or
gani
zatio
ns.
Our
ort
hopa
edic
sur
geon
s w
ork
clos
ely
with
car
ing,
exp
erie
nced
nur
ses
and
cons
ult
with
phy
sici
ans
in o
ther
med
ical
spe
cial
ties
to p
rovi
de th
e la
test
com
preh
ensi
ve c
are.
Fa
culty
phy
sici
ans
in th
e D
epar
tmen
t of
Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n
trea
t tho
usan
ds o
f pat
ient
s ea
ch y
ear i
n
the
area
s of
:
AD
ULT
REC
ON
STRU
CTI
VE A
ND
GEN
ERA
L O
RTH
OPA
EDIC
S:
infla
mm
ator
y an
d de
gene
rativ
e jo
int
prob
lem
s, b
one
and
soft
tiss
ue re
cons
truc
tion
and
pros
thet
ic jo
int r
epla
cem
ent
FOO
T A
ND
AN
KLE
SURG
ERY:
foot
and
ank
le d
isor
ders
rang
ing
from
th
e co
mm
on to
the
com
plex
, fro
m b
unio
ns
to fr
actu
res
HA
ND
SU
RGER
Y:ha
nd a
nd w
rist c
ondi
tions
suc
h as
art
hriti
s,
nerv
e co
mpr
essi
on a
nd re
pair
of c
onge
nita
l ha
nd d
efor
miti
es a
nd in
jurie
s
ORT
HO
PAED
IC O
NC
OLO
GY:
beni
gn a
nd m
alig
nant
bon
e an
d so
ft
tissu
e tu
mor
s, bo
ne g
raft
s an
d cu
stom
pr
osth
etic
impl
ants
SHO
ULD
ER A
ND
ELB
OW
:ev
alua
tion
and
man
agem
ent o
f sho
ulde
r an
d el
bow
art
hriti
s, di
sloc
atio
ns, f
ract
ures
an
d te
ndon
tear
s
TRA
UM
A:
emer
genc
y ev
alua
tion,
trea
tmen
t, an
d
long
-term
follo
w-u
p of
frac
ture
s, di
sloc
atio
ns
and
othe
r mus
culo
skel
etal
inju
ries
PED
IATR
IC O
RTH
OPA
EDIC
S:
limb
and
spin
e de
form
ities
, bon
e an
d jo
int
infe
ctio
ns a
nd fr
actu
res
and
disl
ocat
ions
of
the
arm
s, le
gs a
nd s
pine
in in
fant
s, ch
ildre
n an
d te
enag
ers
SPO
RTS
MED
ICIN
E:
trea
tmen
t of i
njur
ies
or il
lnes
ses
rela
ted
to s
port
s su
ch a
s sp
rain
s, lig
amen
t or c
arti-
lage
inju
ries,
or jo
int a
ilmen
ts in
ath
lete
s
of a
ll ag
es
SPIN
E:
eval
uatio
n an
d m
anag
emen
t of s
pine
co
nditi
ons
such
as
defo
rmiti
es, i
njur
ies
and
dete
riora
tion
PE
RFO
RM
AN
CE
IN M
OTIO
N1
0
EDU
CA
TIO
N:
CRE
ATIN
G
ORT
HO
PAED
IC
SURG
EON
S O
F TO
MO
RR
OW
; C
ULT
IVAT
ING
FU
TURE
ED
UC
ATO
RS
The
orth
opae
dic
resi
denc
y pr
ogra
m
in N
ebra
ska
is fu
lly a
ccre
dite
d by
the
Acc
redi
tatio
n C
ounc
il fo
r Gra
duat
e M
edic
al
Educ
atio
n (A
CG
ME)
and
incl
udes
trai
ning
in
all
nine
ort
hopa
edic
sub
spec
ialit
ies
offe
red
at th
e D
epar
tmen
t of O
rtho
paed
ic S
urge
ry
and
Reha
bilit
atio
n.
The
depa
rtm
ent’s
20
orth
opae
dic
resi
dent
s ar
e in
volv
ed in
dai
ly p
atie
nt c
are
and
impo
rtan
t res
earc
h ac
tiviti
es d
urin
g th
eir fi
ve
year
s of
inte
nsiv
e tr
aini
ng. F
iftee
n fu
ll-tim
e cl
inic
al fa
culty
and
num
erou
s st
aff m
embe
rs
inst
ruct
, eva
luat
e an
d m
ento
r our
resi
dent
s at
var
ious
hos
pita
l loc
atio
ns o
n th
e U
NM
C
cam
pus.
Man
y m
ore
Om
aha-
area
ort
ho-
paed
ic s
urge
ons
serv
e as
vol
unte
er fa
culty
m
embe
rs, s
uper
visi
ng o
ur re
side
nts
as th
ey
rota
te th
roug
h di
ffer
ent s
ubsp
ecia
lty p
rivat
e pr
actic
e si
tuat
ions
. Tw
o fu
ll-tim
e re
sear
ch
facu
lty, l
ab te
chni
cian
s an
d a
full-
time
rese
arch
coo
rdin
ator
ass
ist r
esid
ents
with
th
eir r
esea
rch
proj
ects
.
Not
onl
y ar
e w
e ed
ucat
ing
the
orth
opae
dic
surg
eons
of t
omor
row
, we
are
inve
stin
g in
the
futu
re o
f Neb
rask
a by
cul
tivat
ing
prom
isin
g ed
ucat
ors
who
will
teac
h th
e or
thop
aedi
c su
rgeo
ns o
f gen
erat
ions
to c
ome.
Of a
ll th
e m
en a
nd w
omen
who
hav
e co
mpl
eted
thei
r
orth
opae
dic
surg
ical
trai
ning
thro
ugh
the
Neb
rask
a pr
ogra
m, m
ore
than
hal
f are
now
pr
actic
ing
in th
e st
ate
or th
e M
idw
est.
In
addi
tion,
doc
tors
thro
ugho
ut th
e re
gion
re
gard
UN
MC
as
a so
urce
of c
ontin
uing
ed
ucat
ion
whe
re th
ey c
an le
arn
the
late
st
tech
niqu
es fo
r dia
gnos
is, t
reat
men
t and
pr
even
tion
of b
one
and
join
t dis
ease
s.
PE
RFO
RM
AN
CE
IN M
OTIO
N1
2
PE
RFO
RM
AN
CE
IN M
OTIO
N1
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
15
RESE
AR
CH
: U
SIN
G C
UT
TIN
G-E
DG
E
RESE
ARC
H T
O D
EFIN
E TO
MO
RRO
W’S
DIA
GN
OSI
S A
ND
TRE
ATM
ENT
MET
HO
DS
We
are
build
ing
a w
orld
-cla
ss re
sear
ch
prog
ram
focu
sing
on
the
area
s of
m
uscu
losk
elet
al d
isea
ses,
mol
ecul
ar b
iolo
gy
and
gene
tics,
and
the
deve
lopm
ent o
f les
s in
vasi
ve s
urgi
cal t
echn
ique
s an
d bi
omed
ical
en
gine
erin
g, e
spec
ially
kne
e im
plan
t si
mul
atio
n an
d te
stin
g an
d co
mpu
ter-
aide
d an
d ro
botic
sur
gery
. Rem
aini
ng
at th
e fo
refr
ont o
f ort
hopa
edic
rese
arch
an
d te
chno
logy
mea
ns th
at w
e ca
n of
fer
patie
nts
the
late
st te
chni
ques
and
mos
t ad
vanc
ed d
iagn
osis
and
trea
tmen
t, w
ith
pers
onal
car
e fo
r pat
ient
s an
d th
eir f
amili
es.
Our
Bio
mec
hani
cs L
abor
ator
y an
d N
ano-
Biot
echn
olog
y La
bora
tory
are
hou
sed
in th
e Sc
ott T
echn
olog
y C
ente
r (ST
C),
loca
ted
on th
e A
ksar
ben
cam
pus.
Res
earc
h fa
culty
and
oth
er
engi
neer
s at
the
Biom
echa
nics
Lab
orat
ory
are
perf
orm
ing
cutt
ing-
edge
exp
erim
enta
l si
mul
atio
n an
d te
stin
g of
the
next
gen
erat
ion
of o
rtho
paed
ic im
plan
ts, a
nd c
ontr
ibut
ing
to th
e de
velo
pmen
t of m
ulti-
axia
l im
plan
t si
mul
ator
s. T
hrou
gh th
is re
sear
ch w
e ar
e w
orki
ng to
cre
ate
impl
ants
that
last
long
er
and
perf
orm
bet
ter,
whi
ch a
re d
esig
ned
to
suit
the
mod
ern
patie
nt w
ho is
you
nger
and
m
ore
activ
e.
This
inno
vativ
e w
ork
on w
ear t
estin
g of
join
ts is
als
o he
lpin
g to
set
nat
iona
l an
d in
tern
atio
nal s
tand
ards
for t
estin
g of
kne
e re
plac
emen
t sys
tem
s.
Our
team
of r
esea
rche
rs a
nd s
urge
ons
are
also
dev
elop
ing
a no
vel f
reeh
and
surg
ical
nav
igat
ion
syst
em fo
r use
in k
nee
repl
acem
ent s
urge
ry. T
his
redu
ces
the
need
fo
r bul
ky a
lignm
ent i
nstr
umen
ts c
alle
d jig
s,
and
uses
‘GPS
sty
le te
chno
logy
’ to
help
na
viga
te th
e ha
nds
of a
sur
geon
dur
ing
surg
ery.
This
allo
ws
for m
ore
accu
rate
bon
e cu
ttin
g an
d be
tter
alig
nmen
t of i
mpl
ants
, w
ith le
ss tr
aum
a to
the
soft
tiss
ue a
nd
bone
, whi
ch tr
ansl
ates
to fa
ster
reco
very
tim
es fo
r joi
nt re
plac
emen
t pat
ient
s.
Rese
arch
ers
at o
ur N
ano-
Biot
echn
olog
y La
bora
tory
are
wor
king
with
sup
er-s
mal
l na
nost
ruct
ures
that
are
und
etec
tabl
e to
th
e hu
man
eye
to m
ake
a bi
g im
pact
in
the
field
of o
rtho
paed
ic s
urge
ry. T
hese
m
inis
cule
str
uctu
res
are
bein
g us
ed to
cr
eate
sup
erha
rd, e
xtre
mel
y w
etta
ble,
“s
mar
t” in
fect
ion-
resi
stan
t coa
tings
that
will
pr
olon
g th
e lif
e of
ort
hopa
edic
impl
ants
by
redu
cing
wea
r, th
us re
duci
ng th
e ne
ed fo
r re
visi
on s
urge
ry. I
n cl
ose
colla
bora
tion
with
rese
arch
ers
from
the
UN
MC
dep
artm
ents
of
Gen
etic
s, C
ell B
iolo
gy a
nd A
nato
my,
as
wel
l as
Path
olog
y an
d M
icro
biol
ogy,
thes
e du
rabl
e co
atin
gs a
re b
eing
des
igne
d to
pr
omot
e bo
ne m
arro
w s
trom
al c
ell g
row
th,
redu
cing
bot
h th
e pr
obab
ility
of i
nfec
tions
an
d pa
tient
reco
very
tim
e. B
ecau
se
thes
e ve
rsat
ile c
oatin
gs c
an b
e ap
plie
d to
virt
ually
any
sur
face
, the
y po
tent
ially
ha
ve m
any
othe
r sci
entifi
c an
d bi
omed
ical
ap
plic
atio
ns, i
nclu
ding
ext
endi
ng th
e lif
e of
cr
itica
l mec
hani
cal c
ompo
nent
s in
airc
raft
, w
ater
craf
t and
gro
und
vehi
cles
, by
incr
easi
ng
fuel
effi
cien
cy a
nd p
reve
ntin
g co
rros
ion.
As
a re
sult
of th
e in
nova
tive
rese
arch
be
ing
done
her
e, d
epar
tmen
t res
earc
hers
ar
e at
trac
ting
an in
crea
sing
am
ount
of
exte
rnal
and
inte
rnat
iona
l fun
ding
and
ac
clai
m, a
nd h
ave
pres
ente
d th
eir r
esul
ts
at p
rest
igio
us n
atio
nal a
nd in
tern
atio
nal
scie
ntifi
c an
d ac
adem
ic c
onfe
renc
es.
You
don’
t hav
e to
be
a re
sear
cher
or s
cien
tist t
o co
ntrib
ute
to re
sear
ch th
at c
an p
ositi
vely
aff
ect
the
trea
tmen
t met
hods
of f
utur
e or
thop
aedi
c pa
tient
s. M
any
of o
ur s
urgi
cal p
atie
nts
give
a li
ttle
of
thei
r tim
e to
hel
p us
und
erst
and
wha
t is
wor
king
and
wha
t mig
ht b
e im
prov
ed, b
y al
low
ing
us to
co
llect
pre
- and
pos
t-op
data
abo
ut th
eir s
urgi
cal c
ase.
Pat
ient
s fil
l out
que
stio
nnai
res
rega
rdin
g th
eir h
ealth
, qua
lity
of li
fe a
nd fu
nctio
nal s
tatu
s. T
his
colle
ctio
n of
dat
a, k
now
n as
an
outc
omes
st
udy,
serv
es a
s a
valu
able
tool
for s
urge
ons
to e
valu
ate
and
com
pare
the
effe
ctiv
enes
s of
var
ious
tr
eatm
ents
, and
ens
ure
that
dia
gnos
is a
nd tr
eatm
ent a
re c
ontin
ually
evo
lvin
g an
d im
prov
ing.
Each
yea
r, th
e de
part
men
t con
tinue
s to
exp
and
our s
urge
ry o
utco
mes
dat
abas
e,
whi
ch is
one
mor
e w
ay th
at w
e ar
e lin
king
pat
ient
trea
tmen
t, re
sear
ch a
nd e
duca
tion.
C
urre
ntly
ther
e ar
e ov
er 3
300
surg
ery
subj
ects
in th
e da
taba
se w
ho h
ave
unde
rgon
e to
tal j
oint
repl
acem
ent,
revi
sion
join
t sur
gery
, sho
ulde
r sur
gery
, sur
gica
l tre
atm
ent f
or
oste
ogen
esis
impe
rfec
ta, o
r tre
atm
ent f
or W
hipl
ash
Ass
ocia
ted
Dis
orde
rs (W
AD
).
OU
TCO
MES
RES
EARC
H:
PATI
ENTS
HEL
PIN
G P
ATIE
NTS
PE
RFO
RM
AN
CE
IN M
OTIO
N1
6
It’s
not e
very
day
that
an
orth
opae
dic
surg
ery
depa
rtm
ent c
an b
oast
of w
inni
ng
an a
war
d re
late
d to
the
U.S
. Oly
mpi
cs.
And
whi
le it
isn’
t an
Oly
mpi
c go
ld
med
al, w
e th
ink
rece
ivin
g an
aw
ard
for
part
icip
atin
g in
the
2008
U.S
. Oly
mpi
c Sw
im T
rials
is s
till p
rett
y da
rn im
pres
sive
.
The
awar
d (p
ictu
red
abov
e) w
as p
rese
nted
to
UN
MC
Phy
sici
ans
and
the
Dep
artm
ent
of O
rtho
paed
ic S
urge
ry fr
om th
e O
mah
a Sp
orts
Com
mis
sion
, in
reco
gniti
on fo
r “p
rovi
ding
exc
eptio
nal c
are
and
serv
ice
to
the
2008
Oly
mpi
c Sw
im T
rial p
artic
ipan
ts.”
The
tria
ls, w
hich
wer
e he
ld a
t the
Q
wes
t Cen
ter,
boas
ted
a re
cord
-set
ting
atte
ndan
ce o
f 160
,063
spe
ctat
ors –
over
50
,000
mor
e th
an th
e pr
evio
us tr
ial
reco
rd s
et b
y Lo
ng B
each
, CA
in 2
004.
Dr.
Kevi
n G
arvi
n, c
hair
of O
rtho
paed
ic
Surg
ery
and
a m
embe
r of t
he O
mah
a Sp
orts
Com
mis
sion
, ove
rsaw
med
ical
co
vera
ge o
f the
tria
ls a
t the
requ
est o
f H
arol
d C
liff,
chie
f ope
ratin
g of
ficer
of
the
2008
U.S
. Oly
mpi
c Sw
im T
rials
.
DEP
ARTM
ENT
REC
EIVE
S AW
ARD
FO
R PA
RTIC
IPAT
ION
IN 2
008
U.S
. O
LYM
PIC
SW
IM T
RIA
LS
“The
med
ical
com
mun
ity re
ally
pul
led
toge
ther
for t
his
even
t and
not
onl
y of
fere
d su
perio
r med
ical
ser
vice
s at
no
cost
, but
als
o a
wel
com
ing
attit
ude
and
the
mid
wes
tern
hos
pita
lity
of w
hich
w
e ar
e pr
oud,
” sai
d D
r. G
arvi
n.
Whe
n th
e re
ques
t was
put
out
for v
olun
teer
s,
an a
stou
ndin
g nu
mbe
r of p
hysi
cian
s an
d st
aff f
rom
var
ious
spe
cial
ities
ans
wer
ed
the
call.
Med
ical
pro
fess
iona
ls fr
om U
NM
C
Phys
icia
ns, t
he U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter,
and
The
Neb
rask
a M
edic
al
Cen
ter,
eage
rly v
olun
teer
ed th
eir t
ime
and
know
ledg
e to
car
e fo
r ove
r 125
0 at
hlet
es,
coac
hes
and
trai
ners
that
cam
e fr
om a
ll ov
er th
e co
untr
y to
par
ticip
ate
in th
e tr
ials
.
The
Om
aha
swim
tria
ls e
xper
ienc
e go
t ra
ve re
view
s fr
om c
oach
es a
nd a
thle
tes
alik
e. In
add
ition
to th
e aw
ard
from
the
Om
aha
Spor
ts C
omm
issi
on, a
nd th
e w
arm
ac
cola
des
from
thos
e w
ho a
tten
ded
the
tria
ls, t
he e
vent
was
als
o na
med
“Bes
t A
mat
eur M
ulti-
Spor
t or M
ulti-
Dis
cipl
ine
Even
t” b
y Sp
ort
sTra
vel M
agaz
ine.
In Ju
ne o
f 200
9, o
ffici
als
from
USA
Sw
imm
ing
and
the
Om
aha
Spor
ts
Com
mis
sion
ann
ounc
ed th
at th
e U
.S.
Oly
mpi
c Te
am T
rials
– S
wim
min
g w
ill re
turn
to
Om
aha
in 2
012.
The
com
petit
ion
will
take
pl
ace
from
June
25
to Ju
ly 2
at t
he Q
wes
t C
ente
r Om
aha,
and
will
dec
ide
who
will
re
pres
ent t
he U
.S. i
n th
e Lo
ndon
Gam
es.
“We
are
thril
led
to b
ring
the
Oly
mpi
c Tr
ials
ba
ck to
Om
aha
in 2
012,
” sai
d C
huck
Wie
lgus
, U
SA S
wim
min
g ex
ecut
ive
dire
ctor
, in
an
inte
rvie
w w
ith S
wim
min
g W
orl
d m
agaz
ine.
“T
he 2
008
Tria
ls w
ere
a tr
emen
dous
eve
nt,
offe
ring
a fa
ntas
tic e
xper
ienc
e fo
r our
ath
lete
s,
fans
, fam
ilies
and
coa
ches
. We
look
forw
ard
to n
ot o
nly
recr
eatin
g th
at e
xcite
men
t, bu
t bu
ildin
g on
it, a
nd p
uttin
g to
geth
er a
n ev
en
bett
er s
how
in 2
012.
We
are
fort
unat
e to
ha
ve g
reat
par
tner
s in
the
Om
aha
Spor
ts
Com
mis
sion
, the
U.S
. Oly
mpi
c C
omm
ittee
, N
BC a
nd o
ur c
orpo
rate
par
tner
fam
ily, a
nd
toge
ther
, I a
m c
onfid
ent t
hat w
e w
ill ra
ise
the
bar o
n ou
r spo
rt’s
mar
quee
eve
nt.”
Blue
Cro
ss a
nd B
lue
Shie
ld o
f Neb
rask
a ha
s de
sign
ated
The
Neb
rask
a M
edic
al C
ente
r as
a
Blue
Dis
tinct
ion
Cen
ter f
or S
pine
Sur
gery
SM a
nd a
Blu
e D
istin
ctio
n C
ente
r for
Kne
e an
d H
ip
Repl
acem
entSM
. Blu
e D
istin
ctio
n C
ente
rs fo
r Spi
ne S
urge
ry a
nd B
lue
Dis
tinct
ion
Cen
ters
for
Knee
and
Hip
Rep
lace
men
t are
par
t of t
he B
lue
Cro
ss a
nd B
lue
Shie
ld A
ssoc
iatio
n’s
expa
nsio
n
of it
s Bl
ue D
istin
ctio
n® d
esig
natio
n.
“It i
s an
hon
or to
be
reco
gniz
ed a
s a
Blue
Dis
tinct
ion
Cen
ter f
or K
nee
and
Hip
Rep
lace
men
t,” s
aid
Kevi
n G
arvi
n, M
.D.,
chai
rper
son
and
prof
esso
r of t
he O
rtho
paed
ic S
urge
ry D
epar
tmen
t. “T
he
desi
gnat
ion
valid
ates
the
care
we
prov
ide
to p
atie
nts
affli
cted
with
art
hriti
c co
nditi
ons
of th
e hi
p an
d kn
ee.”
Ort
hopa
edic
sur
geon
s at
The
Neb
rask
a M
edic
al C
ente
r per
form
prim
ary
and
com
plex
hi
p an
d kn
ee re
plac
emen
ts o
n pa
tient
s w
ith a
rthr
itis,
pro
blem
s w
ith jo
int d
isea
se fr
om tr
aum
a,
child
hood
hip
and
kne
e di
seas
es a
nd p
rost
hetic
join
t inf
ectio
ns.
The
Blue
Dis
tinct
ion
desi
gnat
ion
is a
war
ded
by th
e Bl
ue C
ross
and
Blu
e Sh
ield
com
pani
es
to m
edic
al fa
cilit
ies
that
hav
e de
mon
stra
ted
expe
rtis
e in
del
iver
ing
qual
ity h
ealth
car
e in
the
area
s of
bar
iatr
ic s
urge
ry, c
ardi
ac c
are,
com
plex
and
rare
can
cers
, kne
e an
d hi
p re
plac
emen
t, sp
ine
surg
ery
and
tran
spla
nts.
The
pro
gram
is p
art o
f The
Blu
es® e
ffor
ts to
col
labo
rate
with
ph
ysic
ians
and
med
ical
faci
litie
s to
impr
ove
the
over
all q
ualit
y an
d sa
fety
of s
peci
alty
car
e.
“We
wan
t to
reco
gniz
e an
d re
war
d th
ose
netw
ork
prov
ider
s w
ho a
re s
ettin
g ne
w s
tand
ards
of
exce
llenc
e in
the
qual
ity o
f hea
lth c
are,
” sai
d Bi
ll M
inie
r, M
D, c
hief
med
ical
offi
cer a
t Blu
e C
ross
an
d Bl
ue S
hiel
d of
Neb
rask
a. “
We
are
plea
sed
at th
e le
vel o
f out
stan
ding
spe
cial
ty c
are
avai
labl
e to
our
mem
bers
righ
t her
e in
our
sta
te.”
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T1
7
BLU
E D
ISTI
NC
TIO
N
CEN
TER
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T1
9
MEE
T TH
E
FULL
- TIM
EFA
CU
LTY
DEP
ART
MEN
T IN
MO
TIO
N
KEV
IN L
. GA
RV
IN, M
.D.,
CH
AIR
MA
NA
du
lt R
eco
nst
ruct
ive
Su
rger
y
Kevi
n L.
Gar
vin,
M.D
., is
pro
fess
or a
nd c
hair
of t
he U
nive
rsity
of
Neb
rask
a C
olle
ge o
f Med
icin
e’s
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
an
d Re
habi
litat
ion,
as
wel
l as
the
L. T
hom
as H
ood,
M.D
., Pr
ofes
sor o
f O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion.
He
rece
ived
his
M.D
. deg
ree
at t
he M
edic
al C
olle
ge o
f Wis
cons
in. H
e co
mpl
eted
an
orth
opae
dic
surg
ery
resi
denc
y pr
ogra
m a
t the
Uni
vers
ity o
f Ark
ansa
s fo
r Med
ical
Sc
ienc
es in
Litt
le R
ock
and
a fe
llow
ship
in h
ip s
urge
ry a
t the
Hos
pita
l fo
r Spe
cial
Sur
gery
in N
ew Y
ork
City
. Dr.
Gar
vin
has
serv
ed a
s as
soci
-at
e ed
itor f
or th
e Jo
urn
al o
f Bo
ne
an
d J
oin
t S
urg
ery
, as
wel
l as
depu
ty
edito
r for
Clin
ical
Ort
ho
pae
dic
s an
d R
ela
ted
Re
sear
ch a
nd c
ontin
ues
to s
erve
as
a co
nsul
tant
revi
ewer
for b
oth
publ
icat
ions
. In
addi
tion,
he
is o
n th
e ed
itoria
l boa
rd fo
r Tec
hniq
ues
in K
nee
Surg
ery.
Dr.
Gar
vin
is
a m
embe
r of
the
Am
eric
an O
rtho
paed
ic A
ssoc
iatio
n (A
BC T
rave
ling
Fello
w,
1995
; ch
air,
Resi
dent
Lea
ders
hip
Foru
m,
2008
; C
ounc
il of
O
rtho
paed
ic R
esid
ency
Dire
ctor
s Bo
ard,
200
9-20
12),
the
Hip
Soc
iety
(m
embe
r-at
-larg
e, B
oard
of
Dire
ctor
s, 2
008;
Boa
rd o
f Sp
ecia
lty
Soci
etie
s Ex
ecut
ive
Com
mitt
ee,
2009
-201
2),
the
Knee
Soc
iety
, th
e A
ssoc
iatio
n of
Bo
ne
and
Join
t Su
rgeo
ns
and
the
Mid
-Am
eric
a O
rtho
paed
ic A
ssoc
iatio
n (p
resi
dent
, 200
4-20
05).
Dr.
Gar
vin
has b
een
sele
cted
as
one
of th
e Be
st D
octo
rs in
Am
eric
a fr
om 1
996-
2010
. He
was
als
o se
lect
ed a
s on
e of
Am
eric
a’s
Top
Doc
tors
by
Cas
tle C
onno
lly
Med
ical
, Ltd
. (20
07-2
010)
. He
is a
boa
rd c
ertifi
ed o
rtho
paed
ic su
rgeo
n w
ith sp
ecia
l inte
rest
s in
hip
and
knee
reco
nstr
uctio
n, a
s wel
l as p
reve
n-tio
n an
d tr
eatm
ent o
f mus
culo
skel
etal
infe
ctio
ns.
MIG
UEL
S. D
AC
CA
RE
TT,
M.D
.S
po
rts
Med
icin
e a
nd
Ort
ho
pa
edic
Tra
um
ato
log
y
Mig
uel S
. Dac
care
tt, M
.D., i
s an
assi
stan
t pro
fess
or in
the
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Re
habi
litat
ion.
He
rece
ived
his
med
ical
deg
ree
from
Pon
tifici
a U
nive
rsita
s Xav
eria
na, I
HS
in B
ogot
a,
Col
ombi
a in
199
2. In
coo
rdin
atio
n w
ith h
is la
st ye
ar o
f med
ical
scho
ol, h
e co
mpl
eted
a g
ener
al ro
tat-
ing
inte
rnsh
ip a
t St.
Igna
tius U
nive
rsity
Hos
pita
l, an
d in
200
0 co
mpl
eted
his
ort
hopa
edic
resi
denc
y pr
ogra
m a
t El B
osqu
e U
nive
rsity
Ort
hope
dic
Surg
ery
Prog
ram
in B
ogot
a, C
olom
bia.
Dr.
Dac
care
tt
has
com
plet
ed t
hree
ort
hopa
edic
fel
low
ship
s, i
nclu
ding
an
Ort
hopa
edic
Tra
uma
Fello
wsh
ip
(Uni
vers
ity o
f Lo
uisv
ille,
KY,
200
4),
an O
rtho
paed
ic O
ncol
ogy
Fello
wsh
ip (
Uni
vers
ity o
f Fl
orid
a in
Gai
nesv
ille,
FL,
200
5), a
nd a
n O
rtho
paed
ic S
port
s M
edic
ine
Fello
wsh
ip (H
arva
rd U
nive
rsity
/C
hild
ren’
s H
ospi
tal i
n Bo
ston
, MA
, 200
6). H
e is
a c
andi
date
mem
ber o
f the
Mus
culo
skel
etal
Tum
or
Soci
ety,
as w
ell a
s a
mem
ber o
f the
Am
eric
an O
rtho
paed
ic S
ocie
ty fo
r Spo
rts
Med
icin
e (A
OSS
M),
the
Ort
hopa
edic
Tra
uma
Ass
ocia
tion
(OTA
), an
d fa
culty
mem
ber
of A
O N
orth
Am
eric
a (A
ON
A).
He
is a
lso
a m
embe
r of t
he In
tern
atio
nal C
artil
age
Repa
ir So
ciet
y (IC
RS),
the
Col
ombi
an S
ocie
ty o
f O
rtho
pedi
c Sur
gery
and
Trau
mat
olog
y (SC
CO
T), a
nd th
e In
tern
atio
nal S
ocie
ty o
f Art
hros
copy
, Kne
e Su
rger
y an
d O
rtho
paed
ic S
port
s M
edic
ine
(ISA
KOS)
. His
spe
cial
inte
rest
s in
clud
e th
e tr
eatm
ent o
f pe
lvis
and
per
i-art
icul
ar f
ract
ures
, as
wel
l as
arth
rosc
opic
ass
essm
ent
of f
ract
ures
com
prom
is-
ing
the
artic
ular
join
t. H
is a
dditi
onal
inte
rest
s in
clud
e th
e tr
eatm
ent o
f spo
rts-
rela
ted
inju
ries
and
mul
ti-lig
amen
tous
inju
ries
of th
e kn
ee, i
nclu
ding
AC
L an
d PC
L re
cons
truc
tion,
car
tilag
e re
pair
pro-
cedu
res,
ost
eoar
ticul
ar c
artil
age
tran
sfer
(OAT
S) a
nd m
enis
cal r
epai
r and
tran
spla
ntat
ion,
as
wel
l as
aut
olog
ous
chon
droc
yte
tran
spla
ntat
ion
(AC
I).
MAR
K E.
DIE
TRIC
H, M
.D.
Sp
ort
s M
ed
icin
e a
nd
Gen
era
l Ort
ho
pa
ed
ics
Mar
k E.
Die
tric
h, M
.D.,
is an
ass
ista
nt p
rofe
ssor
in t
he D
epar
tmen
t of
Ort
hopa
edic
Sur
gery
and
Re
habi
litat
ion.
He
rece
ived
his
med
ical
deg
ree
from
the
Uni
vers
ity o
f Neb
rask
a C
olle
ge o
f Med
icin
e.
Dr.
Die
tric
h co
mpl
eted
a fi
ve-y
ear
resi
denc
y pr
ogra
m a
t th
e U
nive
rsity
of
Neb
rask
a/C
reig
hton
U
nive
rsity
Hea
lth F
ound
atio
n, f
ollo
wed
by
an O
rtho
paed
ic S
port
s M
edic
ine
Fello
wsh
ip a
t M
inne
sota
Spo
rts M
edic
ine
in M
inne
apol
is, M
inne
sota
. He
is a
can
dida
te m
embe
r of t
he A
mer
ican
O
rtho
paed
ic S
ocie
ty fo
r Sp
orts
Med
icin
e. D
r. D
ietr
ich’
s sp
ecia
lty in
tere
sts
incl
ude
spor
ts-re
late
d in
jurie
s, h
ip a
rthr
osco
py, a
nd a
rthr
osco
pic
knee
and
sho
ulde
r rec
onst
ruct
ion.
PAU
L W
. ES
PO
SITO
, M.D
.Ped
iatr
ic O
rth
op
aed
ic S
urg
ery
Paul
W. E
spos
ito, M
.D.,
is a
pro
fess
or o
f Ort
hopa
edic
Sur
gery
and
Ped
iatr
ics
at th
e U
nive
rsity
of
Neb
rask
a C
olle
ge o
f Med
icin
e. H
e re
ceiv
ed h
is M
.D. d
egre
e fr
om H
ahne
man
n M
edic
al C
olle
ge
and
Hos
pita
l. H
e co
mpl
eted
his
inte
rnsh
ip a
nd re
side
ncy
in o
rtho
paed
ic s
urge
ry a
t the
U.S
. Nav
al
Hos
pita
l, O
akla
nd,
Cal
iforn
ia,
and
a pe
diat
ric o
rtho
paed
ic f
ello
wsh
ip a
t C
hild
ren’
s H
ospi
tal
Med
ical
Cen
ter
Cin
cinn
ati.
He
is b
oard
cer
tified
and
is a
mem
ber
of t
he P
edia
tric
Ort
hopa
edic
So
ciet
y of
Nor
th A
mer
ica,
a m
embe
r of
the
Am
eric
an O
rtho
paed
ic A
ssoc
iatio
n, a
fel
low
of t
he
Am
eric
an A
cade
my o
f Ort
hopa
edic
Sur
geon
s, a
nd a
fello
w o
f the
Am
eric
an A
cade
my o
f Ped
iatr
ics.
H
e is
act
ive
in th
e A
mer
ican
Aca
dem
y of
Ped
iatr
ics (
AA
P), s
ervi
ng o
n th
e Se
ctio
n on
Ort
hopa
edic
s,
the
Sect
ion
on S
port
s M
edic
ine,
and
the
Cou
ncil
on C
hild
ren
with
Dis
abili
ties.
Dr.
Espo
sito
is th
e A
AP
repr
esen
tativ
e to
the
U.S
. Bon
e an
d Jo
int D
ecad
e (U
SBJD
), a
natio
nal
orga
niza
tion
dedi
cate
d to
incr
easi
ng a
war
enes
s of
bon
e an
d jo
int c
ondi
tions
and
dis
ease
. He
is a
revi
ewer
for P
EDIA
TR
ICS
and
the
Jou
rnal
of
Pe
dia
tric
Ort
ho
pae
dic
s. H
e is
on
the
exec
utiv
e co
mm
ittee
of t
he O
ne W
orld
H
ealth
Cen
ter.
Dr.
Espo
sito
is o
n th
e bo
ard
of d
irect
ors
at C
hild
ren’
s H
ospi
tal a
nd M
edic
al C
ente
r, se
rved
as
pres
iden
t of t
he M
edic
al S
taff
(200
8-20
10),
and
is th
e pe
diat
ric o
rtho
paed
ic s
urge
on o
f th
e os
teog
enes
is im
perf
ecta
clin
ic. H
e ha
s pu
blis
hed
a bo
ok c
hapt
er a
nd m
ade
num
erou
s pr
esen
-ta
tions
in th
e la
st tw
o ye
ars
rega
rdin
g th
e tr
eatm
ent o
f ost
eoge
nesi
s im
perf
ecta
. D
r. Es
posi
to w
as
once
aga
in s
elec
ted
as o
ne o
f Bes
t Doc
tors
in A
mer
ica
in 2
009-
2010
, an
hono
r he
has
rec
eive
d si
nce
1998
. His
spe
cial
inte
rest
s ar
e in
chi
ldre
n’s
extr
emity
def
orm
ities
, ost
eoge
nesi
s im
perf
ecta
, co
ngen
ital a
nd d
evel
opm
enta
l dis
orde
rs, a
nd c
ereb
ral p
alsy
.
PE
RFO
RM
AN
CE
IN M
OTIO
N1
8
EDW
ARD
V. F
EH
RIN
GE
R, M
.D.
Sh
ou
lder
an
d E
lbo
w S
urg
ery
Edw
ard
V. F
ehrin
ger,
M.D
., is
an
asso
ciat
e pr
ofes
sor
at t
he U
nive
rsity
of
Neb
rask
a C
olle
ge o
f M
edic
ine’
s Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n. H
e re
ceiv
ed h
is m
edic
al d
egre
e at
the
Uni
vers
ity o
f Neb
rask
a C
olle
ge o
f Med
icin
e. H
e th
en c
ompl
eted
a fi
ve-y
ear o
rtho
paed
ic re
si-
denc
y at
the
Cre
ight
on U
nive
rsity
/Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r Hea
lth F
ound
atio
n. A
fter
co
mpl
etin
g hi
s re
side
ncy,
Dr.
Fehr
inge
r wen
t on
to c
ompl
ete
a sh
ould
er a
nd e
lbow
fello
wsh
ip a
t the
U
nive
rsity
of W
ashi
ngto
n Sc
hool
of M
edic
ine
in S
eatt
le, W
ashi
ngto
n. H
e is
boa
rd c
ertifi
ed b
y th
e A
mer
ican
Boa
rd o
f Ort
hopa
edic
Sur
gery
. He
is a
n as
soci
ate
mem
ber
of t
he A
mer
ican
Sho
ulde
r an
d El
bow
Sur
geon
s an
d a
fello
w o
f the
Am
eric
an A
cade
my
of O
rtho
paed
ic S
urge
ons.
He
is a
lso
a m
embe
r of
the
Am
eric
an O
rtho
paed
ic A
ssoc
iatio
n, t
he M
id-A
mer
ica
Ort
hopa
edic
Ass
ocia
tion,
an
d th
e A
rthr
osco
py A
ssoc
iatio
n of
Nor
th A
mer
ica.
He
has b
een
sele
cted
as o
ne o
f the
Bes
t Doc
tors
in
Am
eric
a fr
om 2
007-
2010
. His
clin
ical
inte
rest
s in
clud
e sh
ould
er a
nd e
lbow
art
hriti
s, d
islo
catio
ns,
frac
ture
s, a
nd te
ndon
tear
s. H
is re
sear
ch in
tere
sts
incl
ude
rota
tor c
uff t
ears
and
thei
r ass
ocia
tion
with
agi
ng, a
nd s
houl
der s
ocke
t rec
onst
ruct
ion
in s
houl
ders
with
art
hriti
s.
GLE
N M
. GIN
SBU
RG
, M.D
.Ped
iatr
ic O
rth
op
aed
ic a
nd
Sp
ine
Su
rger
y
Gle
n M
. Gin
sbur
g, M
.D., i
s an
asso
ciat
e pro
fess
or a
t the
Uni
vers
ity o
f Neb
rask
a C
olle
ge o
f Med
icin
e’s
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n. H
e is
als
o m
edic
al d
irect
or o
f the
Mun
roe-
Mey
er In
stitu
te M
otio
n A
naly
sis
Labo
rato
ry. D
r. G
insb
urg
earn
ed h
is M
.D. d
egre
e fr
om th
e St
ate
Uni
vers
ity o
f New
Yor
k at
Buf
falo
and
com
plet
ed a
n or
thop
aedi
c re
side
ncy
at th
e St
ate
Uni
vers
ity
of N
ew Y
ork
at B
uffa
lo. H
e co
mpl
eted
a fe
llow
ship
in p
edia
tric
ort
hopa
edic
s at
Chi
ldre
n’s
Hos
pita
l in
Los
Ang
eles
. A b
oard
cer
tified
ort
hopa
edic
sur
geon
, Dr.
Gin
sbur
g is
a m
embe
r of t
he G
ait a
nd
Clin
ical
Mov
emen
t Ana
lysi
s So
ciet
y, th
e A
mer
ican
Aca
dem
y of
Cer
ebra
l Pal
sy a
nd D
evel
opm
enta
l M
edic
ine,
the
Am
eric
an A
cade
my o
f Ort
hopa
edic
Sur
geon
s, a
nd th
e Pe
diat
ric O
rtho
paed
ic S
ocie
ty
of N
orth
Am
eric
a. H
e is
a f
ello
w o
f bo
th t
he A
mer
ican
Boa
rd o
f O
rtho
paed
ic S
urge
ry a
nd t
he
Scol
iosi
s Res
earc
h So
ciet
y. H
is a
reas
of f
ocus
incl
ude
pedi
atric
spin
e de
form
ities
and
gai
t dis
orde
rs.
Dr.
Gin
sbur
g ha
s be
en s
elec
ted
as o
ne o
f the
Bes
t Doc
tors
in A
mer
ica
from
200
3-20
10.
HA
NI H
AID
ER
, PH
.D.
Dir
ect
or,
Ort
ho
pa
edic
s B
iom
ech
an
ics
an
d A
dva
nce
d S
urg
ica
l Tech
no
log
ies
Lab
ora
tory
Han
i Hai
der,
Ph.D
., is
a p
rofe
ssor
at t
he U
nive
rsity
of N
ebra
ska
Col
lege
of M
edic
ine’
s Dep
artm
ent
of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion,
and
dire
ctor
of B
iom
edic
al E
ngin
eerin
g Re
sear
ch. D
r. H
aide
r st
udie
d in
Eng
land
for
his
first
deg
ree
and
Ph.D
. in
Mec
hani
cal E
ngin
eerin
g. F
rom
a fl
uid
dyna
mic
s an
d m
echa
tron
ics
facu
lty te
achi
ng b
ackg
roun
d at
the
Uni
vers
ity o
f She
ffiel
d, h
e jo
ined
th
e fa
culty
of U
nive
rsity
Col
lege
Lon
don
Med
ical
Sch
ool a
t the
wel
l-kno
wn
Cen
tre
of B
iom
edic
al
Engi
neer
ing
in S
tanm
ore
in 1
997.
He
was
the
prin
cipa
l mec
hani
cal a
nd so
ftw
are
engi
neer
who
pro
-du
ced
the
Inst
ron-
Stan
mor
e Kn
ee S
imul
ator
and
the
Inte
rnat
iona
l Sta
ndar
ds O
rgan
izat
ion
(ISO
) m
etho
d fo
r sim
ulat
ion
and
wea
r tes
ting
of k
nee
repl
acem
ent s
yste
ms.
He
was
invi
ted
to jo
in th
e fa
culty
of t
he U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter i
n M
arch
200
0.
Dr.
Hai
der
had
won
thre
e di
ffer
ent U
nive
rsity
priz
es in
his
uni
vers
ity s
tude
nt c
aree
r, an
d tw
o as
fa
culty
from
the
Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r for
Spe
cial
and
Out
stan
ding
Pro
fess
iona
l A
chie
vem
ent.
He
also
rec
eive
d th
e “T
he K
LIN
GER
Inte
rnat
iona
l Res
earc
h Pr
ize”
/Aus
tria
, and
the
HA
P Pa
ul A
war
d by
the
Inte
rnat
iona
l Soc
iety
for T
echn
olog
y in
Art
hrop
last
y fo
r inn
ovat
ion
in jo
int
repl
acem
ent t
echn
olog
y. In
Neb
rask
a, D
r. H
aide
r has
rece
ived
ove
r 30
rese
arch
con
trac
ts, m
ostly
fr
om o
rtho
paed
ic c
ompa
nies
in th
e U
SA, a
nd fr
om E
urop
e an
d Ja
pan,
as
wel
l as
fede
ral f
undi
ng,
alto
geth
er to
talin
g ov
er $
6 m
illio
n. H
e ha
s pr
esen
ted
over
150
pap
ers
in p
eer-
revi
ewed
jour
nals
an
d in
tern
atio
nal c
onfe
renc
es in
ort
hopa
edic
s bi
omec
hani
cs. H
e co
-cha
irs t
he c
omm
ittee
for
Kn
ee Im
plan
t Wea
r Tes
ting
of A
STM
Inte
rnat
iona
l, an
d ch
airs
the
AST
M To
tal A
nkle
Spe
cific
atio
n/Te
stin
g st
anda
rd c
omm
ittee
. He
is p
rogr
am d
irect
or o
f the
Inte
rnat
iona
l Soc
iety
of T
echn
olog
y in
A
rthr
opla
sty
(ISTA
) and
a m
embe
r of i
ts B
oard
of D
irect
ors.
Dr.
Hai
der i
s on
e of
two
non-
surg
eon
mem
bers
/con
sulta
nts
on t
he B
iom
edic
al E
ngin
eerin
g C
omm
ittee
of T
he A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons
(AA
OS)
.
CU
RTIS
W. H
AR
TMA
N, M
.D.
Ad
ult
Reco
nst
ruct
ive
Su
rger
y
Cur
tis W
. H
artm
an,
M.D
., is
an
assi
stan
t pr
ofes
sor
at t
he U
nive
rsity
of
Neb
rask
a C
olle
ge o
f M
edic
ine’
s Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n. H
e re
ceiv
ed h
is m
edic
al d
egre
e at
the
Uni
vers
ity o
f M
isso
uri i
n 20
03, a
nd c
ompl
eted
his
ort
hopa
edic
sur
gery
res
iden
cy a
t th
e U
nive
rsity
of N
ebra
ska/
Cre
ight
on U
nive
rsity
Med
ical
Cen
ter H
ealth
Fou
ndat
ion
in 2
008.
Fol
low
ing
resi
denc
y, D
r. H
artm
an c
ompl
eted
a f
ello
wsh
ip in
Adu
lt Re
cons
truc
tion
at t
he R
ush
Uni
vers
ity
Med
ical
Cen
ter
and
Cen
tral
DuP
age
Hos
pita
l, in
Chi
cago
, Illi
nois
, in
2009
. He
is a
can
dida
te
mem
ber
of th
e A
mer
ican
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s an
d th
e M
id-A
mer
ica
Ort
hopa
edic
A
ssoc
iatio
n, a
s w
ell a
s a
mem
ber
of th
e A
mer
ican
Ort
hopa
edic
Ass
ocia
tion’
s Em
ergi
ng L
eade
rs
Prog
ram
. Dr.
Har
tman
spec
ializ
es in
com
preh
ensi
ve c
are
for a
dult
patie
nts w
ith h
ip a
nd k
nee
arth
ri-tis
. His
oth
er in
tere
sts i
nclu
de re
visi
on o
f fai
led
hip
and
knee
repl
acem
ents
, as w
ell a
s man
agem
ent
of in
fect
ed h
ip a
nd k
nee
repl
acem
ents
.
BRIA
N P.
HA
SLE
Y, M
.D.
Ped
iatr
ic O
rth
op
aed
ic a
nd
Sp
ine
Su
rger
y
Bria
n P.
Has
ley,
M.D
., is
an
assi
stan
t pr
ofes
sor
of O
rtho
paed
ic S
urge
ry a
t th
e U
nive
rsity
of
Neb
rask
a C
olle
ge o
f Med
icin
e, D
epar
tmen
t of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion.
He
earn
ed
his
med
ical
deg
ree
from
the
Uni
vers
ity o
f Neb
rask
a C
olle
ge o
f Med
icin
e an
d co
mpl
eted
his
res
i-de
ncy
in o
rtho
paed
ic s
urge
ry a
t the
Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r. Fo
llow
ing
resi
denc
y,
Dr.
Has
ley
com
plet
ed th
e D
orot
hy a
nd B
ryan
t Edw
ards
Fel
low
ship
in p
edia
tric
ort
hopa
edic
surg
ery
and
scol
iosi
s at
the
Texa
s Sc
ottis
h Ri
te H
ospi
tal f
or C
hild
ren,
Uni
vers
ity o
f Tex
as a
t Sou
thw
este
rn
Med
ical
Cen
ter,
in D
alla
s, T
exas
. Dr.
Has
ley
com
plet
ed p
ost f
ello
wsh
ip s
pine
rese
arch
at t
he s
ame
faci
lity.
Dr.
Has
ley
is b
oard
cer
tified
by
the
Am
eric
an B
oard
of O
rtho
paed
ic S
urge
ry. H
e is
a fe
llow
of
the
Am
eric
an A
cade
my
of O
rtho
paed
ic S
urge
ons,
and
a c
andi
date
mem
ber
of t
he S
colio
sis
Rese
arch
Soc
iety
and
the
Ped
iatr
ic O
rtho
paed
ic S
ocie
ty o
f Nor
th A
mer
ica
(PO
SNA
). D
r. H
asle
y ha
s be
en s
elec
ted
as o
ne o
f the
Bes
t Doc
tors
in A
mer
ica
from
200
7-20
10. H
is a
reas
of f
ocus
are
pe
diat
ric o
rtho
paed
ic a
nd p
edia
tric
spi
ne s
urge
ry
BEAU
S. K
ON
IGSB
ER
G, M
.D.
Ad
ult
Rec
on
stru
ctiv
e Su
rger
y
Beau
S.
Koni
gsbe
rg,
M.D
., is
an
assi
stan
t pr
ofes
sor
at t
he U
nive
rsity
of
Neb
rask
a C
olle
ge o
f M
edic
ine’
s D
epar
tmen
t of
Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n. D
r. Ko
nigs
berg
rec
eive
d hi
s m
edic
al d
egre
e fr
om th
e U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter i
n 20
01, a
nd c
ompl
eted
his
ort
ho-
paed
ic s
urge
ry r
esid
ency
at t
he U
nive
rsity
of N
ebra
ska/
Cre
ight
on U
nive
rsity
Hea
lth F
ound
atio
n in
200
7. F
ollo
win
g re
side
ncy,
Dr.
Koni
gsbe
rg c
ompl
eted
an
Adu
lt Re
cons
truc
tion
and
Art
hrop
last
y Fe
llow
ship
at M
idw
est O
rtho
paed
ics
at R
ush/
Rush
Uni
vers
ity M
edic
al C
ente
r in
Chi
cago
, Illi
nois
. H
e is
a m
embe
r of
the
Ort
hopa
edic
Res
earc
h an
d Ed
ucat
ion
Foun
datio
n an
d th
e A
mer
ican
O
rtho
paed
ic A
ssoc
iatio
n Em
ergi
ng L
eade
rs P
rogr
am. H
e is
a c
andi
date
mem
ber o
f the
Am
eric
an
Aca
dem
y of O
rtho
paed
ic S
urge
ons a
nd th
e M
id-A
mer
ica
Ort
hopa
edic
Ass
ocia
tion.
Dr.
Koni
gsbe
rg
spec
ializ
es in
com
preh
ensi
ve c
are
for a
dult
patie
nts
with
hip
and
kne
e ar
thrit
is.
PE
RFO
RM
AN
CE
IN M
OTIO
N2
0U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
21
AN
THO
NY
J. L
AU
DE
R, M
.D.
Ha
nd
an
d U
pp
er E
xtre
mit
y S
urg
ery
Ant
hony
J.
Laud
er,
M.D
., is
an
assi
stan
t pr
ofes
sor
at t
he U
nive
rsity
of
Neb
rask
a C
olle
ge o
f M
edic
ine’
s D
epar
tmen
t of
Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n, w
ith a
join
t ap
poin
tmen
t in
th
e D
epar
tmen
t of S
urge
ry a
nd S
ectio
n of
Pla
stic
and
Rec
onst
ruct
ive
Surg
ery.
Dr.
Laud
er re
ceiv
ed
his
med
ical
deg
ree
from
the
Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r in
200
0. H
e co
mpl
eted
an
orth
opae
dic
resi
denc
y at
the
Uni
vers
ity o
f Neb
rask
a/C
reig
hton
Uni
vers
ity H
ealth
Fou
ndat
ion
in
2005
. Fol
low
ing
resi
denc
y he
mov
ed to
the
wes
t coa
st to
com
plet
e a
fello
wsh
ip a
t the
Uni
vers
ity
of W
ashi
ngto
n H
and
Surg
ery
Prog
ram
in S
eatt
le, W
ashi
ngto
n. D
r. La
uder
is b
oard
cer
tified
by
the
Am
eric
an B
oard
of O
rtho
paed
ic S
urge
ry. H
e is
a c
andi
date
mem
ber o
f the
Am
eric
an S
ocie
ty
for S
urge
ry o
f the
Han
d, a
nd a
res
iden
t mem
ber o
f bot
h th
e A
mer
ican
Aca
dem
y of
Ort
hopa
edic
Su
rgeo
ns a
nd O
rtho
paed
ic R
esea
rch
and
Educ
atio
n Fo
unda
tion.
Dr.
Laud
er s
peci
aliz
es in
han
d an
d up
per
extr
emity
sur
gery
, and
has
spe
cial
inte
rest
s in
trau
mat
ic a
nd d
egen
erat
ive
cond
ition
s re
late
d to
the
wris
t.
FERE
YDO
ON
NA
MA
VA
R, S
C.D
.D
irect
or,
Na
no
-Bio
tech
no
log
y La
bo
rato
ry
Fere
ydoo
n N
amav
ar,
Sc.D
., is
a pr
ofes
sor
at t
he U
nive
rsity
of
Neb
rask
a C
olle
ge o
f M
edic
ine’
s D
epar
tmen
t of
Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n, a
nd d
irect
or o
f the
Nan
o-Bi
otec
hnol
ogy
Labo
rato
ry. H
e is
an a
ctiv
e m
embe
r of
the
Neb
rask
a C
ente
r fo
r M
ater
ials
and
Nan
osci
ence
and
a
cour
tesy
pro
fess
or a
t th
e D
epar
tmen
t of
Ele
ctric
al E
ngin
eerin
g at
the
Uni
vers
ity o
f N
ebra
ska
– Li
ncol
n. D
r. N
amav
ar e
arne
d a
Doc
tor
of S
cien
ce, s
umm
a cu
m la
ude,
deg
ree
in n
ucle
ar p
hysi
cs,
from
the
Inst
itute
for N
ucle
ar a
nd R
adia
tion
Phys
ics a
t the
Kat
holie
ke U
nive
rsite
it Le
uven
in B
elgi
um.
Pres
ently
, he
is in
volv
ed w
ith th
e de
velo
pmen
t of n
ovel
con
cept
s an
d te
chno
logi
es to
max
imiz
e th
e lif
etim
e of
ort
hopa
edic
impl
ants
and
min
imiz
e th
e po
ssib
ility
of w
ear a
nd r
evisi
on s
urge
ry th
roug
h th
e de
velo
pmen
t of n
ovel
nan
ostr
uctu
re m
ater
ials
for (
i) fr
ictio
n an
d w
ear r
educ
tion,
(ii)
subs
trat
es
for
tissu
e en
gine
erin
g an
d en
hanc
emen
t of b
one
grow
th, a
nd (i
ii) n
ovel
ant
i-bac
teria
l coa
tings
for
shor
t- an
d lo
ng-te
rm a
pplic
atio
ns o
f pro
sthe
tic d
evic
es. I
n a
colla
bora
tive
rese
arch
pro
ject
with
oth
er
UN
MC
facu
lty, D
r. N
amav
ar is
usi
ng s
tem
cel
l nan
otec
hnol
ogy
to re
gula
te c
ellu
lar g
row
th in
ord
er
to e
nhan
ce o
r pre
vent
cel
l pro
lifer
atio
n, to
eith
er im
prov
e he
alth
or p
reve
nt d
isea
se w
ith a
n em
phas
is
on o
rtho
paed
ic a
pplic
atio
ns. D
r. N
amav
ar h
as re
ceiv
ed g
rant
s an
d co
ntra
cts
from
a v
arie
ty o
f cor
-po
ratio
ns a
nd g
over
nmen
t age
ncie
s, in
clud
ing
NIH
, NA
SA a
nd N
SF. H
e co
llabo
rate
s w
ith s
cien
tists
ar
ound
the
wor
ld a
nd h
olds
seve
ral p
aten
ts, in
clud
ing
US
pate
nt 7,
048,
767,
ent
itled
“Nan
o-cr
ysta
lline
, ho
mo-
met
allic
, pro
tect
ive
coat
ings
” for
redu
cing
the
wea
r of a
rtifi
cial
ort
hopa
edic
s im
plan
ts.
MAT
THEW
A. M
OR
MIN
O, M
.D.
Ort
ho
pa
edic
Tra
um
ato
log
y a
nd
Lo
wer
Ext
rem
ity
Mat
thew
A. M
orm
ino,
M.D
., is
ass
ocia
te p
rofe
ssor
and
resi
denc
y pr
ogra
m d
irect
or, a
s w
ell a
s th
e H
erm
an Fr
ank J
ohns
on, M
.D., P
rofe
ssor
of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion
at th
e U
nive
rsity
of
Neb
rask
a C
olle
ge o
f Med
icin
e. H
e re
ceiv
ed h
is M
.D. d
egre
e fr
om th
e U
nive
rsity
of I
llino
is C
olle
ge
of M
edic
ine
and
com
plet
ed h
is o
rtho
paed
ic s
urge
ry r
esid
ency
at C
reig
hton
Uni
vers
ity/U
nive
rsity
of
Neb
rask
a M
edic
al C
ente
r H
ealth
Fou
ndat
ion.
He
also
com
plet
ed a
tra
uma
fello
wsh
ip a
t th
e U
nive
rsity
of W
ashi
ngto
n. A
boa
rd c
ertifi
ed o
rtho
paed
ic su
rgeo
n, D
r. M
orm
ino
is a
dip
lom
ate
of th
e A
mer
ican
Boa
rd o
f Ort
hopa
edic
Sur
gery
. He
is a
mem
ber o
f the
Am
eric
an A
cade
my o
f Ort
hopa
edic
Su
rgeo
ns, t
he A
mer
ican
Ort
hopa
edic
Ass
ocia
tion,
the
Ort
hopa
edic
Tra
uma
Ass
ocia
tion,
and
the
Mid
-Am
eric
a O
rtho
paed
ic A
ssoc
iatio
n. H
e se
rves
as
a co
nsul
tant
rev
iew
er o
f the
Jo
urn
al o
f th
e
Am
eri
can
Aca
de
my
of O
rth
op
aed
ic S
urg
eo
ns,
and
has
bee
n se
lect
ed a
s on
e of
the
Best
Doc
tors
in
Am
eric
a fr
om 2
005-
2010
. Dr.
Mor
min
o’s
spec
ial c
once
ntra
tions
incl
ude
pelv
ic f
ract
ures
, mal
-un
ions
and
non
unio
ns, f
oot a
nd a
nkle
trau
ma,
and
per
iart
icul
ar fr
actu
res.
LORI
K. R
EED
, M.D
.Fo
ot &
An
kle
an
d G
ener
al O
rth
op
aed
ic S
urg
ery
Lori
K. R
eed,
M.D
., is
an
assi
stan
t pro
fess
or a
t the
Uni
vers
ity o
f Neb
rask
a C
olle
ge o
f Med
icin
e’s
Dep
artm
ent
of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion.
Dr.
Reed
rec
eive
d he
r m
edic
al d
egre
e fr
om t
he U
nive
rsity
of
Iow
a C
olle
ge o
f M
edic
ine
in 1
999.
She
com
plet
ed h
er o
rtho
paed
ic
surg
ery
resi
denc
y at
the
Cre
ight
on U
nive
rsity
/Uni
vers
ity o
f N
ebra
ska
Med
ical
Cen
ter
Hea
lth
Foun
datio
n. S
he t
hen
wen
t on
to
com
plet
e he
r Fo
ot a
nd A
nkle
/Low
er E
xtre
mity
Rec
onst
ruct
ion
Fello
wsh
ip a
t the
Flo
rida
Ort
hopa
edic
Inst
itute
in T
ampa
, FL.
Dr.
Reed
is b
oard
cer
tified
in o
rtho
-pa
edic
surg
ery.
She
is a
mem
ber o
f the
Am
eric
an A
cade
my o
f Ort
hopa
edic
Sur
geon
s, O
rtho
paed
ic
Rese
arch
and
Edu
catio
n Fo
unda
tion,
Am
eric
an O
rtho
paed
ic F
oot a
nd A
nkle
Soc
iety
, Ort
hopa
edic
Tr
aum
a A
ssoc
iatio
n, M
id-A
mer
ica
Ort
hopa
edic
Ass
ocia
tion,
Neb
rask
a O
rtho
paed
ic S
ocie
ty, a
nd
the
Emer
ging
Lea
der
Prog
ram
of t
he A
mer
ican
Ort
hopa
edic
Ass
ocia
tion.
Dr.
Reed
spe
cial
izes
in
foot
and
ank
le d
isor
ders
, low
er e
xtre
mity
pos
t-tra
umat
ic re
cons
truc
tion,
and
gen
eral
ort
hopa
edic
s.
SUSA
N A
. SC
HER
L, M
.D.
Ped
iatr
ic O
rth
op
aed
ic S
urg
ery
Susa
n A
. Sc
herl,
M.D
., is
a p
rofe
ssor
at
the
Uni
vers
ity o
f N
ebra
ska
Col
lege
of
Med
icin
e’s
Dep
artm
ent
of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion.
She
ear
ned
her
M.D
. deg
ree
from
the
Bo
ston
Uni
vers
ity S
choo
l of M
edic
ine.
Dr.
Sche
rl co
mpl
eted
tw
o ye
ars
of a
gen
eral
sur
gery
res
i-de
ncy
at S
t. Lu
ke’s/
Roos
evel
t Hos
pita
l Cen
ter i
n N
ew Y
ork
and
com
plet
ed a
five
-yea
r ort
hopa
edic
re
side
ncy a
t Sta
te U
nive
rsity
of N
ew Yo
rk H
ealth
Sci
ence
Cen
ter,
Broo
klyn
, NY.
She
did
her
ped
iatr
ic
orth
opae
dic
fello
wsh
ip a
t Cas
e W
este
rn R
eser
ve U
nive
rsity
in C
leve
land
. She
is b
oard
cer
tified
in
Ort
hopa
edic
Sur
gery
. Dr.
Sche
rl re
cent
ly s
erve
d as
cha
ir of
the
Pedi
atric
Ort
hopa
edic
Soc
iety
of
Nor
th A
mer
ica
(PO
SNA
) Tra
uma
and
Prev
entio
n C
omm
ittee
and
is a
lso
a m
embe
r of t
he P
OSN
A
Educ
atio
n C
omm
ittee
, th
e A
AO
S Le
ader
ship
Dev
elop
men
t C
omm
ittee
, an
d th
e O
rtho
paed
ic
Trau
ma
Ass
ocia
tion
Mem
bers
hip
Com
mitt
ee.
Dr.
Sche
rl ha
s be
en s
elec
ted
as o
ne o
f th
e Be
st
Doc
tors
in A
mer
ica
for 2
003-
2005
, and
200
7-20
10. H
er a
reas
of f
ocus
are
ped
iatr
ic o
rtho
paed
ic
trau
ma
and
man
agem
ent o
f ort
hopa
edic
asp
ects
of c
ereb
ral p
alsy
. She
has
edi
ted
two
text
book
s on
mus
culo
skel
etal
med
icin
e an
d au
thor
ed n
umer
ous
book
cha
pter
s an
d ar
ticle
revi
ews.
PE
RFO
RM
AN
CE
IN M
OTIO
N2
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
23
N. Å
KE N
YS
TRÖ
M, M
.D.,
PH.D
.U
pp
er E
xtre
mit
y a
nd
Mic
rova
scu
lar
Su
rger
y
N. Å
ke N
ystr
öm, M
.D.,
Ph.D
., is
an
asso
ciat
e pr
ofes
sor
at t
he U
nive
rsity
of
Neb
rask
a M
edic
al
Cen
ter’s
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n, w
ith a
join
t app
oint
men
t in
the
Dep
artm
ent
of S
urge
ry a
nd S
ectio
n of
Pla
stic
and
Rec
onst
ruct
ive
Surg
ery.
A n
ativ
e of
Sw
eden
, D
r. N
ystr
öm c
ompl
eted
his
med
ical
trai
ning
, int
erns
hip,
and
res
iden
cy a
t the
Uni
vers
ity o
f Um
ea
Scho
ol o
f Med
icin
e in
Sw
eden
. Aft
er c
ompl
etin
g a
fello
wsh
ip in
han
d an
d up
per e
xtre
mity
sur
gery
at
the
Uni
vers
ity o
f Lou
isvi
lle, h
e re
turn
ed t
o Sw
eden
whe
re h
e fin
ishe
d a
Ph.D
. in
anat
omy
with
re
sear
ch c
once
ntra
tion
in v
enou
s an
atom
y. H
e jo
ined
the
UN
MC
facu
lty in
200
1 af
ter s
ervi
ng a
s pr
ogra
m d
irect
or o
f Han
d Su
rger
y at
the
Uni
vers
ity o
f Pitt
sbur
gh, 1
994-
2001
. Dr.
Nys
tröm
spe
cial
-iz
es in
han
d an
d up
per e
xtre
mity
surg
ery,
as w
ell a
s pla
stic
and
reco
nstr
uctiv
e su
rger
y. H
e ha
s bee
n se
lect
ed a
s one
of t
he B
est D
octo
rs in
Am
eric
a fr
om 2
007-
2010
. His
rese
arch
inte
rest
s foc
us o
n co
ld
into
lera
nce
afte
r han
d tr
aum
a, m
icro
vasc
ular
surg
ery,
and
surg
ical
trea
tmen
t of c
hron
ic p
ain
in th
e he
ad a
nd n
eck
afte
r whi
plas
h.
WA
LTER
W. H
UU
RM
AN
, M.D
.Ped
iatr
ic O
rth
op
aed
ic S
urg
ery
Wal
ter
W. H
uurm
an, M
.D.,
is a
pro
fess
or e
mer
itus
of O
rtho
paed
ic S
urge
ry a
nd P
edia
tric
s at
the
Uni
vers
ity o
f N
ebra
ska
Col
lege
of
Med
icin
e. H
e re
ceiv
ed h
is M
.D. d
egre
e fr
om N
orth
wes
tern
U
nive
rsity
and
com
plet
ed h
is o
rtho
paed
ic re
side
ncy
at th
e U
.S. N
aval
Med
ical
Cen
ter i
n O
akla
nd,
Cal
iforn
ia. D
r. H
uurm
an c
ompl
eted
tra
inin
g in
ped
iatr
ic o
rtho
paed
ic s
urge
ry a
t th
e A
.I. d
uPon
t In
stitu
te.
A b
oard
cer
tified
ort
hopa
edic
sur
geon
, D
r. H
uurm
an h
as s
erve
d on
the
edi
toria
l bo
ards
of t
he A
mer
ican
Aca
dem
y of
Ped
iatr
ics’
Pe
dia
tric
s in
Re
vie
w, a
nd th
e Jo
urn
al o
f P
ed
iatr
ic
Ort
ho
pae
dic
s. H
e ha
s se
rved
as
asso
ciat
e ed
itor o
f the
Jo
urn
al o
f Bo
ne
an
d J
oin
t S
urg
ery
and
on
the
edito
rial r
evie
w b
oard
s of
the
Jo
urn
al o
f th
e A
me
rica
n A
cad
em
y o
f O
rth
op
aed
ic S
urg
eo
ns,
an
d C
linic
al O
rth
op
aed
ics
and
Re
late
d R
ese
arch
. He
is a
n or
al e
xam
iner
for
the
Am
eric
an B
oard
of
Ort
hopa
edic
Sur
gery
, a m
embe
r of
the
Ped
iatr
ic O
rtho
paed
ic S
ocie
ty o
f Nor
th A
mer
ica,
the
A
mer
ican
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s, t
he A
mer
ican
Aca
dem
y of
Ped
iatr
ics,
the
Nor
th
Am
eric
an S
pine
Soc
iety
, and
the
Am
eric
an O
rtho
paed
ic A
ssoc
iatio
n. H
is a
reas
of c
once
ntra
tion
incl
ude
the
juve
nile
spi
ne, c
lubf
oot,
and
juve
nile
hip
dis
ease
, as
wel
l as
editi
ng p
edia
tric
pub
lica-
tions
. Dr.
Huu
rman
retir
ed w
ith th
e ra
nk o
f Cap
tain
from
the
U.S
. Nav
y in
199
6 af
ter s
ervi
ng in
the
Vie
t Nam
and
Gul
f war
s an
d to
pro
fess
or e
mer
itus
stat
us o
n Ju
ly 3
1, 2
006.
SEA
N V
. MC
GA
RR
Y, M
.D.
Mu
scu
losk
eleta
l On
colo
gy
Sean
V. M
cGar
ry, M
.D., i
s an
assi
stan
t pro
fess
or a
t the
Uni
vers
ity o
f Neb
rask
a C
olle
ge o
f Med
icin
e’s
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n. D
r. M
cGar
ry re
ceiv
ed h
is m
edic
al d
egre
e fr
om t
he C
reig
hton
Uni
vers
ity S
choo
l of
Med
icin
e in
199
8. H
e co
mpl
eted
a s
urge
ry in
tern
ship
at
the
Uni
vers
ity o
f Col
orad
o H
ealth
Sci
ence
s C
ente
r in
199
9. D
r. M
cGar
ry c
ontin
ued
on a
t the
U
nive
rsity
of
Col
orad
o H
ealth
Sci
ence
s C
ente
r to
com
plet
e hi
s or
thop
aedi
c re
side
ncy
in 2
004.
Fo
llow
ing
resi
denc
y, he
com
plet
ed a
n or
thop
aedi
c on
colo
gy fe
llow
ship
at t
he U
nive
rsity
of F
lorid
a –
Shan
ds H
ospi
tal i
n 20
05, w
here
he
rese
arch
ed th
e ro
le o
f ste
m c
ells
in b
one
and
soft
tiss
ue c
ance
r. D
r. M
cGar
ry is
boa
rd c
ertifi
ed b
y th
e A
mer
ican
Boa
rd o
f Ort
hopa
edic
Sur
gery
. He
is a
can
dida
te
mem
ber o
f bot
h th
e A
mer
ican
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s an
d th
e M
uscu
losk
elet
al Tu
mor
So
ciet
y. H
e sp
ecia
lizes
in O
rtho
paed
ic O
ncol
ogy
with
a fo
cus
on li
mb
salv
age.
IMA
GIN
E |
Six
sur
geon
s, fo
ur s
urgi
cal
team
s, a
ppro
xim
atel
y 50
vol
unte
ers,
900
0 po
unds
of s
uppl
ies,
and
50
-60
tota
l kne
e or
hip
repl
acem
ents
com
plet
ed o
ver t
hree
lo
ng, b
ut g
ratif
ying
day
s of
sur
gery
. If
you
thin
k it
soun
ds li
ke a
dau
ntin
g ta
sk,
you’
d be
righ
t; bu
t tho
se w
ho h
ave
done
it
say
the
rew
ard
far o
utw
eigh
s w
hat c
an
som
etim
es b
e an
ard
uous
und
erta
king
. The
se
nse
of p
erso
nal f
ulfil
lmen
t rec
eive
d fr
om
know
ing
they
hav
e he
lped
som
eone
that
w
ould
hav
e ot
herw
ise
gone
with
out,
keep
s th
em g
oing
bac
k. It
was
that
infe
ctio
us,
givi
ng a
ttitu
de th
at in
spire
d D
r. G
arvi
n,
to s
tart
Op
era
tio
n W
alk
- N
ebra
ska
.
THE
TRIP
| In
the
fall,
Dr.
Gar
vin
and
Team
N
ebra
ska
will
trav
el to
Ant
igua
, Gua
tem
ala.
Fo
r the
ir fir
st tr
ip th
ey w
ill p
air u
p w
ith T
eam
C
anad
a, w
ho h
as tr
avel
ed to
Ant
igua
sev
eral
tim
es a
nd is
gra
ciou
sly
will
ing
to s
how
them
th
e ro
pes.
A m
issi
on o
f thi
s m
agni
tude
is n
o sm
all
unde
rtak
ing.
Tea
m N
ebra
ska
and
Team
C
anad
a ha
ve c
ombi
ned
forc
es fo
r our
fir
st tr
ip. A
ll pr
ofes
sion
als
will
don
ate
thei
r se
rvic
es, a
nd a
ll of
the
supp
lies
incl
udin
g m
edic
al e
quip
men
t, m
edic
atio
ns, s
urgi
cal
dres
sing
s, s
teril
izat
ion
and
radi
olog
y eq
uipm
ent,
and
join
t im
plan
ts, a
re g
athe
red
thro
ugh
dona
tions
. How
ever
, fun
ds m
ust b
e ra
ised
for t
rave
l exp
ense
s, m
eals
, lod
ging
, an
d th
e sh
ipm
ent o
f med
ical
sup
plie
s, w
hich
ca
n to
tal a
s m
uch
as $
150,
000
per t
rip.
THE
OBS
ERVA
TIO
N T
RIP
| Bu
t fir
st th
ings
firs
t. Be
fore
the
trip
, com
es th
e ob
serv
atio
n tr
ip. T
his
trip
is d
esig
ned
to a
llow
ea
ch n
ew te
am a
n op
port
unity
to u
nder
stan
d th
e re
ality
of t
he p
roce
ss p
rior t
o be
ing
resp
onsi
ble
for t
heir
own
trip
. And
who
bes
t to
lear
n fr
om th
an th
e fo
unde
r him
self?
So,
tw
o ke
y m
embe
rs o
f Tea
m N
ebra
ska
deci
ded
to ta
g al
ong
with
Dr.
Law
renc
e D
orr,
and
his
team
on
Ope
ratio
n W
alk
- Vie
tnam
. Dr.
Dor
r, fo
unde
r and
med
ical
dire
ctor
of T
he D
orr
Art
hriti
s In
stitu
te in
Los
Ang
eles
, CA
, sta
rted
O
pera
tion
Wal
k in
199
5. O
n Ja
nuar
y 15
th, D
r. G
arvi
n, a
nd M
ary
Pete
rson
, R.N
., de
part
ed
for H
o C
hi M
inh
City
, als
o kn
own
as S
aigo
n,
for s
ix d
ays
of a
n ey
e-op
enin
g an
d hu
mbl
ing
expe
rienc
e. H
ere
is a
reca
p of
thei
r wee
k:
WE
ARE
EXC
ITED
TO
AN
NO
UN
CE
THAT
TH
IS F
ALL
, D
R. K
EVIN
GA
RVIN
AN
D 1
6 O
THER
HEA
LTH
CA
RE
PRO
VID
ERS
WIL
L BE
TR
AVEL
ING
TO
AN
TIG
UA
, G
UAT
EMA
LA, O
N T
HE
FIRS
T O
PE
RA
TIO
N
WA
LK–
NE
BR
AS
KA
MIS
SIO
N.
DEP
ART
MEN
T IN
MO
TIO
N
OPE
RA
TIO
N W
ALK
TEAM
N
EBRA
SKA
O
N T
HE
ROA
D T
O A
NTI
GU
A
PE
RFO
RM
AN
CE
IN M
OTIO
N2
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
25
OP
ER
ATI
ON
WA
LK IS
A P
RIVA
TE,
NO
T-FO
R-PR
OFI
T VO
LUN
TEER
MED
ICA
L O
RGA
NIZ
ATIO
N T
HAT
PRO
VID
ES C
OM
PREH
ENSI
VE,
STAT
E-O
F-TH
E-A
RT F
REE
HIP
AN
D K
NEE
REP
LAC
EMEN
TS
FOR
IMPO
VER
ISH
ED P
ATIE
NTS
WIT
H D
EBIL
ITAT
ING
JOIN
T
DIS
EASE
, WH
ILE
EDU
CAT
ING
LOC
AL
HEA
LTH
CA
RE
PRO
FESS
ION
ALS
ON
TH
E M
OST
AD
VAN
CED
TRE
ATM
ENTS
FOR
THES
E C
ON
DIT
ION
S.
Star
ted
in 1
995
by L
aw
ren
ce D
. Do
rr, M
.D.,
a le
adin
g jo
int r
epla
cem
ent s
urge
on in
the
Uni
ted
Stat
es, O
pera
tion
Wal
k ha
s tr
avel
ed to
Cub
a, C
hina
, Nep
al, t
he P
hilip
pine
s,
Nic
arag
ua, G
uate
mal
a, P
eru,
El S
alva
dor,
Mex
ico
and
Keny
a, a
nd h
as o
pera
ted
on o
ver 2
500
patie
nts
in
ten
coun
trie
s.
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T2
7
The
team
div
ided
into
four
scr
een-
ing
team
s th
at e
ach
pres
ente
d th
eir
case
s in
fron
t of t
he g
roup
. Pat
ient
s w
ere
rate
d an
d ch
osen
bas
ed o
n a
prev
ious
ly d
eter
min
ed s
et o
f crit
eria
. A
sur
gery
sch
edul
e w
as d
eter
min
ed,
and
in th
e af
tern
oon
a ‘te
st ru
n’ o
f fo
ur s
urgi
cal c
ases
was
com
plet
ed to
m
ake
sure
eve
ryth
ing
ran
smoo
thly
.
Som
e of
the
afte
rnoo
n w
as a
lso
spen
t tea
ch-
ing
fam
ilies
how
to a
ssis
t with
pos
t-op
care
. In
sta
rk c
ontr
ast t
o th
e he
alth
care
sys
tem
in
the
U.S
., th
e fa
mili
es to
ok o
n m
any
of th
e du
ties
norm
ally
con
side
red
resp
onsi
bilit
ies
of a
nur
se. S
ome
of th
ese
dutie
s in
clud
ed
doin
g dr
essi
ng c
hang
es, p
rovi
ding
line
ns a
nd
pillo
ws
for t
heir
fam
ily m
embe
r, w
hich
are
no
t pro
vide
d by
the
hosp
ital (
pillo
ws
are
very
im
port
ant t
o or
thop
aedi
c po
st-o
p ca
re),
and
prov
idin
g fo
od (o
ften
from
ven
dors
loca
ted
outs
ide
of th
e ho
spita
l).
“It w
as d
efini
tely
a re
ality
che
ck,”
said
Pet
erso
n.
“I h
ad to
reve
rt b
ack
to th
e ba
sics
of ‘
nurs
ing
101.
’ Thi
ngs
wer
e ve
ry d
iffer
ent,
not w
hat
we
are
used
to in
term
s of
cle
anlin
ess
and
avai
labl
e eq
uipm
ent t
hat w
e w
ould
nor
mal
ly
cons
ider
nec
essa
ry, a
nd w
e ju
st h
ad to
re
mem
ber t
hat w
e w
ere
not t
here
to ju
dge
- w
e w
ere
ther
e to
hel
p.”
Due
to th
e la
ck o
f res
ourc
es, f
amili
es m
ust b
e fle
xibl
e an
d re
sour
cefu
l. Fo
r exa
mpl
e, in
som
e in
stan
ces,
mot
or b
ike
tires
wer
e su
bstit
uted
fo
r rai
sed
toile
t sea
ts.
It w
asn’
t con
vent
iona
l, ex
plai
ned
Pete
rson
, bu
t it w
orke
d.
This
was
a fu
ll su
rger
y da
y, ta
cklin
g
12 to
13 p
atie
nts
(oft
en b
ilate
ral j
oint
s w
ere
done
; the
refo
re th
e nu
mbe
r of
repl
acem
ents
don
e du
ring
a m
issi
on
is c
ount
ed in
join
ts, n
ot p
atie
nts)
.
Dili
gent
reco
rd k
eepi
ng w
as v
ital.
Firs
t, to
ens
ure
the
corr
ect p
atie
nt
was
bei
ng id
entifi
ed; a
nd s
econ
d, fo
r pu
rpos
es o
f fol
low
-up
care
. Bec
ause
of
the
obvi
ous
lang
uage
bar
riers
, pat
ient
s w
ere
iden
tified
by
phot
o an
d ro
om n
umbe
r or
a p
atie
nt n
umbe
ring
syst
em –
not
nam
es.
Som
e pe
ople
bor
n in
war
times
did
not
eve
n kn
ow th
eir b
irth
date
, and
man
y ha
d no
m
edic
al h
isto
ry o
r med
icat
ion
reco
rds
to o
ffer
.
Volu
ntee
r am
bass
ador
s w
ere
extr
emel
y im
port
ant d
ue to
the
lang
uage
and
pol
itica
l ba
rrie
rs. N
ot o
nly
wer
e th
ey k
ey in
com
mun
i-ca
ting
with
pat
ient
s, b
ut a
lso
with
the
hosp
ital
staf
f and
adm
inis
trat
ion.
Stu
dent
vol
unte
ers
wer
e al
so e
ager
to h
elp
and
show
team
m
embe
rs a
roun
d th
e ar
ea.
“GR
ATEF
UL .
. . EV
ERYO
NE
WA
S V
ER
Y K
IND
, IN
QU
ISIT
IVE,
AN
D
EAG
ER T
O D
O W
HAT
EVER
TH
EY
CO
ULD
,” SA
ID P
ETER
SON
. “TH
EY
ARE
DEF
INIT
ELY
VIT
AL
TO A
TRI
P O
F TH
IS N
ATU
RE, A
ND
TH
EIR
ASS
ISTA
NC
E W
AS
INVA
LUA
BLE.
”
Day
thre
e w
as a
noth
er fu
ll su
rgic
al
day,
with
a fo
llow
-up
clin
ic h
eld
in
the
afte
rnoo
n. T
he g
oal a
fter
eac
h in
itial
trip
is to
see
pat
ient
s at
thre
e m
onth
s fo
r fol
low
-up
if po
ssib
le, b
ut
defin
itely
a o
ne-y
ear f
ollo
w-u
p is
a
nece
ssity
. Ide
ally
, the
pre
-trip
team
will
se
e pa
tient
s in
follo
w-u
p w
hen
they
go
to s
cout
the
area
(prio
r to
the
actu
al
mis
sion
) and
sel
ect p
ossi
ble
patie
nts
for t
he fo
llow
ing
year
’s tr
ip.
This
was
the
third
and
fina
l ful
l su
rgic
al d
ay. A
lso
on d
ay fo
ur, a
sy
mpo
sium
for t
he h
ost c
ity w
as
held
, dur
ing
whi
ch O
pera
tion
Wal
k ph
ysic
ians
off
ered
did
actic
trai
n-in
g fo
r the
hos
t city
’s ph
ysic
ians
.
For t
he h
ost c
ity, t
he p
atie
nts,
an
d th
eir f
amili
es, t
he s
ympo
-si
um w
as a
ver
y bi
g de
al.
“Gra
tefu
l…” P
eter
son
said
aga
in a
nd a
gain
, w
hen
desc
ribin
g th
e pa
tient
s, th
e fa
mili
es,
and
the
over
all r
ecep
tion
give
n to
the
team
. “E
very
one
was
just
so
grat
eful
that
we
wer
e th
ere.
It m
ade
you
feel
goo
d–th
at a
ll th
e ha
rd
wor
k w
e w
ere
doin
g w
as re
ally
wor
th it
.”
Seei
ng h
ow th
ankf
ul a
nd g
raci
ous
the
fam
ilies
are
cre
ates
a v
ery
high
sen
se o
f tea
m
dedi
catio
n an
d pl
ays
a bi
g ro
le in
why
team
m
embe
rs g
o ba
ck y
ear a
fter
yea
r.
“We
felt
wha
t the
y fe
lt,” e
xpla
ined
Pet
erso
n.
“Whe
n a
patie
nt d
oesn
’t do
as
wel
l exp
ecte
d,
or in
the
even
t tha
t we
had
to tu
rn a
pat
ient
do
wn
for s
urge
ry, w
e al
l fel
t the
dis
appo
int-
men
t.” B
ut o
n th
e fli
p si
de, t
he te
am fe
lt th
eir
joy
as w
ell;
and
than
kful
ly o
n a
mis
sion
like
th
is, t
here
is m
uch
mor
e jo
y ex
perie
nced
th
an d
isap
poin
tmen
t.
Ope
ratio
n W
alk
oper
ates
on
a “d
o no
har
m”
polic
y, sa
id P
eter
son,
whi
ch e
nsur
es th
at
ever
y m
issi
on is
a s
ucce
ssfu
l trip
.
“If w
e ar
en’t
100%
pos
itive
that
sur
gery
is th
e rig
ht c
hoic
e fo
r a p
atie
nt, w
e ha
ve to
giv
e th
em th
e un
fort
unat
e ne
ws
that
they
will
no
t be
rece
ivin
g a
join
t rep
lace
men
t,” s
aid
Pete
rson
. “Th
at is
har
d ne
ws
to g
ive,
but
it is
a
muc
h be
tter
opt
ion
than
doi
ng a
sur
gery
th
at h
as th
e po
tent
ial t
o tu
rn o
ut w
orse
for
the
patie
nt th
an w
hen
they
cam
e in
.”
The
last
day
was
pre
tty
unev
entf
ul.
Ther
e w
as n
o su
rger
y. A
fina
l che
ck
was
per
form
ed o
n pa
tient
s an
d dr
essi
ng c
hang
es w
ere
done
. The
n it
was
tim
e fo
r eve
ryon
e to
repa
ck a
nd
go h
ome.
In Ju
ly o
f thi
s ye
ar, D
r. G
arvi
n an
d Pe
ters
on jo
ined
Can
adia
n te
am
mem
bers
on
a pr
e-tr
ip to
Ant
igua
to ‘s
cout
’ fo
r the
upc
omin
g m
issi
on in
the
fall,
do
post
-op
exam
s on
pat
ient
s fr
om a
pre
viou
s tr
ip, o
btai
n x-
rays
and
com
plet
e pr
e-op
exa
ms
on p
ossi
ble
patie
nts
for t
he n
ext m
issi
on, a
nd
begi
n th
e fu
ll-cir
cle p
roce
ss a
ll ove
r aga
in.
“BEI
NG
ABL
E TO
CO
MPL
ETE
60 T
OTA
L JO
INTS
IN T
HRE
E D
AYS,
AN
D K
NO
WIN
G Y
OU
HAV
E
INC
REA
SED
TH
E Q
UA
LITY
OF
LIFE
FO
R SO
MA
NY
PATI
ENTS
WH
O O
THER
WIS
E W
OU
LD H
AVE
FAC
ED
A L
IFET
IME
OF
SUFF
ERIN
G, W
AS
A R
EWA
RDIN
G
AN
D M
OTI
VATI
NG
EXP
ERIE
NC
E,”
SAID
DR
. GA
RV
IN.
“WE
ARE
DEF
INIT
ELY
LOO
KIN
G F
ORW
ARD
TO
OU
R
UPC
OM
ING
MIS
SIO
N IN
AN
TIG
UA
.”
DAY TWO:
DAY THREE: DAY FOUR:
DAY FIVE:
DAY ONE:
PE
RFO
RM
AN
CE
IN M
OTIO
N2
6
Mar
y Pe
ters
on, R
.N.,
clin
ical
nur
se fo
r D
r. Ke
vin
Gar
vin,
dur
ing
Ope
ratio
n W
alk–
Vie
tnam
enj
oy-
ing
the
only
air
-con
ditio
ned
room
in th
e ho
spita
l (a
lso
used
to s
tore
med
ical
sup
plie
s).
(Bot
tom
left
) Pat
ient
s an
d fa
mily
mem
bers
are
dee
ply
grat
eful
for
the
help
they
hav
e re
ceiv
ed. W
ithou
t a
join
t rep
lace
men
t, m
any
wou
ld li
kely
not
wal
k ag
ain.
(B
otto
m r
ight
) Ope
ratio
n W
alk
– V
ietn
am te
am m
embe
rs ta
ke a
sho
rt b
reak
from
sur
gery
. Fro
m le
ft
to r
ight
: Kev
in G
arvi
n, M
.D.,
(Neb
rask
a); A
amer
Mal
ik, M
.D.,
(Spa
in);
Mic
hael
McS
hane
, M.D
., (O
hio)
; Ro
n H
opki
ns, P
.A.,
(Ohi
o); a
nd R
icha
rd B
oiar
do, M
.D.,
(New
Jer
sey)
.
(Top
left
) A p
atie
nt’s
fam
ily m
embe
r sh
ows
team
mem
bers
to a
typ
ical
hos
pita
l roo
m
whe
re p
atie
nts
will
rec
over
aft
er s
urge
ry.
(Top
rig
ht) S
tude
nt v
olun
teer
s w
ere
eage
r to
ass
ist t
eam
mem
bers
. Vol
unte
er
amba
ssad
ors
are
vita
l to
the
succ
ess
of a
n O
pera
tion
Wal
k m
issi
on.
If y
ou
wo
uld
like
mo
re in
form
ati
on
ab
ou
t h
ow
yo
u c
an
su
pp
ort
Op
era
tio
n
Wa
lk–
Ne
bra
ska
, co
nta
ct
Su
san
Sie
ble
r a
t
ssie
ble
r@u
nm
c.e
du
or
(40
2)
55
9-4
25
1.
PE
RFO
RM
AN
CE
IN M
OTIO
N2
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
29
THE
7.0
MA
GN
ITU
DE
EART
HQ
UA
KE T
HAT
RAV
AG
ED
THE
NA
TIO
N O
F H
AIT
I O
N JA
NU
ARY
12,
201
0,
OC
CU
RRED
APP
ROXI
MAT
ELY
25 M
ILES
WES
T O
F TH
E
CA
PITA
L C
ITY
OF
PORT
-AU
-PRI
NC
E A
ND
LA
STED
ON
LY
ABO
UT
35 S
ECO
ND
S, B
UT
LEFT
A P
ATH
OF
DEA
TH
AN
D D
ESTR
UC
TIO
N T
HAT
TH
E W
ORL
D W
ILL
LIKE
LY
NEV
ER F
ORG
ET. I
T’S
SOM
ETH
ING
TH
AT O
RTH
OPA
EDIC
SURG
EON
S D
RS. M
IGU
EL D
AC
CA
RETT
AN
D S
EAN
MC
GA
RRY
WIL
L N
EVER
FO
RGET
EIT
HER
.
Drs
. Dac
care
tt a
nd M
cGar
ry, b
oth
assi
stan
t pro
fess
ors
in th
e D
epar
tmen
t of O
rtho
paed
ic
Surg
ery
at U
NM
C, r
ecen
tly tr
avel
ed to
Hai
ti an
d ut
ilize
d th
eir s
kills
to h
elp
surv
ivor
s of
the
horr
ible
trag
edy.
Dr.
Dac
care
tt (s
how
n le
ft) w
as a
mon
g th
e fir
st
wav
e of
vol
unte
ers
sent
to H
aiti
thro
ugh
UN
MC
an
d M
edi-S
hare
. He
was
par
t of a
13-
mem
ber
team
of h
ealth
care
wor
kers
incl
udin
g si
x phy
sici
ans
and
seve
n nu
rses
that
dep
loye
d to
Por
t-au-
Prin
ce
on Ja
nuar
y 23
rd. F
or s
ome
it w
as th
eir fi
rst t
ime
volu
ntee
ring
in a
situ
atio
n of
this
kin
d; fo
r oth
ers,
like
D
r. D
acca
rett
, the
y ha
d ex
perie
nce
volu
ntee
ring
in
Third
Wor
ld c
ount
ries
or d
urin
g ot
her d
isas
ters
. His
pa
st e
xper
ienc
es v
olun
teer
ing
with
bot
h a
natu
ral
disa
ster
and
man
-mad
e vi
olen
ce in
his
nat
ive
coun
try
of C
olom
bia,
and
dur
ing
the
afte
rmat
h of
the
9/11
te
rror
ist a
ttac
ks in
New
Yor
k, b
race
d hi
m fo
r wha
t w
as to
com
e.
The
eart
hqua
ke h
ad c
ause
d m
ajor
dam
age
to th
e in
fras
truc
ture
of P
ort-a
u-Pr
ince
, and
the
surr
ound
ing
area
s. M
any
land
mar
ks w
ere
sign
ifica
ntly
dam
aged
or d
estr
oyed
, as
wel
l as
man
y ho
mes
, sch
ools
and
hos
pita
ls, c
rippl
ing
the
coun
trie
s m
edic
al in
fras
truc
ture
.
The
team
of v
olun
teer
s be
gan
wor
k at
L’H
ôpita
l de
la C
omm
unau
té H
aïtie
nne
shor
tly a
fter
thei
r ar
rival
. The
re w
ere
roug
hly
300
patie
nts
and
only
30
beds
. Ano
ther
100
pat
ient
s w
ith n
onsu
rgic
al
inju
ries
wer
e be
ing
trea
ted
in te
nts
outs
ide
the
hosp
ital t
hat w
ere
used
prim
arily
as
a sk
illed
nu
rsin
g fa
cilit
y.
“TH
ERE
WA
S RE
ALL
Y N
O O
RGA
NIZ
ATIO
N A
T TH
AT P
OIN
T, N
O S
TRAT
EGY,
”
SAID
DR
. DA
CC
ARE
TT. “
BEFO
RE L
ON
G, A
N A
DM
INIS
TRAT
OR
FRO
M K
AN
SAS
CIT
Y TO
OK
CO
NTR
OL,
ORG
AN
IZED
A M
EETI
NG
, DIV
IDED
EV
ERYO
NE
INTO
TEA
MS,
AN
D N
AM
ED D
EPA
RTM
ENT
HEA
DS.
SO
ON
AFT
ER T
HAT
, TEA
MS
BEG
AN
SCO
UTI
NG
PAT
IEN
TS F
OR
SURG
ERY
AN
D P
RIO
RITI
ZIN
G C
ASE
S. T
HAT
’S
A H
ARD
CA
LL T
O M
AK
E W
HEN
EV
ERYO
NE
NEE
DS
SURG
ERY.
”
Dur
ing
that
wee
k th
ey p
erfo
rmed
mor
e th
an 3
0 op
erat
ions
on
19 p
atie
nts.
Dr.
Dac
care
tt re
calle
d on
e of
his
mos
t mem
orab
le p
atie
nts,
a 17
-yea
r-old
hig
h sc
hool
stu
dent
who
w
as th
e on
ly s
urvi
vor w
hen
the
scho
ol s
he w
as in
col
laps
ed. S
he w
as re
scue
d th
ree
days
aft
er
LEN
DIN
G A
HEL
PIN
G
HA
ND
IN H
AIT
I
Ruin
s of
the
Hai
tian
Pres
iden
tial H
ouse
follo
win
g th
e Ja
nuar
y 12
, 201
0 ea
rthq
uake
.
(Rig
ht) D
r. D
acca
rett
had
to u
se
a m
anua
l han
d re
amer
for
intr
amed
ulla
ry
fem
oral
and
tibi
a na
iling
.
PE
RFO
RM
AN
CE
IN M
OTIO
N3
0
the
eart
hqua
ke a
nd h
ad s
uffe
red
a br
oken
pe
lvis
and
arm
. For
her
sur
gery
they
had
no
light
s, n
o bl
ood,
no
nurs
es, a
nd n
o su
rgic
al
tech
nici
an, w
hich
als
o m
eant
san
itizi
ng th
eir
own
equi
pmen
t.
“We
wer
e us
ing
Hom
e D
epot
hea
d la
mps
,” sa
id D
r. D
acca
rett
with
a c
huck
le. “
You
lear
n to
impr
ovis
e qu
ickl
y, an
d ev
eryo
ne h
elps
in
wha
teve
r cap
acity
they
can
, no
mat
ter w
hat
thei
r job
or t
itle
in th
e re
al w
orld
.”
Dr.
Dac
care
tt m
arve
led
at h
ow w
ell e
very
one
cam
e to
geth
er w
ithou
t a s
ingl
e qu
arre
l abo
ut
who
sho
uld
be g
iven
wha
t job
.
“The
re w
ere
no fi
ghts
, no
argu
men
ts a
bout
‘s
tatu
s’ o
r who
sho
uld
do w
hat,”
sai
d D
r. D
acca
rett
. “Ev
eryo
ne s
impl
y st
eppe
d in
w
here
ver n
eede
d an
d di
d w
hate
ver j
ob th
at
need
ed to
be
done
. The
re w
as a
law
yer a
nd
a h
ead
of s
urge
ry a
ctin
g as
scr
ub n
urse
s, a
nd
two
spor
ts m
edic
ine
surg
eons
act
ing
as s
crub
te
chs
and
help
ing
with
sur
gery
. Eve
ryon
e ju
st
got a
long
. . .It
was
aw
esom
e.”
Aft
er a
wee
k of
non
-sto
p su
rger
y an
d lit
tle
slee
p, th
e gr
oup
head
ed b
ack
to N
ebra
ska.
D
r. D
acca
rett
had
bee
n ho
me
for o
nly
a fe
w
days
whe
n w
as c
alle
d fo
r a s
econ
d de
ploy
-m
ent t
hrou
gh th
e In
stitu
te fo
r Lat
in A
mer
ican
C
once
rn (I
LAC
), C
reig
hton
Uni
vers
ity, a
nd th
e In
tern
atio
nal M
edic
al A
llian
ce o
f Ten
ness
ee
(IMA
). H
e di
dn’t
hesi
tate
.
By F
ebru
ary
8th,
he
was
onc
e ag
ain
aboa
rd
a pl
ane.
Thi
s tim
e th
ey tr
avel
ed to
the
tow
n
of Ji
man
i, lo
cate
d on
the
bord
er o
f the
D
omin
ican
Rep
ublic
, nea
r Hai
ti. T
here
, D
r. D
acca
rett
ser
ved
as a
team
lead
er
and
orth
opae
dic
trau
ma
surg
eon.
Ther
e w
ere
seve
ral l
arge
tent
s w
ith a
ppro
xi-
mat
ely
50 p
atie
nts
each
, and
a to
tal o
f ar
ound
200
pat
ient
s. T
he h
ospi
tal b
uild
ing
was
use
d fo
r sur
gery
, pos
t op
room
s, IC
U,
phar
mac
y an
d to
hou
se th
e m
edic
al te
ams.
Dur
ing
the
seco
nd tr
ip, t
he te
am h
ad 4
0
surg
ical
pat
ient
s an
d co
mpl
eted
an
unkn
own
num
ber o
f sur
gerie
s.
“Thi
s op
erat
ion
was
muc
h be
tter
org
aniz
ed,”
said
Dac
care
tt, “
We
had
time
to b
ring
in
surg
ical
impl
ants
(don
ated
by
our U
NM
C
orth
opae
dic
lab)
and
pla
n fo
r bet
ter s
urgi
cal
and
non-
surg
ical
trea
tmen
t.”
On
Febr
uary
20t
h, D
r. M
cGar
ry (s
how
n rig
ht)
trav
eled
to H
aiti
thro
ugh
Med
i-Sha
re a
nd th
e U
nive
rsity
of M
iam
i. Th
eir t
eam
of a
bout
20
phys
icia
ns w
as s
tatio
ned
at a
hos
pita
l nea
r th
e Po
rt-a
u-Pr
ince
airp
ort.
The
grou
p w
as
com
pris
ed o
f eig
ht o
rtho
paed
ic s
urge
ons,
as
wel
l as
phys
icia
ns fr
om p
last
ic s
urge
ry, i
nter
-na
l med
icin
e, e
mer
genc
y m
edic
ine,
ob-
gyn
and
path
olog
y.
The
hosp
ital c
onsi
sted
of f
our l
arge
“M.A
.S.H
. st
yle”
tent
s th
at w
ere
each
des
igna
ted
for
a sp
ecifi
c pu
rpos
e, in
clud
ing:
1) s
leep
ing
quar
ters
, 2) a
dult
care
3) p
edia
tric
car
e,
an in
tens
ive
care
uni
t, an
d fo
ur s
urgi
cal a
reas
, an
d 4)
sup
plie
s.
For s
even
day
s it
was
bas
ical
ly th
e sa
me
rout
ine.
The
y ro
se e
arly
for a
7:3
0 a.
m. s
taff
m
eetin
g w
ith th
e or
thop
aedi
c te
am (d
ivid
ed
into
thre
e te
ams
of 2
-3 p
hysi
cian
s ea
ch),
gave
su
rger
y an
d ou
tpat
ient
ass
ignm
ents
, and
as
a
team
saw
abo
ut 1
20 p
atie
nts
each
day
.
They
had
to ro
und
on a
ll of
the
patie
nts
each
da
y, w
hich
mea
nt 3
0-40
per
phy
sici
an.
Whi
le th
ey h
ad m
ost o
f the
reso
urce
s th
ey
need
ed, i
nclu
ding
a C
-arm
mac
hine
and
mos
t ba
sic
lab
faci
litie
s, th
ey h
ad n
o w
orki
ng a
uto-
clav
es. T
his
mea
nt s
oaki
ng a
ll in
stru
men
ts
in b
leac
h, ri
nsin
g th
em in
alc
ohol
, and
then
co
verin
g th
em a
s be
st th
ey c
ould
to k
eep
out
germ
s an
d du
st. M
eanw
hile
, man
y pa
llets
of
supp
lies
rem
aine
d un
usab
le u
ntil
volu
ntee
rs
coul
d in
vent
ory
and
iden
tify
them
.
Ther
e w
ere
no p
erm
anen
t im
plan
ts
utili
zed,
as
the
impl
anta
tion
of p
late
s,
nails
or s
crew
s, u
nder
less
than
ste
rile
cond
ition
s, c
ould
put
pat
ient
s at
a h
igh
risk
of i
nfec
tion
and
pote
ntia
lly d
o m
ore
harm
than
goo
d. A
s a
resu
lt, m
any
mor
e am
puta
tions
wer
e do
ne th
an w
ould
ha
ve b
een
unde
r nor
mal
con
ditio
ns.
Whi
le th
e te
am d
id tr
eat a
num
ber o
f acu
te
trau
ma
case
s, a
rriv
ing
six w
eeks
pos
t-qua
ke
pres
ente
d D
r. M
cGar
ry’s
team
with
a d
if-fe
rent
dyn
amic
than
thos
e te
ams
who
had
ar
rived
imm
edia
tely
follo
win
g th
e qu
ake.
W
ell o
ver h
alf o
f the
inju
ries
seen
wer
e or
thop
aedi
c in
nat
ure
and
requ
ired
follo
w-
up c
are
incl
udin
g ne
w x
-rays
, som
etim
es
cast
ing,
and
oft
en re
habi
litat
ion
inst
ruct
ion.
“The
re w
ere
also
a s
urpr
isin
g nu
mbe
r of s
pina
l co
rd in
jurie
s,” s
aid
Dr.
McG
arry
. One
day
, he
reca
lled,
they
real
ized
that
ther
e w
ere
20
to 3
0 sp
inal
cor
d pa
tient
s w
ho h
ad b
een
confi
ned
to th
eir b
eds
for w
eeks
, una
ble
to
mov
e an
d de
velo
ping
bed
sore
s. B
ecau
se th
e im
med
iate
focu
s in
the
wee
ks a
fter
the
quak
e ha
d be
en o
n st
abili
zing
pat
ient
s su
ffer
ing
from
acu
te tr
aum
a, th
ese
patie
nts
had
beco
me
a lo
w p
riorit
y, as
ther
e w
as n
othi
ng
surg
ical
that
cou
ld b
e do
ne to
hel
p th
em.
“One
of t
he m
ost s
atis
fyin
g th
ings
we
wer
e ab
le to
acc
ompl
ish
was
to g
et e
very
one
of
thos
e pa
tient
s ou
t of t
heir
beds
and
out
side
,” sa
id D
r. M
cGar
ry. “
We
had
them
all
in w
heel
-ch
airs
, lin
ed u
p in
a ro
w o
utsi
de th
e ho
spita
l,
and
they
wer
e al
l so
happ
y to
just
be
out
of th
eir b
eds.”
With
so
man
y sp
inal
cor
d in
jurie
s (q
uad-
riple
gics
and
par
aple
gics
), th
e ho
spita
l was
ev
olvi
ng in
to p
rimar
ily a
reha
bilit
atio
n fa
cilit
y,
said
Dr.
McG
arry
, whi
ch w
ould
be
a vi
tal
com
pone
nt o
f the
ir re
cove
ry. F
amily
mem
bers
w
ere
taug
ht h
ow to
mob
ilize
and
tran
sfer
pa
tient
s an
d w
ere
resp
onsi
ble
for h
elpi
ng
with
muc
h of
that
car
e.
Als
o su
rpris
ing,
wer
e th
e nu
mbe
r of a
cute
in
jurie
s th
at c
ame
into
the
hosp
ital t
hat
wer
e un
rela
ted
to th
e qu
ake.
Bec
ause
so
muc
h of
the
med
ical
infr
astr
uctu
re h
ad b
een
dam
aged
, the
re w
as n
owhe
re e
lse
to tr
eat
thes
e pa
tient
s.
Dr.
McG
arry
reca
lled
a ra
ther
sur
real
exp
eri-
ence
late
one
nig
ht w
hen
a pe
dest
rian
vs.
mot
orcy
cle
acci
dent
vic
tim h
ad p
rese
nted
to
the
hosp
ital.
The
man
had
sur
vive
d th
e qu
ake,
on
ly to
be
wal
king
dow
n th
e st
reet
six
wee
ks
late
r and
be
stru
ck b
y a
mot
orcy
cle.
“Whi
le w
e w
ere
trea
ting
his
open
tibi
a fr
actu
re
and
putt
ing
on a
n ex
tern
al fi
xato
r, w
e su
d-de
nly
hear
d a
loud
wai
ling
soun
d. W
e lo
oked
ov
er to
see
a b
aby
bein
g bo
rn o
n th
e su
rgic
al
tabl
e rig
ht n
ext t
o us
. Tha
t was
defi
nite
ly
som
ethi
ng I
had
neve
r enc
ount
ered
bef
ore,
” he
sai
d w
ith a
chu
ckle
.
Som
ethi
ng e
lse
new
to h
im, w
ere
the
thre
e af
ters
hock
s th
at o
ccur
red
durin
g hi
s st
ay.
Oth
er th
an th
at, i
t was
pre
tty
unev
entf
ul.
“ON
E O
F TH
E M
OST
SAT
ISFY
-
ING
TH
ING
S W
E W
ERE
ABL
E TO
ACC
OM
PLIS
H W
AS
TO G
ET E
VERY
ON
E O
F TH
OSE
PAT
IEN
TS O
UT
OF
THEI
R BE
DS
AN
D O
UTS
IDE,
” SA
ID
DR
. MC
GA
RR
Y. “
WE
HA
D T
HEM
ALL
IN W
HEE
LCH
AIR
S, L
INED
UP
IN A
RO
W O
UTS
IDE
THE
HO
SPIT
AL,
AN
D T
HEY
WER
E A
LL S
O H
APP
Y
TO JU
ST B
E O
UT
OF
THEI
R BE
DS.
”
This
tent
ser
ved
as th
e em
erge
ncy
room
at t
he
L’H
ôpita
l de
la C
omm
unau
té H
aïtie
nne.
Pat
ient
s an
d th
eir
fam
ilies
wai
t out
side
for
thei
r tu
rn to
be
see
n.D
r. M
cGar
ry a
nd h
is te
am w
ere
able
to h
elp
seve
ral s
pina
l inj
ury
patie
nts
get o
utsi
de to
enj
oy s
ome
fres
h ai
r fo
r th
e fir
st ti
me
in w
eeks
.
He
enco
unte
red
no lo
otin
g, m
ost l
ikel
y th
anks
to
the
Uni
ted
Nat
ions
sec
urity
forc
e th
at
serv
ed a
s se
curit
y ou
tsid
e th
e ho
spita
l, in
ad
ditio
n to
the
unar
med
gua
rds
insi
de. T
he
ten
“bañ
os” f
eatu
ring
mak
eshi
ft s
how
ers
serv
ed h
undr
eds
of p
eopl
e an
d w
ere
not
wha
t you
’d fi
nd a
t the
Hilt
on, b
ut e
very
one
man
aged
to g
et b
y. It
was
hot
and
hum
id, b
ut
than
kful
ly m
osqu
ito s
easo
n ha
dn’t
set i
n ye
t.
On
day
five
they
rece
ived
a s
hort
repr
ieve
w
hen
they
got
to g
o to
the
Uni
ted
Nat
ions
ba
se to
enj
oy A
mer
ican
food
and
som
e do
wn
time.
Day
s si
x and
sev
en w
ere
spen
t orie
ntin
g th
e ne
w te
am, b
efor
e fly
ing
hom
e vi
a M
iam
i th
e ne
xt d
ay.
Whe
n as
ked
if he
mig
ht re
turn
for a
sec
ond
trip
, Dr.
McG
arry
repl
ied,
“It w
as d
efini
tely
an
insp
iring
exp
erie
nce,
a o
nce-
in-a
-life
time
oppo
rtun
ity to
use
my
skill
s as
an
orth
opae
dic
surg
eon
in th
is ty
pe o
f set
ting.
”
Aft
er a
few
sec
onds
of r
eflec
tion,
he
cont
inue
d,
“I w
ould
defi
nite
ly g
o ba
ck, j
ust m
aybe
not
rig
ht a
way
. I th
ink
you
need
to ta
ke s
ome
time
to re
coup
. . . it
take
s a
lot o
ut o
f you
.”
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T3
1
DEP
ART
MEN
T O
F O
RTH
OPA
ED
IC S
UR
GE
RY
AN
D R
EH
AB
ILIT
ATI
ON
SEC
TIO
N
02
Your
feed
back
cou
nts.
Sim
ply
go to
ww
w.U
NM
CO
rtho
InM
otio
n.co
m
THE
DEP
ART
MEN
T O
F O
RTH
OPA
ED
IC
SU
RG
ER
Y A
ND
R
EH
AB
ILIT
ATI
ON
’S
OR
THO
PAED
IC
RE
SID
EN
CY
TR
AIN
ING
PR
OG
RA
M A
T U
NM
C
The
com
bine
d pr
ogra
m is
dire
cted
by
Ma
tth
ew M
orm
ino
, M.D
., (le
ft) a
ssoc
iate
pr
ofes
sor o
f ort
hopa
edic
sur
gery
at
UN
MC
. The
pro
gram
incl
udes
trai
ning
in
all
nine
ort
hopa
edic
sub
spec
ialti
es:
�
HA
ND
�
FOO
T A
ND
AN
KLE
�
MA
JOR
JOIN
T RE
CO
NST
RUC
TIO
N
�
ON
CO
LOG
Y
�
PED
AIA
TRIC
OR
THO
PAED
IC S
URG
ERY
�
SHO
ULD
ER A
ND
ELB
OW
�
SPIN
E
�
SPO
RTS
MED
ICIN
E
�
TRA
UM
A
Our
ort
hopa
edic
resi
dent
s ar
e in
volv
ed
in d
aily
pat
ient
car
e as
wel
l as
impo
rtan
t re
sear
ch a
ctiv
ities
dur
ing
thei
r int
ensi
ve
trai
ning
. As
part
of T
he N
ebra
ska
Med
ical
C
ente
r, th
e U
nive
rsity
Hos
pita
l is
a Le
vel
I Tra
uma
Cen
ter,
and
our o
rtho
paed
ic
surg
ery
resi
dent
s pl
ay a
n in
tegr
al
role
on
the
hosp
ital t
raum
a te
am.
AB
OU
T TH
E P
RO
GR
AM
: TH
E U
NM
C D
EPA
RTM
ENT
OF
ORT
HO
PAED
IC S
URG
ERY
AN
D
REH
ABI
LITA
TIO
N’S
ORT
HO
PAED
IC R
ESID
ENC
Y TR
AIN
ING
PRO
GR
AM
IS A
FFIL
IATE
D W
ITH
THE
FOLL
OW
ING
HO
SPIT
ALS
: CH
ILD
REN
’S H
OSP
ITA
L A
ND
MED
ICA
L C
ENTE
R, O
MA
HA
VET
ERA
NS
AFF
AIR
S M
EDIC
AL
CEN
TER
, CRE
IGH
TON
UN
IVER
SITY
MED
ICA
L C
ENTE
R,
AN
D B
ERG
AN
MER
CY
MED
ICA
L C
ENTE
R. L
OC
ATED
IN M
ETRO
POLI
TAN
OM
AH
A, O
UR
RESI
DEN
CY
PRO
GR
AM
PRO
VID
ES A
N O
UTS
TAN
DIN
G E
DU
CAT
ION
AL
EXPE
RIEN
CE,
A S
AFE
TO
WN
WIT
H A
FFO
RDA
BLE
LIV
ING
, AN
D A
N E
NRI
CH
ED S
OC
IAL
ENV
IRO
NM
ENT.
The
prog
ram
rece
ived
full
accr
edita
tion
by th
e Re
side
ncy
Revi
ew C
omm
ittee
of
the
Acc
redi
tatio
n C
ounc
il fo
r Gra
duat
e M
edic
al E
duca
tion
(AC
GM
E) in
200
9,
with
the
next
revi
ew c
omin
g in
201
3. T
he
resi
denc
y cu
rric
ulum
add
ress
es th
e si
x cor
e co
mpe
tenc
ies
as o
utlin
ed b
y th
e A
CG
ME
outc
ome
proj
ect f
or R
esid
ent E
duca
tion:
�
PATI
ENT
CA
RE
�
INTE
RPER
SON
AL
AN
D
CO
MM
UN
ICA
TIO
N S
KIL
LS
�
PRO
FESS
ION
ALI
SM
�
MED
ICA
L K
NO
WLE
DG
E
�
SYST
EMS
BASE
D P
RA
CTI
CE
�
PRA
CTI
CE
BASE
D L
EARN
ING
A
ND
IMPR
OV
EMEN
T
Like
wis
e 80
-hou
r wor
k w
eek
rest
rictio
ns h
ave
been
met
in o
ur re
side
nts’
sch
edul
es. O
vera
ll th
e ad
ditio
n of
new
att
endi
ng s
taff
and
the
chan
ges
to th
e cu
rric
ulum
impr
oved
an
alre
ady
exce
llent
resi
denc
y tr
aini
ng p
rogr
am.
Of a
ll th
e m
en a
nd w
omen
who
hav
e co
mpl
eted
thei
r ort
hopa
edic
sur
gica
l tra
inin
g th
roug
h th
e N
ebra
ska
prog
ram
, mor
e th
an h
alf a
re n
ow p
ract
icin
g in
the
stat
e or
the
Mid
wes
t. Th
e re
mai
ning
phy
sici
ans
are
prac
ticin
g ar
ound
the
coun
try
and
over
seas
. Doc
tors
thro
ugho
ut th
e re
gion
re
gard
UN
MC
as
a so
urce
of c
ontin
uing
ed
ucat
ion
whe
re th
ey c
an le
arn
the
late
st
tech
niqu
es fo
r dia
gnos
is, t
reat
men
t, an
d pr
even
tion
of b
one
and
join
t dis
ease
s.
RE
SID
EN
TS
IN M
OTI
ON
PE
RFO
RM
AN
CE
IN M
OTIO
N3
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
35
PE
RFO
RM
AN
CE
IN M
OTIO
N3
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
37
Om
aha
resi
dent
s ar
e pr
oud
of th
eir c
ity’s
repu
tatio
n fo
r sup
erb
heal
th c
are,
agr
i-cu
lture
, tel
emar
ketin
g an
d hi
gh-te
ch
busi
ness
es, a
nd th
e af
ford
able
qua
lity
of
life.
Om
aha
is h
ome
to th
e he
adqu
arte
rs
of fi
ve F
ortu
ne 5
00 c
ompa
nies
, inc
ludi
ng
Berk
shire
Hat
haw
ay, I
nc.,
Uni
on P
acifi
c,
Con
Agr
a Fo
ods,
Pet
er K
iew
it So
ns, I
nc. a
nd
Mut
ual o
f Om
aha.
The
re a
re a
lso
four
Fo
rtun
e 10
00 c
ompa
nies
hea
dqua
rter
ed
here
, whi
ch in
clud
e TD
Am
eritr
ade,
Wes
t, Va
lmon
t Ind
ustr
ies,
and
Wer
ner E
nter
pris
es.
Out
side
of w
ork,
resi
dent
s ca
n en
joy
a va
riety
of
soc
ial a
ctiv
ities
incl
udin
g m
any
won
derf
ul
rest
aura
nts
and
nigh
tclu
bs, s
ever
al s
port
ing
even
ts, n
umer
ous
mus
ic a
nd a
rts
venu
es, a
nd
vario
us s
ocia
l gat
herin
gs h
eld
by th
e re
si-
dent
s an
d th
eir f
amili
es th
roug
hout
the
year
.
Con
tinuo
usly
in a
sta
te o
f gro
wth
and
re
vita
lizat
ion,
Om
aha
stri
ves
to p
rovi
de
new
and
uni
que
venu
es. M
ost r
ecen
tly,
Des
tinat
ion
Mid
tow
n w
as u
nvei
led–
a pr
emie
r ur
ban
envi
ronm
ent l
ocat
ed in
the
hear
t
RE
SID
EN
T LI
FE IN
OM
AH
A
of M
idto
wn
Om
aha
- tha
t off
ers
a vi
bran
t an
d di
stin
ct a
tmos
pher
e, w
ith m
any
uniq
ue
shop
s, re
stau
rant
s, a
nd h
ousi
ng o
ptio
ns.
Om
aha
is a
lso
wel
l kno
wn
for t
he h
isto
ric
Old
Mar
ket,
Qw
est C
ente
r Om
aha,
Josl
yn
Art M
useu
m, H
olla
nd P
erfo
rmin
g A
rts C
ente
r, Be
mis
Cen
ter f
or C
onte
mpo
rary
Art
s, D
urha
m
Wes
tern
Her
itage
Mus
eum
, and
man
y m
ore
won
derf
ul th
eatr
e an
d ar
ts fa
cilit
ies.
We
tout
a c
laim
to fa
me
for t
he N
ebra
ska
Cor
nhus
kers
, Col
lege
Wor
ld S
erie
s, C
reig
hton
U
nive
rsity
bas
ketb
all,
Om
aha
Roya
ls b
aseb
all,
thre
e ho
ckey
team
s an
d th
e an
nual
Cox
C
lass
ic, a
mon
gst o
ther
s. In
add
ition
, the
Q
wes
t Cen
ter O
mah
a w
ill o
nce
agai
n ho
st
the
U.S
. Oly
mpi
c Sw
imm
ing
Tria
ls in
201
2.
If yo
u en
joy
the
outd
oors
, Om
aha’
s w
orld
-fa
mou
s H
enry
Doo
rly Z
oo is
a g
reat
pla
ce
to s
tart
. Oth
er lo
cal o
utdo
or fe
atur
es in
clud
e th
e be
autif
ul L
aurit
zen
Gar
dens
, Om
aha’
s Bo
tani
cal C
ente
r nea
r the
Mis
sour
i Riv
er,
Mem
oria
l Par
k an
d its
fabu
lous
rose
gar
dens
,
or Z
orin
sky
and
Cun
ning
ham
lake
s lo
cate
d in
w
est O
mah
a. T
he O
mah
a ar
ea a
lso
feat
ures
m
any
city
and
sta
te p
arks
, doz
ens
of jo
ggin
g an
d bi
king
trai
ls, f
amily
ent
erta
inm
ent a
nd
wat
er p
arks
, cha
mpi
onsh
ip g
olf c
ours
es, a
nd
seve
ral o
ther
lake
and
recr
eatio
n ar
eas.
Each
yea
r res
iden
ts g
et to
geth
er fo
r the
infa
-m
ous
Cra
wfis
h Bo
il, O
ktob
erfe
st, H
allo
wee
n,
Chr
istm
as a
nd N
ew Y
ears
. The
re is
an
annu
al
Wel
com
e BB
Q fo
r inc
omin
g re
side
nts
and
vario
us o
ther
eve
nts
such
as
flag
foot
ball
and
intr
amur
al b
aske
tbal
l thr
ough
out t
he y
ear.
DES
PITE
TH
E C
ITY’
S V
IBR
AN
T G
RO
WTH
, RES
IDEN
TS E
NJO
Y A
LO
W-
STRE
SS, S
MA
LL-TO
WN
ATM
OSP
HER
E. V
ISIT
ORS
NO
TIC
E TH
E FR
IEN
DLY
SMIL
ES A
ND
SO
ON
FEE
L RI
GH
T AT
HO
ME.
LO
CAT
ED O
N T
HE
WES
T
BAN
K O
F TH
E M
ISSO
URI
RIV
ER IN
TH
E U
.S. “
HEA
RTLA
ND
” OM
AH
A
WEL
CO
MES
VIS
ITO
RS F
ROM
ALL
OVE
R TH
E W
ORL
D A
S TH
EY A
RRIV
E AT
THE
CIT
Y’S
INTE
RNAT
ION
AL
AIR
PORT
, LO
CAT
ED O
NLY
MIN
UTE
S FR
OM
THE
MED
ICA
L C
ENTE
R A
ND
CO
MFO
RTA
BLE
ACC
OM
MO
DAT
ION
S.
RE
SID
EN
TS
IN M
OTI
ON
PE
RFO
RM
AN
CE
IN M
OTIO
N3
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
39
NEB
RA
SKA
O
RTH
OPA
EDIC
A
LUM
NI
136 74 IN
NEB
RA
SKA
AN
D T
HE
MID
WE
ST
NA
ME
STAT
E
YEA
R
Low
ell N
ieba
um
NV
1971
Osc
ar Ja
rdon
*
1972
Dal
e Ph
elps
IA
19
72C
arl S
chw
artz
A
K 19
73W
illia
m S
mith
N
E 19
73Ri
char
d Be
rgst
rom
N
E 19
74Ro
nald
Bou
lwar
e TX
19
74Jo
hn K
aufm
an
CA
19
74Ro
bert
Sta
ver
OR
1974
Robe
rt C
ochr
an, I
I N
E 19
75Ja
mes
Kul
lbom
SD
19
75Ri
char
d W
ecke
r W
Y 19
75Fl
oyd
Pohl
man
H
I 19
76Ja
ck B
rindl
ey
IA
1977
Will
iam
Bou
lden
IA
19
78Er
ic B
ugna
C
A
1978
Nei
l Hal
brid
ge
CA
19
78Ro
nald
Sch
wab
N
E 19
79Ja
sper
Will
iam
s W
I 19
79Jo
hn Y
eakl
ey
NE
1979
Alo
is P
roet
t W
I 19
80Sa
mar
Ray
N
E 19
80Ba
rry
Turn
er
NE
1980
Joel
Ada
ms
ME
1981
Edw
ard
Sim
odyn
es
* 19
81
Gur
pal B
hulle
r VA
19
82Ra
m P
anka
j IL
19
82D
onal
d W
alla
N
E 19
82Ra
ndal
l Neu
man
n N
E 19
83G
ary
Poru
bsky
LA
19
83M
ark
Buch
man
N
E 19
84C
hris
teen
Kag
a N
C
1984
Mic
hael
Sch
mid
t KS
19
84M
ark
Seco
r K
Y 19
84G
regg
Tay
lor
WI
1984
Robe
rt H
anse
n U
T 19
85Jo
hn K
elbe
l IN
19
85Sc
ott S
mith
U
T 19
85La
rry
Chi
dgey
FL
19
86Th
omas
Eas
tman
N
E 19
86F.
Stig
Jaco
bsen
W
I 19
86Jo
seph
Yao
A
R 19
86Pa
ul D
uwel
ius
OR
1987
Kirk
Gre
en
IA
1987
Lew
is O
ster
, Jr.
CO
19
87D
avid
Pet
erso
n KS
19
87M
arci
a Be
ckm
an-N
else
n SD
19
88Je
ffre
y Fa
rber
IA
19
88G
rego
ry H
anse
n *
1988
Rich
ard
Shin
dell
AZ
1988
Lynn
Cro
sby
GA
19
89Ja
n D
avis
C
O
1989
Robe
rt D
ehne
TX
19
89Sa
mue
l Sm
ith
CO
19
89Br
yan
Bred
thau
er
NE
1990
Roy
Gus
e TX
19
90Ke
vin
O’M
alle
y N
E 19
90M
icha
el S
icur
anza
PA
19
90D
ougl
as B
eard
C
O
1991
Teri
Form
anek
IA
19
91M
ark
Goe
bel
NE
1991
Bret
Mill
er
TX
1991
Jeff
rey
Moo
re
AK
1992
Dav
id T
hull
AZ
1992
Jeff
rey
Tied
eman
N
E 19
92Th
omas
Wal
sh
MN
19
92Je
ffre
y D
avic
k IA
19
93Er
ic G
ordo
n M
O
1993
Todd
Kile
A
Z 19
93Sc
ott B
eck
FL
1994
Jam
es H
ill
IL
1994
Scot
t McM
ulle
n N
E 19
94Ro
bert
Tai
t N
V 19
94Te
d Ye
e C
A
1994
Dee
pak
Cha
vda
TX
1995
Cla
y Fr
ank
WI
1995
Robe
rt M
ilesk
i A
Z 19
95Ve
rn P
roch
aska
N
V 19
95Ju
lian
Arr
oyo
WA
19
96Jo
hn M
iyan
o W
A
1996
Mat
thew
Mor
min
o N
E 19
96Je
ffre
y Ro
dger
s IA
19
96D
avid
Cas
tro
CA
19
97
Khie
m D
ao
CA
19
97Ke
ith H
ughe
s N
E 19
97St
even
Kum
agai
N
E 19
97C
harle
s Bu
rt
NE
1998
Bret
t Fis
cher
N
E 19
98Jo
hn M
cCle
llan,
III
NE
1998
Mic
hael
Soc
hack
i A
Z 19
98St
anle
y Bo
wlin
g KS
19
99D
anie
l Hoe
ffel
M
N
1999
Erik
Ott
erbe
rg
NE
1999
Jeff
rey
Zach
aria
s M
I 19
99Br
ian
Brig
man
N
C
2000
Edw
ard
Fehr
inge
r N
E 20
00Jo
hn S
chne
ider
W
I 20
00Er
ic W
atso
n SD
20
00A
aron
Ask
ew
OR
2001
Mic
hael
Cla
re
FL
2001
Arm
odio
s H
atzi
daki
s C
O
2001
Cra
ig M
ahon
ey
IA
2001
Jam
es B
alla
rd
OR
2002
Dav
id In
da
NE
2002
Dou
glas
McI
nnis
ID
20
02M
icha
el T
hom
pson
N
E 20
02Kr
isto
ffer
Bre
ien
MN
20
03Ja
son
Brow
dy
MO
20
03Jo
hn S
ojka
KS
20
03Jo
shua
Urb
an
NE
2003
Rich
ard
Dav
is
ID
2004
Step
hen
Han
sen
UT
2004
Bria
n H
asle
y N
E 20
04Lo
ri Re
ed
NE
2004
Scot
t Hum
phre
y ID
20
05A
ntho
ny L
aude
r N
E 20
05Ed
war
d Pr
ince
U
T 20
05Iv
an T
arki
n PA
20
05M
ark
Die
tric
h N
E 20
06Ka
thle
en G
rier
NE
2006
Dan
iel M
ulco
nrey
IL
20
06C
harle
s Ro
sipa
l N
E 20
06St
even
Vol
in
NE
2006
Dav
id B
uck
NE
2007
Beau
Kon
igsb
erg
NE
2007
Scot
t Sw
anso
n N
E 20
07Ki
mbe
rly T
urm
an
NE
2007
Cur
tis H
artm
an
NE
2008
Mic
hael
Haw
ks
FL
2008
Rand
on Jo
hnso
n IL
20
08Le
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buul
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20
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ica
Burn
s W
A
2009
Cas
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hnst
on
MN
20
09Br
ian
Klei
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MO
20
09Ju
stin
Sie
bler
FL
20
09Ry
an A
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2010
Kurt
Bor
man
n N
Z **
2010
Gus
tavo
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20
10M
icha
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ID
2010
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OF
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ME
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OM
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OG
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197
1.
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MPA
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NG
MA
P SH
OW
TH
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CAT
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S O
F O
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RESI
DEN
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TH
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TATE
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OST
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IN M
OTIO
N4
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NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
41
CLA
SS O
F
2011
Mic
ha
el J
. Ca
rlso
n, M
.D.
Hom
etow
n: G
reen
Riv
er, W
YC
olle
ge: B
righa
m Y
oung
Uni
vers
ityM
edic
al S
choo
l: M
edic
al C
olle
geof
Wis
cons
inA
rea
of c
linic
al/r
esea
rch
inte
rest
: Spo
rts
Act
iviti
es/h
obbi
es: S
kiin
g, s
port
s, o
utdo
or
activ
ities
, han
ging
out
with
fam
ily
Mic
ha
el S
. Dee
, M.D
.H
omet
own:
Ogd
en, U
TC
olle
ge: W
eber
Sta
te U
nive
rsity
Med
ical
Sch
ool:
Uni
vers
ity o
f Uta
hA
rea
of c
linic
al/r
esea
rch
inte
rest
: Spo
rts;
sh
ould
er a
nd e
lbow
; tra
uma
Act
iviti
es/h
obbi
es: S
pend
ing
time
with
m
y fa
mily
and
enj
oyin
g th
e ou
tdoo
rs
Jaso
n M
. Erp
eld
ing
, M.D
.H
omet
own:
Gra
nd F
orks
, ND
Col
lege
: Uni
vers
ity o
f Nor
th D
akot
aM
edic
al S
choo
l: U
nive
rsity
of N
orth
Dak
ota
Scho
ol o
f Med
icin
eA
rea
of c
linic
al/r
esea
rch
inte
rest
: H
and
and
uppe
r ext
rem
ityA
ctiv
ities
/hob
bies
: H
untin
g, fi
shin
g, tr
avel
ing
Da
nie
l E. F
irest
on
e, M
.D.
Hom
etow
n: L
inco
ln, N
EC
olle
ge: N
ebra
ska
Wes
leya
n U
nive
rsity
Med
ical
Sch
ool:
Uni
vers
ity o
f Iow
a C
olle
ge
of M
edic
ine
Are
a of
clin
ical
/res
earc
h in
tere
st: H
and
and
uppe
r ext
rem
ityA
ctiv
ities
/hob
bies
: Mus
ic, t
echn
olog
y,
fam
ily, f
aith
, fitn
ess
CLA
SS O
F
2012
Nic
ho
las
S. A
ber
le, I
I, M
.D.
Hom
etow
n: B
ism
arck
, ND
Col
lege
: Uni
vers
ity o
f Nor
th D
akot
aM
edic
al S
choo
l: U
nive
rsity
of N
orth
Dak
ota
Scho
ol o
f Med
icin
eA
rea
of c
linic
al/r
esea
rch
inte
rest
: O
rtho
paed
ic s
port
s m
edic
ine;
tota
l joi
nt
arth
ropl
asty
; tra
uma
Act
iviti
es/h
obbi
es: B
ikin
g, fo
otba
ll
Luca
s J.
Bu
rto
n, M
.D.
Hom
etow
n: O
rlean
s, IN
Col
lege
: Van
derb
ilt U
nive
rsity
Med
ical
Sch
ool:
Cas
e W
este
rn
Rese
rve
Uni
vers
ityA
rea
of c
linic
al/r
esea
rch
inte
rest
: H
ip a
nd k
nee
arth
ropl
asty
Act
iviti
es/h
obbi
es: G
olf
Rya
n W
. Hess
, M.D
.H
omet
own:
Ver
ndal
e, M
NC
olle
ge: C
onco
rdia
Col
lege
, M
oorh
ead,
MN
Med
ical
Sch
ool:
Med
ical
Col
lege
of
Wis
cons
inA
rea
of c
linic
al/r
esea
rch
inte
rest
: O
rtho
paed
ic s
port
s m
edic
ine,
jo
int a
rthr
opla
sty
Act
iviti
es/h
obbi
es: S
oftb
all,
bask
etba
ll,
play
ing
guita
r, w
ater
spo
rts
Bri
an
A. V
ern
on
, M.D
.H
omet
own:
Spr
ingv
ille,
UT
Col
lege
: Brig
ham
You
ng U
nive
rsity
Med
ical
Sch
ool:
Med
ical
Col
lege
of
Wis
cons
inA
rea
of c
linic
al/r
esea
rch
inte
rest
: H
and/
uppe
r ext
rem
ity s
urge
ry,
tota
l joi
nt a
rthr
opla
sty
Act
iviti
es/h
obbi
es: S
occe
r, hi
king
CLA
SS O
F
2013
A
nn
ie E
. Kn
ieri
m, M
.D.
Hom
etow
n: G
lasg
ow, M
TC
olle
ge: C
onco
rdia
Col
lege
, M
oorh
ead,
MN
Med
ical
Sch
ool:
Cre
ight
on U
nive
rsity
Sc
hool
of M
edic
ine
Act
iviti
es/h
obbi
es: H
ocke
y, ba
sket
ball,
sk
iing,
hik
ing,
bik
ing
Eri
c M
. Sa
mu
elso
n, M
.D.
Hom
etow
n: G
rand
Isla
nd, N
E C
olle
ge: U
nive
rsity
of N
ebra
ska
- Lin
coln
Med
ical
Sch
ool:
UN
MC
Col
lege
of
Med
icin
eA
rea
of c
linic
al/r
esea
rch
inte
rest
: Spo
rts;
sh
ould
er a
nd e
lbow
; tot
al jo
int a
rthr
opla
sty
Act
iviti
es/h
obbi
es: S
pend
ing
time
with
fam
ily,
runn
ing,
bik
ing,
out
door
act
iviti
es
Na
te E
. Sn
edd
on,
M.D
.H
omet
own:
Lin
coln
, NE
Col
lege
: Brig
ham
You
ng U
nive
rsity
Med
ical
Sch
ool:
UN
MC
Col
lege
of
Med
icin
eA
rea
of c
linic
al/r
esea
rch
inte
rest
: To
tal j
oint
art
hrop
last
yA
ctiv
ities
/hob
bies
: Run
ning
, hik
ing,
sk
iing,
Hus
ker f
ootb
all
Jere
my
P. T
oo
mey
, M.D
.H
omet
own:
New
port
, RI
Col
lege
: Mon
trea
t Col
lege
Med
ical
Sch
ool:
Uni
vers
ity o
f Nev
ada
Scho
ol o
f Med
icin
eA
rea
of c
linic
al/r
esea
rch
inte
rest
: Sp
orts
, sho
ulde
r & e
lbow
, tra
uma
Act
iviti
es/h
obbi
es: B
aske
tbal
l, w
oodw
orki
ng,
gett
ing
outs
ide,
fam
ily
CLA
SS O
F
2014
K
ha
lid A
. Azz
am
, M.D
.H
omet
own:
Cai
ro, E
gypt
Col
lege
: Uni
vers
ity o
f Cai
ro, E
gypt
Med
ical
Sch
ool:
Uni
vers
ity o
f Cai
ro, E
gypt
Are
a of
clin
ical
/res
earc
h in
tere
st:
Adu
lt re
cons
truc
tion
Act
iviti
es/h
obbi
es: S
wim
min
g,
hors
ebac
k rid
ing
Kev
in E
. Lin
dg
ren
, M.D
.H
omet
own:
Jack
son,
WI
Col
lege
: Uni
vers
ity o
f Wis
cons
inM
edic
al S
choo
l: M
edic
al C
olle
ge
of W
isco
nsin
Are
a of
clin
ical
/res
earc
h in
tere
st:
Spor
ts, a
dult
reco
nstr
uctio
n, tr
aum
aA
ctiv
ities
/hob
bies
: Hom
e br
ewin
g,
golf,
sof
tbal
l
No
lan
R. M
ay,
M.D
.H
omet
own:
Hay
es C
ente
r, N
EC
olle
ge: N
ebra
ska
Wes
leya
n U
nive
rsity
Med
ical
Sch
ool:
UN
MC
Col
lege
of M
edic
ine
Act
iviti
es/h
obbi
es: S
port
s, h
untin
g/fis
hing
, sp
endi
ng ti
me
with
fam
ily
Da
vid
P. M
ing
es,
M.D
.H
omet
own:
St.
Loui
s, M
OC
olle
ge: C
reig
hton
Uni
vers
ityM
edic
al S
choo
l: C
reig
hton
Uni
vers
ity
Scho
ol o
f Med
icin
eA
rea
of c
linic
al/r
esea
rch
inte
rest
: Sp
orts
med
icin
eA
ctiv
ities
/hob
bies
: Spo
rts,
runn
ing,
mus
ic,
hang
ing
out w
ith fr
iend
s
201
0 IN
CO
MIN
G
RESI
DEN
TS
CLA
SS O
F
2015
Joh
n C
. Fra
nk,
M.D
.M
edic
al S
choo
l: U
nive
rsity
of A
rkan
sas
for
Med
ical
Sci
ence
s C
olle
ge o
f Med
icin
e
Tod
d J
. Ga
dd
ie, M
.D.
Med
ical
Sch
ool:
Uni
vers
ity o
f Nor
th D
akot
a Sc
hool
of M
edic
ine
and
Hea
lth S
cien
ces
Bre
nt R
. Ho
od
, D.O
.M
edic
al S
choo
l: D
es M
oine
s U
nive
rsity
–
Ost
eopa
thic
Med
ical
Cen
ter
An
dre
w J
. Ta
iber
, M.D
.M
edic
al S
choo
l: U
nive
rsity
of I
owa
Roy
J. an
d Lu
cille
A. C
arve
r Col
lege
of M
edic
ine
CLA
SS O
F 2
011
Left
to ri
ght:
Drs
. Dan
iel F
irest
one,
Mic
hael
D
ee, M
icha
el C
arls
on a
nd Ja
son
Erpe
ldin
g
CLA
SS O
F 2
013
Left
to ri
ght:
Drs
. Eric
Sam
uels
on, A
nnie
Kn
ierim
, Jer
emy
Toom
ey, a
nd N
ate
Sned
don
CLA
SS O
F 2
012
Left
to ri
ght:
Drs
. Bria
n Ve
rnon
, Nic
hola
s A
berle
, Luc
as B
urto
n, a
nd R
yan
Hes
s
CLA
SS O
F 2
014
Left
to ri
ght:
Drs
. Kev
in L
indg
ren,
Nol
an
May
, Dav
id M
inge
s, a
nd K
halid
Azz
am
MEE
T TH
E R
ESID
ENTS
PE
RFO
RM
AN
CE
IN M
OTIO
N4
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
43
REC
ENT
POST
-GRA
DU
ATE
FELL
OW
SHIP
SA
FTER
CO
MPL
ETIN
G T
HEI
R TR
AIN
ING
AT
NEB
RA
SKA
, RES
IDEN
TS M
OV
E O
N T
O T
HE
NEX
T ST
AG
E
OF
THEI
R TR
AIN
ING
. MA
NY
OPT
TO
CO
NTI
NU
E TH
EIR
EDU
CAT
ION
BY
CH
OO
SIN
G O
NE
OF
MA
NY
FELL
OW
SH
IP O
PP
OR
TUN
ITIE
S A
ROU
ND
TH
E C
OU
NTR
Y. F
OR
SOM
E, G
OIN
G D
IREC
TLY
INTO
A P
RA
CTI
CE
OPP
ORT
UN
ITY
IS T
HE
RIG
HT
CH
OIC
E. O
UR
MO
ST R
ECEN
T G
RA
DU
ATES
AN
D T
HE
FELL
OW
SHIP
OR
PRA
CTI
CE
OPP
ORT
UN
ITIE
S TH
EY C
HO
SE A
RE L
ISTE
D H
ERE.
2010
G
RA
DU
ATES
:RY
AN
M. A
RNO
LD, M
.D.:
Fello
wsh
ip:
Atla
nta
Spor
ts M
edic
ine
& C
artil
age
Reco
nstr
uctio
n Fe
llow
ship
, Atla
nta
Spor
ts M
edic
ine
and
Ort
hopa
edic
C
ente
r, A
tlant
a, G
A.
KU
RT
T. B
ORM
AN
N, M
.D.:
Fello
wsh
ip:
Trav
elin
g Fe
llow
ship
, AO
Inte
rnat
iona
l Tr
aum
a Fe
llow
ship
, Han
nove
r Med
ical
Sch
ool,
Han
nove
r, G
erm
any,
Sept
. - O
ct. 2
010;
Shou
lder
and
Elb
ow F
ello
wsh
ip, N
orth
Sh
ore
Hos
pita
l, A
uckl
and,
New
Ze
alan
d, D
ec 2
010
- Jul
y 20
11
GU
STA
VO
X. C
ORD
ERO
, M.D
.: Fe
llow
ship
: Ort
hopa
edic
Tra
uma
Fello
wsh
ip,
Uni
vers
ity o
f Pitt
sbur
gh M
edic
al C
ente
r, U
nive
rsity
of P
ittsb
urgh
, Pitt
sbur
gh, P
A
MIC
HA
EL J.
SH
EVLI
N, M
.D.:
Prac
tice:
Wes
t Ida
ho O
rtho
pedi
cs
and
Spor
ts M
edic
ine,
Cal
dwel
l, ID
2009
GR
AD
UAT
ES:
ERIC
A B
URN
S, M
.D.:
Shou
lder
and
Elb
ow
Fello
wsh
ip, U
nive
rsity
of W
ashi
ngto
n M
edic
al C
ente
r, Se
attle
, WA
CA
SEY
JOH
NST
ON
, M.D
.: Sp
orts
M
edic
ine
Fello
wsh
ip, M
inne
sota
Sp
orts
Med
icin
e, M
inne
apol
is, M
N
BRIA
N K
LEIB
ER, M
.D.:
Foot
and
Ank
le
Fello
wsh
ip, W
ashi
ngto
n U
nive
rsity
M
edic
al C
ente
r, St
. Lou
is, M
O
JUST
IN S
IEBL
ER, M
.D.:
Ort
hopa
edic
Tr
aum
a Fe
llow
ship
, Flo
rida
Ort
hopa
edic
Inst
itute
, Tam
pa, F
L
Left
to
rig
ht:
Drs
. Gus
tavo
Cor
dero
, Rya
n A
rnol
d, M
icha
el S
hevl
in, a
nd K
urt B
orm
ann
Left
to
rig
ht:
Drs
. Cas
ey Jo
hnst
on, J
ustin
Sie
bler
, Bria
n Kl
eibe
r, an
d Er
ica
Burn
s
PE
RFO
RM
AN
CE
IN M
OTIO
N4
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
45
SEC
TIO
N
03
DEP
ART
MEN
T O
F O
RTH
OPA
ED
IC S
UR
GE
RY
AN
D R
EH
AB
ILIT
ATI
ON
Your
feed
back
cou
nts.
Sim
ply
go to
ww
w.U
NM
CO
rtho
InM
otio
n.co
m
PE
RFO
RM
AN
CE
IN M
OTIO
N4
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
47
The
Ort
hopa
edic
Reg
istr
y to
Mon
itor
Trea
tmen
t Out
com
es is
now
act
ive
at
UN
MC
, Chi
ldre
n’s
Hos
pita
l and
The
Vet
eran
’s
Adm
inis
trat
ion
Hos
pita
l, w
ith o
ver 3
300
surg
ery
subj
ects
enr
olle
d w
ho h
ave
unde
r-go
ne to
tal j
oint
repl
acem
ent,
revi
sion
join
t su
rger
y, sh
ould
er s
urge
ry, s
urgi
cal t
reat
men
t fo
r ost
eoge
nesi
s im
perf
ecta
, or t
reat
men
t fo
r Whi
plas
h A
ssoc
iate
d D
isor
ders
(WA
D).
Any
pre
- or p
ost-s
urgi
cal p
atie
nt w
ho is
se
eing
a U
NM
C o
rtho
paed
ic s
urge
on m
ay
be in
clud
ed in
the
data
base
. Pat
ient
s fil
l ou
t rou
tine
ques
tionn
aire
s re
gard
ing
thei
r he
alth
, qua
lity
of li
fe a
nd fu
nctio
nal s
tatu
s,
preo
pera
tivel
y an
d at
regu
lar p
ost-o
pera
tive
inte
rval
s. If
the
patie
nts
are
unab
le to
UTI
LIZI
NG
O
UTC
OM
ES
STU
DIE
S TO
IM
PRO
VE
PA
TIEN
T O
UTC
OM
ESEA
CH
YEA
R, T
HE
DEP
ART
MEN
T C
ON
TIN
UES
TO
EXP
AN
D O
UR
SURG
ERY
OU
TCO
MES
DAT
ABA
SE, U
SIN
G P
ATIE
NT
OU
TCO
MES
TO
EVA
LUAT
E A
ND
CO
MPA
RE
THE
EFFE
CTI
VEN
ESS
OF
VARI
OU
S TR
EATM
ENTS
IN A
N E
FFO
RT T
O E
NSU
RE T
HAT
D
IAG
NO
SIS
AN
D T
REAT
MEN
T A
RE C
ON
TIN
UA
LLY
EVO
LVIN
G A
ND
IMPR
OV
ING
.
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T4
7
RESE
ARC
H IN
MO
TIO
N
retu
rn, t
hey
are
cont
acte
d by
pho
ne a
nd
ques
tionn
aire
s m
aile
d to
thei
r hom
e.
Eval
uatio
n of
cur
rent
pra
ctic
e th
roug
h th
e co
llect
ion,
inte
rpre
tatio
n an
d an
alys
is o
f ou
tcom
es d
ata
incl
udin
g pa
tient
que
stio
n-na
ires,
clin
ical
ly-o
btai
ned
asse
ssm
ent a
nd
mea
sure
men
ts, a
nd re
tros
pect
ive
med
ical
re
cord
revi
ews
(incl
udin
g ra
diog
raph
s),
ultim
atel
y le
ads
to a
dvan
cem
ents
in
patie
nt c
are
thro
ugh
the
esta
blis
hmen
t of
impr
ovem
ent o
bjec
tives
and
an
incr
ease
in
gen
eral
ized
kno
wle
dge
that
can
be
pres
ente
d or
pub
lishe
d to
sha
re fi
nd-
ings
with
the
orth
opae
dic
com
mun
ity.
In a
dditi
on to
stu
dies
bei
ng u
tiliz
ed in
the
out-
com
es d
atab
ase,
ther
e ar
e a
varie
ty o
f clin
ical
st
udie
s be
ing
perf
orm
ed in
the
depa
rtm
ent.
Cur
rent
ly, t
here
are
24
activ
e IR
B ap
prov
ed
rese
arch
stu
dies
bei
ng d
one
invo
lvin
g 15
fa
culty
mem
bers
and
20
resi
dent
s. In
add
ition
, 19
stu
dies
wer
e co
mpl
eted
in 2
008-
2009
. As
a re
sult
of th
ese
stud
ies,
mul
tiple
pos
ters
, ab
stra
cts
and
pres
enta
tions
wer
e ac
cept
ed
at th
e an
nual
mee
tings
of b
oth
the
Am
eric
an
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s an
d th
e M
id-A
mer
ica
Ort
hopa
edic
Ass
ocia
tion,
whi
ch
prov
ides
us
the
oppo
rtun
ity to
sha
re a
nd
com
pare
find
ings
with
oth
er in
stitu
tions
.
PE
RFO
RM
AN
CE
IN M
OTIO
N4
6
PE
RFO
RM
AN
CE
IN M
OTIO
N4
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
49
AC
TIV
E ST
UD
IES:
»Ea
rly O
pera
tive
Expe
rienc
e of
the
Fass
ier-
Duv
al T
eles
copi
c Ro
d Sy
stem
for C
hild
ren
with
Ost
eoge
nesi
s Im
perf
ecta
»In
cide
nces
of S
pond
ylol
ysis
and
Spo
ndyl
olis
thes
is in
Chi
ldre
n w
ith
O
steo
gene
sis
Impe
rfec
ta
»Fu
nctio
nal O
utco
mes
aft
er P
late
Fix
atio
n of
Hum
erus
Sha
ft F
ract
ures
:
Ant
erio
r Ver
sus
Post
erio
r App
roac
h
»A
cute
Bra
cing
of H
umer
us S
haft
Fra
ctur
es
»Fu
nctio
nal O
utco
mes
of I
ntra
-art
icul
ar D
ista
l Hum
erus
Fix
atio
n Th
roug
h
an
Ext
enso
r Mec
hani
sm S
parin
g Po
ster
ior A
ppro
ach
»O
rtho
paed
ic R
egis
try
To M
onito
r Tre
atm
ent O
utco
mes
»Ev
alua
tion
of F
unct
iona
l Out
com
es o
f Min
i Ope
n Ro
tato
r Cuf
f Rep
air
w
ithou
t Acr
omio
plas
ty
»O
utco
mes
of T
otal
Hip
Rep
lace
men
t Util
izin
g O
xidi
zed
Zirc
oniu
m F
emor
al
H
eads
on
Cro
ss-L
inke
d Po
lyet
hyle
ne.
»Fu
nctio
nal O
utco
mes
Fol
low
ing
a Q
uad
Snip
App
roac
h in
Kne
e Re
visi
on S
urge
ry
»W
hy A
re T
otal
Hip
Art
hrop
last
ies
Revi
sed?
»C
linic
al R
esul
ts o
f Unc
emen
ted
Tape
red
Stem
s w
ith T
otal
Hip
Art
hrop
last
y
in
Pat
ient
s A
ges
50 Y
ears
or Y
oung
er
»O
rtho
paed
ic R
egis
try
to M
onito
r Tre
atm
ent O
utco
mes
»Li
nkag
e A
naly
sis
and
Gen
e M
appi
ng o
f Fam
ilial
Spi
nal D
isor
ders
(Sco
liosi
s,
Sc
heue
rman
n’s
Kyph
osis
, Spo
ndyl
olis
thes
is, L
umba
r Dis
c D
isea
se, O
steo
poro
sis)
»C
SSG
Mul
ti-ce
nter
Ret
rosp
ectiv
e an
d Pr
ospe
ctiv
e O
bser
vatio
nal D
ata
Regi
stry
for
Clin
ical
and
Rad
iogr
aphi
c O
utco
mes
of S
pina
l Sur
gery
Com
parin
g In
stru
men
tatio
n
and
Proc
edur
es
»Th
e Tr
eatm
ent o
f Pro
gres
sive
Ear
ly O
nset
Spi
nal D
efor
miti
es: A
Mul
ti-ce
nter
O
utco
me
Stud
y.
»Lo
ng-te
rm (2
4 to
27
year
) Fol
low
-up
afte
r Tot
al H
ip A
rthr
opla
sty
Usi
ng a
Tap
ered
Tr
i-loc
k C
ompo
nent
Inse
rted
with
out C
emen
t
»Ve
rtic
al E
xpan
dabl
e Pr
osth
etic
Tita
nium
Rib
Hum
anita
rian
Use
Dev
ice
»Re
sults
of T
otal
Kne
e A
rthr
opla
sty
Revi
sion
for R
otat
iona
l Mal
alig
nmen
t
»H
orse
back
Rid
ing
and/
or M
otor
cycl
e Ri
ding
Aft
er a
Tot
al H
ip A
rthr
opla
sty
»Lo
cal A
nalg
esia
ver
sus
Con
scio
us S
edat
ion
in C
lose
d Re
duct
ion
of D
ista
l
Radi
us F
ract
ures
»D
istin
guis
hing
Com
men
sal v
ersu
s Pa
thol
ogic
Sta
phyl
ococ
cus
Spec
ies
in C
ases
of F
ract
ure
Non
unio
n A
fter
Inte
rnal
Fix
atio
n
»C
linic
al R
esul
ts o
f the
Ana
tom
ic C
ompr
essi
on A
rthr
odes
is T
echn
ique
with
Ant
erio
r
Te
nsio
n Ba
n Pl
ate
Aug
men
tatio
n fo
r Ank
le A
rthr
odes
is
»Su
rgic
al T
reat
men
t Out
com
es fo
r Whi
plas
h A
ssoc
iate
d D
isor
der
»Fa
ctor
s Th
at In
fluen
ce M
edic
al S
tude
nts’
Cho
ice
of R
esid
ency
THE
FOLL
OW
ING
IS A
LIS
T O
F A
LL
OU
TCO
MES
AN
D C
LIN
ICA
L ST
UD
IES
THAT
H
AVE
TAK
EN P
LAC
E IN
TH
E D
EPA
RTM
ENT
FRO
M 2
00
8 T
O P
RE
SE
NT.
CO
MPL
ETED
STU
DIE
S:
»O
utco
mes
Fol
low
ing
Fixa
tion
of P
roxi
mal
Hum
erus
Fra
ctur
es w
ith S
hort
Intr
amed
ulla
ry L
ocke
d N
ail
»D
ispl
aced
Fem
oral
(Nec
k Fr
actu
re) A
rthr
opla
sty
Con
sort
ium
for T
reat
men
t
and
Out
com
es (D
FAC
TO)
»Fu
ll Th
ickn
ess
Rota
tor C
uff R
e- T
ear P
reva
lenc
e an
d C
orre
latio
n w
ith S
houl
der
Func
tion
in P
atie
nts
65 Y
ears
and
Old
er (U
NM
C)
»H
uman
itaria
n U
se D
evic
e, O
P-1:
Impl
ant i
s an
Ost
eoin
duct
ive
and
Ost
eoco
nduc
tive
Bo
ne G
raft
Mat
eria
l for
Use
as
an A
ltern
ativ
e to
Aut
ogra
ft in
Rec
alci
tran
t Lon
g
Bone
Non
unio
ns w
here
Use
of A
utog
raph
is U
nfea
sibl
e an
d A
ltern
ativ
e Tr
eatm
ents
H
ave
Faile
d
»C
ompu
ted
Tom
ogra
phic
and
Fun
ctio
nal F
ollo
w-u
p of
Gle
noid
Anc
hor P
eg
C
ompo
nent
Fix
atio
n U
tiliz
ing
Aut
olog
ous
Bone
Gra
ft in
Tot
al S
houl
der A
rthr
opla
sty
»A
Stu
dy in
the
Sim
ulat
ion
of C
hond
rocy
tes
in 3
-D C
ultu
re b
y C
ontin
uous
Ultr
asou
nd
»A
ssay
s of
Ste
m C
ell f
unct
ion
in C
linic
al A
ging
Res
earc
h
»A
n Ev
alua
tion
of O
utco
mes
of T
otal
Join
t Art
hrop
last
y in
Ort
hoto
pic
Live
r
Tran
spla
nt R
ecip
ient
s
»A
Pro
spec
tive
Stud
y on
the
Effe
ct o
f Sur
gica
l Tre
atm
ent f
or C
hron
ic P
ostt
raum
atic
H
eada
ches
(Whi
plas
h A
ssoc
iate
d D
isor
ders
) on
Phot
opho
bia
»O
utco
mes
Fol
low
ing
Ace
tabu
lar F
ract
ure
»D
ista
l Rad
ius
Frac
ture
s
»Pl
ate
Aug
men
tatio
n fo
r Fem
oral
Sha
ft N
onun
ions
Pre
viou
sly
Trea
ted
with
an In
tram
edul
lary
Nai
l
»C
ompa
rison
of t
he S
ingl
e vs
. Dou
ble
Inci
sion
Tec
hniq
ue fo
r Ach
illes
Ten
don
Re
cons
truc
tion
with
Fle
xor H
allu
cis
Tend
on T
rans
fer –
Is th
e Se
cond
Inci
sion
Real
ly N
eces
sary
?
»O
steo
tom
y H
ealin
g in
Ped
iatr
ic O
steo
gene
sis
Impe
rfec
ta P
atie
nts
Rece
ivin
g
Lo
w-D
ose
Pam
idro
nate
The
rapy
»Sh
ould
Obe
se a
nd M
orbi
dly
Obe
se P
atie
nts
Wai
t for
TJA
?
»Ra
dial
Hea
d Re
plac
emen
t Ste
m L
oose
ning
and
Its
Ass
ocia
tion
with
Fore
man
Sys
tem
s
»Fu
ll Th
ickn
ess
Rota
tor C
uff R
e-te
ar P
reva
lenc
e an
d C
orre
latio
n w
ith S
houl
der
Func
tion
in P
atie
nts
65 Y
ears
and
Old
er (V
A)
»Ev
alua
tion
of a
Cuf
f Tea
r Art
hrop
athy
Hem
ipro
sthe
sis
for t
he T
reat
men
t
of G
leno
hum
eral
Art
hriti
s in
the
Pres
ence
of a
Chr
onic
Rot
ator
Cuf
f Tea
r
LA
BS
AN
D E
DU
CA
TIO
NA
L O
PPO
RTU
NIT
IES
THE
DEP
ART
MEN
T A
LSO
HO
LDS
ON
-GO
ING
CA
DAV
ER L
AB
RESE
ARC
H
PRO
JEC
TS A
ND
ED
UC
ATIO
NA
L SE
SSIO
NS
ABO
UT
ON
CE
EVER
Y SI
X W
EEK
S.
THE
GIF
T O
F A
N A
NAT
OM
ICA
L D
ON
ATIO
N A
LLO
WS
OU
R O
RTH
OPA
EDIC
SU
RGEO
NS
TO D
EVEL
OP
AN
D P
RA
CTI
CE
NEW
AN
D H
IGH
LY-R
EFIN
ED
TEC
HN
IQU
ES T
HAT
BEN
EFIT
LIV
ING
PAT
IEN
TS W
ITH
OU
T TH
E A
DD
ITIO
NA
L RI
SK. T
HES
E SU
RGIC
AL
CA
DAV
ER L
ABS
ARE
NO
T O
NLY
INVA
LUA
BLE
EDU
CAT
ION
AL
OPP
ORT
UN
ITIE
S FO
R O
UR
FAC
ULT
Y A
ND
RES
IDEN
TS,
THEY
ARE
OFT
EN O
PEN
TO
OTH
ER C
OM
MU
NIT
Y PH
YSIC
IAN
S A
S W
ELL.
PE
RFO
RM
AN
CE
IN M
OTIO
N5
0U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
51
UN
MC
’S O
RTH
OPA
ED
IC R
ES
EA
RC
H L
AB
IS T
HE
TE
STIN
G P
LAC
E FO
R LO
NG
-LA
STIN
G IM
PLA
NTS
. W
hen
peop
le th
ink
of g
reat
thin
gs th
at N
ebra
ska
is k
now
n fo
r, th
e us
ual n
ames
com
e to
m
ind:
Ber
kshi
re H
atha
way
(syn
onym
ous
with
War
ren
Buff
ett),
Con
Agr
a Fo
ods,
Uni
on P
acifi
c,
Mut
ual o
f Om
aha,
and
of c
ours
e th
e H
uske
rs, j
ust t
o na
me
a fe
w.
Wha
t peo
ple
mig
ht n
ot k
now
is th
at O
mah
a is
als
o ho
me
to o
ne o
f the
wor
ld’s
larg
est,
mos
t act
ive
and
best
-equ
ippe
d un
iver
sity
-bas
ed te
stin
g fa
cilit
ies
for k
nees
, hip
s an
d ot
her
orth
opae
dic
impl
ants
; inc
reas
ingl
y re
cogn
ized
as
such
by
the
natio
nal a
nd in
tern
atio
nal
orth
opae
dic
impl
ant t
echn
olog
y fie
ld, s
tand
ardi
zatio
n or
gani
zatio
ns, a
nd th
e FD
A. T
he
Ort
hopa
edic
s Bi
omec
hani
cs a
nd A
dvan
ced
Surg
ical
Tec
hnol
ogie
s La
bora
tory
is p
art o
f th
e D
epar
tmen
t of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion
at th
e U
nive
rsity
of N
ebra
ska
M
edic
al C
ente
r.
As
dire
ctor
of t
he la
b, H
an
i Ha
ider
, Ph
.D.,
spea
rhea
ds th
e w
ork
at th
e 5,
500
-squ
are-
foot
fa
cilit
y in
the
Scot
t Tec
hnol
ogy
Cen
ter j
ust s
outh
of t
he U
NO
Pac
ific
Stre
et c
ampu
s. T
he te
am
is g
uide
d cl
inic
ally
by
orth
opae
dic
surg
eons
led
by K
evin
Gar
vin,
M.D
., ch
airm
an o
f th
e de
part
men
t.
Engi
neer
s an
d ph
ysic
ians
are
wor
king
toge
ther
not
onl
y to
phy
sica
lly te
st o
rtho
paed
ic
impl
ants
, but
als
o to
des
ign
bett
er w
ays
to im
plan
t the
m in
to th
e bo
dy. H
ere,
they
are
not
on
ly u
sing
the
late
st te
chni
ques
, the
y ar
e ac
tivel
y cr
eat
ing
som
e of
them
.
Cut
ting-
edge
in-v
itro
test
ing
of o
rtho
paed
ic im
plan
ts is
per
form
ed in
the
lab
with
a s
uite
of
knee
sim
ulat
ors
and
vario
us o
ther
inno
vativ
e te
stin
g m
achi
nes.
Man
y of
the
devi
ces
wer
e de
sign
ed b
y Pr
ofes
sor H
aide
r, pa
rtic
ular
ly th
e In
stro
n-St
anm
ore
Knee
Sim
ulat
or, w
hich
mim
ics
the
wea
r and
tear
of k
nee
impl
ants
, rep
licat
ing
with
gre
at fi
delit
y th
e m
yria
d of
inst
anta
neou
s fo
rces
, tor
ques
, mot
ions
and
rota
tions
that
a k
nee
unde
rgoe
s in
the
body
, sim
ulat
ing
prol
onge
d pe
riods
of c
linic
al u
se.
The
lab
has
thre
e of
his
sim
ulat
ors,
whi
ch a
re u
niqu
e fr
om th
ose
bein
g us
ed in
the
rest
of t
he
wor
ld, b
ecau
se P
rofe
ssor
Hai
der h
as p
erso
nally
upg
rade
d hi
s in
vent
ion
with
doz
ens
of d
esig
n an
d co
ntro
l im
prov
emen
ts. W
ith th
e da
ta g
athe
red
from
thes
e ad
vanc
ed te
stin
g m
etho
ds,
Prof
esso
r Hai
der a
nd h
is te
am a
re h
elpi
ng to
pio
neer
new
test
ing
met
hods
, whi
ch in
turn
hel
p im
plan
t des
igne
rs c
reat
e a
new
gen
erat
ion
of o
rtho
paed
ic im
plan
ts, d
esig
ned
to s
uit
the
mod
ern
patie
nt.
“By
crea
ting
bett
er, l
onge
r-la
stin
g im
plan
ts, w
e w
ill s
igni
fican
tly in
crea
se th
e qu
ality
of l
ife fo
r pa
tient
s un
derg
oing
join
t rep
lace
men
t sur
gery
,” sa
id D
r. G
arvi
n, “a
nd d
rast
ical
ly re
duce
the
num
ber o
f rev
isio
ns b
eing
per
form
ed a
nnua
lly –
a s
tatis
tic w
hich
has
bee
n co
nsis
tent
ly ri
sing
in
rece
nt y
ears
as
mor
e pa
tient
s ar
e un
derg
oing
join
t rep
lace
men
t ear
lier i
n lif
e.”
Thro
ugho
ut th
e 10
yea
rs s
ince
Pro
fess
or H
aide
r has
join
ed th
e fa
culty
at U
NM
C, t
he la
b ha
s se
cure
d m
ore
than
30
rese
arch
and
test
ing
cont
ract
s fr
om in
dust
rial c
ompa
nies
, com
mer
cial
te
stin
g ho
uses
, and
oth
ers
that
lack
the
stat
e-of
-the-
art s
imul
ator
s.
The
inno
vativ
e w
ork
on w
ear t
estin
g of
join
ts b
eing
don
e in
the
lab
here
in N
ebra
ska
is h
elpi
ng
to s
et n
atio
nal a
nd in
tern
atio
nal s
tand
ards
for t
estin
g of
kne
e re
plac
emen
t sys
tem
s. S
ome
of
the
data
and
per
form
ance
crit
eria
from
thes
e ex
perim
ents
hav
e di
rect
ly in
fluen
ced
the
late
st
inte
rnat
iona
l tes
ting
stan
dard
s, s
uch
as th
ose
of k
nee
repl
acem
ent w
ear,
cons
trai
nt
and
stan
dard
ized
spe
cific
atio
n of
rang
e of
mot
ion.
“Thi
s is
not
blu
e-sk
y re
sear
ch; i
t is
tran
slat
iona
l and
ver
y re
al, s
o m
any
of th
e im
plan
ts w
e te
st
here
end
up
with
FD
A o
r equ
ival
ent E
urop
ean
appr
oval
for w
ide
clin
ical
use
inte
rnat
iona
lly,”
said
Pro
fess
or H
aide
r, w
ho h
as e
arne
d w
ide-
rang
ing
influ
ence
as
a m
embe
r of v
ario
us
inte
rnat
iona
l com
mitt
ees
and
scie
ntifi
c bo
ards
. In
2010
alo
ne, P
rofe
ssor
Hai
der h
as b
een
appo
inte
d as
a c
onsu
ltant
/mem
ber o
f the
Bio
med
ical
Eng
inee
ring
Com
mitt
ee o
f the
Am
eric
an
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s an
d ha
s re
ceiv
ed th
e A
STM
Inte
rnat
iona
l Man
ny H
orow
itz
Aw
ard
whi
ch “r
ecog
nize
s th
e m
ost h
onor
ed m
embe
r” o
f the
com
mitt
ee o
n M
edic
al a
nd
Surg
ical
Mat
eria
ls a
nd D
evic
es in
the
gene
ral i
nter
est c
ateg
ory
who
has
con
trib
uted
to th
e st
anda
rds
deve
lopm
ent a
nd/o
r rel
ated
act
iviti
es.
Knee
join
ts, P
rofe
ssor
Hai
der e
xpla
ined
, mus
t with
stan
d a
dyna
mic
com
pres
sive
forc
e of
m
any
times
a p
erso
n’s
wei
ght o
ccur
ring
mor
e th
an o
nce
in e
ach
wal
king
ste
p. B
ecau
se o
f how
cl
osel
y th
e m
uscl
es li
gam
ent c
onne
cts
to th
e jo
int,
the
act o
f squ
attin
g an
d si
mila
r pos
ture
s cr
eate
s en
orm
ous
pres
sure
– u
p to
six
or s
even
tim
es a
per
son’
s bo
dy w
eigh
t.
If th
e jo
int d
oes
fail,
it m
ust b
e re
paire
d, o
ften
by
repl
acin
g th
e w
eigh
t bea
ring
surf
ace
of th
e jo
int.
Prof
esso
r Hai
der’s
lab
is a
lso
at w
ork
on a
sys
tem
that
pro
vide
s un
prec
eden
ted
feed
back
to
a s
urge
on d
urin
g th
ese
pote
ntia
lly d
ifficu
lt su
rger
ies.
Sim
ulat
ors
mim
ic th
e w
ear a
nd te
ar o
f hip
an
d kn
ee im
plan
ts a
t the
Bio
mec
hani
cs a
nd
Adv
ance
d Su
rgic
al T
echn
olog
ies
Labo
rato
ry
at th
e U
nive
rsity
of N
ebra
ska
Med
ical
C
ente
r’s D
epar
tmen
t of O
rtho
paed
ic
Surg
ery
and
Reha
bilit
atio
n. S
taff
mem
bers
at
the
lab,
loca
ted
at th
e Sc
ott T
echn
olog
y C
ente
r in
Om
aha,
are
not
onl
y at
the
fore
fron
t of t
oday
’s te
chno
logi
cal a
dvan
ces,
they
are
pio
neer
ing
man
y of
them
.
NEB
RASK
A’S
VER
YH
IP W
HEN
IN K
NEE
D
OF
TEST
ING
!
RE
SE
AR
CH
IN M
OTI
ON
Rese
arch
eng
inee
r Joe
l Wei
senb
urge
r (TO
P)
mon
itors
the
perf
orm
ance
of o
ne o
f the
la
b’s
thre
e kn
ee jo
int s
imul
ator
(tes
ting)
m
achi
nes
– se
en in
act
ion
on th
e (B
OTT
OM
).
DR
. HA
NI H
AID
ER
DIR
ECTO
R,
BIO
MEC
HA
NIC
S LA
BOR
ATO
RY
PE
RFO
RM
AN
CE
IN M
OTIO
N5
0
PE
RFO
RM
AN
CE
IN M
OTIO
N5
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
53
Com
pute
r-A
ided
Ort
hopa
edic
Sur
gery
(n
avig
ated
free
hand
bon
e cu
ttin
g fo
r tot
al
knee
repl
acem
ent s
urge
ry) i
s a
Neb
rask
a-bo
rn te
chno
logy
that
redu
ces
the
need
for
bulk
y al
ignm
ent i
nstr
umen
ts (j
igs)
dur
ing
knee
repl
acem
ent s
urge
ry. R
esea
rche
rs in
th
e la
b de
velo
ped
grou
ndbr
eaki
ng s
oftw
are
that
use
s da
ta fr
om C
AT s
cans
to c
reat
e a
patie
nt-s
peci
fic, 3
-D b
one
mod
el o
n a
com
pute
r scr
een.
The
sof
twar
e is
als
o lo
aded
w
ith m
odel
s of
the
surg
ical
inst
rum
ents
bei
ng
used
. An
infr
ared
cam
era
syst
em p
rovi
des
real
-tim
e da
ta to
the
com
pute
r, al
low
ing
sur-
geon
s re
alis
tic 3
-D tr
acki
ng a
nd n
avig
atio
n
of h
and-
held
sur
gica
l ins
trum
ents
and
bon
es.
The
optim
al s
urgi
cal b
one
cuts
are
re
pres
ente
d as
targ
et p
lane
s su
perim
pose
d on
the
3-D
mod
els
of th
e bo
nes.
The
sur
geon
ca
n vi
sual
ize
on th
e sc
reen
the
desi
red
targ
et c
uts
and
view
the
inst
anta
neou
s m
ovem
ent o
f the
ir ha
nd-h
eld
cutt
ing
tool
s or
oth
er in
stru
men
ts. I
f the
sur
geon
dev
iate
s ev
en s
light
ly fr
om th
e op
timal
pla
ne o
f th
e cu
t, an
ala
rm c
an (o
ptio
nally
) be
set
to c
him
e an
d th
e sa
w b
lade
slo
ws,
and
th
en s
tops
. Thi
s en
sure
s m
ore
accu
rate
bo
ne c
uttin
g an
d be
tter
alig
nmen
t of
impl
ants
with
less
trau
ma
to th
e so
ft ti
ssue
an
d bo
ne, w
hich
in tu
rn e
nsur
es fa
ster
he
alin
g an
d im
prov
ed p
atie
nt o
utco
mes
.
Twel
ve in
nova
tive
conc
epts
are
the
subj
ect
of p
aten
ts, a
nd tw
o pa
tent
app
licat
ions
ha
ve b
een
filed
, sai
d O
. And
res
Barr
era,
a
rese
arch
ass
ocia
te w
orki
ng w
ith P
rofe
ssor
H
aide
r on
the
proj
ect.
This
tech
nolo
gy
garn
ered
nat
iona
l and
inte
rnat
iona
l att
entio
n w
hen
Prof
esso
r Hai
der’s
rese
arch
team
was
aw
arde
d th
e pr
estig
ious
HA
P Pa
ul A
war
d fo
r be
st p
aper
pre
sent
ed a
t the
Inte
rnat
iona
l So
ciet
y fo
r Tec
hnol
ogy
in A
rthr
opla
sty’s
20
05 a
nnua
l mee
ting
in Ja
pan,
the
soci
ety’s
hi
ghes
t hon
or fo
r dis
tingu
ishe
d re
sear
ch.
The
soci
ety
desc
ribed
the
tech
nolo
gy
as “t
he m
ost e
xciti
ng te
chno
logy
in th
e fie
ld.”
Subs
eque
ntly
, in
2007
, Pro
fess
or
Hai
der w
as a
ppoi
nted
Pro
gram
Dire
ctor
fo
r the
Inte
rnat
iona
l Soc
iety
for T
echn
olog
y in
Art
hrop
last
y, an
d st
ill h
olds
this
pos
t.
Pres
entin
g th
e re
sults
of t
heir
wor
k at
in
tern
atio
nal s
cien
tific
conf
eren
ces
has
gain
ed th
e la
b na
tiona
l att
entio
n an
d ev
entu
ally
suc
ceed
ed in
sec
urin
g fu
ndin
g in
the
form
of a
$5
mill
ion
dolla
r, 5-
year
do
natio
n us
ed to
fund
the
expa
nsio
n of
the
depa
rtm
ent a
nd c
atap
ult t
heir
rese
arch
to a
ne
w le
vel.
In a
dditi
on, t
hey
have
sec
ured
ove
r 30
diff
eren
t ext
ram
ural
ly-fu
nded
rese
arch
co
ntra
cts
over
rece
nt y
ears
tota
lling
$1.3
m
illio
n do
llars
. Thi
s N
ebra
ska-
born
nav
igat
ed
free
hand
tech
nolo
gy is
the
subj
ect o
f a
prop
osal
that
the
labo
rato
ry h
as s
ubm
itted
to
the
U.S
. gov
ernm
ent f
or la
rge
sum
fund
ing
to
take
it fu
rthe
r tow
ards
larg
e sc
ale
clin
ical
use
.
“WE
HO
PE T
HAT
WH
EN
NEB
RA
SKA
NS
AN
D O
UR
ALU
MN
I DIS
CO
VER
HO
W F
AR
THE
REPU
TATI
ON
OF
THEI
R
ORT
HO
PAED
IC R
ESEA
RCH
LABO
RAT
ORY
HA
S TR
AVEL
ED
INTE
RNAT
ION
ALL
Y,”
PRO
FESS
OR
HA
IDER
SA
ID, “
THEY
WIL
L
EMBR
AC
E O
UR
EFFO
RTS
TO
SOLI
DIF
Y TH
IS P
REM
IER
HAV
EN
WH
ERE
MEA
NIN
GFU
L SC
IEN
TIFI
C
STRI
DES
ARE
BEI
NG
MA
DE
FOR
THE
BEN
EFIT
OF
FUTU
RE P
ATIE
NTS
.”
Th
is a
rtic
le is
an
ad
apta
tio
n o
f a s
tory
th
at
pre
vio
usl
y ap
pe
are
d in
th
e F
ALL
20
09
iss
ue
of
Pri
de
of P
lace
, a b
ian
nu
al p
ub
licat
ion
pu
blis
he
d
by
the
Un
ive
rsit
y o
f Ne
bra
ska
Fou
nd
atio
n.
Com
pute
r-A
ided
Ort
hopa
edic
Sur
gery
: A
n ex
peri
men
tal p
roto
type
wor
king
saw
to
trim
kne
e jo
ints
for t
he in
stal
latio
n of
a
join
t im
plan
t and
its
virt
ually
real
ity
repr
esen
tatio
n.
PE
RFO
RM
AN
CE
IN M
OTIO
N5
2
OPP
OSI
TES
ATTR
AC
TA
N A
GE-
OLD
AD
AGE
M
OD
ELS
THE
THEO
RY B
EHIN
D
A N
OV
EL C
OA
TIN
G F
OR
TO
TAL
JOIN
T IM
PLA
NTS
A c
omm
on is
sue
in jo
int r
epla
cem
ent s
urge
ry
is th
e ra
te a
t whi
ch o
rtho
paed
ic im
plan
ts
wea
r, w
hich
can
lead
to s
ubse
quen
t hea
lth
issu
es a
nd o
ften
the
need
for r
evis
ion
surg
ery.
Whe
n th
e jo
int s
urfa
ces
rub
toge
ther
, it c
ause
s fr
ictio
n an
d ca
n re
leas
e sm
all p
artic
les
into
a p
atie
nt’s
bloo
dstr
eam
. Th
is w
ear a
nd te
ar h
appe
ns b
ecau
se
surf
aces
use
d on
toda
y’s
orth
opae
dic
impl
ants
are
too
soft
and
lack
the
abili
ty
to s
tay
wet
, but
Dr.
Fere
ydoo
n N
amav
ar,
prof
esso
r and
dire
ctor
of t
he d
epar
tmen
t’s
Nan
o-Bi
otec
hnol
ogy
Labo
rato
ry, i
s w
orki
ng to
impr
ove
impl
ant s
urfa
ces.
With
ort
hopa
edic
impl
ants
, it w
ould
be
idea
l fo
r the
sur
face
s to
be
oppo
site
s, e
xpla
ined
D
r. N
amav
ar, w
ith o
ne b
eing
hyd
roph
ilic
(wat
er-a
ttra
ctin
g) a
nd th
e ot
her b
eing
hy
drop
hobi
c (o
r wat
er-re
pelli
ng).
“If b
oth
surf
aces
wer
e w
et, t
hey
wou
ld s
tick
toge
ther
and
dra
stic
ally
incr
ease
fric
tion,
” D
r. N
amav
ar s
aid.
“But
, whe
n yo
u ha
ve
thes
e op
posi
tes
toge
ther
, you
hav
e lo
wer
fr
ictio
n an
d sm
ooth
er m
otio
n on
the
surf
ace,
w
hich
ulti
mat
ely
resu
lts in
pro
long
ed li
fe o
f th
e jo
int i
mpl
ant.”
His
insp
iratio
n ca
me
one
day
whe
n he
he
ard
his
mot
her-
in-la
w c
ompl
aini
ng th
at
her c
ubic
zirc
onia
alw
ays
fogg
ed u
p w
hen
wet
. Im
med
iate
ly, h
e kn
ew h
e ha
d fo
und
his
subs
tanc
e –
a m
ater
ial t
hat i
s ha
rd a
nd c
an
also
mai
ntai
n hy
drop
hilic
pro
pert
ies.
With
th
is in
min
d he
beg
an to
des
ign
a ne
w im
plan
t co
atin
g, b
ut in
ord
er to
cre
ate
the
mo
st e
ffe
c-ti
ve jo
int s
urfa
ce, D
r. N
amav
ar w
ante
d to
alte
r th
e pr
oper
ties
of h
is c
ubic
zirc
onia
coa
ting
to
atta
in m
axim
um w
etta
bilit
y.
“WH
EN Y
OU
HAV
E TH
ESE
OPP
OSI
TES
TOG
ETH
ER, Y
OU
H
AVE
LOW
ER F
RIC
TIO
N A
ND
SM
OO
THER
MO
TIO
N O
N T
HE
SURF
AC
E, W
HIC
H U
LTIM
ATEL
Y RE
SULT
S IN
PRO
LON
GED
LIF
E O
F TH
E JO
INT
IMPL
AN
T.”
DR
. FER
EYD
OO
N N
AM
AVA
R
DIR
ECTO
R,
NA
NO
-BIO
TEC
HN
OLO
GY
LA
BOR
ATO
RY
PE
RFO
RM
AN
CE
IN M
OTIO
N5
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
55
For t
his
he tu
rned
to th
e lo
tus
leaf
–a
plan
t tha
t is
cons
ider
ed a
sym
bol
of p
urity
in m
any
cultu
res
beca
use
of it
s se
lf-cl
eani
ng p
rope
rtie
s.
“WH
EN A
DRO
P O
F W
ATER
HIT
S A
LO
TUS
LEA
F,
IT R
OLL
S O
FF T
HE
SURF
AC
E, W
ASH
ING
AW
AY
DIR
T A
ND
DU
ST,”
DR.
NA
MAV
AR
SAID
. “TH
IS IS
BE
CA
USE
TH
E LO
TUS
LEA
F IS
HYD
ROPH
OBI
C.”
By m
imic
king
the
nano
stru
ctur
al p
rope
rtie
s of
the
lotu
s le
af, D
r. N
amav
ar a
nd h
is
team
cre
ated
the
oppo
site
eff
ect,
and
engi
neer
ed a
nan
ocry
stal
line
cubi
c zi
rco-
nia
coat
ing
with
sup
er-h
ydro
phili
c pr
oper
ties
and
tota
l wet
tabi
lity
to w
ater
.
Thei
r wor
k ga
rner
ed n
atio
nal a
tten
tion
whe
n th
eir fi
ndin
gs, e
ntitl
ed “
The
Lotu
s Ef
fect
in
Engi
neer
ed Z
ircon
ia,”
wer
e pu
blis
hed
in th
e A
pril
2008
issu
e of
Nan
oLet
ters
jour
nal,
a le
adin
g fo
rum
for n
anos
cale
rese
arch
.
To a
lter t
he c
ubic
zirc
onia
, Dr.
Nam
avar
’s te
am u
ses
a sp
ecia
l ion
-bea
m-a
ssis
ted-
depo
sitio
n
(IBA
D) p
roce
ss, d
urin
g w
hich
they
exp
ose
a su
bsta
nce
to a
larg
e am
ount
of i
ons
– at
oms
that
ha
ve g
aine
d an
ele
ctric
al c
harg
e by
losi
ng a
n el
ectr
on.
“Util
izin
g bi
llion
s of
ene
rget
ic io
ns a
s an
ioni
c ha
mm
er, w
e ha
ve fo
rged
pyr
amid
al n
anos
truc
ture
fil
ms
poss
essi
ng c
ombi
ned
prop
ertie
s of
sup
er-h
ardn
ess
and
com
plet
e w
ettin
g be
havi
or,”
Dr.
Nam
avar
sai
d.
The
IBA
D c
ombi
nes
evap
orat
ion
with
con
curr
ent i
on b
eam
bo
mba
rdm
ent i
n a
high
vac
uum
env
ironm
ent,
and
gene
rate
s a
vapo
r flux
of m
etal
, allo
y, or
cer
amic
ato
ms
from
sev
eral
cr
ucib
les.
The
cru
cibl
e is
hea
ted
to a
few
thou
sand
deg
rees
Fa
hren
heit
by a
n in
tens
e el
ectr
on b
eam
from
a p
ower
ful
elec
tron
gun
. The
ene
rget
ic io
ns a
re th
en e
mpl
oyed
to p
rodu
ce
engi
neer
ed n
anoc
ryst
als
with
sup
erio
r mec
hani
cal p
rope
rtie
s th
at a
re ‘s
titch
ed’ t
o an
y su
bstr
ate
by b
omba
rdm
ent.
This
io
n-bo
mba
rdm
ent p
roce
ss is
cru
cial
for c
reat
ing
the
nano
-st
ruct
ured
cha
ract
eris
tics
of s
urfa
ces
that
resu
lt in
impr
oved
ha
rdne
ss, a
dhes
ion,
mor
phol
ogy
and
chem
ical
com
posi
tion.
Th
is s
tate
-of-t
he-a
rt s
yste
m c
an o
pera
te in
a u
niqu
e tw
in IB
AD
m
ode
to p
rodu
ce m
ulti-
nano
-laye
r (su
per l
attic
e st
ruct
ure)
co
atin
gs w
ith s
uper
b su
rfac
e pr
oper
ties
that
are
not
pos
sibl
e
thro
ugh
conv
entio
nal t
echn
ique
s.
Dr.
Nam
avar
’s gr
oup
is o
ne o
f the
few
team
s in
the
coun
try
capa
ble
of u
sing
the
IBA
D
proc
ess
in a
cade
mia
.
“To
our k
now
ledg
e it
is u
npar
alle
led
in a
ny a
cade
mic
inst
itutio
n in
the
Uni
ted
Stat
es
and
is c
ompa
rabl
e or
bet
ter t
han
mos
t sys
tem
s us
ed b
y hi
gh te
chno
logy
com
pani
es,”
D
r. N
amav
ar s
aid.
With
his
coa
ting
mad
e of
alte
red
pure
cub
ic z
ircon
ia, D
r. N
amav
ar k
new
he
had
crea
ted
a
hard
er, w
etta
ble
subs
tanc
e th
at s
tand
s to
impr
ove
the
life
of o
rtho
paed
ic im
plan
ts. W
hat
he d
idn’
t im
med
iate
ly re
aliz
e w
as th
at b
y al
terin
g th
e hy
drop
hilic
pro
pert
ies
of th
ese
nove
l m
ater
ials
, he
had
also
cre
ated
a s
ubst
ance
that
bon
es li
ke to
gro
w o
n.
Test
s do
ne in
col
labo
ratio
n w
ith Jo
hn Ja
ckso
n, P
h.D
., of
the
depa
rtm
ent o
f pat
holo
gy a
nd
mic
robi
olog
y; a
nd G
raha
m S
harp
, Ph.
D.,
of th
e de
part
men
t of g
enet
ics,
cel
l bio
logy
and
an
atom
y, ha
ve s
how
n th
at b
one
stem
cel
ls a
ctua
lly li
ke to
att
ach
to a
nd g
row
on
D
r. N
amav
ar’s
coat
ing.
“IT
SEEM
S TH
AT O
UR
PYR
AM
IDA
L N
AN
OST
RUC
TURE
S H
AVE
A C
HA
RGE
DIS
TRIB
UTI
ON
, WH
ICH
TH
E C
ELLS
FIN
D H
OSP
ITA
BLE,
” H
E SA
ID. “
THIS
WA
S A
N
UN
EXPE
CTE
D D
EVEL
OPM
ENT
AN
D O
NE
WE
WER
E TH
RILL
ED T
O E
NC
OU
NTE
R.”
In o
rtho
paed
ic te
rms,
exp
lain
ed D
r. N
amav
ar, t
his
lead
s no
t onl
y to
pro
long
ed li
fe o
f or
thop
aedi
c im
plan
ts, a
nd fe
wer
revi
sion
sur
gerie
s du
e to
redu
ced
fric
tion
and
wea
r of
the
impl
ant,
but a
lso
enha
nced
bon
e gr
owth
.
By le
arni
ng h
ow c
ells
‘com
mun
icat
e’ w
ith v
ario
us im
plan
t coa
tings
, the
y ar
e cr
eatin
g ‘sm
art’
surf
aces
that
boo
st a
nti-i
nfec
tive
prop
ertie
s in
resp
onse
to th
e de
tect
ion
of in
fec-
tious
age
nts,
and
als
o ex
hibi
t sup
erio
r adh
esio
n an
d gr
owth
pro
pert
ies
for b
one
mar
row
ce
lls a
s co
mpa
red
to tr
aditi
onal
ort
hopa
edic
mat
eria
ls. I
n es
senc
e, th
is w
ill m
ake
it ea
sier
fo
r the
join
t im
plan
t to
surv
ive
with
in th
e hu
man
bod
y. Th
ese
coat
ings
will
act
ually
redu
ce
the
prob
abili
ty o
f bac
teria
l for
mat
ion
on th
e jo
int s
urfa
ce, a
s w
ell a
s pr
omot
e bo
ne g
row
th
and
adhe
sion
of t
he a
rtifi
cial
impl
ant t
o th
e liv
ing
bone
.
Dr.
Kevi
n G
arvi
n, p
rofe
ssor
and
cha
ir in
the
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
, sai
d
Dr.
Nam
avar
’s co
atin
g co
uld
prov
e pa
rtic
ular
ly im
port
ant a
s th
e he
alth
car
e sy
stem
face
s a
surg
e in
the
elde
rly p
opul
atio
n, w
hich
will
lead
to m
ore
impl
ant s
urge
ries.
“By
redu
cing
the
num
ber o
f rev
isio
n su
rger
ies
that
pat
ient
s ne
ed d
ue to
wea
r, lo
osen
ing,
in
fect
ion,
or j
oint
failu
re,”
Dr.
Gar
vin
said
, “w
e w
ould
hel
p to
take
str
ess
off a
hea
lthca
re
syst
em th
at is
alre
ady
over
burd
ened
and
goi
ng th
roug
h an
unp
rece
dent
ed tr
ansi
tion.
”
NA
NO
-EN
GIN
EERE
D IM
PLA
NT
CO
ATIN
G
MIM
ICS
PRO
PERT
IES
OF
LIN
KER
PRO
TEIN
S TO
EN
HA
NC
E BO
NE
GRO
WTH
Dr.
Nam
avar
and
his
team
(in
colla
bora
-tio
n w
ith P
rofe
ssor
Ren
at S
abiri
anov
and
D
r. A
lexa
nder
Rub
inst
ein
of U
NO
) hav
e de
term
ined
thro
ugh
exte
nsiv
e qu
antu
m-
mec
hani
cal c
alcu
latio
ns a
nd m
olec
ular
m
odel
ing,
that
the
uniq
ue p
yram
idal
nan
o-st
ruct
ures
in D
r. N
amav
ar’s
coat
ing
have
a
char
ge d
istr
ibut
ion
com
plem
enta
ry
to li
nker
pro
tein
s, w
hich
are
a k
ey fa
ctor
in
cel
l adh
esio
n an
d bo
ne g
row
th.
In c
ompa
rison
with
mos
t ort
hopa
edic
im
plan
ts u
sed
toda
y th
at fe
atur
e a
smoo
th
surf
ace
in re
spec
t to
prot
ein
size
, Dr.
Nam
avar
’s co
atin
g fe
atur
es p
yram
idal
na
nost
ruct
ures
cre
ated
usi
ng th
e IB
AD
pr
oces
s th
at a
re c
ompa
rabl
e to
the
actu
al
size
of t
he p
rote
in. B
ecau
se th
e py
ram
idal
na
nost
ruct
ures
are
of s
imila
r siz
e ra
nge
as
the
prot
eins
, the
y cr
eate
an
envi
ronm
ent
that
the
prot
eins
are
mor
e at
trac
ted
to.
Furt
herm
ore,
Dr.
Nam
avar
’s ar
tifici
al im
plan
t su
rfac
e im
prov
es th
e lin
ker p
rote
in b
indi
ng
due
to s
tron
ger e
lect
rost
atic
att
ract
ion
and
larg
er a
vaila
ble
cont
act a
rea
in c
ompa
rison
w
ith a
sm
ooth
, sol
id s
urfa
ce. T
his
effe
ct
enha
nces
the
atta
chm
ent o
f the
bon
e m
arro
w s
tem
cel
ls to
the
impl
ant s
urfa
ce.
Beca
use
of th
is u
niqu
e ch
arac
teris
tic,
Dr.
Nam
avar
’s na
nocr
ysta
lline
cub
ic
zirc
onia
coa
ting
supp
orts
hig
her c
ell
grow
th th
an o
ther
com
mon
ly u
sed
orth
o-pa
edic
mat
eria
ls s
uch
as ti
tani
um, t
itani
um
oxid
es, o
r eve
n hy
drox
yapa
tite
(HA
).
Dr.
Nam
avar
’s te
am m
imic
ked
the
prop
ertie
s of
the
lotu
s le
af (f
rom
the
lotu
s flo
wer
)– a
pla
nt
that
is c
onsi
dere
d a
sym
bol o
f pur
ity in
man
y cu
lture
s be
caus
e of
its
self-
clea
ning
pro
pert
ies
- to
cre
ate
a na
nocr
ysta
lline
cub
ic z
ircon
ia c
oatin
g w
ith s
uper
-hyd
roph
ilic
prop
ertie
s, d
esig
ned
to re
duce
the
wea
r of o
rtho
paed
ic im
plan
ts.
Dr.
Fere
ydoo
n N
amav
ar’s
lab
uses
a s
peci
al io
n-be
am-a
ssis
ted-
depo
sitio
n (IB
AD
) mac
hine
to c
reat
e th
e na
nost
ruct
ured
cha
ract
eris
tics
of s
urfa
ces
that
resu
lt in
the
impr
oved
har
dnes
s an
d co
mpl
ete
wet
tabi
lity
need
ed to
im
prov
e th
e lif
e of
ort
hopa
edic
impl
ants
.
Ato
mic
forc
e m
icro
scop
y im
age
of c
ubic
zi
rcon
ia s
how
ing
pyra
mid
al n
anos
truc
ture
s cr
eate
d us
ing
a sp
ecia
l ion
-bea
m-a
ssis
ted-
depo
sitio
n (IB
AD
) pro
cess
.
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T5
5
(a) S
chem
atic
repr
esen
tatio
n of
the
frag
-m
ent (
7FN
3-10
FN3)
of h
uman
fibr
onec
tin
(1fn
f PD
B co
de fo
r 3D
str
uctu
re),
a lin
ker
prot
ein
that
act
s as
a b
ondi
ng a
gent
be
twee
n bo
ne m
arro
w s
trom
al c
ells
and
th
e im
plan
t sur
face
. The
leng
th o
f thi
s se
gmen
t is
appr
oxim
atel
y 16
nano
me-
ters
(nm
) and
the
diam
eter
is a
bout
3.6
nm
, whi
ch is
app
roxi
mat
ely
1/40
,000
of
the
diam
eter
of a
hum
an h
air.
(b) D
istr
ibut
ion
of th
e su
rfac
e el
ectr
osta
tic
pote
ntia
l is
repr
esen
ted
with
pos
itive
ly
char
ged
regi
ons
in b
lue,
neg
ativ
ely
char
ged
regi
ons
in re
d, a
nd n
eutr
al in
whi
te.
PE
RFO
RM
AN
CE
IN M
OTIO
N5
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
57
CO
ATIN
G D
ISS
OC
IATI
ON
RIS
KS
WIT
H T
ITA
NIU
M N
ITRI
DE
CO
ATED
TO
TAL
HIP
RE
PLA
CE
MEN
T S
YSTE
MS
H
aid
er, H
an
i, W
eise
nb
urg
er, J
oel
N. a
nd
Ga
rvin
, Kev
in L
.
INTR
OD
UC
TIO
N:
Tita
nium
nitr
ide
(TiN
) coa
tings
are
som
etim
es a
pplie
d th
roug
h pr
essu
re
vapo
r dep
ositi
on to
fem
oral
hea
ds a
nd a
ceta
bula
r lin
ers.
Thi
s co
atin
g is
typi
cally
cla
imed
to h
ave
suffi
cien
t har
dnes
s an
d th
eref
ore
may
resi
st
abra
sion
and
redu
ce o
vera
ll w
ear,
or a
t lea
st n
ot p
rohi
bitiv
ely
com
pro-
mis
e th
em. I
t is
also
cla
imed
to s
omet
imes
act
as
a di
ffus
ion
barr
ier
agai
nst m
etal
ion
rele
ase,
mak
ing
the
coat
ed m
etal
-on-
met
al (M
OM
) To
tal H
ip R
epla
cem
ent (
TKR)
mor
e su
itabl
e fo
r pat
ient
s w
ith m
etal
ion
sens
itivi
ty. S
uch
coat
ings
are
alre
ady
com
mer
cial
ly a
vaila
ble
in E
urop
e.
This
stu
dy c
ompa
red
the
long
evity
in v
itro
of c
oate
d an
d un
coat
ed
MO
M h
ip im
plan
ts s
uppl
ied
by th
e sa
me
impl
ant v
endo
r (an
d co
ated
by
a c
omm
erci
al th
ird p
arty
).
MA
TERI
ALS
AN
D M
ETH
OD
S:
An
exte
nded
5 m
illio
n cy
cle
(Mc)
in v
itro
wea
r tes
t was
con
duct
ed o
n a
hip
sim
ulat
or (A
MTI
, Bos
ton)
sho
wn
in F
igur
e 1.
Six M
OM
TH
R sy
stem
spe
cim
ens
com
pris
ing
CoC
r fem
oral
hea
ds
(44m
m d
iam
eter
), ac
etab
ular
line
rs, a
nd a
ceta
bula
r she
lls (F
igur
e 2)
w
ere
test
ed. T
hree
of t
he s
ix h
ad h
eads
and
line
rs w
ere
coat
ed in
TiN
, an
d th
e re
mai
ning
thre
e w
ere
unco
ated
for c
ontr
ol. T
he s
peci
men
s w
ere
mou
nted
ana
tom
ical
ly a
nd w
ere
lubr
icat
ed w
ith b
ovin
e se
rum
dilu
ted
with
dei
oniz
ed w
ater
to h
ave
20 g
/l p
rote
in c
once
ntra
tion.
The
lubr
ican
t w
as c
ontin
ually
circ
ulat
ed a
nd k
ept a
t 37°
C. T
he T
HR
spec
imen
s w
ere
subj
ecte
d to
the
load
ing
and
rota
tions
of t
he w
alki
ng c
ycle
as
spec
i-fie
d in
ISO
-142
42-1
[1] a
t 1H
z fo
r 5 M
c. T
he lo
adin
g an
d ro
tatio
ns w
ere
cont
inua
lly o
bser
ved
to e
nsur
e co
nsis
tenc
y w
ith th
e de
sire
d w
avef
orm
s.
The
fem
oral
hea
ds a
nd a
ceta
bula
r lin
ers
wer
e ca
refu
lly c
lean
sed,
gra
vi-
met
rical
ly w
eigh
ed, a
nd th
e lu
bric
ant w
as c
hang
ed a
t 0, 0
.25,
0.5
, and
ev
ery
0.5
Mc
afte
rwar
ds.
RESU
LTS:
Ove
r 5 M
c, th
e un
coat
ed h
eads
dis
play
ed a
wea
r rat
e of
1.8
4±0.
18 m
g/M
c, w
hile
the
TiN
-coa
ted
fem
oral
hea
ds w
ore
at 4
.37±
2.01
mg/
Mc.
W
ear o
f the
unc
oate
d an
d co
ated
met
al a
ceta
bula
r lin
ers
was
1.3
5±0.
11
mg/
Mc
and
4.16
±2.0
6 m
g/M
c, re
spec
tivel
y. Th
e w
ear o
f all
test
ed
spec
imen
s is
sho
wn
in F
igur
e 3,
and
the
aver
age
wea
r of e
ach
type
(c
ombi
ned
head
and
line
r wea
r) is
sho
wn
in F
igur
e 4.
The
thre
e Ti
N-c
oate
d TH
R sp
ecim
ens
disp
laye
d a
loss
of c
oatin
g on
bo
th th
e he
ad a
nd li
ner i
n th
e ar
ticul
atin
g re
gion
(Fig
ure
5). T
he a
rea
whe
re th
e co
atin
g w
ore
away
incr
ease
d in
siz
e as
the
test
pro
gres
sed.
Th
e lo
ss o
f coa
ting
occu
rred
rapi
dly
and
early
in th
e te
stin
g (a
fter
onl
y 0.
25 M
c) in
the
case
of o
ne s
peci
men
whi
ch c
ause
d se
vere
scr
atch
ing
and
high
wea
r. A
fter
this
“br
eaka
way
wea
r” o
ccur
red,
the
wea
r on
that
sp
ecim
en s
tabi
lized
.
The
diff
eren
ce in
wea
r bet
wee
n th
e co
ated
and
unc
oate
d fe
mor
al h
eads
w
as n
ot s
tatis
tical
ly s
igni
fican
t. Th
e w
ear b
etw
een
coat
ed a
nd u
ncoa
ted
met
al a
ceta
bula
r lin
ers
was
als
o no
t sta
tistic
ally
sig
nific
ant u
ntil
3 M
c,
afte
r whi
ch it
bec
ame
mar
gina
lly s
igni
fican
t (p
< 0.
05).
Top
: 44m
m T
iN-C
oate
d C
oCrM
o fe
mor
al h
ead
and
acet
abul
ar li
ner.
Bo
tto
m:
unco
ated
TH
R co
mpo
nent
s
Fig
ure
1:
Hip
sim
ulat
or a
nd s
umm
ary
of te
st c
ondi
tions
Fig
ure
2: S
peci
men
s an
d fix
ture
s
Left
: Fem
oral
hea
d m
ount
ed o
n cu
stom
jig
to a
lign
at a
nato
mic
ally
re
leva
nt a
ngle
. Ce
nte
r: T
iAlV
ace
tabu
lar s
hell.
Rig
ht:
Ace
tabu
lar
shel
l fixe
d in
bon
e ce
men
t at a
nato
mic
ally
rele
vant
ang
le.
�
Mul
ti-s
tatio
n A
MTI
hip
sim
ulat
or�
IS
O-1
4242
-1 [1
] inp
ut w
avef
orm
s at
1 H
z�
5
mill
ion
cycl
e w
ear t
est
�
20 g
/L p
rotie
n bo
vine
ser
um @
37° C
�
Wea
r mea
sure
d gr
avim
etri
cally
(10
μg r
es.)
Fig
ure
4:
Com
bine
d w
ear o
f 44m
m T
iN-c
oate
d an
d st
anda
rd T
HRs
ov
er 5
mill
ion
cycl
es.
Ave
rage
d da
ta a
nd 9
5% c
onfid
ence
inte
rval
s ar
e sh
own.
The
wid
e 95
% c
onfid
ence
inte
rval
on
the
TiN
-coa
ted
spec
i-m
ens
was
due
to th
e “b
reak
away
wea
r” e
xhib
ited
by o
ne s
peci
men
be
fore
1 M
c (s
peci
men
6, s
ee F
igur
e 1)
.
Fig
ure
5:
The
TiN
-coa
ted
fem
oral
hea
ds a
t diff
eren
t sta
ges
of te
stin
g sh
owin
g co
atin
g ha
d di
sapp
eare
d re
lativ
ely
earl
y.
Fig
ure
6:
A T
iN-c
oate
d fe
mor
al c
ompo
nent
aft
er te
st c
ompl
etio
n at
8M
c, s
how
ing
wor
n co
atin
g on
med
ial c
ondy
le.
Fig
ure
3:
Wea
r of 4
4mm
TiN
-coa
ted
and
stan
dard
TH
Rs. F
emor
al
head
s an
d ac
etab
ular
line
rs a
re s
how
n se
para
tely
.
DIS
CU
SSIO
N:
Our
sim
ulat
or re
sults
con
firm
sm
all w
ear o
vera
ll fo
r MO
M T
HRs
; ho
wev
er, w
e di
d fin
d ex
trem
e “r
un-in
” wea
r on
one
TiN
-coa
ted
spec
i-m
en. T
he h
ighe
r wea
r obs
erve
d on
the
coat
ed s
peci
men
s w
as li
kely
du
e to
the
loss
of t
he c
oatin
g, w
here
coa
ting
debr
is p
artic
les
may
hav
e ca
used
third
bod
y w
ear e
vide
nced
by
high
er le
vel o
f scr
atch
ing
on
coat
ed c
ompo
nent
s.
The
even
tual
loss
of t
he T
iN c
oatin
g on
all
thre
e co
ated
spe
cim
ens
is
of c
once
rn. I
t is
poss
ible
that
the
coat
ing
proc
ess
suff
ered
impe
rfec
-tio
ns w
hich
resu
lted
in p
oor a
dhes
ion
to th
e su
bstr
ate,
or p
erha
ps
resu
lted
in th
in a
pplic
atio
n/de
posi
tion
in th
e ar
ea w
here
the
coat
ing
was
lost
. The
resu
lts fo
und
here
ech
o th
e re
sults
of a
pre
viou
s To
tal
Knee
Rep
lace
men
t (TK
R) w
ear s
imul
atio
n te
st (F
igur
e 6)
whi
ch fe
atur
ed
TiN
bN c
oate
d fe
mor
al c
ompo
nent
s, a
ll of
whi
ch lo
st a
por
tion
of th
e co
atin
g on
the
med
ial c
ondy
le [2
].
It is
the
unde
rsta
ndin
g of
the
auth
ors
that
suc
h co
atin
gs a
re c
urre
ntly
us
ed c
linic
ally
in E
urop
e! In
nova
tions
of t
his
kind
can
alw
ays
bene
fit
from
mor
e th
orou
gh te
stin
g, s
uch
as is
don
e in
Neb
rask
a.
REFE
REN
CES
:
1. IS
O 1
4242
-1: 1
999-
06: I
mpl
ants
for s
urge
ry -
wea
r of t
otal
hip
pro
s-th
eses
- Pa
rt 1
: Loa
ding
and
dis
plac
emen
t par
amet
ers
for w
ear-t
estin
g m
achi
nes
and
corr
espo
ndin
g en
viro
nmen
tal c
ondi
tions
for t
ests
.
Wei
senb
urge
r, J.N
., C
roso
n, R
.E.,
Nam
avar
, F.,
Gar
vin,
K.L
., H
aide
r, H
., “C
once
rn w
ith a
dhes
ion
and
wea
r of a
Tita
nium
Nio
bium
Nitr
ide
coat
ing
on T
otal
Kne
e Re
plac
emen
ts fo
r met
al s
ensi
tive
patie
nts”
, Pos
ter
2007
, Tra
nsac
tions
of t
he 4
th A
nnua
l Mee
ting
of th
e O
rtho
paed
ic
Rese
arch
Soc
iety
, San
Fra
ncis
co, M
arch
200
8.
������������� ������� ��
PE
RFO
RM
AN
CE
IN M
OTIO
N5
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
57
PE
RFO
RM
AN
CE
IN M
OTIO
N5
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
59
BON
E PR
ESEN
CE
BETW
EEN
TH
E C
ENTR
AL
PEG
’S R
AD
IAL
FIN
S O
F A
PA
RTI
ALL
Y-C
EM
EN
TED
, PE
GG
ED A
LL-P
OLY
GLE
NO
ID
CO
MPO
NEN
T SU
GG
EST
FEW
RA
DIO
LUC
ENC
IES
Rya
n M
. Arn
old
, MD
; Ro
bin
R. H
igh
, MB
A, M
A; K
evin
T. G
ross
ha
ns,
MD
; Cra
ig W
. Wa
lker
, MD
; an
d E
dw
ard
V. F
ehri
ng
er, M
D
INTR
OD
UC
TIO
N:
Sinc
e its
evo
lutio
n, to
tal s
houl
der a
rthr
o-pl
asty
(TSA
) has
bec
ome
an e
ffec
tive
trea
tmen
t for
prim
ary
glen
ohum
eral
art
hriti
s as
mea
sure
d by
sho
ulde
r-sp
ecifi
c an
d ge
nera
l hea
lth-s
peci
fic o
utco
mes
met
rics.
Ye
t, ce
men
ted
all-p
olye
thyl
ene
glen
oid
com
pone
nt lo
osen
ing
rem
ains
a p
robl
em.
Radi
oluc
ent l
ines
sur
roun
ding
cem
ente
d al
l-pol
yeth
ylen
e gl
enoi
d co
mpo
nent
s m
ay b
e pr
esen
t as
early
as
the
reco
very
ro
om a
nd s
ugge
st s
ubop
timal
cem
entin
g te
chni
que.
It is
als
o po
ssib
le th
at c
emen
ted-
indu
ced
ther
mal
nec
rosi
s m
ay c
ontr
ibut
e to
ost
eocy
te d
eath
and
radi
oluc
ent l
ines
.
In a
n at
tem
pt to
dec
reas
e ce
men
t util
iza-
tion,
Wirt
h, e
t al.,
des
igne
d a
cem
entle
ss
all-p
olye
thyl
ene
com
pone
nt fo
r use
in c
anin
es.
In th
eir m
odel
, the
com
pone
nt a
llow
ed fo
r ra
diog
raph
ical
ly-p
rove
n an
d hi
stol
ogic
ally
-pr
oven
bon
e gr
owth
bet
wee
n th
e ra
dial
fins
of
the
peg
used
to a
ncho
r the
gle
noid
com
po-
nent
in b
one.
A c
ompo
nent
for u
tiliz
atio
n in
hu
man
s ba
sed
upon
the
cani
ne c
ount
erpa
rt
was
des
igne
d an
d ha
s be
en u
sed
exte
n-si
vely
with
cem
ent f
or th
e pe
riphe
ral 3
peg
s (F
igur
e 1)
. Its
pre
mis
e is
to a
llow
bon
e gr
owth
be
twee
n th
e ra
dial
fins
of t
he c
entr
al p
eg
(as
it di
d in
the
cani
ne m
odel
) in
a co
ntro
lled
frac
ture
resp
onse
-like
fash
ion.
Yet
, litt
le
radi
ogra
phic
or c
linic
al d
ata
exis
ts fo
r thi
s pr
osth
esis
in h
uman
s de
spite
its
wid
espr
ead
use
for 1
0 ye
ars.
And
, to
date
, no
CT
data
ex
ists
for t
his
pros
thes
is d
espi
te th
e fa
ct th
at
CT
inte
rpre
tatio
n of
gle
noid
com
pone
nts
has
been
sho
wn
to b
e m
ore
relia
ble
than
pla
in
radi
ogra
phy
and
fluor
osco
pica
lly-g
uide
d im
ages
. We
hypo
thes
ized
that
bet
ter b
one
pres
ence
bet
wee
n th
e ra
dial
fins
of t
he c
entr
al
peg
of th
is p
rost
hesi
s w
ould
be
asso
ciat
ed
with
less
ove
rall
com
pone
nt ra
diol
ucen
cies
. Th
e pu
rpos
e of
this
stu
dy w
as to
ass
ess
for
bone
pre
senc
e be
twee
n th
e ra
dial
fins
of t
his
hybr
id g
leno
id c
ompo
nent
’s ce
ntra
l peg
, as
Yian
CT-
base
d ra
diol
ucen
cy s
core
s w
ere
orig
inal
ly d
escr
ibed
and
cal
cula
ted
base
d up
on a
ce
men
ted
4-pe
gged
all
poly
ethy
lene
gle
noid
des
ign.
For
the
com
pone
nt in
our
stu
dy, t
he 4
peg
s ar
e in
the
sam
e co
nfigu
ratio
n as
that
des
crib
ed b
y Yi
an (F
igur
e 2)
, but
the
com
pone
nt in
our
st
udy’
s ce
ntra
l peg
was
pla
ced
in u
ncem
ente
d fa
shio
n an
d ha
s ra
dial
fins
. Yia
n sc
ores
rang
e fr
om
0-1
8 w
ith 0
repr
esen
ting
no ra
diol
ucen
cies
and
18
bein
g th
e m
axim
um (w
orst
) (Ta
ble
I). F
inal
ly, t
he
CT
scan
s in
Yia
n’s
stud
y w
ere
perf
orm
ed w
ith 3
mill
imet
er c
uts;
our
CT
scan
s ha
d 0.
625
mill
imet
er
cuts
. The
Laz
arus
radi
oluc
ency
sco
ring
syst
em (F
igur
e 3)
was
orig
inal
ly d
escr
ibed
for a
cem
ente
d,
pegg
ed, a
ll-po
lyet
hyle
ne g
leno
id c
ompo
nent
bas
ed u
pon
plai
n ra
diog
raph
s. S
core
s ra
nge
from
0
-5 w
ith 0
bei
ng n
o ra
diol
ucie
ncie
s (T
able
II).
With
the
pros
thes
is in
this
stu
dy, t
here
are
6 “c
ompa
rtm
ents
” bet
wee
n th
e ra
dial
fins
of t
he
cent
ral p
eg in
whi
ch o
ne c
ould
vis
ualiz
e bo
ne o
n pl
ain
radi
ogra
phs
(Fig
ure
4) a
nd/o
r CT
scan
s (F
igur
es 5
& 6
). W
e as
ked
our r
adio
logi
st to
ass
ess
all C
T sc
an c
uts
for b
one
pres
ence
or a
bsen
ce
in th
ese
“com
part
men
ts.”
Bone
pre
senc
e in
all
6 co
mpa
rtm
ents
sco
red
a 6;
the
min
imum
sco
re
(no
bone
pre
sent
in a
ny c
ompa
rtm
ent)
was
0.
RESU
LTS:
Hav
ing
a da
ta s
et w
ith a
mea
n pa
tient
age
at t
he ti
me
of s
urge
ry o
f 70
year
s (ra
nge
49-8
9 ye
ars)
an
d w
ith m
easu
rem
ents
col
lect
ed a
t an
aver
age
43 m
onth
s (ra
nge
24-6
6 m
onth
s) a
fter
sur
gery
, w
e fo
und
the
follo
win
g (T
able
III):
1.) B
y C
T, be
tter
bon
e pr
esen
ce b
etw
een
the
radi
al fi
ns o
f the
ce
ntra
l peg
was
ass
ocia
ted
with
bet
ter (
low
er) Y
ian
scor
es (p
<0.0
01) (
Figu
re 7
). 2.
) Als
o by
CT,
bo
ne w
as p
rese
nt in
6/6
radi
al fi
n co
mpa
rtm
ents
in 2
3/35
sho
ulde
rs. O
n av
erag
e (w
hen
cons
id-
erin
g al
l 35)
bon
e co
mpa
rtm
ent p
rese
nce
was
4.5
/6 (r
ange
0-6
). O
nly
3 sh
ould
ers
had
no b
one
pres
ent i
n an
y of
the
com
part
men
ts (s
core
of 0
).
With
resp
ect t
o th
e fu
nctio
nal d
ata,
nei
ther
abs
olut
e C
onst
ant n
or S
ST s
core
s w
ere
asso
ciat
ed
with
bon
e pr
esen
ce b
y C
T. N
eith
er h
ighe
r SST
nor
abs
olut
e C
onst
ant s
core
s w
ere
asso
ciat
ed w
ith
bett
er (l
ower
) Yia
n sc
ores
. But
, thi
s m
ay h
ave
been
due
to n
o ca
ses
of lo
osen
ing.
Mea
n La
zaru
s ra
diol
ucen
cy s
core
(0-5
with
0=n
o lu
cenc
y) w
as 0
.45.
Fin
ally
, mea
n SS
T sc
ore
was
10.
3 w
hile
th
e m
ean
abso
lute
Con
stan
t sco
re w
as 8
1.3.
No
com
plic
atio
ns w
ere
expe
rienc
ed. N
o gl
enoi
d co
mpo
nent
was
radi
ogra
phic
ally
loos
e ac
cord
ing
to th
e La
zaru
s cl
assi
ficat
ion.
No
shou
lder
has
be
en re
vise
d.
wel
l as
for o
vera
ll co
mpo
nent
radi
oluc
enci
es
with
thin
cut
CT
scan
s an
d pl
ain
radi
ogra
phs.
W
e al
so w
ishe
d to
obt
ain
shou
lder
sco
res
for
each
sho
ulde
r as
a ba
selin
e fo
r fut
ure
stud
y.
Fig
ure
1: D
ePuy
Anc
hor P
eg G
leno
id
Com
pone
nt; W
arsa
w, I
N.
MET
HO
DS:
Aft
er IR
B ap
prov
al a
t our
inst
itutio
n, w
e as
ked
patie
nts
in w
hom
the
seni
or a
utho
r (E
VF)
had
per
form
ed p
rimar
y to
tal s
houl
der
repl
acem
ents
for p
rimar
y gl
enoh
umer
al
arth
ritis
with
out p
revi
ous
surg
ery
to re
turn
a
min
imum
of 2
yea
rs fo
llow
ing
thei
r pr
oced
ures
per
form
ed b
etw
een
July
of 2
003
and
July
of 2
007.
Thi
s st
udy
was
sup
port
ed
by a
gra
nt fr
om o
ur C
olle
ge o
f Med
icin
e.
Of t
he 4
8 sh
ould
ers
repl
aced
with
a to
tal
shou
lder
art
hrop
last
y fo
r one
dia
gnos
is
(prim
ary
glen
ohum
eral
ost
eoar
thrit
is), 3
5 (2
9 pa
tient
s) w
ere
stud
ied.
All
patie
nts
had
been
invi
ted
to p
artic
ipat
e. B
ecau
se o
f di
stan
ce to
trav
el (s
ome
>200
mile
s), i
llnes
s,
lack
of fi
nanc
ial r
esou
rces
, or u
nwill
ingn
ess
to p
artic
ipat
e in
a s
tudy
that
requ
ired
near
ly
>½ d
ay o
f the
pat
ient
’s tim
e, 3
5 of
the
48
wer
e st
udie
d. 2
0/35
sho
ulde
rs w
ere
in m
ales
. N
o sh
ould
er h
as b
een
re-o
pera
ted
to d
ate.
All
repl
acem
ent p
roce
dure
s w
ere
perf
orm
ed
with
a c
onsi
sten
t tec
hniq
ue a
nd p
rost
hesi
s (D
epuy
Glo
bal A
dvan
tage
with
an
Anc
hor
Peg
glen
oid;
War
saw
, IN
). Pr
ior t
o gl
enoi
d co
mpo
nent
impl
anta
tion,
we
pack
ed b
one
betw
een
the
radi
al fi
ns o
f the
com
pone
nt’s
ce
ntra
l peg
. Thi
s bo
ne w
as o
btai
ned
by
ream
ing
the
cut s
urfa
ce s
ide
of th
e os
te-
otom
ized
hum
eral
hea
d. R
eam
ing
allo
wed
th
e cr
eatio
n of
a “
bone
pas
te” t
hat w
as
left
bet
wee
n th
e re
amer
bla
des.
Thi
s pa
ste
was
app
lied
easi
ly a
nd n
icel
y be
twee
n th
e ra
dial
fins
. We
used
min
imal
cem
ent f
or th
e pe
riphe
ral 3
peg
s, b
ut p
lace
d it
in p
ress
ur-
ized
fash
ion
with
a 6
0 cc
Too
mey
syr
inge
.
A 5
th-y
ear o
rtho
paed
ic s
urge
ry re
side
nt,
blin
ded
as to
the
min
imum
2-y
ear r
adio
-gr
aphi
c st
udy
resu
lts, e
xam
ined
eac
h pa
tient
. H
e ob
tain
ed a
hea
lth h
isto
ry, a
Sim
ple
Shou
lder
Tes
t (SS
T) s
core
, and
an
abso
lute
C
onst
ant S
core
. Pla
in fi
lms
and
CT
scan
s (H
elic
al s
cans
with
0.6
25m
m X
0.6
25m
m
slic
e th
ickn
ess)
wer
e ob
tain
ed fo
r eac
h sh
ould
er. P
lain
film
s w
ere
stan
dard
ized
and
in
clud
ed a
con
vent
iona
l axi
llary
vie
w a
s w
ell
as a
Gra
shey
(AP)
vie
w. A
fello
wsh
ip-tr
aine
d m
uscu
losk
elet
al ra
diol
ogis
t with
gre
ater
th
an 2
0 ye
ars
of c
linic
al e
xper
ienc
e, b
linde
d as
to th
e pu
rpos
e of
the
stud
y as
wel
l as
to p
atie
nt id
entit
ies,
eva
luat
ed fo
r bon
e be
twee
n ra
dial
fins
as
wel
l as
com
pone
nt
radi
oluc
enci
es b
ased
upo
n th
in C
T sc
an
cuts
as
desc
ribed
by
Yian
and
Ger
ber.
Thes
e au
thor
s pr
evio
usly
util
ized
CT
scan
s w
ith
3-m
illim
eter
axi
al c
uts
to e
stab
lish
a ne
w g
old
stan
dard
for g
leno
id c
ompo
nent
radi
olu-
cenc
y ev
alua
tion.
The
sam
e ra
diol
ogis
t als
o ev
alua
ted
all p
lain
radi
ogra
phs
to o
btai
n a
Laza
rus
radi
oluc
ency
sco
re fo
r eac
h.
0N
o r
ad
iolu
cen
cy
1In
com
ple
te r
ad
iolu
cen
cy a
rou
nd
1 o
r 2
peg
s
2C
om
ple
te r
ad
iolu
cen
cy (<
/= 2
mm
wid
e) a
rou
nd
1 p
eg
on
ly, w
ith
or
wit
ho
ut co
m-
ple
te r
ad
iolu
cen
cy a
rou
nd
1 o
ther
peg
3C
om
ple
te r
ad
iolu
cen
cy (<
/= 2
mm
wid
e) a
rou
nd
2 o
r m
ore
peg
s
4C
om
ple
te r
ad
iolu
cen
cy (>
2m
m w
ide)
aro
un
d 2
or
mo
re p
eg
s
5G
ross
loo
sen
ing
Tab
le II:
Laz
arus
sco
ring
for g
leno
id c
ompo
nent
on
plai
n ra
diog
raph
0N
o lu
cen
cy p
rese
nce
11
mm
of l
uce
ncy
22
mm
of l
uce
ncy
Tab
le I
: Yia
n sc
orin
g sy
stem
for e
ach
zone
of g
leno
id c
ompo
nent
on
CT
scan
PE
RFO
RM
AN
CE
IN M
OTIO
N5
8
Fig
ure
2: Z
ones
1 th
roug
h 6
utili
zed
for Y
ian
scor
ing
on C
ompu
ted
Tom
ogra
phy
scan
s.
Fig
ure
4: S
tand
ard
radi
ogra
ph o
f gle
noid
co
mpo
nent
for L
azar
us s
corin
g. L
azar
us
Gra
de 0
/5.
Fig
ure
5: C
T Sc
an e
valu
atio
n of
gle
noid
com
-po
nent
dem
onst
ratin
g bo
ne b
etw
een
radi
al
fins
of c
entr
al p
eg. Y
ian
Scor
e =
0/18
. Bo
ne
pres
ence
bet
wee
n ce
ntra
l fins
Sco
re =
6/6
.
Fig
ure
3: L
azar
us s
corin
g sy
stem
for r
adio
lu-
cenc
ies
abou
t peg
ged
glen
oid
com
pone
nts.
C
ourt
esy
of L
azar
us e
t al.
& R
ockw
ater
, Inc
.
Fig
ure
6: C
T Sc
an e
valu
atio
n of
gle
noid
com
-po
nent
dem
onst
ratin
g bo
ne b
etw
een
radi
al
fins
of c
entr
al p
eg. Y
ian
Scor
e =
0/18
. Bo
ne
pres
ence
bet
wee
n ce
ntra
l fins
sco
re =
6/6
.
PE
RFO
RM
AN
CE
IN M
OTIO
N6
0U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
61
MA
TERI
ALS
AN
D M
ETH
OD
S:
48 to
tal h
ip re
plac
emen
t sys
tem
spe
cim
ens
of 1
4 di
ffer
ent c
onte
mpo
rary
TH
R de
sign
s an
d/or
m
ater
ial o
r siz
e co
mbi
natio
ns (t
otal
) wer
e te
sted
. The
spe
cim
en g
roup
s w
ere
as fo
llow
s:
Eig
hte
en
Me
tal-
on
-UH
MW
PE
(M
OP
) TH
Rs
(sho
wn
oppo
site
):
Twel
ve 3
6mm
hea
d si
ze, s
ix o
f whi
ch h
ad a
CoC
r coa
ting
on th
e fe
mor
al h
ead,
the
othe
r six
un
coat
ed, a
ll w
ith c
onve
ntio
nal U
HM
WPE
line
rs.
Six 4
4mm
hea
d si
ze, t
hree
of w
hich
had
hig
hly
cros
slin
ked
(HXL
) lin
ers,
the
othe
r thr
ee li
ners
w
ere
conv
entio
nal U
HM
WPE
.
Twe
lve 4
4m
m s
ize M
eta
l-o
n-M
eta
l (M
OM
) TH
Rs:
Thre
e st
anda
rd a
nd th
ree
TiN
coa
ted
spec
imen
s (s
how
n op
posi
te fa
r rig
ht).
Six h
ip re
surf
acin
g ty
pe, t
hree
of
whi
ch h
ad p
ocke
ts o
n th
e fe
mor
al
head
sur
face
for fl
uid
tran
spor
t (s
how
n op
posi
te).
DIS
CU
SSIO
N:
Gle
noid
com
pone
nt lo
osen
ing
rem
ains
a
maj
or c
once
rn. D
espi
te th
e co
mpo
nent
de
scrib
ed in
this
repo
rt’s
wid
espr
ead
use
in
hum
ans,
lim
ited
liter
atur
e ex
ists
rega
rdin
g its
ou
tcom
es w
ith ra
diog
raph
ic s
tudi
es c
onfin
ed
to p
lain
radi
ogra
phs.
The
pur
pose
of t
his
stud
y w
as to
ass
ess
for b
one
betw
een
the
radi
al fi
ns o
f thi
s hy
brid
gle
noid
com
pone
nt’s
ce
ntra
l peg
as
wel
l as
for o
vera
ll ra
diol
ucen
-ci
es w
ith th
in c
ut C
T an
d pl
ain
radi
ogra
phy.
Radi
oluc
enci
es th
at s
urro
und
glen
oid
com
pone
nts
are
caus
e fo
r con
cern
. One
re
port
dem
onst
rate
d a
near
ly 2
0% in
cide
nce
of ra
diol
ucen
t lin
es in
cem
ente
d gl
enoi
ds
with
in 2
wee
ks o
f sur
gery
, and
man
y ha
ve
repo
rted
thes
e ra
diol
ucen
cies
to b
e pr
esen
t in
reco
very
room
radi
ogra
phs.
Gar
tsm
an e
t al
. dem
onst
rate
d th
ese
initi
al ra
diog
raph
ic
luce
ncie
s to
be
furt
her d
epen
dent
upo
n th
e gl
enoi
d de
sign
, find
ing
initi
al ra
diol
ucen
cies
in
39% o
f kee
led
com
pone
nts
and
5% o
f peg
ged
com
pone
nts.
Bon
e co
mpa
ctio
n te
chni
ques
ha
ve s
ugge
sted
redu
ced
initi
al lu
cenc
ies
pres
ent i
n ke
eled
com
pone
nts,
but
luce
ncie
s ha
ve s
till b
een
show
n to
pro
gres
s. R
ecen
t st
udie
s ha
ve c
onfir
med
a h
ighe
r sur
viva
l rat
e fo
r peg
ged
com
pone
nts
com
pare
d to
kee
led.
Nee
r sug
gest
ed th
at in
itial
radi
oluc
enci
es
wer
e at
trib
utab
le to
poo
r cem
entin
g. M
oder
n ce
men
ting
tech
niqu
es h
ave
show
n sl
ight
de
crea
ses
in lo
osen
ing,
but
it h
as b
een
show
n th
at ra
diol
ucen
t lin
es a
re s
till p
rese
nt a
nd
are
prog
ress
ive.
A 2
004
stud
y by
Chu
rchi
ll,
et a
l. de
mon
stra
ted
that
hea
t pro
duct
ion
durin
g m
ethy
lmet
hacr
ylat
e cu
ring
is e
noug
h to
resu
lt in
ther
mal
nec
rosi
s of
bon
e. T
his
necr
osis
may
be
a ca
use
or c
ontr
ibut
or o
f im
med
iate
and
/or p
rogr
essi
ve ra
diol
ucen
t lin
es. I
n th
eir s
tudy
, gre
ater
than
two
gram
s of
cem
ent l
ed to
sig
nific
ant t
herm
al n
ecro
sis.
CO
MPA
RISO
N O
F 14
DIF
FERE
NT
THR
DE
SIG
NS
UN
DER
TH
E SA
ME
TEST
ING
CO
ND
ITIO
NS
Ha
ider
, Ha
ni;
Wei
sen
bu
rger
, Jo
el N
.; a
nd
Ga
rvin
, Kev
in L
.
INTR
OD
UC
TIO
N:
Mos
t of t
he p
ublis
hed
data
from
in v
itro
wea
r tes
ting
of T
otal
Hip
Rep
lace
men
t (TH
R) s
yste
ms
have
resu
lted
from
the
so-c
alle
d “o
rbita
l mac
hine
” si
mul
ator
met
hod
(now
ISO
sta
ndar
d 14
242-
3 [1
]) w
ith tw
o co
uple
d ro
tatio
n si
mul
ator
axe
s. M
uch
less
has
em
anat
ed fr
om th
e IS
O 1
4242
-1 [2
] m
etho
d w
ith th
e m
ore
anat
omic
ally
real
istic
con
figur
atio
n, w
ith th
ree
unco
uple
d ax
es o
f rot
atio
n as
wou
ld o
ccur
clin
ical
ly. A
lso,
wea
r res
ults
are
ge
nera
lly s
carc
er fo
r the
mor
e m
oder
n de
sign
s an
d m
ater
ial c
oupl
es o
f TH
R sy
stem
s.
This
stu
dy c
ompa
res
the
wea
r rat
es o
f som
e co
ntem
pora
ry T
HR
desi
gns
and/
or m
ater
ial o
r siz
e co
mbi
natio
ns te
sted
on
a hi
p si
mul
ator
with
the
anat
omic
al c
onfig
urat
ion.
Six
Ce
ram
ic-o
n-P
last
ic (C
OP
) TH
Rs
(sho
wn
oppo
site
):
Thre
e 32
mm
hea
d si
ze B
iolo
x For
te c
eram
ic h
eads
with
con
vent
iona
l UH
MW
PE li
ners
.
Thre
e 44
mm
hea
d si
ze C
eram
etal
(cer
amic
she
ll ov
er m
etal
tape
r mou
nt) w
ith c
onve
ntio
nal
UH
MW
PE li
ners
.
Tab
le III
: Res
ults
Pa
tien
ts29
Sh
ou
lder
s35
Follo
w-U
p43
MO
NTH
S
SS
T10
.3
Co
nst
an
t S
core
81.3
Mo
difi
ed L
aza
rus
Sco
re
(0-5
)0.
45
Cen
tra
l Peg
C
om
pa
rtm
ents
w
ith
Bo
ne
(0-6
)
4.5
Sh
ou
lder
s w
ith
Bo
ne
in
All
6 C
om
pa
rtm
ents
23
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T6
1
Fig
ure
7: M
ore
bone
bet
wee
n th
e ra
dial
fins
of t
he c
entr
al p
eg c
orre
late
s w
ith b
ette
r (lo
wer
) m
odifi
ed Y
ian
scor
es. N
ote:
x-a
xis
max
imum
is 1
0 fo
r sim
plic
ity; m
axim
um is
18
but h
ighe
st
scor
e w
as 9
in th
is s
tudy
).
Nee
r not
ed th
at a
hig
h de
gree
of v
aria
bilit
y ex
ists
in th
e ea
rly ra
diol
ucen
cies
sur
roun
d-in
g ce
men
ted
keel
com
pone
nts
due
to th
e va
riatio
ns o
f rad
iogr
aphi
c te
chni
que
and
inte
r-ob
serv
er e
rror
. In
2002
Laz
arus
, et a
l. de
scrib
ed a
pla
in ra
diog
raph
ic c
lass
ifica
-tio
n sy
stem
to e
valu
ate
pegg
ed g
leno
id
com
pone
nts
for r
adio
luce
ncie
s. Y
ian,
et a
l.,
follo
win
g th
eir C
T sc
an s
tudy
to e
valu
ate
pegg
ed g
leno
id c
ompo
nent
s ut
ilizi
ng 3
mil-
limet
er C
T cu
ts, c
oncl
uded
that
“com
pute
d to
mog
raph
y sc
ans
wer
e a
mor
e se
nsiti
ve
and
repr
oduc
ible
tool
for t
he a
sses
smen
t of
loos
enin
g of
peg
ged
glen
oid
com
pone
nts
than
was
fluo
rosc
opic
ally
-gui
ded
conv
en-
tiona
l rad
iogr
aphy
. Fur
ther
impr
ovem
ent
in im
plan
t des
ign
and
fixat
ion
tech
niqu
e ap
pear
s to
be
nece
ssar
y fo
r lon
g-te
rm
succ
ess
of c
emen
ted
glen
oid
com
pone
nts.”
In
thei
r stu
dy, Y
ian,
et a
l. pe
rfor
med
intr
a-
and
inte
r-ob
serv
er re
liabi
lity
test
ing.
The
ov
eral
l sco
ring
relia
bilit
y w
as h
ighe
r for
the
com
pute
d to
mog
raph
y sc
ores
than
for t
he
Laza
rus
plai
n ra
diog
raph
ic ra
diol
ucen
cy
scor
es. T
his
was
true
for b
oth
intr
a-ob
serv
er
relia
bilit
y (0
.95
for C
T, 0
.70
for L
azar
us)
and
inte
r-ob
serv
er re
liabi
lity
(0.8
9 fo
r CT,
0.51
for L
azar
us).
Chu
rchi
ll, e
t al.,
rece
ntly
de
mon
stra
ted
low
rate
s of
radi
oluc
enci
es
base
d up
on L
azar
us ra
diol
ucen
cy s
core
s at
a m
inim
um 5
-yea
r fol
low
-up
with
the
pros
thes
is d
escr
ibed
in o
ur s
tudy
. How
ever
, on
ly 2
/20
wer
e as
sess
ed w
ith C
T sc
ans.
In W
irth’
s co
mpo
nent
des
igne
d fo
r can
ines
, by
pla
in ra
diog
raph
ic a
nd h
isto
logi
cal
anal
ysis
, the
y fo
und
wha
t loo
ked
like
bone
ra
diog
raph
ical
ly b
etw
een
the
radi
al fi
ns o
n th
e ce
ntra
lized
peg
, and
it tu
rned
out
to b
e ju
st th
at in
all
case
s hi
stol
ogic
ally
. As
with
our
st
udy,
Wirt
h, e
t al.
sim
ply
repo
rted
whe
ther
bo
ne w
as o
r was
not
pre
sent
bet
wee
n
the
radi
al fi
ns. T
he h
uman
com
pone
nt
coun
terp
art t
hat w
e st
udie
d he
re a
lso
has
thre
e ce
men
ted
perip
hera
l peg
s in
add
ition
to
the
cent
ral p
eg, b
ut th
e pr
inci
ples
sur
roun
ding
th
e ce
ntra
l peg
rem
ain
the
sam
e as
thos
e in
th
e ca
nine
stu
dy.
CO
NC
LUSI
ON
S:
Prim
ary
tota
l sho
ulde
r art
hrop
last
y fo
r pr
imar
y gl
enoh
umer
al o
steo
arth
ritis
ut
ilizi
ng m
inim
al g
leno
id p
erip
hera
l peg
ce
men
t and
aut
olog
ous
ream
ings
pla
ced
betw
een
radi
al fi
ns o
f the
cen
tral
peg
al
low
ed fo
r per
sist
ent c
entr
al p
eg b
one
pres
ence
at a
min
imum
2 y
ears
aft
er
surg
ery.
Bett
er b
one
pres
ence
impa
rted
fe
wer
ove
rall
com
pone
nt ra
diol
ucen
cies
.
PE
RFO
RM
AN
CE
IN M
OTIO
N6
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
63
Twe
lve C
era
mic
-on
-Me
tal (
CO
M) TH
Rs
(sho
wn
oppo
site
):
All
Biol
ox D
elta
hea
ds, C
oCrM
o m
etal
lic li
ners
»Si
x 36m
m h
ead
size
of h
igh
and
low
cl
eara
nce
(HC
, LC
)
»Si
x 28m
m h
ead
size
, als
o of
two
clea
ranc
es
All
THR
spec
imen
s w
ere
test
ed o
n a
mul
ti-st
atio
n hi
p si
mul
ator
(AM
TI, B
osto
n). T
he s
peci
-m
ens
wer
e lu
bric
ated
with
bov
ine
seru
m d
ilute
d to
con
tain
20
g/L
prot
ein
conc
entr
atio
n,
mai
ntai
ned
at 3
7° C. T
he s
peci
men
s w
ere
iden
tical
ly s
ubje
cted
to th
e lo
adin
g an
d ro
tatio
ns
of th
e w
alki
ng c
ycle
as
spec
ified
in IS
O-14
242-
1 [2
] at 1
Hz
for 5
mill
ion
cycl
es (M
c). T
he li
ners
(a
nd h
eads
whe
re s
peci
fied)
wer
e cl
eane
d an
d gr
avim
etric
ally
wei
ghed
[ 3] (
to a
reso
lutio
n of
10
μg) a
t int
erva
ls 0
, 0.2
5, 0
.5, a
nd e
very
0.5
Mc
afte
rwar
ds.
RESU
LTS:
The
met
al-o
n-pl
astic
(MO
P) s
tand
ard
36m
m s
ize
liner
s sh
owed
a w
ear r
ate
44.5
±4.4
6 m
g/M
c.
The
44 m
m s
ize
MO
P hi
ps w
ore
at a
hig
her r
ate
of 7
2.0±
2.81
mg/
Mc
with
con
vent
iona
l U
HM
WPE
and
at a
low
er 1
4.2±
3.57
mg/
Mc
rate
with
hig
hly
cros
slin
ked
UH
MW
PE.
The
coat
ed C
oCr h
eads
pai
red
with
the
conv
entio
nal p
olye
thyl
ene
resu
lted
in a
hig
her
55.6
±4.2
6 m
g/M
c w
ear r
ate,
and
the
coat
ing
was
see
n to
wea
r aw
ay fr
om th
e m
etal
hea
ds.
The
aver
aged
com
bine
d w
ear r
ate
of th
e he
ads
and
liner
s of
the
stan
dard
met
al-
on-m
etal
(MO
M) T
HRs
was
8.5
3±4.
07 m
g/M
C. T
he c
oate
d ve
rsio
ns w
ore
at a
hi
gher
rate
of 3
.19±
0.28
1 m
g/M
c. A
ll th
ree
TiN
coa
ted
THRs
dis
play
ed a
loss
of
coa
ting
in th
e ar
ticul
atin
g re
gion
whi
ch p
rogr
essi
vely
incr
ease
d in
siz
e.
The
MO
M s
tand
ard
and
pock
eted
resu
rfac
ing
com
pone
nts
show
ed w
ear
rate
s of
2.2
1±0.
45 m
g/M
c an
d 1.8
5±0.
19 m
g/M
c re
spec
tivel
y ov
er 5
Mc.
For c
eram
ic-o
n-pl
astic
(CO
P), t
he la
rger
siz
e hi
ps w
ore
at a
hig
her r
ate
than
the
sm
alle
r siz
e (4
4mm
: 77
.5±8
.17 m
g/M
c, 3
2mm
: 33.1
±4.6
6 m
g/M
c) o
ver 5
Mc.
Th
e 44
mm
CO
P TH
R di
spla
yed
the
high
est o
bser
ved
wea
r rat
e re
port
ed h
ere.
For t
he 3
6mm
siz
e ce
ram
ic-o
n-m
etal
(CO
M) h
ips,
the
wea
r rat
es o
f the
met
allic
H
C a
nd L
C li
ners
wer
e th
e lo
wes
t of a
ll, s
how
ing
no w
ear (
-0.0
19 ±
0.11
8 m
g/M
c an
d -0
.061
±0.0
44 m
g/M
c, re
spec
tivel
y).
All
thre
e 28
mm
CO
M H
C a
nd o
ne
LC li
ner e
xhib
ited
“bre
ak-a
way
” wea
r in
that
they
wou
ld lo
se s
ever
al m
illig
ram
s (H
C: 5
.99m
g, 6
.37m
g, 8
.50m
g, L
C: 1
0.22
mg)
aft
er s
how
ing
near
ly n
o m
easu
rabl
e w
ear (
HC
: 0.9
05 ±
0.4
67 m
g/M
c, 2
8mm
LC
: 0.4
22 ±
0.9
82 m
g/M
c).
HIG
H C
LEA
RA
NC
ELO
W C
LEA
RA
NC
E
DIS
CU
SSIO
N A
ND
CO
NC
LUSI
ON
S:
Wea
r of M
OP
and
CO
P TH
Rs w
as c
onfir
med
to b
e hi
gher
in th
e la
rger
dia
met
er s
izes
. Re
sults
co
nfirm
ed lo
w w
ear f
or h
ard-
on-h
ard
bear
ing
coup
les
(MO
M, C
OM
) exc
ept w
here
coa
ting
failu
re
(if a
ny) w
as o
bser
ved.
36m
m L
ow C
lear
ance
CO
M b
earin
gs fa
ired
the
best
of t
he fo
ur C
OM
type
s te
sted
, sho
win
g no
mea
sura
ble
wea
r and
no
“bre
ak-a
way
” wea
r [4]
. M
OP
THRs
sho
wed
bet
ter
wea
r per
form
ance
whe
n H
XL U
HM
WPE
was
use
d. N
o pi
ttin
g, d
elam
inat
ion,
or a
ny u
nusu
al w
ear
mec
hani
sms
wer
e ob
serv
ed o
n an
y sp
ecim
ens
in th
e ar
ticul
atin
g re
gion
(exc
ept w
hen
coat
ing
loss
ha
d oc
curr
ed).
Wea
r rat
es a
nd p
heno
men
a w
ere
succ
essf
ully
cha
ract
eriz
ed fo
r diff
eren
t mat
eria
l co
uple
s in
diff
eren
t des
ign/
size
com
bina
tions
with
this
sim
ulat
or s
etup
, and
usi
ng 2
0g/l
pro
tein
co
ncen
trat
ion
of d
ilute
d se
rum
lubr
ican
t.
REFE
REN
CES
:
[ 1]
ISO
-142
42-3
“Im
plan
ts fo
r sur
gery
- W
ear o
f tot
al h
ip-jo
int p
rost
hese
s - P
art 3
: Loa
ding
an
d di
spla
cem
ent p
aram
eter
s fo
r orb
ital b
earin
g ty
pe w
ear t
estin
g m
achi
nes
and
corr
espo
ndin
g en
viro
nmen
tal c
ondi
tions
for t
est”
200
9.
[ 2]
SO-1
4242
-1 “I
mpl
ants
for s
urge
ry -
Wea
r of t
otal
hip
-join
t pro
sthe
ses
- Par
t 1: L
oadi
ng a
nd
disp
lace
men
t par
amet
ers
for w
ear-t
estin
g m
achi
nes
and
corr
espo
ndin
g en
viro
nmen
tal c
ondi
-tio
ns fo
r tes
t” 2
002.
[ 3]
ISO
-142
42-2
“Im
plan
ts fo
r sur
gery
- W
ear o
f tot
al h
ip-jo
int p
rost
hese
s - P
art 2
: Met
hods
of
mea
sure
men
t” 2
000.
[ 4] H
aide
r H.,
Wei
senb
urge
r J.W
., N
aylo
r, M
.G.,
Schr
oede
r, D
.W.,
Cro
son,
R.E
., G
arvi
n K
.L.,
“Bea
ring
diam
eter
, rad
ial c
lear
ance
, and
thei
r eff
ect o
n w
ear i
n ce
ram
ic-o
n-m
etal
tota
l hip
re
plac
emen
ts” O
RS 2
008.
PE
RFO
RM
AN
CE
IN M
OTIO
N6
2
PE
RFO
RM
AN
CE
IN M
OTIO
N6
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
65
HE
ALE
D C
UFF
REP
AIR
S
IMPA
RT N
ORM
AL
SHO
ULD
ER
SCO
RES
IN T
HO
SE 6
5 Y
EA
RS
O
F AG
E A
ND
OLD
ERE
dw
ard
V. F
ehri
ng
er, M
D; J
un
fen
g S
un
, Ph
D; J
on
ath
on
Co
tto
n, M
D; M
ich
ael
J. C
arl
son
, MD
; an
d E
rica
M. B
urn
s, M
D
INTR
OD
UC
TIO
N:
Rota
tor c
uff t
ear p
reva
lenc
e in
crea
ses
with
adv
anci
ng a
ge. T
he s
houl
ders
of o
lder
pat
ient
s w
ith in
tact
rota
tor c
uffs
hav
e be
tter
sco
res
than
thos
e w
ith fu
ll-th
ickn
ess
cuff
tear
s. It
is im
port
ant t
o un
ders
tand
whe
ther
full-
thic
knes
s ro
tato
r cuf
f tea
r rep
air i
s w
arra
nted
in o
lder
pat
ient
s w
hen
thei
r sh
ould
ers
func
tion
wel
l des
pite
unt
reat
ed te
ars
or e
ven
impr
ove
with
non
surg
ical
trea
tmen
t, es
peci
ally
bec
ause
the
inci
denc
e of
rete
ar a
fter
sur
gica
l re
pair
is h
ighe
r in
thes
e pa
tient
s. It
is c
urre
ntly
unc
lear
whe
ther
old
er p
atie
nts
with
hea
led
full-
thic
knes
s te
ar re
pairs
hav
e si
mila
r sco
res
as th
ose
who
ha
ve in
tact
rota
tor c
uffs
. Mor
eove
r, it
is u
ncle
ar w
heth
er p
atie
nts
with
hea
led
repa
irs h
ave
bett
er s
core
s th
an th
ose
who
hav
e fu
ll-th
ickn
ess
tear
s bu
t ha
ve n
ever
und
ergo
ne re
pair.
We
ther
efor
e as
ked
whe
ther
: (1) i
n pa
tient
s 65
yea
rs o
f age
and
old
er, s
houl
ders
with
rota
tor c
uff r
epai
rs th
at re
mai
ned
inta
ct (‘
‘hea
led’
’ wou
ld h
ave
Sim
ple
Shou
lder
Tes
t (SS
T) s
core
s an
d C
onst
ant s
core
s si
mila
r to
thos
e of
indi
vidu
als
with
inta
ct ro
tato
r cuf
fs (‘
‘no
tear
’’); (
2) s
houl
ders
with
non
oper
a-tiv
ely
trea
ted
tear
s (‘‘
tear
but
no
repa
ir’’)
wou
ld h
ave
scor
es th
at w
ere
wor
se th
an th
ose
of s
houl
ders
: with
hea
led
repa
irs a
nd w
ithou
t tea
rs; (
3) th
ose
with
hea
led
repa
irs w
ould
hav
e sc
ores
gre
ater
than
thos
e w
ith u
nhea
led
repa
irs.
MA
TERI
ALS
AN
D M
ETH
OD
S:
We
retr
ospe
ctiv
ely
revi
ewed
all
51 p
atie
nts
(54
shou
lder
s) tr
eate
d by
min
i ope
n ro
tato
r cuf
f rep
airs
for c
hron
ic fu
ll-th
ickn
ess
tear
s in
pat
ient
s 65
yea
rs
of a
ge a
nd o
lder
(Gro
up I)
from
Janu
ary
1, 2
003,
to Ja
nuar
y 1,
200
7. M
inim
um fo
llow
-up
was
1 y
ear (
mea
n, 2
.7 y
ears
; ran
ge, 1
–5 y
ears
). D
ata
wer
e co
l-le
cted
aft
er p
atie
nts
wer
e in
vite
d to
par
ticip
ate.
Am
ong
the
54 ro
tato
r cuf
fs re
paire
d, w
e st
udie
d 42
sho
ulde
rs (2
5 is
olat
ed s
upra
spin
atus
tear
s, o
ne
isol
ated
sub
scap
ular
is te
ar, 1
2 su
pras
pina
tus
and
infr
aspi
natu
s te
ars,
four
thre
e-te
ndon
tear
s). W
e ex
clud
ed 1
2 pa
tient
s (1
2 sh
ould
ers)
.
All
patie
nts
unde
rwen
t a s
tand
ard
plai
n ra
diog
raph
ic e
valu
atio
n (tr
ue a
nter
opos
terio
r [A
P] in
inte
rnal
rota
tion,
true
AP
in e
xter
nal r
otat
ion,
and
ax
illar
y) b
efor
e su
rger
y. A
s w
ell,
an M
RI w
as o
btai
ned
of e
ach,
but
they
wer
e ob
tain
ed a
t mul
tiple
loca
tions
dep
endi
ng o
n re
ferr
ing
phys
icia
ns a
nd
othe
r fac
tors
. Aft
er In
tern
al R
evie
w B
oard
app
rova
l, th
ese
patie
nts
(Gro
up I)
wer
e as
ked
to re
turn
a m
inim
um o
f 12
mon
ths
afte
r rep
air.
They
then
co
mpl
eted
the
SST,
a C
onst
ant S
core
, a h
ealth
his
tory
repo
rt, a
nd a
rota
tor c
uff u
ltras
ound
.
We
recr
uite
d G
roup
II w
ith p
oste
r rec
ruitm
ent a
t our
med
ical
cen
ter.
Our
goa
l with
this
gro
up w
as to
det
erm
ine
the
prev
alen
ce o
f ful
l-thi
ckne
ss
rota
tor c
uff t
ears
in p
atie
nts
65 y
ears
of a
ge a
nd o
lder
and
cor
rela
te th
e fin
ding
s w
ith s
houl
der c
omfo
rt, f
unct
ion,
and
pat
ient
com
orbi
ditie
s. A
se
cond
ary
goal
was
to p
rovi
de b
asel
ine
shou
lder
func
tiona
l sta
tus
of p
atie
nts
65 y
ears
of a
ge a
nd o
lder
, with
and
with
out f
ull-t
hick
ness
rota
tor c
uff
tear
s. A
ll w
ere
stud
ied
with
the
sam
e qu
estio
nnai
res
and
shou
lder
sco
res
as th
ose
in G
roup
I. F
or G
roup
II, 1
04 s
ubje
cts
65 y
ears
of a
ge o
r old
er w
ere
recr
uite
d to
obt
ain
200
shou
lder
s be
caus
e ei
ght v
olun
teer
s ha
d un
derg
one
shou
lder
sur
gery
in o
ne s
houl
der;
thus
, the
maj
ority
wer
e bi
late
ral e
xam
i-na
tions
. Ful
l-thi
ckne
ss ro
tato
r cuf
f tea
r pre
vale
nce
was
22%
(44
of 2
00) w
ith a
95%
con
fiden
ce in
terv
al (1
5.5%
–28.
5%).
Nin
e pa
tient
s ha
d bi
late
ral t
ears
. Th
e ot
her 2
6 te
ars
wer
e in
pat
ient
s w
ho h
ad a
uni
late
ral t
ear.
We
com
pare
d th
e sh
ould
ers
with
hea
led
repa
irs (3
3 of
42)
of G
roup
I w
ith th
e su
bset
of G
roup
II s
houl
ders
that
did
not
hav
e te
ars
(‘‘no
tear
’’; 15
6 of
20
0). W
e al
so c
ompa
red
thos
e w
ith h
eale
d re
pairs
with
the
subs
et o
f Gro
up II
sho
ulde
rs th
at h
ad te
ars
but w
ere
not r
epai
red
(‘‘te
ar b
ut n
o re
pair’
’);
44 o
f 200
). Th
e gr
oups
had
sim
ilar g
ende
r and
race
com
posi
tion
(Tab
le 1
). Th
e ‘‘n
o te
ar’’
grou
p w
as y
oung
er (p
= 0
.04)
than
the
‘‘hea
led’
’ gro
up a
nd
youn
ger (
p =
0.00
01) t
han
the
‘‘tea
r but
no
repa
ir’’ g
roup
.
Hea
led
(N=3
3)N
ot H
eale
d(N
=9)
p-va
lue
(test
)
Gen
der:
# M
ale
(%)
19 (5
7.6%)
8 (8
8.9%
)0.
12 (F
ishe
r’s E
xact
test
)
Race
: # W
hite
(%)
32 (9
7.0%
)9
(100
%)
1.0
(Fis
her’s
Exa
ct te
st)
Age
: mea
n (S
D)
72.7
(5.1
)72
.4 (5
.2)
0.90
(tw
o sa
mpl
e t t
est)
Hea
led
(N=3
3)N
ot H
eale
d(N
=9)
p-va
lue
(test
)
SST
Scor
e: m
edia
n (r
ange
)12
(7, 1
2)6
(1, 1
2)0.
01 (W
ilcox
on R
ank
Sum
test
)
Con
stan
t Sco
re:
med
ian
(ran
ge)
85 (6
6, 9
8)58
(38,
87)
0.00
1 (W
ilcox
on R
ank
Sum
test
)
All
surg
ery
was
per
form
ed b
y on
e su
rgeo
n (E
VF)
. No
shou
lder
und
erw
ent a
rthr
osco
pic
eval
uatio
n. C
onco
mita
nt a
crom
iopl
astie
s, d
ista
l cla
vicl
e su
rger
y, an
d la
bral
sur
gery
wer
e no
t per
form
ed. E
leve
n sh
ould
ers
had
conc
omita
nt lo
ng h
ead
of th
e bi
ceps
teno
dese
s to
sof
t tis
sue
surr
ound
ing
the
inte
rtub
ercu
lar g
roov
e an
d th
e pe
ctor
alis
maj
or te
ndon
for c
onco
mita
nt lo
ng h
ead
of th
e bi
ceps
spl
ittin
g, te
arin
g, a
nd/o
r ins
tabi
lity.
Sim
ple
Num
ber
2 br
aide
d po
lyes
ter s
utur
es, b
ony
trou
ghs,
and
bon
e tu
nnel
s w
ere
used
for r
epai
rs. A
hal
f-inc
h os
teot
ome
was
use
d to
mak
e tr
ough
s. S
utur
es w
ere
plac
ed a
s ta
gs th
roug
h th
e te
ndon
tiss
ue w
ith N
umbe
r 5 M
ayo
need
les,
and
thes
e su
ture
s w
ere
subs
eque
ntly
rout
ed in
to th
e bo
ny tr
ough
s an
d ou
t th
roug
h th
e la
tera
l hum
eral
cor
tex w
ith N
umbe
r 3 M
ayo
need
les
with
out p
ower
equ
ipm
ent.
Sutu
res
wer
e tie
d ov
er la
tera
l hum
eral
cor
tical
brid
ges.
Si
de-to
-sid
e su
ture
s w
ere
adde
d de
pend
ing
on te
ar c
onfig
urat
ion
and
shap
e. A
ll re
pairs
wer
e pe
rfor
med
und
er g
ener
al a
nest
hesi
a w
ith a
con
com
i-ta
nt re
gion
al in
ters
cale
ne a
nest
hetic
.
Shou
lder
s in
Gro
ups
I and
II w
ere
exam
ined
12
to 6
0 m
onth
s po
stop
erat
ivel
y w
ith u
ltras
ound
to a
sses
s th
eir r
otat
or c
uff s
tatu
s. D
efec
ts w
ere
no
ted
as th
e ab
senc
e of
the
norm
al ti
ssue
ech
oes
and
failu
re o
f the
tiss
ue to
mov
e ap
prop
riate
ly w
ith d
efine
d hu
mer
al m
ovem
ents
. We
used
a
GE
Hea
lthca
re L
ogiq
book
(Milw
auke
e, W
I) w
ith a
4- to
10
-MH
z lin
ear p
robe
for u
ltras
onog
raph
y. Fu
ll-th
ickn
ess
tear
s w
ere
mea
sure
d fr
om a
nter
ior
to p
oste
rior a
t the
ir fo
otpr
int.
The
surg
eon
who
per
form
ed th
e re
pairs
in G
roup
I al
so p
erfo
rmed
all
test
ing
and
ultr
asou
nds
of a
ll pa
tient
s.
RESU
LTS:
The
‘‘no
tear
’’ an
d ‘‘h
eale
d’’ g
roup
s ha
d si
mila
r SST
and
Con
stan
t sco
res.
The
‘‘te
ar b
ut n
o re
pair’
’ gro
up h
ad lo
wer
SST
sco
re a
nd C
onst
ant s
core
s th
an th
e ‘‘h
eale
d’’ g
roup
(p =
0.0
002
and
p\0.
0001
, res
pect
ivel
y) a
nd th
e ‘‘n
o te
ar’’
grou
p (p
\0.0
001
and
p\0.
0001
, res
pect
ivel
y) (T
able
2).
The
sam
e re
latio
nshi
ps fo
r sho
ulde
r sco
res
held
aft
er a
djus
ting
for p
oten
tial c
onfo
unde
rs a
ge, g
ende
r, an
d ra
ce (T
able
s 3,
4).
Nin
e ro
tato
r cuf
fs (f
rom
nin
e pa
tient
s) h
ad n
ot h
eale
d. A
lthou
gh th
e sa
mpl
e si
ze is
sm
all,
the
two
Gro
up I
subg
roup
s (h
eale
d or
unh
eale
d) w
ere
sim
ilar i
n ag
e, g
ende
r, an
d ra
ce
(resu
lts n
ot s
how
n). T
hose
with
hea
led
repa
irs h
ad h
ighe
r SST
(p =
0.0
1) a
nd C
onst
ant (
p =
0.00
1) s
core
s th
an th
ose
with
unh
eale
d re
pairs
(Tab
le 5
).
Tab
le 1
. Dem
ogra
phic
info
rmat
ion
abou
t Gro
up I
Tab
le 5
. SST
sco
res
and
Con
stan
t sco
res
of G
roup
I
Hea
led
(N=3
3)
Tear
, No
Repa
ir(N
=44
)
No
Tear
(N=1
56)
p-va
lue
(test
)
Gen
der:
# M
ale
(%)
19 (5
7.6%)
23 (5
2.3%
)80
(51.
3%)
0.85
(Fis
her’s
Exa
ct te
st)
Race
: # W
hite
(%)
32 (9
7.0%)
43 (9
7.7%)
155
(99.
4%)
0.25
(Fis
her’s
Exa
ct te
st)
Age
: mea
n (S
D)
72.7
(5.1
)74
.1 (6
.0)
70.6
(5.0
)*0.
0003
(one
way
AN
OVA
)
SST
Scor
e: m
edia
n (r
ange
)12
(7, 1
2)9.
5 (0
, 12)
^12
(2, 1
2)< 0
.000
1 (K
rusk
al-W
allis
Tes
t)
Con
stan
t Sco
re:
med
ian
(ran
ge)
85 (6
6, 9
8)71
.5 (2
4, 9
8)&
84 (2
4, 10
0)< 0
.000
1 (K
rusk
al-W
allis
Tes
t)
*No
Tear
gro
up is
sig
nific
antly
yo
unge
r tha
n H
eale
d gr
oup
(p=
0.04
) and
Tea
r No
Repa
ir gr
oup
(p=
0.00
01) u
sing
one
-way
AN
OVA
.
^Tea
r No
Repa
ir gr
oup
has
sign
ifi-
cant
ly lo
wer
SST
sco
re th
an H
eale
d gr
oup
(p=
0.00
02) a
nd N
o Te
ar
grou
p (p
<0.0
001)
usi
ng W
ilcox
on
Rank
Sum
test
&Te
ar N
o Re
pair
grou
p ha
s si
gnifi
cant
ly lo
wer
Con
stan
t sco
re
than
Hea
led
grou
p (p
<0.0
001)
and
N
o Te
ar g
roup
(p<0
.000
1) u
sing
W
ilcox
on R
ank
Sum
test
Tab
le 2
. Dem
ogra
phic
s an
d sh
ould
er s
core
s fo
r sho
ulde
rs o
f diff
eren
t tea
r sta
tus
from
Gro
ups
I and
II
Tab
le 3
. Est
imat
ed e
ffec
ts o
f cov
aria
tes
on
SST
scor
es (m
ultip
le li
near
regr
essi
on)
Tab
le 4
. Est
imat
ed e
ffec
ts o
f cov
aria
tes
on C
onst
ant-M
urle
y sc
ores
(m
ultip
le li
near
regr
essi
on)
Vari
able
Estim
ated
Ef
fect
Stan
dard
Er
ror
p-va
lue
Age
-0.0
150.
029
0.60
Gen
der (
fem
ale
vs
mal
e)-0
.59
0.30
0.05
Race
(Non
-Whi
te
vs W
hite
)1.
731.
34<0
.000
1
No
Tear
vs
Tear
N
o Re
pair
1.75
0.40
<0.0
001
Hea
led
vs T
ear
No
Repa
ir2.
240.
53<0
.000
1
Vari
able
Estim
ated
Ef
fect
Stan
dard
Er
ror
p-v
alue
Age
-0.2
20.
190.
26
Gen
der (
fem
ale
vs
mal
e)-8
.12.
0<0
.000
1
Race
(Non
-Whi
te
vs W
hite
)4.
08.
80.
65
No
Tear
vs
Tear
N
o Re
pair
11.6
2.7
<0.0
001
Hea
led
vs T
ear
No
Repa
ir15
.53.
5<0
.000
1
PE
RFO
RM
AN
CE
IN M
OTIO
N6
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
67
REVI
SIO
N T
OTA
L K
NEE
A
RTH
ROPL
AST
Y FO
R ST
IFFN
ESS
Cu
rtis
W. H
art
ma
n, M
D1; N
ick
T. T
ing
, BA
2; M
ari
o M
ori
c, M
S3; R
ich
ard
A. B
erg
er, M
D2; A
aro
n G
. Ro
sen
ber
g,
MD
2; a
nd
Cra
ig J
. Del
la V
alle
, MD
2
1. D
epar
tmen
t of O
rtho
paed
ic S
urge
ry a
nd R
ehab
ilita
tion,
Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r2.
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
, Rus
h U
nive
rsity
Med
ical
Cen
ter,
Chi
cago
, Illi
nois
3. D
epar
tmen
t of A
nest
hesi
a, R
ush
Uni
vers
ity M
edic
al C
ente
r, C
hica
go, I
llino
is
Inve
stig
atio
n Pe
rfor
med
at t
he R
ush
Uni
vers
ity M
edic
al C
ente
r, C
hica
go, I
L
DIS
CU
SSIO
N:
Few
abs
olut
es e
xist
with
rota
tor c
uff d
isea
se.
How
ever
, one
that
is a
ppro
pria
te is
that
ro
tato
r cuf
f tea
r pre
vale
nce
incr
ease
s w
ith
incr
easi
ng a
ge. M
oreo
ver,
rota
tor c
uff r
etea
rs
or fa
ilure
s to
hea
l aft
er re
pair
may
be
mor
e lik
ely
in a
ged
patie
nts.
Giv
en th
at s
houl
ders
of
old
er p
atie
nts
with
inta
ct ro
tato
r cuf
fs h
ave
bett
er s
core
s th
an th
ose
with
full-
thic
knes
s cu
ff te
ars,
it is
impo
rtan
t to
unde
rsta
nd
whe
ther
full-
thic
knes
s ro
tato
r cuf
f tea
r rep
air
is w
arra
nted
in o
lder
pat
ient
s w
hen
thei
r sh
ould
ers
func
tion
wel
l des
pite
unt
reat
ed
tear
s or
eve
n im
prov
e w
ith n
onsu
rgic
al
trea
tmen
t. To
dat
e, it
is u
ncle
ar w
heth
er o
lder
pa
tient
s w
ith h
eale
d fu
ll-th
ickn
ess
tear
repa
irs
have
sim
ilar s
core
s as
thos
e w
ho h
ave
inta
ct
rota
tor c
uffs
. Mor
eove
r, it
is u
ncle
ar w
heth
er
patie
nts
with
hea
led
repa
irs h
ave
bett
er
scor
es th
an th
ose
who
hav
e fu
ll-th
ickn
ess
tear
s bu
t hav
e ne
ver u
nder
gone
repa
ir. W
e th
eref
ore
aske
d w
heth
er in
pat
ient
s 65
yea
rs
of a
ge a
nd o
lder
, sho
ulde
rs w
ith ro
tato
r cuf
f re
pairs
that
rem
aine
d in
tact
wou
ld h
ave
SS
T an
d C
onst
ant s
core
s si
mila
r to
thos
e
of in
divi
dual
s w
ith in
tact
rota
tor c
uffs
.
Our
stu
dy h
as s
ever
al im
port
ant l
imita
tions
. Fi
rst,
it is
retr
ospe
ctiv
e be
caus
e ou
r que
stio
ns
wer
e as
ked
afte
r rep
airs
had
bee
n pe
rfor
med
. Ye
t, ou
r goa
l was
sim
ply
to lo
ok a
t sho
ulde
rs
with
and
with
out h
eale
d re
pairs
and
com
pare
th
em w
ith a
gro
up o
f the
ir pe
ers
with
and
w
ithou
t tea
rs. S
econ
d, th
e su
rgeo
n w
ho
perf
orm
ed a
ll ex
amin
atio
ns, i
nclu
ding
the
ultr
asou
nds,
was
als
o th
e on
e w
ho p
erfo
rmed
th
e re
pairs
. Alth
ough
pot
entia
l for
sur
geon
bi
as e
xist
s, o
ur g
oal w
as n
ot to
det
erm
ine
cuff
in
tegr
ity ra
tes
afte
r rep
air;
rath
er, w
e w
ante
d to
stu
dy h
eale
d an
d un
heal
ed te
ndon
s an
d co
mpa
re th
ose
with
sho
ulde
rs o
f the
ir pe
ers.
Th
is b
ias
coul
d ha
ve in
fluen
ced
the
ultr
asou
nd
exam
inat
ion
as to
whe
ther
a c
uff w
as h
eale
d or
unh
eale
d, w
hich
wou
ld in
fluen
ce o
ur fi
nd-
ings
. Thi
rd, G
roup
II m
ay n
ot h
ave
repr
esen
ted
a tr
ue c
ross
-sec
tion
of th
e 65
-yea
r or o
lder
po
pula
tion.
Yet
, it w
as a
val
id a
ttem
pt to
stu
dy
this
gro
up w
ithou
t exa
min
er b
ias.
Fou
rth,
we
did
not a
ttem
pt to
qua
ntify
mus
cle
atro
phy,
fa
tty
infil
trat
ion,
and
retr
actio
n on
MRI
sc
ans
as a
resu
lt of
man
y va
riabl
es, i
nclu
ding
m
ultip
le s
cann
ers.
Yet
, the
se m
easu
res
invo
lve
man
y va
riabl
es th
at w
ould
wea
ken
the
stud
y.
Fift
h, a
crom
iopl
astie
s w
ere
not p
erfo
rmed
in
any
shou
lder
. Bas
ed o
n th
e st
udie
s su
gges
ting
exce
llent
clin
ical
out
com
es w
ithou
t acr
omio
-pl
asty
at t
he ti
me
of re
pair,
we
elec
ted
not
to p
erfo
rm th
em. S
ixth
, the
re is
a d
iffer
ence
be
twee
n ch
rono
logi
c ag
e an
d ph
ysio
logi
cal
age,
as
Pott
er re
min
ds u
s. S
ome
patie
nts
who
ar
e 65
yea
rs o
f age
and
old
er, a
re in
exc
elle
nt
heal
th a
nd h
ave
tissu
es th
at a
re w
orth
y of
re
pair.
Chr
onol
ogic
age
is c
lear
ly n
ot th
e on
ly v
aria
ble
to c
onsi
der i
n th
e tr
eatm
ent o
f ro
tato
r cuf
f dis
ease
. Fin
ally
, as
a re
sult
of th
e la
ck o
f pilo
t dat
a an
d re
leva
nt p
ublis
hed
lit-
erat
ure,
par
ticul
arly
for t
his
age
grou
p, w
e di
d no
t do
a po
wer
cal
cula
tion
befo
re th
e st
udy.
Th
eref
ore,
the
nega
tive
resu
lts w
e ob
serv
ed
may
be
fals
e-ne
gativ
es a
s a
resu
lt of
lack
of
pow
er. I
n ad
ditio
n, w
e di
d no
t adj
ust f
or m
ul-
tiple
com
paris
ons
beca
use
we
cons
ider
ed o
ur
stud
y to
be
hypo
thes
is-g
ener
atin
g. A
lthou
gh
we
do n
ot b
elie
ve th
is re
duce
s th
e im
port
ance
of
our
find
ings
, the
se li
mita
tions
may
dim
in-
ish
the
valu
e of
this
att
empt
to d
eter
min
e w
heth
er th
e sh
ould
ers
of p
atie
nts
65 y
ears
of
age
and
olde
r with
hea
led
rota
tor c
uff r
epai
rs
scor
e be
tter
than
thos
e of
thei
r pee
rs w
ith
and
with
out p
revi
ous
surg
ical
trea
tmen
t.
We
foun
d no
diff
eren
ce in
SST
or C
onst
ant
scor
es b
etw
een
the
‘‘hea
led’
’ gro
up a
nd
the
‘‘no
tear
’’ or
ess
entia
lly ‘‘
norm
al’’
grou
p.
Mor
eove
r, th
e ‘‘t
ear b
ut n
o re
pair’
’ gro
up
had
low
er S
ST a
nd C
onst
ant s
core
s th
an th
e ‘‘h
eale
d’’ g
roup
and
the
‘‘no
tear
’’ gr
oup.
The
sa
me
rela
tions
hips
for s
houl
der s
core
s he
ld
afte
r adj
ustin
g fo
r pot
entia
l con
foun
ders
age
, ge
nder
, and
race
. Alth
ough
the
sam
ple
size
is
smal
l, th
e tw
o G
roup
I su
bgro
ups
(hea
led
or
unhe
aled
) wer
e si
mila
r. H
arry
man
et a
l. w
ere
the
first
to u
se u
ltras
ound
to s
tudy
rota
tor
cuff
inte
grity
aft
er re
pairs
and
repo
rted
80
% o
f the
ir re
pairs
wer
e in
tact
whe
n th
e te
ar w
as c
onfin
ed to
the
supr
aspi
natu
s at
a
min
imum
of 2
yea
rs a
fter
repa
ir. H
owev
er,
isol
ated
sup
rasp
inat
us te
ars
wer
e al
so in
pa
tient
s w
ho w
ere
youn
ger.
The
aver
age
age
of th
e pa
tient
s w
ith re
curr
ent t
ears
was
ol
der t
han
that
of t
hose
with
a h
eale
d re
pair.
Sh
ould
ers
with
hea
led
repa
irs w
ere
mor
e fu
nctio
nal t
han
in th
ose
that
had
not
hea
led,
a
findi
ng w
e al
so n
oted
in o
ur s
tudy
. Gal
atz
et a
l. al
so s
ucce
ssfu
lly s
tudi
ed s
houl
ders
with
ul
tras
ound
aft
er re
pair,
mea
surin
g te
ars
in
the
tran
sver
se d
imen
sion
. How
ever
, the
ir av
erag
e pa
tient
age
at t
he ti
me
of s
urge
ry
was
61
year
s. B
oile
au e
t al.
repo
rted
com
plet
e he
alin
g in
71%
of 6
7 is
olat
ed s
upra
spin
atus
te
ars
repa
ired
base
d on
eith
er M
RI o
r CT
arth
rogr
aphy
. How
ever
, the
y no
ted,
on
aver
age,
pat
ient
s w
ith a
hea
led
tend
on w
ere
10 y
ears
you
nger
than
thos
e in
who
m th
e te
ndon
did
not
hea
l.
In p
atie
nts
65 y
ears
of a
ge a
nd o
lder
, w
e fo
und
com
para
ble
SST
and
Con
stan
t sc
ores
in s
houl
ders
with
hea
led
rota
tor c
uff
repa
irs a
nd in
unt
reat
ed s
houl
ders
with
inta
ct
rota
tor c
uffs
.
INTR
OD
UC
TIO
N:
Stiff
ness
follo
win
g to
tal k
nee
arth
ropl
asty
(TK
A) i
s am
ong
the
mor
e co
mm
on c
ompl
icat
ions
fol-
low
ing
TKA
, with
a re
port
ed p
reva
lenc
e of
1.3
% to
6.9
% . Th
e tr
eatm
ent o
f stif
fnes
s ca
n ra
nge
from
ag
gres
sive
phy
sica
l the
rapy
to re
visi
on a
rthr
opla
sty.
Isol
ated
art
hrol
ysis
and
tibi
al li
ner e
xcha
nge
has
been
foun
d to
be
an u
nrel
iabl
e te
chni
que
for i
mpr
ovin
g ra
nge
of m
otio
n. O
ther
aut
hors
hav
e re
port
ed m
ore
succ
ess
with
eith
er a
rthr
osco
pic
or a
mod
ified
ope
n de
brid
emen
t and
revi
sion
of
both
com
pone
nts.
The
pur
pose
of o
ur s
tudy
was
to e
valu
ate
the
outc
omes
of a
coh
ort o
f pat
ient
s w
ho h
ad re
visi
on o
f a w
ell-fi
xed,
ase
ptic
TK
A fo
r sym
ptom
atic
stif
fnes
s.
MA
TERI
ALS
AN
D M
ETH
OD
S:
Follo
win
g ap
prov
al b
y th
e In
stitu
tiona
l Rev
iew
Boa
rd w
e se
arch
ed th
e in
stitu
tiona
l tot
al jo
int
regi
stry
for a
ll pa
tient
s ha
ving
revi
sion
of a
TK
A fr
om 1
997
to 2
006.
Any
pat
ient
with
a d
iagn
osis
of
per
ipro
sthe
tic s
epsi
s, a
sept
ic lo
osen
ing,
or r
evis
ion
of a
sin
gle
com
pone
nt w
as e
xclu
ded
from
th
e an
alys
is. W
e id
entifi
ed 3
5 kn
ees
in 3
5 pa
tient
s w
ho m
et th
e in
clus
ion
crite
ria. T
he c
ohor
t co
nsis
ted
of 2
0 m
ales
and
15
fem
ales
with
a m
ean
age
of 6
2 ye
ars
(rang
e, 3
2 to
81
year
s) a
t the
tim
e of
revi
sion
.
All
patie
nts
wer
e ev
alua
ted
with
Kne
e So
ciet
y Sc
ores
and
radi
ogra
phs
at th
e pr
eope
rativ
e vi
sit
prio
r to
revi
sion
and
at y
early
and
fina
l fol
low
-up
inte
rval
s. R
adio
grap
hs w
ere
eval
uate
d fo
r im
plan
t loo
seni
ng, c
hang
e in
join
t lin
e, a
nd c
hang
e in
the
Insa
ll-Sa
lvat
i rat
io.
Stat
istic
al a
naly
sis
was
per
form
ed u
sing
pai
red
t-tes
ts to
com
pare
the
preo
pera
tive
arc
of m
otio
n to
the
post
oper
ativ
e ar
c of
mot
ion
and
the
preo
pera
tive
Knee
Sco
re v
alue
s to
the
post
oper
ativ
e va
lues
. A lo
gist
ic re
gres
sion
ana
lysi
s w
as p
erfo
rmed
to d
eter
min
e if
age,
gen
der,
body
mas
s in
dex,
use
of a
tunn
eled
epi
dura
l for
pos
tope
rativ
e pa
in m
anag
emen
t, hi
stor
y of
pre
viou
s re
visi
on,
chan
ge in
the
Insa
ll-Sa
lvat
i rat
io, c
hang
e in
join
t lin
e, o
r len
gth
of ti
me
from
prim
ary
surg
ery
to
revi
sion
sur
gery
wer
e pr
edic
tive
of th
e po
stop
erat
ive
arc
of m
otio
n.
RESU
LTS:
Tw
o pa
tient
s di
ed o
f unr
elat
ed c
ause
s be
fore
hav
ing
two-
year
follo
w-u
p an
d on
e pa
tient
was
lo
st to
follo
w-u
p le
avin
g 32
pat
ient
s fo
llow
ed fo
r a m
ean
of 5
4.5
mon
ths
(rang
e, 2
4 to
134
m
onth
s). T
he m
ean
arc
of m
otio
n im
prov
ed fr
om a
mea
n of
53.
6° (ra
nge,
10° t
o 90
° ) to
a m
ean
of 9
8.1° (
rang
e, 50
° to
130° )
(p<0
.000
1). T
he p
osto
pera
tive
arc
of m
otio
n im
prov
ed in
all
but
one
of th
e pa
tient
s. T
he a
rc o
f mot
ion
impr
oved
by
>30°
in 7
5% (2
4/32
) of p
atie
nts.
The
mea
n pr
eope
rativ
e fle
xion
con
trac
ture
of 1
3.5° i
mpr
oved
to a
mea
n of
2.7
° (p<
0.00
1). M
ean
preo
pera
-tiv
e fle
xion
impr
oved
from
67.1
° to
a m
ean
of 1
00.7
° (p<
0.00
1). P
osto
pera
tive
flexi
on w
as >
90°
in 8
4% (2
7/32
) of p
atie
nts.
The
mea
n Kn
ee S
ocie
ty k
nee
scor
e im
prov
ed fr
om 3
2.2
poin
ts to
60.
9 po
ints
(p<0
.000
1) a
nd th
e Kn
ee S
ocie
ty fu
nctio
n sc
ore
impr
oved
from
41.
6 po
ints
to 5
6.3
poin
ts
(p<0
.001
). Re
gres
sion
ana
lysi
s fo
und
no re
latio
nshi
p be
twee
n ag
e, g
ende
r, bo
dy m
ass
inde
x, u
se
of a
tunn
eled
epi
dura
l for
per
iope
rativ
e pa
in m
anag
emen
t, hi
stor
y of
pre
viou
s re
visi
on, c
hang
e in
the
Insa
ll-Sa
lvat
i rat
io, c
hang
e in
join
t lin
e, o
r len
gth
of ti
me
from
prim
ary
surg
ery
to re
visi
on
surg
ery
and
post
oper
ativ
e ar
c of
mot
ion.
Com
plic
atio
ns a
nd re
-ope
ratio
ns a
re li
sted
in T
able
1. I
n to
tal,
12 o
f the
35
patie
nts
(34%
) req
uire
d an
add
ition
al in
terv
entio
n fo
r stif
fnes
s in
clud
ing
nine
man
ipul
atio
ns u
nder
ane
sthe
sia
(MU
A.
Seve
ntee
n of
the
35 p
atie
nts
(49%
) req
uire
d ei
ther
som
e ty
pe o
f re-
oper
atio
n (in
clud
ing
an M
UA
) or
sus
tain
ed a
t lea
st o
ne c
ompl
icat
ion.
Thr
ee p
atie
nts
with
follo
w-u
p of
mor
e th
an tw
o ye
ars
(9%)
requ
ired
revi
sion
of o
ne o
r bot
h co
mpo
nent
s in
clud
ing
one
for d
eep
infe
ctio
n, o
ne fo
r ase
ptic
lo
osen
ing
and
one
for n
on-u
nion
of a
per
ipro
sthe
tic fr
actu
re.
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T6
7
PE
RFO
RM
AN
CE
IN M
OTIO
N6
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
69
ACU
TE H
EM
ATO
GE
NO
US
IN
FEC
TIO
N F
OLL
OW
ING
TO
TAL
HIP
AN
D K
NEE
AR
THR
OP
LA
ST
YC
raig
J. D
ella
Va
lle, M
D1; B
eau
Ko
nig
sber
g, M
D2; N
ich
ola
s T.
Tin
g, B
A1; F
an
g Q
iu, P
hD
3; a
nd
Sco
tt M
. Sp
ore
r, M
D1
1. D
epar
tmen
t of O
rtho
paed
ic S
urge
ry, R
ush
Uni
vers
ity M
edic
al C
ente
r, C
hica
go, I
llino
is2.
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n, U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter,
Om
aha,
NE
3. B
iost
atis
tics
Dep
artm
ent,
Col
lege
of P
ublic
Hea
lth, T
he N
ebra
ska
Med
ical
Cen
ter,
Om
aha,
NE
CA
SEC
OM
PLIC
ATI
ON
(S)
ELA
PSED
TIM
E FR
OM
REV
ISIO
N
(MO
NTH
S)TR
EATM
ENT
1A
rthr
ofibr
osis
8A
rthr
osco
pic
rele
ase,
m
anip
ulat
ion
Dee
p in
fect
ion
12Ir
rigat
ion
and
debr
idem
ent,
poly
ethy
lene
exc
hang
e
Pers
iste
nt in
fect
ion;
ext
enso
r mec
ha-
nism
dis
rupt
ion
34Re
mov
al o
f im
plan
ts, p
lace
men
t of
ant
ibio
tic s
pace
r
Rem
oval
of i
mpl
ants
and
pla
cem
ent
of a
ntib
iotic
spa
cer
382n
d-st
age
reim
plan
tatio
n,
exte
nsor
mec
hani
sm a
llogr
aft
2Pe
ripro
sthe
tic fe
mur
frac
ture
�1O
pen
redu
ctio
n in
tern
al fi
xatio
n
Skin
bre
akdo
wn
over
pla
te7
Irrig
atio
n an
d de
brid
emen
t of
wou
nd, r
emov
al o
f fra
ctur
e ha
rdw
are
Fem
oral
frac
ture
site
non
unio
n8
Repe
at O
RIF,
revi
sion
fem
oral
co
mpo
nent
4Se
vere
het
erot
opic
oss
ifica
tion;
ar
thro
fibro
sis
52Ex
cisi
on h
eter
otop
ic b
one,
pa
tella
r rev
isio
n an
d po
lyet
hyle
ne
liner
exc
hang
e
6C
hron
ic p
ain
10Tu
nnel
ed e
pidu
ral
8A
rthr
ofibr
osis
�1M
anip
ulat
ion
Pers
iste
nt a
rthr
ofibr
osis
3Se
cond
man
ipul
atio
n
10Tr
aum
atic
pat
ella
r ten
don
rupt
ure
�1Im
mob
iliza
tion
Acu
te p
osto
pera
tive
infe
ctio
n�1
Irrig
atio
n an
d de
brid
emen
t, po
lyet
hyle
ne e
xcha
nge,
prim
ary
pate
llar t
endo
n re
pair,
and
m
edia
l gas
troc
nem
ius
flap
12A
rthr
ofibr
osis
�1M
anip
ulat
ion
17Tr
ansi
ent p
eron
eal n
erve
pal
sy�1
Non
e
18A
rthr
ofibr
osis
2M
anip
ulat
ion;
tunn
eled
epi
dura
l
20A
rthr
ofibr
osis
6M
anip
ulat
ion
Pers
iste
nt a
rthr
ofibr
osis
8Se
cond
man
ipul
atio
n
Ase
ptic
loos
enin
g of
fem
oral
and
tib
ial c
ompo
nent
s47
Revi
sion
TK
A, a
ll co
mpo
nent
s
22A
rthr
ofibr
osis
�1M
anip
ulat
ion
24A
rthr
ofibr
osis
33A
rthr
osco
pic
rele
ase
25A
rthr
ofibr
osis
�1M
anip
ulat
ion;
tunn
eled
epi
dura
l
30A
rthr
ofibr
osis
1M
anip
ulat
ion
Pers
iste
nt a
rthr
ofibr
osis
2A
rthr
osco
pic
rele
ase
32A
rthr
ofibr
osis
2M
anip
ulat
ion
34H
emat
oma;
dis
rupt
ion
of q
uadr
icep
s sn
ip re
pair
�1Q
uadr
icep
s te
ndon
repa
ir
35A
rthr
ofibr
osis
1M
anip
ulat
ion;
tunn
eled
epi
dura
l
Pers
iste
nt a
rthr
ofibr
osis
2A
rthr
osco
pic
rele
ase;
tu
nnel
ed e
pidu
ral
DIS
CU
SSIO
N:
The
stiff
TK
A is
a c
halle
ngin
g cl
inic
al p
robl
em.
Patie
nts
are
freq
uent
ly d
isab
led
and
com
plai
n of
sig
nific
ant p
ain.
Gai
t stu
dies
eva
luat
ing
activ
ities
of d
aily
livi
ng h
ave
foun
d th
e sw
ing
phas
e of
gai
t req
uire
s 67
° of fl
exio
n to
cle
ar
the
foot
. Suc
cess
ful s
tair
asce
nt re
quire
s 83
° w
hile
des
cent
requ
ires
90° t
o 10
0° .
Man
y tr
eatm
ent o
ptio
ns h
ave
been
re
port
ed in
the
lite
ratu
re w
ith
vari
able
re
sult
s. R
evis
ion
arth
ropl
asty
pro
vide
s m
ore
pred
icta
ble
resu
lts w
hen
a cl
ear d
iag-
nosi
s fo
r the
cau
se o
f stif
fnes
s ca
n be
mad
e an
d co
rrec
ted
intr
aope
rativ
ely
(loos
enin
g,
seps
is, o
r im
plan
t mal
alig
nmen
t). P
atie
nts
in w
hom
a c
lear
dia
gnos
is c
anno
t be
mad
e ha
ve h
ad le
ss p
redi
ctab
le o
utco
mes
. In
our
anal
ysis
we
atte
mpt
ed to
defi
ne a
sin
gle
fact
or re
spon
sibl
e fo
r stif
fnes
s. H
owev
er,
in a
lmos
t all
of th
e ca
ses
in th
is re
port
, m
ultip
le fa
ctor
s th
at m
ay h
ave
cont
ribu
ted
to s
tiffn
ess
wer
e id
entifi
ed a
nd th
us s
uch
an
anal
ysis
may
be
an o
ver s
impl
ifica
tion
of w
hat
is o
ften
times
a c
ompl
ex c
linic
al s
cena
rio.
We
eval
uate
d a
coho
rt o
f pat
ient
s ha
ving
re
visi
on T
KA
for s
tiffn
ess
with
wel
l-fixe
d co
mpo
nent
s. O
ften
thes
e pa
tient
s ha
ve
subt
le e
rror
s in
siz
e, a
lignm
ent,
and
soft
tis
sue
bala
ncin
g. W
e be
lieve
the
best
tr
eatm
ent o
ptio
n fo
r th
ese
patie
nts
is
a co
mpl
ete
fem
oral
and
tibi
al r
evis
ion.
Re
visi
on o
f bot
h co
mpo
nent
s al
low
s th
e su
rgeo
n to
per
form
a m
ore
thor
ough
so
ft ti
ssue
déb
ride
men
t bot
h an
terio
rly
and
post
erio
rly w
hile
opt
imiz
ing
com
pone
nt
size
, alig
nmen
t, an
d so
ft ti
ssue
bal
ance
. Fu
rthe
r, re
tent
ion
of e
ither
the
fem
oral
or
tibia
l com
pone
nts
or b
oth
may
lim
it th
e su
rgeo
ns a
bilit
y to
use
a m
ore
cons
trai
ned
poly
ethy
lene
inse
rt, a
s w
as d
eem
ed n
eces
-sa
ry in
15
of th
e 35
kne
es in
this
ser
ies.
We
foun
d si
gnifi
cant
impr
ovem
ents
in fl
exio
n,
exte
nsio
n an
d to
tal a
rc o
f mot
ion
follo
win
g re
visi
on. W
e al
so fo
und
the
Knee
Soc
iety
sc
ores
, whi
le s
till p
oor f
ollo
win
g re
visi
on,
wer
e si
gnifi
cant
ly im
prov
ed b
y pe
rfor
min
g a
revi
sion
. Few
stu
dies
hav
e be
en p
ublis
hed
eval
uatin
g th
e ou
tcom
es o
f ful
l rev
isio
n fo
r st
iffne
ss. T
he re
sults
hav
e ge
nera
lly b
een
favo
rabl
e. T
he re
sults
of t
his
stud
y ar
e co
m-
para
ble
to th
ose
of R
ies
and
Bada
lam
ente
, w
ho p
ublis
hed
the
resu
lts o
f six
kne
es re
vise
d fo
r rec
urre
nt s
tiffn
ess
with
no
iden
tifiab
le
caus
e ot
her t
han
soft
tiss
ue c
ontr
actu
re.
The
rate
of c
ompl
icat
ion
in th
is s
tudy
was
su
bsta
ntia
l, w
ith n
early
hal
f of p
atie
nts
eith
er re
quiri
ng a
n ad
ditio
nal i
nter
vent
ion
for s
tiffn
ess
or s
usta
inin
g a
com
plic
atio
n an
d m
any
requ
iring
mul
tiple
inte
rven
tions
an
d/or
sus
tain
ing
mul
tiple
com
plic
atio
ns.
Both
pat
ient
s an
d su
rgeo
ns c
onsi
derin
g re
visi
on T
KA
for s
tiffn
ess
shou
ld b
e aw
are
of th
e co
mpl
exity
of t
he p
roce
dure
and
th
e in
here
nt ri
sks
of th
is in
terv
entio
n.
In c
oncl
usio
n, w
e ha
ve fo
und
that
revi
sion
TK
A fo
r stif
fnes
s pr
ovid
ed a
sig
nific
ant i
mpr
ovem
ent i
n th
e po
stop
erat
ive
arc
of m
otio
n an
d Kn
ee S
ocie
ty s
core
s. H
owev
er, t
he ri
sk o
f com
plic
atio
n an
d ne
cess
ity o
f a re
peat
pro
cedu
re w
ere
high
. We
belie
ve th
ese
data
sup
port
the
prac
tice
of re
visi
on
of b
oth
fem
oral
and
tibi
al c
ompo
nent
s in
pat
ient
s w
ith a
deb
ilita
ting,
stif
f TK
A w
ho h
ave
faile
d no
n-op
erat
ive
man
agem
ent a
nd h
ave
been
fully
cou
nsel
ed a
bout
the
risk
of c
ompl
icat
ions
.
Tab
le 1
. Com
plic
atio
ns a
nd R
e-O
pera
tions
Inve
stig
atio
n pe
rfor
med
at t
he D
epar
tmen
t of O
rtho
paed
ic S
urge
ry, R
ush
Uni
vers
ity M
edic
al C
ente
r, C
hica
go, I
L
BAC
KGRO
UN
D:
Whi
le th
e m
anag
emen
t of c
hron
ic in
fect
ion
follo
win
g to
tal h
ip (T
HA
) and
tota
l kne
e ar
thro
plas
ty (T
KA) h
as b
een
wel
l-des
crib
ed, t
here
is a
pau
city
of
info
rmat
ion
avai
labl
e on
the
man
agem
ent a
nd o
utco
mes
of p
atie
nts
trea
ted
for a
n ac
ute
hem
atog
enou
s in
fect
ion.
PURP
OSE
:
The
purp
ose
of th
is s
tudy
is to
revi
ew o
ur e
xper
ienc
e w
ith tr
eatin
g ac
ute
hem
atog
enou
s in
fect
ions
follo
win
g TH
A a
nd T
KA.
MET
HO
DS:
Fort
y co
nsec
utiv
e pa
tient
s (42
join
ts; 2
2 TK
A, 2
0 TH
A) tr
eate
d fo
r an
acut
e he
mat
ogen
ous i
nfec
tion
wer
e re
view
ed a
t a m
inim
um o
f tw
o ye
ars p
ost-
oper
ativ
ely.
A lis
t of t
he in
fect
ing
orga
nism
s ide
ntifi
ed is
show
n in
Tabl
e 1;
th
e m
ost c
omm
on in
fect
ing
orga
nism
s wer
e st
aph
ylo
cocc
al a
nd st
rep
toco
ccu
s sp
ecie
s. Al
l pat
ient
s wer
e tr
eate
d w
ith ir
rigat
ion
and
debr
idem
ent w
ith
exch
ange
of t
he m
odul
ar c
ompo
nent
s fol
low
ed b
y 6-
wee
ks o
f int
rave
nous
an
tibio
tics a
nd a
var
iabl
e co
urse
of o
ral a
ntib
iotic
s.
RESU
LTS:
The
mea
n du
ratio
n of
sym
ptom
s be
fore
sur
gica
l deb
ridem
ent w
as 5
.3 d
ays
(rang
e, o
ne to
twen
ty-e
ight
day
s). A
t a m
ean
of 5
6 m
onth
s (ra
nge,
25
to 1
24
mon
ths)
recu
rren
t inf
ectio
n de
velo
ped
in 9
of t
he 4
2 jo
ints
(21%
); 8
of th
e 9
recu
rren
t inf
ectio
ns w
ere
in p
atie
nts
with
a st
aph
ylo
cocc
al in
fect
ion.
The
log-
rank
test
sho
wed
a s
igni
fican
t (p=
0.00
4) d
iffer
ence
in s
urvi
vors
hip
betw
een
join
ts in
fect
ed w
ith st
aph
ylo
cocc
al a
s op
pose
d to
oth
er o
rgan
ism
s. Te
n of
the
fort
y pa
tient
s (2
5%) d
ied
with
in tw
o ye
ars
(Fig
ure
1).
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T6
9
CO
NC
LUSI
ON
S:
Irrig
atio
n an
d de
brid
emen
t for
the
trea
tmen
t of a
n ac
ute
hem
atog
-en
ous
infe
ctio
n w
as a
ssoc
iate
d w
ith
impl
ant r
eten
tion
in th
e m
ajor
ity o
f pa
tient
s (7
6% s
urvi
vors
hip
at tw
o ye
ars)
with
non
-stap
hyl
oco
ccal
in
fect
ions
, in
part
icul
ar, h
avin
g a
low
failu
re ra
te (9
6% s
urvi
vors
hip
at
two
year
s) (F
igur
e 2)
. The
mor
talit
y ra
te a
mon
g th
is s
ubse
t of p
atie
nts
was
str
ikin
gly
high
.
Fig
ure
1:
Surv
ivor
ship
cur
ve w
ith d
eath
as th
e en
dpoi
nt.
Fig
ure
2: S
urvi
vors
hip
curv
es s
how
ing
surv
ivor
ship
of
pat
ient
s in
fect
ed w
ith a
sta
ph
ylo
cocc
al o
rgan
ism
(S
taph
) as
oppo
sed
to a
non
-sta
ph
ylo
cocc
al
orga
nism
(Non
stap
h).
PE
RFO
RM
AN
CE
IN M
OTIO
N7
0U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
71
CA
PTU
RIN
G W
EAR
CH
AR
ACTE
RIST
ICS
VIA
FR
ICTI
ON
ME
ASU
RE
ME
NT
DU
RIN
G T
ESTI
NG
ON
A
MU
LTI-
STA
TIO
N H
IP S
IMU
LATO
RH
aid
er, H
an
i1; W
eise
nb
urg
er, J
oel
N.1; N
ayl
or,
Ma
lco
lm G
.2; S
chro
ed
er, D
avi
d W
.2; W
hit
e, B
ruce
F.3
; an
d G
arv
in, K
evin
L.1
1. D
ep
art
me
nt
of
Ort
ho
pa
ed
ic S
urg
ery
an
d R
eh
ab
ilit
ati
on
, U
niv
ers
ity
of
Ne
bra
ska
Me
dic
al C
en
ter,
Om
ah
a, N
E, U
SA
2. B
iom
et,
In
c., W
ars
aw
, IN
, U
SA
3. A
MTI
, In
c., W
ate
rto
wn
, M
A, U
SA
4
. U
niv
ers
ity
of
Du
rha
m, U
K
INTR
OD
UC
TIO
N:
With
the
boom
in m
etal
-on-
met
al h
ip re
surf
acin
g an
d ha
rd-o
n-ha
rd to
tal h
ip re
plac
emen
ts
(TH
R) w
ith e
xtre
mel
y lo
w w
ear,
obta
inin
g ac
cura
te tr
ibol
ogic
al m
easu
rem
ents
bec
omes
diffi
cult.
C
hara
cter
izin
g TH
R fr
ictio
n ca
n he
lp, e
spec
ially
if th
e pr
ogre
ss o
f suc
h fr
ictio
n ca
n be
trac
ked
durin
g w
ear t
ests
. Fric
tion
mea
sure
men
t can
als
o be
use
d as
a to
ol to
stu
dy th
e ef
fect
s of
ac
etab
ular
line
r def
orm
atio
n du
ring
inse
rtio
n, a
nd p
ossi
ble
fem
oral
hea
d “c
lam
ping
”. Th
is s
tudy
pr
esen
ts e
stim
ates
of f
rictio
n du
ring
exte
nded
TH
R w
ear t
estin
g.
MA
TERI
ALS
AN
D M
ETH
OD
S:
Five
mill
ion
cycl
e (M
c) w
ear t
ests
wer
e pe
rfor
med
on
the
sam
e si
ze T
HR,
but
with
diff
eren
t mat
e-ria
l com
bina
tions
, on
a tw
elve
sta
tion
hip
sim
ulat
or (A
MTI
, Bos
ton)
. Fric
tion
of th
e ar
ticul
atin
g su
rfac
es w
as m
easu
red
usin
g a
nove
l tec
hniq
ue p
rese
nted
pre
viou
sly
[1],
base
d on
equ
ilibr
ium
of
forc
es a
nd m
omen
ts m
easu
red
usin
g th
e si
mul
ator
’s si
x deg
ree
of fr
eedo
m (D
OF)
load
cel
l on
eac
h st
atio
n.
Fig
ure
1: F
ree
body
dia
gram
(FBD
) sho
win
g fo
rces
due
to th
e jo
int r
eact
ion
(FJR
y, F JR
z) an
d th
ose
mea
sure
d by
the
load
cel
l (F L
Cy,
F LC
z). Th
e to
rque
s ��
(join
t rea
ctio
n to
rque
) and
Mx (
torq
ue m
easu
red
by th
e lo
ad c
ell)
are
also
sho
wn.
For
ce a
nd m
omen
t equ
ilibr
ia a
naly
ses
wer
e co
nduc
ted
on th
e da
ta
mea
sure
d by
the
load
cel
l to
com
pute
the
join
t rea
ctio
n to
rque���a
nd u
ltim
atel
y th
e fr
ictio
n fa
ctor
.
The
44m
m s
ize
(fem
oral
hea
d di
amet
er) T
HR
sam
ples
incl
uded
6 m
etal
-on-
plas
tic (M
OP)
(3 w
ith c
onve
ntio
nal U
HM
WPE
and
3 w
ith h
ighl
y cr
ossl
inke
d (H
XL) U
HW
MPE
line
rs),
6 m
etal
-on-
met
al (M
OM
) (3
TiN
-coa
ted
and
3 un
coat
ed),
6 M
OM
resu
rfac
ing
(3 s
tand
ard
and
3 w
ith s
mal
l poc
kets
for l
ubri
-ca
tion
tran
spor
t), a
nd 3
cer
amic
-on-
UH
MW
PE (C
OP)
TH
Rs. A
ll w
ere
lubr
icat
ed w
ith d
ilute
d bo
vine
ser
um to
con
tain
20
g/L
prot
ein
conc
entr
atio
n at
37
ºC, a
nd s
ubje
cted
to th
e w
alki
ng c
ycle
load
ing
and
rota
tions
of I
SO 1
4242
-1 [ 2
] .
RESU
LTS:
Fig
ure
2: T
HR
fric
tion
fact
ors
of s
even
diff
eren
t des
igns
/mat
eria
l com
bina
tions
mea
sure
d ov
er 5
mill
ion
cycl
e w
ear s
imul
atio
ns.
The
conv
entio
nal a
nd H
XL M
OPs
had
st
eady
fric
tion
fact
ors
of 0
.045
±0.0
09 a
nd
0.04
6±0.
003
over
5 M
c, e
xpla
ined
by
the
stab
ility
of w
ear r
ates
of b
oth
thes
e M
OP
type
s (7
2.0±
2.81
mg/
Mc
and
14.2
±3.5
7 m
g/M
c, re
spec
tivel
y). H
owev
er, d
urin
g th
e fir
st
0.5
Mc
the
conv
entio
nal M
OP
fric
tion
fact
or
rose
from
0.0
47±0
.004
to 0
.057
±0.0
04 w
hile
hi
gh w
ear w
as o
ccur
ring
(147
.1±1
0.08
mg/
Mc)
.
The
TiN
-coa
ted
and
unco
ated
MO
Ms
disp
laye
d in
itial
fric
tion
fact
ors
of 0
.124±
0.11
7 an
d 0.
039±
0.00
3, re
spec
tivel
y. Th
e hi
gh s
tan-
dard
dev
iatio
n fo
r the
coa
ted
THRs
was
due
to
coa
ting
rem
oval
on
one
spec
imen
whi
ch
caus
ed s
crat
ches
and
scu
ffs
on it
s ar
ticul
at-
ing
surf
aces
. Thi
s si
ngle
spe
cim
en h
ad a
fr
ictio
n fa
ctor
of 0
.260
at 0
.028
Mc.
By
1 M
c,
the
TiN
coa
ting
wor
e aw
ay o
n th
e ot
her t
wo
coat
ed s
peci
men
s (fr
ictio
n fa
ctor
s at
1 M
c:
coat
ed 0
.081
±0.0
36, u
ncoa
ted
0.05
0±0.
014)
. O
ver t
he 5
Mc
test
, ave
rage
fric
tion
fact
ors
for t
he c
oate
d an
d un
coat
ed T
HRs
wer
e 0.
097±
0.02
0 an
d 0.
049±
0.01
4, re
spec
tivel
y.
The
stan
dard
and
“poc
kete
d” M
OM
resu
rfac
-in
g TH
Rs d
ispl
ayed
initi
al fr
ictio
n fa
ctor
s of
0.
038±
0.00
9 an
d 0.
059±
0.02
6, re
spec
tivel
y,
whi
ch in
crea
sed
to th
e sa
me
leve
l at 2
Mc
(0.0
94±0
.020
and
0.0
94±0
.029
, res
pect
ivel
y).
No
diff
eren
ce in
wea
r was
det
ecte
d be
twee
n th
e tw
o re
surf
acin
g he
ad ty
pes
(wea
r rat
es
over
2 M
c: s
tand
ard
3.32
±0.2
5 m
g/M
c, p
ock-
eted
2.2
2±1.
76 m
g/M
c), b
ut c
urio
usly
, bot
h ty
pes
exhi
bite
d an
equ
al le
vel o
f scr
atch
ing
and
scuf
fing
on th
eir a
rtic
ular
sur
face
. By
the
end
of 5
Mc,
the
stan
dard
resu
rfac
ing
com
pone
nts
disp
laye
d a
mod
erat
ely
low
er
fric
tion
fact
or th
an th
e po
cket
ed d
esig
n (0
.036
±0.0
12 a
nd 0
.072
±0.0
37, r
espe
ctiv
ely)
al
thou
gh th
e po
cket
ed d
esig
n w
ore
less
(n
ot s
tatis
tical
ly s
igni
fican
t, p
> 0.
05).
Fina
lly, t
he th
ree
CO
P TH
Rs e
xhib
ited
high
U
HM
WPE
line
r wea
r ove
r 2 M
c (9
7.44±
3.08
m
g/M
c), w
hich
slo
wed
to 7
2.92
± 11
.60
mg/
Mc.
The
fric
tion
fact
or a
lso
decr
ease
d fr
om
0.09
1 ±
0.00
5 to
0.0
70 ±
0.0
08 o
ver t
he s
ame
perio
d. T
owar
d th
e en
d of
the
test
the
fric
tion
fact
or in
crea
sed
agai
n to
0.0
88 ±
0.0
04 b
y 5
Mc,
coi
ncid
enta
l with
a s
mal
l inc
reas
e of
w
ear (
from
3.3
9 ±
0.39
mg/
Mc
betw
een
2 M
c an
d 4.
5 M
c to
7.75
± 2
.62
mg/
Mc
betw
een
4.5
and
5 M
c) o
f the
cer
amic
fem
oral
hea
d.
DIS
CU
SSIO
N:
The
initi
ally
-dec
reas
ing
fric
tion
fact
or fo
r MO
P an
d C
OP
THRs
coi
ncid
ed w
ith a
pos
sibl
e “b
eddi
ng-in
” per
iod
whe
re th
e U
HM
WPE
line
r co
nfor
med
to th
e fe
mor
al h
ead.
The
hig
h in
itial
fric
tion
mea
sure
d on
the
TiN
-coa
ted
MO
M T
HRs
was
evi
denc
e of
a fa
iling
coa
ting,
an
d ev
en d
iffer
entia
ted
whi
ch s
peci
men
w
ould
fail
first
. In
the
case
of t
he p
ocke
ted
resu
rfac
ing
spec
imen
s, it
is p
ossi
ble
that
the
pock
ets
on th
is d
esig
n m
argi
nally
incr
ease
d th
e fr
ictio
n th
roug
h vi
scou
s sh
ear a
nd
fluid
tran
spor
tatio
n in
to th
e jo
int,
ther
eby
mar
gina
lly im
prov
ing
wea
r dur
abili
ty.
The
high
-wea
ring
CO
P TH
R di
spla
yed
high
er
fric
tion
tow
ard
the
end
of th
e te
st w
hen
an
incr
ease
in w
ear o
f the
cer
amic
fem
oral
he
ad w
as o
bser
ved.
Whe
ther
this
wea
r was
ta
king
pla
ce o
n th
e ar
ticul
atin
g su
rfac
e or
at
the
stem
/hea
d in
terf
ace
is u
nkno
wn.
Fric
tion
fact
ors
in n
ativ
e ca
rtila
ge ty
pica
lly
rang
e fr
om 0
.01
to 0
.03,
and
fric
tion
fact
ors
in w
ell-d
esig
ned
THRs
fall
betw
een
0.04
an
d 0.1
, a ra
nge
into
whi
ch o
ur m
easu
red
fric
tion
fact
ors
inde
ed h
ave
falle
n. W
hen
high
fric
tion
fact
ors
wer
e ob
serv
ed, h
igh
wea
r was
mea
sure
d on
TH
R sp
ecim
ens,
or
dam
age
to a
rtic
ulat
ing
surf
aces
was
se
en. A
dditi
onal
ly, t
he m
etho
d ut
ilize
d he
re
faci
litat
es o
n-lin
e sa
mpl
ing
and
mon
itorin
g th
roug
hout
the
prog
ress
of a
pro
long
ed
wea
r tes
t, an
d th
eref
ore
allo
ws
pred
ictio
ns
on T
HR
perf
orm
ance
/wea
r to
be m
ade.
REFE
REN
CES
:
1. W
eise
nbur
ger e
t al.
On-
line
mea
sure
men
t of
fric
tion
of to
tal h
ip re
plac
emen
t sys
tem
s.
ORS
200
8.
2. IS
O 1
4242
-1. L
oad
and
disp
. par
amet
ers
fo
r hip
wea
r sim
ulat
ion
2002
.
PE
RFO
RM
AN
CE
IN M
OTIO
N7
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
73
ORI
GIN
OF
BIO
CO
MPA
TIBI
LITY
O
F IB
AD
EN
GIN
EER
ED
N
AN
OS
TRU
CTU
RE
SFe
reyd
oo
n N
am
ava
r, S
cD; R
ena
t S
ab
iria
no
v, P
hD
1; A
lexa
nd
er R
ub
inst
ein
, Ph
D1; J
oh
n J
ack
son
, Ph
D2; J
. Gra
ha
m S
ha
rp, P
hD
3;
Ro
xan
na
Na
ma
var,
DO
; Ha
ni H
aid
er, P
hD
; Ed
wa
rd F
ehri
ng
er, M
D; a
nd
Kev
in G
arv
in, M
D
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n, U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter,
Om
aha,
Neb
rask
a1 D
epar
tmen
t of P
hysi
cs, U
nive
rsity
of N
ebra
ska
- Om
aha
2 Dep
artm
ent o
f Pat
holo
gy a
nd M
icro
biol
ogy,
Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r3 D
epar
tmen
t of G
enet
ics,
Cel
l Bio
logy
and
Ana
tom
y, U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter
ABS
TRA
CT:
This
repo
rt is
an
atte
mpt
to a
ddre
ss th
e or
igin
of e
nhan
ced
cell
adhe
sion
and
gro
wth
on
nano
crys
talli
ne m
ater
ials
and
und
erst
and
the
mec
hani
sms
invo
lved
in c
ell a
dhes
ion.
We
com
pare
d ou
r eng
inee
red
nano
crys
talli
ne c
oatin
g, c
reat
ed b
y io
n be
am a
ssis
ted
depo
sitio
n (IB
AD
), to
the
mos
t com
-m
only
use
d m
etal
lic a
nd c
eram
ic b
ioco
mpa
tible
mat
eria
ls w
ith m
icro
crys
talli
ne s
truc
ture
s, in
clud
ing
coba
lt ch
rom
ium
(CoC
r), ti
tani
um (T
i), a
nd
hydr
oxya
patit
e (H
A).
Our
find
ings
indi
cate
that
eng
inee
red
nano
stru
ctur
es a
re s
uper
ior i
n su
ppor
ting
the
adhe
sion
and
pro
lifer
atio
n of
ost
eobl
ast-l
ike
cells
of a
mou
se b
one
mar
row
str
omal
cel
l lin
e. C
ell a
ttac
hmen
t bot
h in
viv
o a
nd in
vit
ro is
usu
ally
med
iate
d by
kno
wn
adhe
sive
pro
tein
s. T
he a
bsor
p-tio
n of
pro
tein
s su
ch a
s fib
rone
ctin
and
vitr
onec
tin is
a k
ey fa
ctor
in c
ell a
dhes
ion
and
bone
form
atio
n at
an
impl
ant s
urfa
ce [ 1
] . Th
e ro
le o
f wet
tabi
lity,
ch
arge
, and
pol
arity
, as
wel
l as
the
topo
logy
of t
he s
urfa
ce, h
as b
een
stud
ied
in re
cent
yea
rs w
ithou
t the
em
erge
nce
of a
com
preh
ensi
ve m
odel
[ 1] .
The
impo
rtan
ce o
f ele
ctro
stat
ic a
nd s
teric
com
plem
enta
rity
is w
ell-e
stab
lishe
d in
the
form
atio
n of
kno
wn
prot
ein
com
plex
es d
urin
g pr
otei
n-pr
otei
n in
tera
ctio
ns. W
e ar
e pr
opos
ing
a ph
enom
enol
ogic
al c
once
pt th
at m
ay e
xpla
in th
e en
hanc
ed a
dhes
ion
of c
ells
to th
e en
gine
ered
nan
ostr
uctu
red
surf
aces
com
pare
d to
con
vent
iona
l sm
ooth
sur
face
s. T
his
conc
ept c
onsi
ders
ste
ric a
nd e
lect
rost
atic
fit (
com
plem
enta
rity)
bet
wee
n in
tera
ctiv
e ad
he-
sive
pro
tein
s an
d th
e su
rfac
e. T
he s
teric
fit c
once
pt e
mph
asiz
es th
e va
n de
r Waa
ls c
ompo
nent
, whi
le th
e el
ectr
osta
tic fi
t is
a lo
ng-ra
nge
elec
tros
tatic
co
mpo
nent
of t
he a
bove
inte
ract
ions
. A ra
ther
larg
e an
d he
tero
gene
ous
elec
tros
tatic
fiel
d in
duce
d on
the
nano
-str
uctu
red
non-
cond
uctin
g m
ater
ial
surf
ace
may
be
resp
onsi
ble
for t
he e
nhan
ced
phys
ical
abs
orpt
ion
of m
edia
ting
adhe
sive
pro
tein
s an
d, a
s a
resu
lt, in
crea
sed
cell
adhe
sion
.
INTR
OD
UC
TIO
N:
Idea
lly, t
o pr
omot
e an
d m
aint
ain
osse
oint
egra
tion,
the
surf
ace
of im
plan
t dev
ices
sho
uld
posi
tivel
y in
tera
ct w
ith m
esen
chym
al s
trom
al c
ells
(MSC
) an
d th
eir p
re-o
steo
blas
t pro
geny
. By
mim
icki
ng th
e na
nost
ruct
ure
of th
e lo
tus
leaf
and
app
lyin
g IB
AD
, we
have
alre
ady
dem
onst
rate
d th
e fa
bric
atio
n of
a p
ure
cubi
c Zr
O2 (
diam
ond
sim
ulan
t) co
atin
g w
ith 5
-20
nm g
rain
siz
e. T
his
nano
stru
ctur
ed Z
rO2 c
oatin
g is
tran
spar
ent,
extr
emel
y ha
rd, a
nd d
is-
play
s a
tota
l wet
tabi
lity
to w
ater
and
cal
f ser
um. I
t can
be
depo
site
d at
room
tem
pera
ture
ont
o an
y m
ater
ial (
even
pol
ymer
s) w
ith e
xcel
lent
adh
eren
ce
and
mec
hani
cal i
nteg
rity.
EXPE
RIM
ENTA
L PR
OC
EDU
RES:
We
have
syn
thes
ized
[2] a
n ul
tra-
hydr
ophi
lic [3
], ha
rd, p
ure
(with
out c
hem
ical
sta
biliz
er) c
ubic
zirc
onia
(dia
mon
d si
mul
ant)
film
with
a ro
ughn
ess
of
a fe
w to
20
nm u
sing
IBA
D, w
hich
com
bine
s ph
ysic
al v
apor
dep
ositi
on w
ith c
oncu
rren
t ion
bea
m b
omba
rdm
ent (
from
an
ion
gun)
in a
hig
h va
cuum
en
viro
nmen
t to
prod
uce
film
s w
ith s
uper
ior p
rope
rtie
s. T
hese
film
s ar
e th
en “s
titch
ed” t
o th
e or
thop
aedi
c ar
tifici
al im
plan
t mat
eria
ls w
ith d
iffer
entia
l na
nosc
ale
(5 to
50
nm g
rain
siz
e) c
hara
cter
istic
s th
at a
ffec
t the
wet
tabi
lity
[ 3] ,
roug
hnes
s, a
nd m
echa
nica
l pro
pert
ies
of th
e co
atin
g [ 2
] . W
e ha
ve
stud
ied
adhe
sion
, sur
viva
l, an
d gr
owth
of c
lone
d bo
ne m
arro
w s
trom
al c
ell l
ines
, ter
med
OM
A-A
D c
ells
, on
the
surf
aces
of e
ngin
eere
d na
nocr
ysta
l-lin
e ul
tra-
hydr
ophi
lic h
ard
oxid
e ce
ram
ic fi
lms
fabr
icat
ed b
y IB
AD
. The
str
omal
cel
l lin
e O
MA
-AD
was
der
ived
from
the
bone
mar
row
of a
fem
ale
C57
Bl/6
mou
se b
y re
peat
ed tr
ypsi
niza
tion
of th
e ad
here
nt la
yer o
f a lo
ng-te
rm b
one
mar
row
cul
ture
.
RESU
LTS
AN
D D
ISC
USS
ION
:
We
have
cle
arly
sho
wn
[ Fig
ure
1] th
at IB
AD
nan
o-en
gine
ered
ce
ram
ic c
oatin
gs a
re s
uper
ior t
o bu
lk h
ydro
xyap
atite
(HA
), no
t onl
y in
com
paris
on to
cel
l adh
esio
n an
d gr
owth
, but
als
o w
ith m
echa
nica
l [2
] and
che
mic
al s
tabi
lity
[ 3] o
f the
ort
hopa
edic
mat
eria
ls. T
he
grow
th o
f a b
one
mar
row
str
omal
cel
l lin
e, O
MA
-AD
, on
pure
cu
bic
ZrO
2 is
appr
oxim
atel
y th
ree
times
mor
e th
an w
hat h
as b
een
mea
sure
d fo
r HA
[ Fig
ure
1]. I
n ad
ditio
n, w
e ha
ve s
how
n th
e ab
ility
of
OM
A-A
D to
diff
eren
tiate
to o
steo
blas
t-lik
e ce
lls w
hen
grow
n on
nan
ostr
uctu
rally
-sta
biliz
ed tr
ansp
aren
t pur
e cu
bic
ZrO
2 [4]
.
Mec
hani
sm o
f cel
l adh
esio
n (ro
le o
f adh
esiv
e pr
otei
ns)
The
esse
ntia
l rol
e of
ext
race
llula
r adh
esiv
e pr
otei
ns (s
uch
as fi
bron
ectin
(FN
), vi
tron
ectin
, and
ost
eopo
ntin
) in
cell
adhe
sion
, mor
phol
ogy
and
mig
ratio
n on
th
e im
plan
t mat
eria
l sur
face
has
bee
n es
tabl
ishe
d by
a n
umbe
r of r
esea
rch-
ers
[1] a
nd re
fere
nces
cite
d th
erei
n. T
he a
dhes
ive
prot
eins
con
tain
the
cell
rece
ptor
-bin
ding
RG
D a
min
o ac
id s
eque
nce
mot
if an
d m
edia
te th
e ce
ll ad
he-
sion
to th
e su
rfac
e of
the
impl
ant [
Figu
re 2
]. In
oth
er w
ords
, for
cel
ls, t
hey
play
th
e ro
le o
f the
anc
hor o
n th
e im
plan
t sur
face
. Thu
s, th
e ad
hesi
on o
f the
se p
ro-
tein
s to
the
solid
sur
face
is a
key
fact
or in
cel
l adh
esio
n an
d bo
ne fo
rmat
ion
at a
n im
plan
t sur
face
. The
phy
sico
chem
ical
pro
pert
ies
of th
e im
plan
t sur
face
ar
e cr
ucia
l for
the
adhe
sion
, gro
wth
, and
mig
ratio
n of
cel
ls. T
he d
evel
opm
ent
of a
nan
ostr
uctu
red
surf
ace
allo
ws
for a
dditi
onal
con
trol
of c
ell a
dhes
ion.
Phen
omen
olog
ical
con
cept
of t
he a
dhes
ive
prot
ein
atta
chm
ent o
n th
e so
lid
impl
ant s
urfa
ce
The
phys
ical
adh
esio
n of
the
prot
eins
to th
e su
rfac
e is
det
erm
ined
by
com
plex
inte
r-m
olec
ular
inte
ract
ions
. Am
ong
them
, non
-cov
alen
t ele
ctro
-st
atic
and
van
der
Waa
ls in
tera
ctio
ns w
ere
foun
d to
be
very
impo
rtan
t [5]
. In
fact
, the
se fo
rces
det
erm
ine
the
stre
ngth
and
sel
ectiv
ity o
f the
pro
tein
adh
e-si
on. T
he e
ffec
tive
rang
es o
f the
se in
tera
ctio
ns a
re n
ot th
e sa
me.
Whi
le v
an
der W
aals
forc
es a
re s
hort
rang
e w
ith ty
pica
l int
erac
tion
dist
ance
s of
0.2
-0.4
nm
, the
ele
ctro
stat
ic in
tera
ctio
ns in
aqu
eous
ele
ctro
lyte
sol
utio
ns a
t phy
siol
-og
y co
ncen
trat
ions
can
be
effe
ctiv
e up
to a
ppro
xim
atel
y 2-
3 nm
.
The
role
of s
teric
and
ele
ctro
stat
ic c
ompl
emen
tarit
y in
pro
tein
-pro
tein
in
tera
ctio
ns a
nd fo
rmat
ion
of p
rote
in c
ompl
exes
It is
wel
l kno
wn
that
form
ing
a fu
nctio
nal p
rote
in-p
rote
in (o
r oth
er m
acro
-m
olec
ular
) com
plex
is g
over
ned
by n
on-c
oval
ent (
elec
tros
tatic
and
van
der
W
aals)
inte
ract
ions
[6, 7
]. Th
ese
com
plex
es a
re s
tabi
lized
by
form
ing
hydr
o-ge
n bo
nds,
as
wel
l as
hydr
opho
bic
and
hydr
ophi
lic e
ffec
ts, i
n so
lven
t [5]
. The
ef
fect
s of
ele
ctro
stat
ics,
com
bine
d w
ith th
e ge
omet
ric s
urfa
ce c
ompl
emen
-ta
rity,
are
the
subj
ects
of h
eigh
tene
d in
tere
st in
the
field
of m
olec
ular
bio
logy
an
d ph
arm
acol
ogy.
The
ster
ic c
ompl
emen
tarit
y sc
hem
atic
ally
sho
wn
in
Figu
re 5
dem
onst
rate
s th
e be
st g
eom
etric
fit o
f tw
o pr
otei
ns w
ith d
iffer
ent
shap
es, w
hich
pro
vide
s th
e po
ssib
ility
for m
ultip
le p
oint
s of
adh
esio
n to
the
cont
act s
urfa
ce.
The
elec
tros
tatic
com
plem
enta
rity
has
been
det
erm
ined
by
antic
orre
late
d su
rfac
e el
ectr
osta
tic p
oten
tials
at t
he p
rote
in b
indi
ng s
ites
[8].
It w
as a
lso
show
n th
at e
lect
rost
atic
s pl
ay a
n im
port
ant r
ole
in m
olec
ular
mec
hani
sms
of p
rote
in-p
rote
in re
cogn
ition
[8].
Figu
re 4
sho
ws
two
prot
eins
(bar
nase
and
ba
rsta
r) w
ith k
now
n st
ruct
ures
and
thei
r com
plex
, det
erm
ined
by
X-ra
y di
f-fr
actio
n ex
perim
ents
[9].
Elec
tros
tatic
and
ste
ric c
ompl
emen
tarit
y ef
fect
s fo
r eng
inee
red
na
nost
ruct
ures
and
adh
esiv
e pr
otei
n
We
belie
ve th
at th
e ad
hesi
on o
f pro
tein
on
the
solid
sub
stra
te is
gov
erne
d by
the
sim
ilar p
hysi
coch
emic
al in
tera
ctio
ns a
s in
the
case
of t
he fo
rmat
ion
of
prot
ein-
prot
ein
com
plex
es. T
here
are
diff
eren
ces
betw
een
thes
e tw
o sy
stem
s,
conn
ecte
d w
ith th
e di
ffer
ent n
atur
e of
the
solid
sub
stra
te, w
hich
is ty
pica
lly
mad
e of
non
-org
anic
mat
eria
ls. I
nter
actio
ns b
etw
een
bio-
mac
rom
olec
ules
ha
ve b
een
stud
ied
in d
etai
l, w
hile
the
unde
rsta
ndin
g of
phy
sico
chem
ical
m
echa
nism
s of
the
inte
ract
ion
betw
een
prot
eins
and
non
-org
anic
mat
eri-
als
rem
ains
rath
er p
oor.
This
con
tinue
s to
be
one
of th
e m
ajor
pro
blem
s in
impl
ant b
ioen
gine
erin
g, w
hich
det
erm
ines
the
prog
ress
of a
chie
ving
bi
ocom
patib
ility
of s
ubst
rate
sur
face
s, d
epen
ding
on
the
succ
essf
ulne
ss
of b
iom
edic
al a
pplic
atio
ns. W
e pr
opos
e th
at th
e ph
ysic
al p
rope
rtie
s of
the
subs
trat
e su
rfac
e ca
n be
mod
ified
to u
tiliz
e m
echa
nism
s th
at p
rom
ote
the
adhe
sion
of p
rote
ins
on th
ese
surf
aces
. The
nan
o-en
gine
erin
g of
film
with
the
desi
red
stoi
chio
met
ry, s
urfa
ce to
polo
gy a
nd w
ater
affi
nity
, can
enh
ance
the
adhe
sion
of p
rote
ins
and,
thus
, the
bio
com
patib
ility
of t
he s
urfa
ce. W
e ca
lcu-
late
d th
e po
tent
ial p
rofil
e fo
r the
frag
men
t sho
wn
in F
igur
e 5
on th
e so
lven
t ac
cess
ible
sur
face
. The
pot
entia
l diff
eren
ce a
cros
s th
e FN
pro
tein
frag
men
t de
mon
stra
ted
in F
igur
e 2
is s
how
n in
Fig
ure
5, a
nd ty
pica
lly h
as
a fe
w te
nths
of a
vol
t.
Na
no
crys
tallin
e C
oa
tin
gs
by
IBA
D
Gro
wth
of
Clo
ne
d B
on
e M
arr
ow
Sto
rma
l C
ell (
OM
A-A
D)
on
Dif
fere
nt
Na
no
crys
tallin
e M
ate
ria
lsb
y
Ala
ma
r B
lue
ZrO
2B
ulk
HA
Co
Cr
Co
ntr
ol W
ells
0
50
00
10
00
0
15
00
0
20
00
0
25
00
0
Flurescence Units per cm2
PE
RFO
RM
AN
CE
IN M
OTIO
N7
2
Fig
ure
2. S
chem
atic
repr
esen
tatio
n of
the
frag
men
t of h
uman
fib
rone
ctin
-enc
ompa
ssin
g ty
pe II
I (FN
-III)
dom
ain
repe
ats
7 th
roug
h 10
(1fn
f PD
B co
de).
The
RGD
seq
uenc
e m
otif
of F
N
is s
how
n w
ith th
e el
ectr
osta
tic s
urfa
ce p
oten
tial (
the
tota
l e
lect
rost
atic
su
rfac
e p
ote
nti
al o
f th
is fr
agm
en
t is
sho
wn
in
Fig
ure
5).
Flat
ribb
ons
(teal
) sho
w th
e ty
pica
l sec
onda
ry
stru
ctur
e of
the
mot
if (b
eta-
shee
ts).
Seve
n be
ta s
tran
ds a
re
loca
ted
in e
ach
mot
if.
Fig
ure
4. S
chem
atic
repr
esen
tatio
n of
the
barn
ase
and
bars
tar
prot
eins
in a
n in
term
edia
te s
tate
(lef
t) an
d th
e fin
al c
ompl
ex
(righ
t). B
oth
prot
eins
are
sho
wn
by th
eir m
olec
ular
sur
face
. Blu
e an
d re
d co
lors
sho
w th
e ne
gativ
e an
d po
sitiv
e ch
arge
d am
ino
acid
resi
due
clus
ters
.
Fig
ure
3. S
chem
atic
pre
sent
atio
n ill
ustr
atin
g th
e fo
rmat
ion
of
a st
ereo
-spe
cific
ally
bou
nd p
rote
in-p
rote
in c
ompl
ex in
sol
utio
n.
Fig
ure
1: G
row
th o
f OM
A-A
D o
n na
nocr
ys-
talli
ne h
ydro
phili
c cu
bic
zirc
onia
coa
tings
pr
oduc
ed b
y IB
AD
pro
cess
es c
ompa
red
with
bu
lk H
A, C
oCr a
nd c
ultu
re p
late
s. T
he a
mou
nt
of fl
uore
scen
ce p
rodu
ced
is d
irect
ly p
ropo
r-tio
nal t
o th
e nu
mbe
r of v
iabl
e ce
lls.
PE
RFO
RM
AN
CE
IN M
OTIO
N7
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
75
The
smoo
th s
ubst
rate
sur
face
(or s
urfa
ce w
ith m
icro
-gra
ins)
of i
norg
anic
mat
eria
ls d
oes
not s
how
th
e su
bsta
ntia
l var
iatio
n of
the
pote
ntia
l acr
oss
its s
urfa
ce. O
n th
e ot
her h
and,
the
nano
stru
ctur
ed
surf
aces
sho
w a
sig
nific
ant v
aria
tion
in th
e ch
arge
sta
te (a
nd a
s a
resu
lt th
e el
ectr
osta
tic p
oten
tial)
of
sur
face
site
s of
diff
eren
t coo
rdin
atio
n, i.
e. a
t the
edg
es, v
ertic
es, s
teps
, and
oth
er im
perf
ectio
ns.
Base
d on
the
form
atio
n of
cov
alen
t bon
ds in
tran
sitio
n m
etal
oxi
des,
the
surf
ace
term
inat
ion
resu
lts
in th
e ap
pear
ance
of d
angl
ing
bond
s. T
he a
tom
s at
the
vert
ices
and
edg
es o
f the
nan
o-py
ram
ids
[3]
have
a la
rger
num
ber o
f dan
glin
g bo
nds
than
the
atom
s on
the
smoo
th s
urfa
ce. T
his
sugg
ests
that
th
ese
site
s ha
ve p
artia
lly lo
caliz
ed c
harg
es a
t the
se s
ites.
Base
d on
our
firs
t-prin
cipl
e qu
antu
m-m
echa
nica
l cal
cula
tions
[ 10]
for t
he Z
rO2 p
yram
idal
nan
ostr
uc-
ture
with
thre
e-fo
ld s
ymm
etry
, we
find
ther
e is
inde
ed a
sub
stan
tial c
harg
e tr
ansf
er a
cros
s th
e su
rfac
e.
We
used
Zr 20
O42
tetr
ahed
ron
clus
ter t
erm
inat
ed b
y (11
1) p
lane
s. C
alcu
latio
ns w
ere
perf
orm
ed u
sing
G
amm
a po
int a
nd E
cuto
ff=35
0eV.
Our
cal
cula
tion
sugg
ests
that
the
vert
ex o
f the
nan
o-py
ram
id
has
loca
lized
cha
rges
, whi
le th
e sl
opes
and
bot
tom
of t
he p
yram
id h
ave
sign
ifica
ntly
low
er s
urfa
ce
char
ge d
ensi
ty. B
ased
on
our c
alcu
latio
ns, t
he p
oten
tial d
iffer
ence
in o
ur s
peci
fic c
ase
of th
e py
ram
id
is a
ppro
xim
atel
y a
few
tent
hs o
f a v
olt,
sim
ilar t
o th
e su
rfac
e of
pro
tein
. Thu
s, th
e ad
hesi
ve p
rote
in m
ay
find
a go
od m
atch
(bot
h st
eric
ally
and
ele
ctro
stat
ical
ly) a
cros
s th
e in
terf
ace
with
the
surf
ace
of th
e cu
bic
zirc
onia
. Thi
s is
sho
wn
sche
mat
ical
ly in
Fig
ure
5. In
this
figu
re, t
he fr
agm
ent o
f pro
tein
arr
ange
s its
elf t
o ha
ve th
e po
sitiv
e cl
uste
rs c
lose
r to
the
vert
ex o
f ZrO
2 pyr
amid
, whi
ch is
neg
ativ
ely
char
ged.
In
this
cas
e, th
e st
rong
ele
ctro
stat
ic a
ttra
ctio
n be
twee
n th
e pr
otei
n an
d th
e su
bstr
ate
shou
ld b
e ob
serv
ed.
This
inte
ract
ion
can
be s
igni
fican
t due
to th
e re
duce
d so
lven
t per
mitt
ivity
in th
e re
gion
bet
wee
n in
ter-
actin
g su
rfac
es. I
n co
mbi
natio
n w
ith th
e ef
fect
of s
teric
com
plem
enta
rity,
and
the
abov
e-m
entio
ned
addi
tiona
l mec
hani
sms
spec
ific
to th
e su
per-
hydr
ophi
lic s
urfa
ce o
f ZrO
2, fa
vora
ble
elec
tros
tatic
inte
rac-
tions
pro
vide
enh
ance
d pr
otei
n ad
hesi
on o
n th
e na
nost
ruct
ured
sur
face
.
CO
NC
LUSI
ON
S:
We
have
sho
wn
that
, bas
ed o
n th
e qu
antu
m-m
echa
nica
l cal
cula
tions
, [10
] the
sur
face
of t
he n
ano-
stru
ctur
ed Z
rO2 c
an h
ave
sign
ifica
nt e
lect
rost
atic
pot
entia
l var
iatio
ns b
etw
een
poin
ts w
ith d
iffer
ent
curv
atur
es. T
his
pote
ntia
l var
iatio
n is
com
para
ble
to th
at o
bser
ved
on th
e su
rfac
e of
adh
esiv
e pr
otei
ns.
Thus
, the
nan
ostr
uctu
red
surf
aces
with
loca
lized
cha
rges
on
shar
p hi
llock
s m
ay h
ave
enha
nced
pro
tein
ad
hesi
on, s
uper
ior t
o th
e sm
ooth
sur
face
s w
hich
lack
suc
h ch
arge
s.
We
are
prop
osin
g a
phen
omen
olog
ical
con
cept
that
may
exp
lain
the
enha
nced
adh
esio
n of
cel
ls to
th
e en
gine
ered
nan
ostr
uctu
red
surf
aces
com
pare
d to
con
vent
iona
l sm
ooth
sur
face
s. Th
is c
once
pt
cons
ider
s st
eric
and
ele
ctro
stat
ic fi
t (co
mpl
emen
tarit
y) b
etw
een
inte
ract
ive
adhe
sive
pro
tein
s an
d th
e su
rfac
e. T
he s
teric
fit c
once
pt e
mph
asiz
es th
e va
n de
r Waa
ls c
ompo
nent
, whi
le th
e el
ectr
osta
tic fi
t is
a lo
ng-ra
nge
elec
tros
tatic
com
pone
nt o
f the
abo
ve in
tera
ctio
ns. A
rath
er la
rge
and
hete
roge
neou
s el
ec-
tros
tatic
fiel
d in
duce
d on
the
nano
-str
uctu
red
non-
cond
uctin
g m
ater
ial s
urfa
ce c
an b
e re
spon
sibl
e fo
r th
e en
hanc
ed p
hysic
al a
bsor
ptio
n of
med
iatin
g ad
hesiv
e pr
otei
ns, a
nd a
s a
resu
lt, e
nhan
ced
cell
adhe
sion
.
REFE
REN
CES
:
1.
Wils
on, C
. J.,
et a
l. T
issu
e E
ng
ine
eri
ng
. 200
5, 1
1:1-
18.
2.
Nam
avar
, F.,
et a
l. N
ano
Le
tt. 2
008,
8:9
88-9
96.
3.
Nam
avar
, F.,
et a
l. J.
Nan
ote
chn
olo
gy,
Oct
. 200
7, 1
8:41
5702
.4.
N
amav
ar, F
., et
al.
“Nan
ote
chn
olo
gy
for F
un
ctio
nal
Re
pai
r an
d R
eg
en
era
tive
Me
dic
ine
the
Ro
le
o
f Ce
ram
ics
as In
Bu
lk a
nd
as
Co
atin
g.”
Edi
ted
by R
avag
lioli,
A. a
nd K
raje
wsk
i, A
., N
atio
nal s
cien
ce
fo
unda
tion:
Fae
nza,
Ital
y 20
08, p
. 26-
37.
5.
Isra
elac
hvili
, J. I
nte
rmo
lecu
lar a
nd
su
rfac
e fo
rce
s. A
cade
mic
Pre
ss: S
an D
iego
, 198
5.6.
N
orel
, R.,
et a
l. P
rote
in S
ci. 2
001,
10:2
147-
2161
.7.
La
eder
ach,
A. a
nd R
eilly
, P.J
. J. C
om
p. C
he
m. 2
003,
24:
1748
-175
7. 8.
M
cCoy
A. J
., C
hand
ana
E.V.
, and
Col
man
, P.M
. Ele
ctro
stat
ic c
ompl
emen
taril
y at
pro
tein
/pro
tein
inte
rfac
es. J
. Mo
l. B
iol.
1997
, 268
:570
-584
. 9.
Bu
ckle
, A.M
.; Sc
hrei
ber,
G.;
and
Fers
ht, A
. R. B
ioch
em
istr
y. 1
994,
33:
887
8-88
89.
10. K
ress
e, G
. and
Fur
thm
ülle
r, J.
Ph
ys. R
ev.
B. 1
996,
54:
1116
9.
HIG
HLY
CRO
SSLI
NKE
D
UH
MW
PE IN
TK
A–D
OES
V
ITA
MIN
-E-S
TAB
ILIZ
ED
P
OLY
ETH
YLE
NE
AD
DRE
SS
OU
R C
ON
CER
NS?
+1H
aid
er, H
an
i; 1W
eise
nb
urg
er, J
oel
N.; 2
Ku
rtz,
Ste
ven
M.;
3R
imn
ac,
Cla
re M
.; 4Fr
eed
ma
n, J
ord
an
; 4S
chro
ed
er,
Da
vid
W.;
an
d 1G
arv
in, K
evin
L.
1. U
nive
rsity
of N
ebra
ska
Med
ical
Cen
ter,
Om
aha
NE
+E
-mai
l: hh
aide
r@un
mc.
edu
2. E
xpon
ent I
nc.,
Phila
delp
hia,
PA
3. C
ase
Wes
tern
Res
erve
Uni
vers
ity, C
leve
land
, OH
4. B
iom
et In
c., W
arsa
w IN
INTR
OD
UC
TIO
N:
Con
cern
s ab
out r
educ
ed s
tren
gth,
fatig
ue re
sist
ance
, and
oxi
datio
n of
hig
hly
cros
slin
ked
ultr
a hi
gh m
olec
ular
wei
ght p
olye
thyl
ene
(UH
MW
PE) h
ave
limite
d th
e ac
cept
ance
of t
his
mat
eria
l for
tota
l kne
e re
plac
emen
t (TK
R). I
t was
hyp
othe
size
d th
at a
new
cro
sslin
ked
UH
MW
PE s
tabi
lized
with
vita
min
E
wou
ld s
ubst
antia
lly im
prov
e its
wea
r per
form
ance
and
resi
stan
ce to
oxi
dativ
e de
grad
atio
n w
ithou
t com
prom
isin
g its
mec
hani
cal p
rope
rtie
s. T
his
stud
y te
sted
the
afor
emen
tione
d hy
poth
esis
in v
itro
by
inve
stig
atin
g th
e m
echa
nica
l pro
pert
ies
and
wea
r of b
oth
conv
entio
nal a
nd h
ighl
y cr
ossl
inke
d vi
tam
in-E
-dop
ed U
HM
WPE
tibi
al in
sert
s.
MA
TERI
ALS
AN
D M
ETH
OD
S:
UH
MW
PE w
as m
achi
ned
from
isos
tatic
mol
ded
GU
R102
0 ba
r sto
ck, c
ross
linke
d w
ith 1
00 k
Gy,
and
then
dop
ed w
ith v
itam
in E
. Thi
s m
ater
ial w
as
com
pare
d to
dire
ct m
olde
d G
UR1
050
UH
MW
PE. B
oth
mat
eria
ls w
ere
gam
ma
irrad
iatio
n st
erili
zed
as fo
r clin
ical
use
. Thi
rty-
six s
ampl
es (1
8 of
eac
h m
ater
ial)
wer
e sm
all p
unch
test
ed (A
STM
F21
83-0
2) m
easu
ring
mec
hani
cal p
rope
rtie
s of
bot
h as
man
ufac
ture
d/pr
oces
sed
mat
eria
ls b
efor
e an
d af
ter a
ccel
erat
ed a
ging
(AST
M F
2003
-02)
.
Four
teen
sam
ples
(div
idin
g th
e tw
o m
ater
ial t
ypes
into
six
sub
-gro
ups
repr
esen
ting
none
, 2 w
eeks
and
4 w
eeks
of a
ccel
erat
ed a
ging
) wer
e fa
tigue
te
sted
for c
rack
gro
wth
rate
and
oxi
datio
n in
dex m
easu
rem
ents
. Fat
igue
cra
ck p
ropa
gatio
n (m
easu
red
from
imag
es) a
nd th
us c
rack
gro
wth
rate
, da/
dn, a
nd th
e cy
clic
str
ess
inte
nsity
fact
or,��
K, o
f bot
h m
ater
ials
wer
e m
easu
red
(usi
ng A
STM
E64
7-05
as
a gu
ide)
bef
ore
and
afte
r acc
eler
ated
agi
ng.
Knee
sim
ulat
or te
stin
g ev
alua
ted
wea
r of e
ach
mat
eria
l for
5 m
illio
n w
alki
ng c
ycle
s un
der f
orce
-con
trol
. Eig
ht P
S kn
ees
(4 T
KR s
ampl
es o
f eac
h m
ate-
rial)
wer
e te
sted
on
two
4-st
atio
n In
stro
n-St
anm
ore
knee
sim
ulat
ors.
CR
knee
s w
ere
test
ed o
n a
6-st
atio
n A
MTI
kne
e si
mul
ator
; Sta
tistic
al d
iffer
ence
s in
all
met
rics
wer
e ev
alua
ted
for s
igni
fican
ce w
ith A
NO
VA (p
< 0
.05)
.
Fig
ure
1:
A h
ighl
y cr
ossl
inke
d vi
tam
in-E
-dop
ed U
HM
WPE
tibi
al b
earin
g in
sert
(lef
t) an
d a
conv
entio
nal o
ne (r
ight
) aft
er w
ear t
estin
g.
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T7
5
Fig
ure
5. S
chem
atic
pre
sent
atio
n of
the
poss
ible
att
achm
ent-p
rone
ori
-en
tatio
n of
one
of t
he c
entr
al fr
agm
ents
of t
he a
dhes
ive
FN p
rote
in (t
he
uppe
r par
t) to
the
nano
stru
ctur
ed s
urfa
ce (t
he b
otto
m p
art)
of th
e so
lid
subs
trat
e (c
ubic
zirc
onia
). Th
e fr
agm
ent c
onta
ins
the
RGD
am
ino
acid
se
quen
ce m
otif
that
is b
ound
by
the
inte
grin
cel
l rec
epto
r. Th
e pr
otei
n fr
agm
ent i
s sh
own
with
its
elec
tros
tatic
sur
face
pot
entia
l (bl
ue a
nd re
d co
lors
cor
resp
ond
to lo
caliz
atio
n of
the
posi
tive
and
nega
tive
part
ial
char
ges,
resp
ectiv
ely)
. The
sol
id s
ubst
rate
is s
how
n w
ith it
s ch
arge
de
nsity
dis
trib
utio
n pr
esen
ted
by th
e ba
r. Th
e hi
llock
s of
the
subs
trat
e su
rfac
e ar
e ne
gativ
ely
char
ged
(red)
. The
dou
ble
arro
w s
how
s th
e fa
vor-
able
ele
ctro
stat
ic in
tera
ctio
n be
twee
n pr
otei
n fr
agm
ent a
nd s
ubst
rate
.
PE
RFO
RM
AN
CE
IN M
OTIO
N7
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
77
RESU
LTS:
Aft
er 4
-wee
ks o
f acc
eler
ated
agi
ng,
the
cont
rol m
ater
ial s
how
ed e
leva
ted
oxid
atio
n, lo
ss o
f sm
all p
unch
mec
hani
-ca
l pro
pert
ies
and
decr
ease
d fa
tigue
cr
ack
grow
th re
sist
ance
. In
cont
rast
, th
e vi
tam
in-E
-sta
biliz
ed m
ater
ial h
ad
min
imal
cha
nges
in th
ese
prop
ertie
s.
No
gros
s de
lam
inat
ion
or fr
actu
re o
f the
tib
ial i
nser
ts w
as o
bser
ved,
and
inse
rts
of b
oth
type
s sh
owed
alm
ost l
inea
r wea
r. Fu
rthe
r, th
e vi
tam
in-E
-sta
biliz
ed m
ater
ial
exhi
bite
d 85
% re
duct
ion
in w
ear f
or b
oth
the
CR
and
PS d
esig
ns (p
< 0
.05,
AN
OVA
).
Fig
ure
2:
Smal
l pun
ch te
st re
sults
for a
ged
and
non-
aged
spe
cim
ens
from
the
conv
en-
tiona
l and
E-P
oly
grou
ps.
Fig
ure
3:
da/d
n vs
. �K
for a
ll st
udy
grou
ps.
No
gros
s de
lam
inat
ion
or fr
actu
re o
f the
tibi
al
inse
rts
was
obs
erve
d, a
nd in
sert
s of
bot
h ty
pes
show
ed a
lmos
t lin
ear w
ear.
Furt
her,
the
vita
min
-E-s
tabi
lized
mat
eria
l exh
ibite
d 85
%
redu
ctio
n in
wea
r for
bot
h th
e C
R an
d
PS d
esig
ns (p
< 0
.05,
AN
OVA
).
Fig
ure
4: (
Left)
Wea
r (m
easu
red
as w
eigh
t los
s) o
f con
vent
iona
l UH
MW
PE ti
bial
com
pone
nts
(ope
n sy
mbo
ls) a
nd h
ighl
y cr
ossl
inke
d vi
tam
in-E
-dop
ed
UH
MW
PE ti
bial
com
pone
nts
(sol
id s
ymbo
ls) o
ver a
5-m
illio
n-cy
cle
test
of t
he P
S TK
R de
sign
. (Ri
ght)
Sum
mar
y of
the
all t
he w
ear r
esul
ts.
DIS
CU
SSIO
N:
The
vita
min
E h
ighl
y cr
ossl
inke
d U
HM
WPE
tib
ial b
earin
gs re
duce
d ov
eral
l wea
r by
85% w
hen
com
pare
d to
con
vent
iona
l tib
ial
bear
ings
of t
he s
ame
desi
gn, w
ithou
t any
co
mpr
omis
e (in
deed
, the
re m
ight
hav
e ev
en
been
som
e im
prov
emen
t) in
the
mec
hani
cal
prop
ertie
s of
the
bear
ing
mat
eria
l. Su
ch le
vel
of w
ear r
educ
tion
shou
ld tr
ansl
ate
to w
orth
y cl
inic
al s
igni
fican
ce in
pre
vent
ing
oste
olys
is.
Hig
hly
cros
slin
ked
UH
MW
PE s
tabi
lized
with
vi
tam
in E
app
ears
to b
e pr
omis
ing
for u
se a
s
a be
arin
g su
rfac
e in
TKR
.
PE
RFO
RM
AN
CE
IN M
OTIO
N7
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
79
INA
CC
UR
AC
IES
OR
DIS
TOR
TIO
N
OF
THE
MEA
SURE
MEN
TS:
Inac
cura
cies
or d
isto
rtio
n of
the
mea
sure
-m
ents
can
als
o oc
cur.
The
oper
atin
g ro
om
light
ing
inte
rfer
ence
with
infr
ared
trac
kers
an
d fie
ld d
efor
mat
ion
of e
lect
rom
agne
tic
syst
ems
can
resu
lt fr
om fe
rrom
agne
tic
surg
ical
inst
rum
ents
.
CO
ST O
F N
AV
IGA
TIO
N:
The
incr
ease
d co
st o
f nav
igat
ion
is a
lso
a fa
ctor
of g
reat
inte
rest
and
has
bee
n st
udie
d.
Nov
ak e
t al.
[ 2] d
evel
oped
a d
ecis
ion-
anal
ysis
m
odel
to e
stim
ate
the
cost
-eff
ectiv
enes
s of
na
viga
tion
in T
KA
, and
they
con
clud
ed th
at,
“Co
mp
ute
r-as
sist
ed
su
rge
ry is
po
ten
tial
ly a
co
st-e
ffe
ctiv
e o
r co
st-s
avin
g a
dd
itio
n to
TK
A.
Ho
we
ver,
the
co
st-e
ffe
ctiv
en
ess
is s
en
siti
ve to
va
riab
ility
in t
he
co
st o
f co
mp
ute
r nav
igat
ed
sy
ste
ms,
the
acc
ura
cy o
f alig
nm
en
t ach
ieve
d
wit
h c
om
pu
ter n
avig
atio
n, a
nd
the
pro
bab
ility
o
f a re
visi
on
TK
A w
ith
mal
alig
nm
en
t.”
For S
love
r et a
l. [ 3
] , “C
om
pu
ter n
avig
atio
n
is le
ss li
kely
to b
e a
co
st-e
ffe
ctiv
e tr
eat
me
nt
in h
eal
th c
are
imp
rove
me
nt i
n c
en
ters
wit
h
a lo
w v
olu
me
of j
oin
t re
pla
cem
en
ts, w
he
re
its
be
ne
fit i
s m
ost
like
ly to
be
real
ize
d...
”
CLI
NIC
AL
BEN
EFIT
S A
RE U
NPR
OV
EN!:
Up
to n
ow, t
here
hav
e no
t bee
n st
udie
s do
cum
entin
g im
prov
ed re
sults
usi
ng n
avig
a-tio
n. A
man
uscr
ipt b
y Ba
uwen
s, K
. et a
l. [ 4
] th
at in
clud
ed 3
3 st
udie
s (11
rand
omiz
ed)
and
3423
pat
ient
s sh
owed
that
the
alig
n-m
ent o
f the
mec
hani
cal a
xis
did
not d
iffer
be
twee
n th
e na
viga
ted
and
conv
entio
nal
grou
p. N
avig
ated
gro
ups
had
a lo
wer
risk
of
mal
alig
nmen
t at c
ritic
al th
resh
olds
of >
3° and
>2
° , but
not
>4° . N
o fir
m c
oncl
usio
ns c
ould
be
mad
e on
func
tiona
l out
com
es o
r com
plic
a-tio
n ra
tes,
and
sur
gica
l tim
e w
as le
ngth
ened
(2
3% lo
nger
, on
aver
age)
by
navi
gatio
n. S
ince
no
stu
dies
doc
umen
t bet
ter c
linic
al re
sults
or
few
er c
ompl
icat
ions
, at t
his
time
with
the
curr
ent t
echn
olog
y, sh
ould
nav
igat
ion
be
used
for r
outin
e TK
A?
CO
NC
LUSI
ON
:
Nav
igat
ed o
rtho
paed
ic s
urge
ry re
quire
s ne
w s
kills
and
a le
arni
ng c
urve
, inc
reas
es
oper
atin
g tim
e, a
nd e
nds
up b
eing
mor
e co
stly
. Whi
le it
slig
htly
impr
oves
alig
nmen
t of
the
fem
oral
com
pone
nt in
the
coro
nal
and
sagi
ttal
pla
nes,
it m
ay o
r may
not
im
prov
e th
e tib
ial a
lignm
ent o
r rot
atio
nal
alig
nmen
t of e
ither
com
pone
nt. A
dditi
onal
ly,
base
d on
the
publ
ishe
d st
udie
s ev
alua
ting
the
curr
ent t
echn
olog
y, it
sho
uld
not b
e us
ed fo
r rou
tine
TKA
.
For n
avig
atio
n to
be
a su
cces
sful
app
roac
h fo
r ort
hopa
edic
sur
gery
it m
ust b
e fa
ster
, ea
sier
, che
aper
and
bet
ter,
and
at th
is ti
me
it is
not
. Sin
ce n
o st
udie
s do
cum
ent b
ette
r cl
inic
al re
sults
or f
ewer
com
plic
atio
ns, t
he
man
dato
ry q
uest
ion
rem
ains
: With
the
curr
ent t
echn
olog
y, sh
ould
nav
igat
ion
be
used
for r
outin
e TK
A?
REFE
REN
CES
:
[ 1]
A.Q
. Dut
ton,
S.J
. Yeo
, K.Y.
Yan
g, N
.N.
Lo, K
.U. C
hia
and
H.C
. Cho
ng, “
Com
pute
r-as
sist
ed m
inim
ally
inva
sive
tota
l kne
e ar
thro
plas
ty c
ompa
red
with
sta
ndar
d to
tal k
nee
arth
ropl
asty
. A p
rosp
ectiv
e,
rand
omiz
ed s
tudy
,” J.
Bo
ne
Jo
int S
urg
.A
m.,
vol.
90, p
p. 2
-9, J
an. 2
008.
[ 2] E
.J. N
ovak
, M.D
. Silv
erst
ein
and
K.J
. Boz
ic,
“The
cos
t-eff
ectiv
enes
s of
com
pute
r-as
sist
ed
navi
gatio
n in
tota
l kne
e ar
thro
plas
ty,”
J.B
on
e
Join
t Su
rg.A
m.,
vol.
89, p
p. 2
389-
2397
, N
ov. 2
007.
[ 3] J
.D. S
love
r, A
.N. T
oste
son,
K.J
. Boz
ic,
H.E
. Rub
ash
and
H. M
alch
au, “
Impa
ct
of h
ospi
tal v
olum
e on
the
econ
omic
va
lue
of c
ompu
ter n
avig
atio
n fo
r tot
al
knee
repl
acem
ent,”
J.B
on
e J
oin
t Su
rg.
Am
., vo
l. 90
, pp.
149
2-15
00, J
ul. 2
008.
[ 4] K
. Bau
wen
s, G
. Mat
thes
, M. W
ich,
F.
Geb
hard
, B. H
anso
n, A
. Ekk
ernk
amp
and
D. S
teng
el, “
Nav
igat
ed to
tal k
nee
repl
ace-
men
t. A
met
a-an
alys
is,”
J.B
on
e J
oin
t Su
rg.
Am
., vo
l. 89
, pp.
261
-269
, Feb
. 200
7.
EASI
ER
& B
ETTE
R
& F
AST
ER&
CH
EAPE
R
INTR
OD
UC
TIO
N:
Com
pute
r Aid
ed O
rtho
paed
ic S
urge
ry(C
AO
S)
and
navi
gatio
n te
chno
logy
for a
rthr
opla
sty
has
been
aro
und
for o
ver 2
0 ye
ars.
Whi
le
it m
ay p
rovi
de fe
wer
out
liers
in im
plan
t al
ignm
ent c
ompa
red
to c
onve
ntio
nal j
igs,
on
ly a
ver
y sm
all p
erce
ntag
e of
ort
hopa
edic
su
rgeo
ns in
the
USA
hav
e ad
opte
d na
viga
-tio
n. T
his
pape
r spe
cula
tes
on th
e re
ason
s w
hy n
avig
atio
n ha
s no
t tak
en o
ff, a
nd w
hy it
m
ay n
ot b
e re
ady
for e
xten
sive
use
in 2
010.
Som
e of
the
reas
ons
liste
d in
this
pap
er a
re
not (
yet)
supp
orte
d by
pee
r rev
iew
ed li
tera
ture
, as
no
dire
ctly
-sup
port
ing
liter
atur
e co
uld
be
foun
d; h
owev
er, t
hey
are
real
and
we
men
tion
them
her
e be
caus
e th
ey a
re re
leva
nt to
wha
t m
any
surg
eons
act
ually
do
and
feel
dur
ing
tota
l kne
e re
plac
emen
t (TK
A) s
urge
ry.
AN
ATO
MIC
INVA
SIV
ENES
S:
The
plac
emen
t of p
ins
to h
old
navi
ga-
tion
refe
renc
e fr
ames
infli
cts
dam
age
to
soft
tiss
ue/m
uscl
e an
d to
the
bone
itse
lf,
rais
ing
stre
ss a
nd in
crea
sing
risk
of f
utur
e fr
actu
re. A
n ex
ampl
e of
this
can
be
seen
in
Fig
ure
1 (b
elow
), in
whi
ch a
n el
derly
fe
mal
e su
ffer
ed a
late
ral c
ondy
le fr
actu
re
thro
ugh
the
hole
left
by
a pi
n pl
aced
for t
he
navi
gatio
n re
fere
nce
fram
e. It
is a
spe
cific
co
mpl
icat
ion
dire
ctly
rela
ted
to n
avig
atio
n.
CA
OS
OR
CH
AO
S!:
It is
qui
te p
ossi
ble
that
sur
geon
s an
d st
aff g
et
in th
e w
ay o
f the
infr
a re
d tr
acke
r tha
t tak
es
foot
prin
t spa
ce, a
s it
need
s lin
e of
site
acc
ess.
Th
ere
are
othe
r sub
tle b
ut re
al p
robl
ems,
suc
h as
incr
ease
d ris
k of
infe
ctio
n an
d di
stra
ctio
n of
the
surg
ical
team
, etc
.
LON
GER
SU
RGIC
AL
TIM
E:
Surg
ical
tim
e ca
n in
crea
se b
ecau
se o
f te
stin
g an
d se
ttin
g up
of t
he s
yste
m b
efor
e th
e su
rger
y, re
gist
ratio
n/ca
libra
tion
of th
e na
viga
ted
jigs
and
inst
rum
ents
, dig
itiza
tion
of th
e bo
nes,
bon
e re
gist
ratio
n, ti
me
deal
ing
with
the
syst
em u
ser i
nter
face
to m
ove
to th
e ne
xt s
cree
n, a
nd o
ther
s.
Dut
ton
et a
l. [1
] eva
luat
ed 1
08 c
onse
cutiv
e ra
ndom
ized
pat
ient
s. C
AO
S av
erag
es 1
07
min
utes
ver
sus
83 m
inut
es fo
r con
vent
iona
l TK
A (p
<0.0
01).
The
diff
eren
ce in
tim
e ad
ds
up o
ver t
he c
ours
e of
a d
ay in
the
OR
and
it eq
uate
s to
1-2
few
er s
urge
ries
per d
ay.
MO
RE (N
OT
LESS
) IN
STRU
MEN
TATI
ON
IS N
EED
ED:
Inst
ead
of s
impl
ifyin
g su
rger
y by
redu
cing
th
e nu
mbe
r of i
nstr
umen
ts, n
ew in
stru
men
ta-
tion
is a
dded
(e.g
. poi
nter
/sty
lus,
nav
igat
ed
alig
nmen
t too
ls, e
tc.).
Mor
eove
r, if
the
surg
ery
need
s to
be
conv
erte
d to
con
vent
iona
l (e.
g.
due
to fa
tal n
avig
atio
n sy
stem
failu
re),
the
conv
entio
nal s
et o
f man
ual j
igs
has
to b
e av
aila
ble
anyw
ay.
NA
VIG
ATI
ON
: MO
RE C
OM
PLEX
?:
Incr
ease
d in
stru
men
tatio
n m
akes
the
surg
ery
mor
e co
mpl
ex a
nd th
e le
arni
ng c
urve
is s
igni
fi-ca
nt. P
rope
r use
of n
avig
atio
n of
ten
requ
ires
know
ledg
e of
the
corr
ect a
nato
mic
land
mar
ks,
adds
mor
e st
eps
and
diff
eren
t ins
trum
ents
, an
d in
trod
uces
a n
ew le
arni
ng c
urve
.
ARE
MO
RPH
ED/G
ENER
ATE
D
BON
ES A
CC
UR
ATE
?:
Som
e co
ncer
ns h
ave
been
rais
ed a
bout
th
e ac
cura
cy o
f mor
phed
/gen
erat
ed b
one
mod
els.
Mos
t nav
igat
ion
syst
ems
are
non-
imag
e ba
sed,
and
they
use
mor
phed
bon
e m
odel
s as
vis
ual a
ids.
The
se m
odel
s as
sum
e no
n-de
form
ed a
nato
my,
and
the
surg
eon
may
nee
d to
go
agai
nst t
he c
ompu
ter’s
su
rgic
al p
lan
in th
e ca
se o
f a p
atie
nt w
ith
abno
rmal
ana
tom
y.
��
��
��
��
��
���
�������
NAV
IGAT
ION
IN T
KA
: ARG
UM
ENTS
AG
AIN
ST^
THE
USE
OF
NA
VIG
ATI
ON
.G
arv
in, K
.L.;
Ba
rrer
a, O
.A.;
an
d H
aid
er, H
.
PE
RFO
RM
AN
CE
IN M
OTIO
N7
8
Fig
ure
1
Fig
ure
2: T
he o
verl
appi
ng m
iddl
e sh
ould
be
the
desi
red
targ
et fo
r req
uire
men
ts fo
r na
viga
tion
to b
e a
succ
essf
ul a
ppro
ach.
PE
RFO
RM
AN
CE
IN M
OTIO
N8
0U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
81
ASS
ESSM
ENT
OF
OR
THO
PAE
DIC
SU
RG
EON
S’
DEX
TERI
TY ( H
AN
D-S
KILL
S):
A N
EW T
ECH
NO
LOG
Y BO
RN IN
NEB
RA
SKA
, TE
STED
ON
RES
IDEN
TSB
arr
era
, O.A
.; H
art
ma
n, C
.W.;
Ko
nig
sber
g, B
.S.;
Ga
rvin
, K.L
; an
d H
aid
er, H
.
INTR
OD
UC
TIO
N:
The
hand
ski
ll of
the
surg
eon
whi
le c
uttin
g bo
ne d
urin
g ar
thro
plas
ty is
an
impo
rtan
t fac
tor w
hich
influ
ence
s su
rgic
al o
utco
me.
A s
killf
ully
-per
form
ed
surg
ery
is 7
5% d
ecis
ion
mak
ing
and
25% d
exte
rity
[ 1] .
For s
ome
spec
ialti
es, s
uch
as a
rthr
opla
sty
(and
esp
ecia
lly m
inim
ally
inva
sive
sur
gery
), de
xter
ity
beco
mes
eve
n m
ore
impo
rtan
t [2]
. Cur
rent
sur
gica
l ski
ll as
sess
men
t met
hods
hav
e ye
t to
mat
ure,
and
tend
to re
quire
add
ition
al in
stru
men
tatio
n,
cost
and
tim
e. T
hose
issu
es c
an b
e ov
erco
me,
how
ever
, by
a no
vel m
etho
d w
e pr
opos
e he
re w
hich
qua
ntita
tivel
y an
d th
ree-
dim
ensi
onal
ly re
cord
s th
e m
otio
n of
sur
gica
l ins
trum
enta
tion
for t
he p
urpo
se o
f doc
umen
tatio
n, s
urgi
cal-s
kill
asse
ssm
ent,
and
safe
ty a
naly
sis.
Tar
getin
g si
mila
r obj
ectiv
es
to [3
], th
e m
etho
d pr
opos
ed in
this
stu
dy u
ses
an e
xist
ing
Com
pute
r Aid
ed O
rtho
pedi
c Su
rger
y (C
AO
S) n
avig
atio
n sy
stem
with
out c
ompr
omis
ing
its re
al-ti
me
trac
king
, ren
derin
g, o
r sim
ulat
ion
func
tions
. The
sto
red
data
can
be
play
ed b
ack
as a
real
istic
3D
sim
ulat
ion
of th
e co
mpl
ete
bone
cu
ttin
g/re
finin
g pr
oces
s. T
he d
imen
sion
al a
ccur
acy
of th
is te
chni
que
and
its s
ensi
tivity
had
bee
n pr
evio
usly
val
idat
ed b
y tr
acki
ng s
urgi
cal i
nstr
u-m
enta
tion
atta
ched
to a
robo
tic a
rm w
hich
ser
ved
as a
relia
ble
actu
ator
and
mov
ed th
e in
stru
men
tatio
n al
ong
cont
rolle
d pa
ths
[ 4] .
In th
is s
tudy
, in
stea
d of
eva
luat
ing
the
mot
ions
of t
he ro
bot,
the
syst
em w
as u
sed
to e
valu
ate
the
surg
ical
ski
lls o
f act
ual o
rtho
paed
ic re
side
nts
in o
ur h
ospi
tal.
MA
TERI
ALS
AN
D M
ETH
OD
S:
Two
chie
f ort
hopa
edic
sur
gery
resi
dent
s w
ere
requ
ired
to c
ut th
e fiv
e di
stal
cut
s on
eig
ht s
ynth
etic
fem
urs
to a
ccom
mod
ate
the
sam
e TK
R fe
mor
al
impl
ant.
They
use
d an
in-h
ouse
bui
lt na
viga
tion
syst
em th
at fa
cilit
ates
nav
igat
ed fr
eeha
nd b
one
cutt
ing
(NFC
) [5]
. The
3D
mot
ion
of th
e su
rgic
alto
ol, w
hich
in th
is c
ase
was
an
osci
llatin
g sa
w, w
as re
cord
ed in
real
tim
e by
the
navi
gatio
n sy
stem
dur
ing
the
who
le p
roce
dure
. The
sub
ject
s w
ere
no
t aw
are
of th
e m
otio
n re
cord
ing
proc
ess,
bec
ause
the
mai
n go
al o
f the
exp
erim
ent w
as to
max
imiz
e re
liabi
lity
and
obje
ctiv
ity o
f the
resu
lts. T
he
mai
n bo
dy o
f the
reco
rded
dat
a w
as a
seq
uenc
e of
tim
e-st
ampe
d 3D
pos
ition
and
orie
ntat
ion
coor
dina
tes
for a
ll na
viga
ted
obje
cts
incl
udin
g th
e bo
nes
and
the
rele
vant
cut
ting
inst
rum
ents
.
The
reco
rded
dat
a w
as p
ost-p
roce
ssed
and
ana
lyze
d to
ass
ess
the
follo
win
g pa
ram
eter
s:
���
Cu
ttin
g ti
me
(s):
This
cha
ract
eriz
ed d
iffer
ent a
spec
ts o
f the
bon
e re
shap
ing
proc
ess,
suc
h as
tim
e fo
r cut
ting
each
fem
oral
pla
nar c
ut, t
ime
for
refin
emen
t of a
n in
divi
dual
cut
(e.g
. for
bet
ter i
mpl
ant fi
t), a
nd o
vera
ll to
tal t
ime.
���
Are
a/c
utt
ing
tim
e r
atio
(mm
2/ s)
: Rat
io o
f the
are
a of
eac
h su
rfac
e cu
t (m
easu
red
on th
e vi
rtua
l mod
el o
f the
bon
e, a
ccor
d in
g to
the
impl
ant’s
id
eal l
ocat
ion
durin
g pl
anni
ng) o
ver m
easu
red
time
spen
t cut
ting
it. T
his
ratio
is s
ome
mea
sure
of e
ffici
ency
.
���
Len
gth
of t
he
traj
ect
ory
of t
he
saw
(mm
): C
alcu
late
d as
the
sum
of t
he le
ngth
s of
all
cons
ecut
ive
segm
ents
(dis
tanc
es) b
etw
een
cons
ecut
ive
re
cord
ed 3
D p
ositi
ons
of th
e sa
w.
���
Erro
rs in
dis
tan
ce o
ffse
t fro
m t
he
de
sire
d p
lan
e, r
oll
and
pit
ch a
ng
les
(mm
or d
eg
.): C
alcu
late
d fo
r eac
h cu
ttin
g su
rfac
e, a
s sh
own
in F
ig. 1
.
���
Dis
tan
ce a
lon
g th
e fe
ed
axi
s (m
m):
Cal
cula
ted
as th
e di
stan
ce o
f the
tip
of th
e sa
w re
lativ
e to
the
begi
nnin
g of
eac
h cu
t alo
ng th
e fe
ed a
xes
at
ev
ery
sing
le in
stan
ce (d
y' in
Fig
. 1),
depe
ndin
g on
wha
t pla
nar a
rea
was
bei
ng c
ut a
t a p
artic
ular
tim
e.
The
data
ana
lysi
s w
as p
erfo
rmed
with
spe
cial
ly-p
rogr
amm
ed c
ompu
tatio
nal r
outin
es in
Mat
lab®
v7.4
.0 (R
2007
a) a
nd M
icro
soft
® E
xcel
® , an
d SP
SS®
v17.
0 fo
r add
ition
al s
tatis
tics.
RESU
LTS:
The
aver
age
stor
ed fi
le s
ize
(with
out
com
pres
sion
) for
all
8 pr
oced
ures
was
onl
y 2.
73 M
b. N
o si
gnifi
cant
diff
eren
ce b
etw
een
the
two
subj
ects
was
foun
d on
act
ual b
one
cutt
ing
time
(mea
n 53
1s v
s. 6
42s,
p=0
.099
), bu
t Sub
ject
1 (S
1) w
as fa
ster
than
Sub
ject
2
(S2)
in to
tal t
ime,
whi
ch in
clud
ed c
uttin
g,
resh
apin
g of
the
bone
, and
impl
anta
tion
(mea
n 71
9s v
s. 9
58 s,
p=0
.035
). Su
rfac
e ar
ea/t
ime
ratio
reve
aled
mar
gina
lly (b
ut n
ot
sign
ifica
ntly
) hig
her c
uttin
g ef
ficie
ncy
for
S1 c
ompa
red
to S
2 (m
ean
16 m
m2/
s vs.
13
mm
2/s , p
=0.0
84).
The
anal
ysis
did
, how
ever
, sh
ow s
igni
fican
t diff
eren
ce in
the
post
erio
r ch
amfe
r cut
(mea
n 9
vs. 5
mm
2/s ,
p=0.
015)
. Th
e an
alys
is o
f tra
ject
ory
of th
e sa
w s
how
ed
less
eco
nom
y of
mot
ion
and
less
con
sist
ency
fo
r S1
com
pare
d to
S2
(ave
rage
tota
l len
gth
of tr
ajec
tory
was
8.6
m, s
d=2.
1m v
s. 8.1
m,
sd=0
.4m
), an
d lo
nger
pat
hs in
bet
wee
n cu
ts
(ave
rage
39%
vs.
33% o
f the
tota
l tra
ject
ory)
.
DIS
CU
SSIO
N:
The
smal
l and
thus
ver
y m
anag
eabl
e st
ored
da
ta fi
le s
ize
had
resu
lted
from
reco
rdin
g co
here
nt ti
me
and
vect
or in
form
atio
n as
op
pose
d to
the
larg
e, c
umbe
rsom
e an
d in
co-
here
nt s
eque
nce
of d
igita
l im
ages
ass
ocia
ted
with
vid
eo re
cord
ing
tech
niqu
es c
omm
on
in th
is fi
eld.
The
coh
eren
ce te
rm u
sed
here
is
inte
nded
to m
ean
the
ease
of a
utom
atic
(m
athe
mat
ical
) pro
cess
ing
and
inte
rpre
ta-
tion
of th
e da
ta. T
he n
umer
ical
dat
a he
re w
as
easy
to a
naly
ze c
ompu
tatio
nally
and
inte
rpre
t w
ith s
tatis
tical
tool
s, w
ithou
t a h
uge
burd
en
of h
uman
man
ual (
e.g.
vid
eo) a
naly
sis.
The
in
corp
orat
ion
of d
ata
logg
ing
and
anal
ysis
ro
utin
es n
eith
er c
ompr
omis
ed q
ualit
y no
r fre
-qu
ency
of t
he C
AO
S sy
stem
real
-tim
e tr
acki
ng,
rend
erin
g or
sim
ulat
ion
func
tions
. The
sys
tem
an
d m
etho
ds c
hara
cter
ized
diff
eren
t sub
ject
s w
ithou
t add
ition
al in
stru
men
tatio
n, c
ost,
time,
aw
aren
ess
of (o
r dis
trac
tion
to) t
he u
ser.
This
met
hod
can
also
be
used
to c
hara
cter
ize
diff
eren
t sur
gica
l tec
hniq
ues
or o
pera
ting
room
effi
cien
cy. F
or e
xam
ple,
obs
ervi
ng th
e tim
e sp
ent a
t diff
eren
t loc
atio
ns a
long
the
feed
ing
axis
indi
cate
d th
at s
igni
fican
t tim
e w
as (c
onsi
sten
tly) s
pent
at t
he in
itiat
ion
of
each
cut
(Fig
. 2),
impl
ying
that
use
rs h
ad
mor
e di
fficu
lty c
reat
ing
the
initi
al g
roov
e in
the
bone
whe
n cu
ttin
g fr
eeha
nd.
The
vast
am
ount
of c
ompu
ter-
logg
ed d
ata
poss
ible
from
nav
igat
ion
syst
ems
in s
urge
ry
is u
ntap
ped
and
yet t
o be
fully
util
ized
. As
navi
gatio
n be
com
es m
ore
popu
lar i
n su
rger
y, m
ore
than
just
loca
tion
of b
one,
in
stru
men
ts, a
nd ji
gs c
an b
e lo
gged
. Bey
ond
docu
men
tatio
n an
d an
alys
is o
f sur
gica
l sk
ills,
the
data
can
be
used
for t
rain
ing
and
optim
izat
ion
of b
one-
cutt
ing
appr
oach
es
and
who
le s
urgi
cal p
lans
, as
wel
l as
inpu
t for
ro
botic
s (te
achi
ng th
e ro
bot w
here
/how
to
cut).
It c
an a
lso
be u
sed
to c
ompa
re d
iffer
-en
t sur
gica
l tec
hniq
ues
for l
ater
cor
rela
tion
with
long
term
clin
ical
out
com
e re
sults
.
Fig
ure
1: C
alcu
latio
n of
ang
ular
and
off
set e
rror
s. A
n au
xilia
ry a
xis
on e
ach
plan
e (w
hite
) is
used
to
cal
cula
te o
ffse
t err
ors
in d
ista
nces
(dz')
and
dis
tanc
e al
ong
the
feed
ing
axes
(dy')
, as
wel
l as
the
saw
’s ro
tatio
nal (
angu
lar)
erro
rs.
Fig
ure
2: D
istr
ibut
ion
of ti
me
spen
t on
each
cut
. The
bar
cha
rt s
how
s av
erag
ed c
uttin
g tim
e sp
ent
at d
iffer
ent s
tage
s of
cut
ting,
alo
ng th
e fe
edin
g ax
is.
Ass
essm
ent o
f a la
rger
num
ber o
f sub
ject
s sh
ould
hel
p es
tabl
ish
quan
titat
ive
acce
p-ta
nce
thre
shol
ds. H
as th
e tim
e co
me
for
“qua
lity”
to b
e au
tom
atic
ally
and
dyn
amic
ally
lo
gged
in o
rtho
paed
ic s
urge
ry?
REFE
REN
CES
:
[ 1] S
penc
er F
: “Te
achi
ng a
nd m
easu
ring
surg
ical
tech
niqu
es: t
he te
chni
cal e
valu
atio
n of
com
pete
nce.
” Bu
ll A
me
r Co
ll Su
rg 1
978;
63
: 9-1
2.
[ 2] D
arzi
et a
l.: “A
sses
sing
ope
rativ
e sk
ill
need
s to
bec
ome
mor
e ob
ject
ive.
” BM
J, 19
99
Apr
3; 3
18(7
188)
887
-888
.
[ 3] C
ondi
tt, N
oble
et a
l.: “A
com
pute
rized
bi
oski
lls s
yste
m fo
r sur
gica
l ski
lls tr
aini
ng in
to
tal k
nee
repl
acem
ent.”
Pro
c. In
st. M
ech
. En
g.
[ H] ,
2007
, 221
, 1, 6
1-69
, Eng
land
.
[ 4] B
arre
ra e
t al.:
“Va
lidat
ion
with
robo
tics
of d
ocum
enta
tion
and
anal
ysis
of s
urgi
cal
skill
s th
roug
h re
al-ti
me
mot
ion
reco
rdin
g of
nav
igat
ed a
rthr
opla
sty
inst
rum
ents
” O
RS 2
008.
[ 5] H
aide
r et a
l.: “M
inim
ally
inva
sive
tota
l kn
ee a
rthr
opla
sty
surg
ery
thro
ugh
navi
gate
d fr
eeha
nd b
one
cutt
ing:
win
ner o
f the
200
5 “H
AP
Paul
Aw
ard.
” J. A
rth
rop
last
y, 2
007,
22, 4
, 53
5-54
2, U
nite
d St
ates
.
PE
RFO
RM
AN
CE
IN M
OTIO
N8
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
83
SEC
TIO
N
04
DEP
ART
MEN
T O
F O
RTH
OPA
ED
IC S
UR
GE
RY
AN
D R
EH
AB
ILIT
ATI
ON
Your
feed
back
cou
nts.
Sim
ply
go to
ww
w.U
NM
CO
rtho
InM
otio
n.co
m
PE
RFO
RM
AN
CE
IN M
OTIO
N8
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
85
VISI
TIN
G
SPE
AK
ERS
EN
HA
NC
E R
ESID
ENT
EDU
CAT
ION
EAC
H Y
EAR
THE
DEPA
RTM
EN
T O
F O
RTH
OPA
ED
IC S
UR
GER
Y A
ND
REH
ABI
LITA
TIO
N H
OST
S SE
VER
AL
VISI
TIN
G S
PEA
KERS
WH
O P
RESE
NT
SEM
INA
RS
FOR
ORT
HO
PAED
IC F
ACU
LTY,
RES
IDEN
TS, S
TAFF
, AN
D P
RAC
TIC
ING
SU
RGEO
NS
IN T
HE
ARE
A. B
RIN
GIN
G IN
SPE
AKE
RS W
HO
SH
ARE
TH
EIR
KNO
WLE
DG
E
AN
D E
XPER
TISE
ON
A V
ARI
ETY
OF
TOPI
CS
IS A
LA
RGE
PART
OF
PRO
VID
ING
A
WEL
L-RO
UN
DED
ED
UC
ATIO
NA
L EX
PERI
ENC
E FO
R O
UR
RESI
DEN
TS. P
RIVA
TE
CO
NTR
IBU
TIO
NS
FRO
M A
LUM
NI A
ND
FRI
END
S TO
TH
E D
EPA
RTM
ENT’
S
DEV
ELO
PMEN
T FU
ND
ALL
OW
US
TO C
ON
TIN
UE
TO B
RIN
G G
UES
T SP
EAKE
RS
WH
O O
FFER
NEW
AN
D IN
NO
VATI
VE ID
EAS
IN S
URG
ICA
L TE
CH
NIQ
UES
, RES
EARC
H
TOPI
CS,
AN
D P
ATIE
NT
CA
RE.
JAN
UA
RY 2
8, 2
008
Eri
k O
tter
ber
g, M
.D.
GIK
KO
mah
a, N
E“A
vasc
ular
Nec
rosi
s of
the
Hip
”
FEBR
UA
RY 4
, 200
8C
ha
d V
oko
un
, M.D
.U
NM
C In
tern
al M
edic
ine
Om
aha,
NE
“Sur
gica
l Cle
aran
ce”
MA
RCH
14,
200
8K
lau
s D
raen
ert,
M.D
., P
h.D
.Te
chni
cal U
nive
rsity
of M
unic
hZO
W C
ente
r of O
rtho
paed
ic S
cien
ces
Mun
ich,
Ger
man
y“A
utol
ogou
s O
steo
chon
dral
Tra
nspl
anta
tion”
APR
IL 1
0, 2
008
Dr.
Kyl
e D
icks
on
Uni
vers
ity o
f Tex
as M
edic
al S
choo
l at H
oust
onH
oust
on, T
X“A
ceta
bulu
m a
nd P
elvi
c M
alun
ions
and
N
onun
ions
: Fro
m S
tart
to F
inis
h”
MAY
12,
200
8D
r. Iv
an
Ta
rkin
Uni
vers
ity o
f Pitt
sbur
ghPi
ttsb
urgh
, PA
“Pilo
n Fr
actu
res”
MAY
19,
200
8D
r. J
oh
n M
cCle
llan
Neb
rask
a Sp
ine
Cen
ter
Om
aha,
NE
“Tra
umat
ic S
pine
Fra
ctur
es”
JUN
E 27
-28,
200
8 O
rth
op
aed
ic G
rad
ua
tio
n
Dr.
Ja
mes
Go
ule
tU
nive
rsity
of M
ichi
gan
Ann
Arb
or, M
I“F
ract
ures
of t
he D
ista
l Tib
ia: O
ur B
igge
st
Cha
lleng
e?”
“Tra
umat
olog
ists
and
(gas
p!) H
ip
Repl
acem
ents
. Is
ther
e a
Role
for A
rthr
opla
sty
for A
cute
Fra
ctur
es?”
AU
GU
ST 8
, 200
8D
r. A
nd
rea
s H
. Go
mo
llBr
igha
m a
nd W
omen
’s H
opsi
tal
Bost
on, M
A“S
TAR:
An
Inno
vativ
e A
ppro
ach
to th
e Tr
eatm
ent o
f Car
tilag
e D
efec
ts”
Dr.
Lesl
ie W
olf
eV
P C
ellu
lar T
hera
pies
Gen
zym
e C
orpo
ratio
n“S
cien
ce a
nd M
anuf
actu
ring
Car
ticel
”
AU
GU
ST 1
4, 2
008
Co
lon
el K
ory
Co
rnu
m, M
.D.
Air
Com
bat C
omm
and
Surg
eon
U.S
. Air
Forc
e“M
oder
n W
artim
e Ex
trem
ity C
are”
SEPT
EMBE
R 8,
200
8D
r. S
cott
Ho
fma
nn
Dep
t. of
Ane
sthe
siol
ogy,
UN
MC
Om
aha,
NE
“Reg
iona
l Ane
sthe
sia”
SEPT
EMBE
R 15
, 200
8A
my
Lon
go
Ellic
k, Jo
nes,
Bue
lt, B
laze
k &
Lon
goO
mah
a, N
E“M
edic
oleg
al Is
sues
in O
rtho
paed
ics”
OC
TOBE
R 27
, 200
8D
r. E
liza
beth
Th
om
pso
nD
ept o
f Onc
olog
y, U
NM
CO
mah
a, N
E“C
hem
othe
rapy
in M
uscu
losk
elet
al O
ncol
ogy”
NO
VEM
BER
3, 2
008
Mr.
Ja
mes
Am
bro
seW
ealth
Man
agem
ent A
dvis
or/M
erril
l Lyn
chO
mah
a, N
E“F
inan
cial
and
Est
ate
Plan
ning
Cha
lleng
es fo
r th
e Yo
ung
Phys
icia
n”
JAN
UA
RY 1
9, 2
009
Dr.
Tim
oth
y B
urd
Neb
rask
a Sp
ine
Cen
ter
Om
aha,
NE
“Tre
atm
ents
for D
egen
erat
ive
Dis
c D
isea
se”
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T8
5P
ER
FO
RM
AN
CE
IN M
OTIO
N8
4
Left
to
rig
ht:
Dr.
Kevi
n G
arv
in, c
ha
ir o
f O
rth
op
aed
ic S
urg
ery
, wit
h O
ma
ha
ph
ilan
thro
-
pis
t R
uth
Sco
tt, a
nd
Dr.
La
wre
nce D
orr
, fo
un
der
an
d m
ed
ica
l dir
ecto
r o
f Th
e D
orr
Art
hri
tis
Inst
itu
te, a
s w
ell
as
fou
nd
er
of O
pera
tio
n W
alk
. Dr.
Do
rr w
as
the d
ep
art
men
t’s
20
09
gra
du
ati
on
gu
est
sp
ea
ker.
PE
OP
LE IN
MO
TIO
N
PE
RFO
RM
AN
CE
IN M
OTIO
N8
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
87
OC
TOBE
R 19
, 200
9D
r. L
on
Kei
mPu
lmon
olog
y, TN
MC
Om
aha,
NE
“Hyp
erba
ric O
xyge
n Tr
eatm
ent o
f Wou
nds
and
Infe
ctio
ns”
OC
TOBE
R 26
, 200
9B
urt
on
Pro
sth
eti
csO
mah
a, N
E“O
rtho
paed
ic P
rost
hesi
s”
NO
VEM
BER
2, 2
009
Dr.
Ted
Mik
uls
UN
MC
Inte
rnal
Med
icin
e, R
heum
atol
ogy
Om
aha,
NE
“Cry
stal
line
Art
hrop
last
y”
NO
VEM
BER
16, 2
009
Resi
den
t R
ese
arc
h F
oru
m
Dr.
To
dd
McK
inle
yU
nive
rsity
of I
owa
Hos
pita
ls a
nd C
linic
sIo
wa
City
, Iow
a“A
rtic
ular
frac
ture
s: A
bas
ic s
cien
tific
pe
rspe
ctiv
e”
NO
VEM
BER
20, 2
009
Dr.
Ch
ris
Co
rnett
Uni
vers
ity o
f Wis
cons
inM
adis
on, W
isco
nsin
“Cer
vica
l Mye
lopa
thy”
NO
VEM
BER
25, 2
009
Dr.
Cyn
thia
Fer
ris
UN
MC
Ane
sthe
siol
ogy
Om
aha,
NE
“Sed
atio
n” N
OV
EMBE
R 30
, 200
9D
r. D
avi
d B
row
nO
rtho
Wes
t, PC
Om
aha,
NE
“A
rtic
ular
Car
tilag
e In
jurie
s”
DEC
EMBE
R 7,
2009
Dr.
Jo
hn
McC
lella
nN
ebra
ska
Spin
e C
ente
rO
mah
a, N
E“D
egen
erat
ive
Spon
dylo
listh
esis
”
DEC
EMBE
R 21
, 200
9D
r. J
am
es
Dev
ney
Neb
rask
a Sp
ine
Cen
ter
Om
aha,
NE
“Dia
gnos
is a
nd N
onop
erat
ive
Trea
tmen
t of
Back
Pai
n”
FEBR
UA
RY 1
6, 2
009
Da
rcy
Mill
erM
edic
al S
ocia
l Wor
ker/
TNM
CO
mah
a, N
E“M
anda
tory
Rep
ortin
g”
MA
RCH
4, 2
009
Dr.
Gre
go
ry D
um
an
ian
Nor
thw
este
rn U
nive
rsity
Chi
cago
, IL
“Rob
otic
Arm
”
MA
RCH
19,
200
9D
r. T
on
ey R
uss
ell
Cam
pbel
l Clin
icU
nive
rsity
of T
enne
ssee
Mem
phis
, TN
“The
Evo
lutio
n of
the
Lock
ing
Plat
e an
d M
IS
Tech
nolo
gy”
MA
RCH
30,
200
9D
r. E
rik
Ott
erb
erg
GIK
KO
mah
a, N
E“C
ompl
icat
ions
in T
KA”
JUN
E 26
-27,
2009
O
rth
op
aed
ic G
rad
ua
tio
n
Dr.
La
wre
nce
Do
rr
The
Dor
r Art
hriti
s In
stitu
teLo
s A
ngel
es, C
A“M
edic
ine,
My
Med
icin
e”“O
rtho
pedi
c A
ntito
xin”
Ma
rk G
ilber
tSc
ottis
h po
rtra
it ar
tist
Art
ist-i
n-re
side
nce,
UN
MC
(2 y
rs)
“Art
and
Med
icin
e”
JULY
20,
200
9 Sa
nd
i An
der
son
UN
MC
Phy
sici
ans
Om
aha,
NE
“Doc
umen
tatio
n/Bi
lling
Com
plia
nce”
AU
GU
ST 2
7, 2
009
Dr.
Da
vid
Ste
ph
enSu
nnyb
rook
Hea
lth S
cien
ces
Cen
tre
Toro
nto,
Ont
ario
, Can
ada
“The
Acu
te a
nd D
efini
tive
Man
agem
ent o
f Pe
lvic
Rin
g D
isru
ptio
ns”
SEPT
EMBE
R 14
, 200
9D
r. A
ng
ela
Hew
lett
UN
MC
, Inf
ectio
us D
isea
ses
Om
aha,
NE
“Mus
culo
skel
etal
Infe
ctio
ns”
FEBR
UA
RY 2
2, 2
010
Dr.
Sco
tt M
cMu
llen
GIK
KO
mah
a, N
E
“Cha
rcot
Art
hrop
last
y”
MA
RCH
24,
201
0D
r. M
ark
Pu
ccio
ni
Mid
wes
t Neu
rosu
rger
y &
Spi
ne S
peci
alis
ts“N
euro
surg
ical
Issu
es in
Ped
iatr
ic
Ort
hopa
edic
s”
APR
IL 7,
201
0D
r. A
da
m R
ein
ha
rdt
Chi
ldre
n’s
Hos
pita
l & M
edic
al C
ente
rO
mah
a, N
E“P
edia
tric
Rhe
umat
olog
y”
APR
IL 1
2, 2
010
Dr.
Da
vid
Ind
aG
IKK
Om
aha,
NE
“Ach
illes
Ten
don
Rupt
ures
”
MAY
3, 2
010
Dr.
Eri
k O
tter
ber
gG
IKK
Om
aha,
NE
“Man
agem
ent o
f Kne
e A
rthr
itis
with
out T
KA”
MAY
17,
2010
Dr.
Tim
Fit
zgib
bo
ns
GIK
KO
mah
a, N
E“F
oot I
njur
ies
in th
e C
olle
giat
e A
thle
te”
JUN
E 18
-19,
201
0 O
rth
op
aed
ic G
rad
ua
tio
n
Dr.
Bri
an
D. A
da
ms
Uni
vers
ity o
f Iow
aIo
wa
City
, IA
“Evo
lutio
n of
Ort
hope
dic
Impl
ants
Use
d in
H
and
Surg
ery”
“Wris
t Art
hriti
s –
Expa
ndin
g Tr
eatm
ent
Opt
ions
”
JUN
E 24
, 201
0D
r. B
ria
n C
ole
Rush
Uni
vers
ityC
hica
go, I
L“C
artil
age
tran
spla
ntat
ion
(kne
e)”
Gift
s fr
om o
rtho
paed
ic a
lum
ni a
nd fr
iend
s,
foun
datio
ns a
nd c
orpo
ratio
ns, a
nd d
epar
t-m
ent f
acul
ty, a
ll su
ppor
t the
dep
artm
ent’s
m
issi
on b
y pr
ovid
ing
vita
l res
ourc
es fo
r re
side
nt e
duca
tion,
sci
entifi
c re
sear
ch, a
nd
vario
us o
ther
pro
gram
s w
ithin
the
depa
rt-
men
t. Pr
ivat
e gi
fts
mak
e a
day-
to-d
ay
diff
eren
ce in
the
educ
atio
nal o
ppor
tuni
ties
we
are
able
to p
rovi
de fo
r our
ort
hopa
edic
re
side
nts,
the
cutt
ing-
edge
rese
arch
we
perf
orm
in o
ur la
bora
torie
s, a
nd th
e ex
celle
nt
trea
tmen
t we
are
able
to o
ffer
our
pat
ient
s.
Som
e pe
ople
cho
ose
to s
uppo
rt th
e de
part
-m
ent’s
ann
ual f
und
(dep
artm
ent-w
ide
fund
) th
at is
use
d pr
imar
ily fo
r res
iden
t edu
catio
n;
othe
rs c
hoos
e to
spe
cify
thei
r gift
to b
e ut
ilize
d fo
r sch
olar
ship
s, re
sear
ch, l
ibra
ry re
sour
ces,
or
labo
rato
ry e
quip
men
t, fo
r exa
mpl
e.
The
follo
win
g ho
nor r
oll l
ists
the
nam
es o
f in
divi
dual
s an
d or
gani
zatio
ns th
at s
uppo
rted
th
e D
epar
tmen
t of O
rtho
paed
ic S
urge
ry
Reha
bilit
atio
n du
ring
the
cale
ndar
yea
rs
2008
and
200
9.
On
beha
lf of
the
depa
rtm
ent’s
facu
lty,
resi
dent
s, s
taff,
and
pat
ient
s w
ho b
enefi
t fr
om y
our p
rivat
e co
ntrib
utio
ns, w
e ex
tend
ou
r mos
t sin
cere
than
ks fo
r you
r vita
l sup
port
.
$10,0
00
an
d a
bo
ve
Mar
k E.
Die
tric
h, M
.D.
Paul
W. E
spos
ito, M
.D.
Edw
ard
V. F
ehrin
ger,
M.D
.Ke
vin
L. G
arvi
n, M
.D.
Lesl
ie A
. Gus
e, M
.D.
Bria
n P.
Has
ley,
M.D
.M
arjo
rie H
ood
Ant
hony
J. L
aude
r, M
.D.
Mat
thew
A. M
orm
ino,
M.D
.N
. Ake
Nys
trom
, M.D
.Lo
ri K
. Ree
d, M
.D.
$5
,00
0 -
$9
,99
9
Cha
rles
F. Bu
rt, M
.D.
Mig
uel S
. Dac
care
tt, M
.D.
Gle
n M
. Gin
sbur
g, M
.D.
Cra
ig M
ahon
ey, M
.D.
Sean
V. M
cGar
ry, M
.D.
Way
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thw
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. Bro
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nnet
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Cav
anau
gh, M
.D.
Mic
hael
P. C
lare
, M.D
.Pa
ul J.
Duw
eliu
s, M
.D.
Geo
rge
J. Em
odi,
M.D
.Fi
delit
y C
harit
able
Gift
Fun
dBr
ett W
. Fis
cher
, M.D
.Ki
rk D
. Gre
en, M
.D.
Hea
rtla
nd O
rtho
paed
ic &
Spo
rts
M
edic
ine
Clin
ic L
LCTh
omas
M. H
eise
r, M
.D.
Jam
es M
. Hill
, M.D
.Be
au S
. Kon
igsb
erg,
M.D
.Li
nder
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ily F
ound
atio
nJa
mes
R. L
inde
r, M
.D.
Will
iam
M. L
ydia
tt, M
.D.
R. M
icha
el M
endl
ick,
M.D
.Je
ffre
y S.
Moo
re, M
.D.
Rand
all D
. Neu
man
n, M
.D.
Dav
id A
. Pet
erso
n, M
.D.
Susa
n A
. Sch
erl,
M.D
.Te
rry
D. S
chw
ab, M
.D.
Jam
es R
. Sco
tt-M
iller
, M.D
.Si
gnifi
canc
e Fo
unda
tion
*Rob
ert J
. Tai
t, M
.D.,
P.C.
*Rob
ert J
. Tai
t, M
.D.,
P.C.
Up
to
$9
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Stua
rt L
. Bar
truf
fJo
seph
A. B
yrd
Stev
en R
. Cas
wel
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ffre
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Dav
ick,
M.D
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ffre
y M
. Far
ber,
M.D
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istin
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ottu
laR.
M. G
ross
, M.D
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anie
l R. H
anso
nJ.
Kirk
Han
son
F. S.
Jaco
bsen
, M.D
.O
mah
a C
omm
unity
Fou
ndat
ion
Cyn
thia
A. O
ster
, M.D
.C
arol
yn M
. San
azar
oJo
n C
. Sna
reSc
ott A
. Sw
anso
n, M
.D.
Plea
se n
ote:
If y
ou h
ave
a qu
estio
n or
co
rrec
tion
to th
is h
onor
roll,
ple
ase
cont
act
the
Uni
vers
ity o
f Neb
rask
a Fo
unda
tion’
s O
mah
a of
fice
at 2
285
Sout
h 67
th S
tree
t, St
e.
200,
Om
aha,
NE
6810
6, o
r cal
l (4
02
) 50
2-0
30
0.
Thos
e w
ho c
ontr
ibut
ed to
dep
artm
enta
l fun
ds
this
cal
enda
r yea
r (20
10) w
ill b
e re
cogn
ized
in
an
hono
r rol
l to
be p
ublis
hed
in th
e fa
ll 20
10 is
sue
of th
e de
part
men
t’s n
ewsl
ette
r, B
reak
ing
Ne
ws,
and
in a
futu
re O
rth
op
aed
ic
De
par
tme
nt R
ep
ort
, a p
ublic
atio
n w
hich
is
prod
uced
eve
ry tw
o ye
ars.
*Den
otes
two
sepa
rate
don
atio
ns.
HO
NO
R R
OLL
OF
CO
NTR
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TOR
S 2
008-
2009
PE
RFO
RM
AN
CE
IN M
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PO
RT
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ho
ws
the
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mes,
so
urc
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nd
ing
of g
ran
ts
the
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art
men
t h
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ived
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S G
LEBE
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ehan
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ne C
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r Kne
e Re
plac
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$
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TIO
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L IN
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L IN
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KER
RY P
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nato
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ditio
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IND
UST
RY:
BIO
MET
, IN
C.
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In-V
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r Dur
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tudy
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etal
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tal H
ip R
epla
cem
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6
5,00
0
BIO
MET
, IN
C.
“Eva
luat
ion
of a
New
Hig
hly
Cro
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UH
MW
PE S
tabi
lized
with
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itam
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for P
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rior-S
tabi
lized
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CH
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C.
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r Tes
ting
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plac
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plan
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uttin
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ge
Know
-How
and
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port
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m th
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nive
rsity
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plan
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ufac
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stry
to H
elp
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$
63,
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AR
THRE
X, IN
C.
“Det
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tigue
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nico
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l Car
tilag
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plac
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ompo
nent
s”
$
32,6
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CTE
CH
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C.
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ect o
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terio
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pe o
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ear o
f Bea
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” $
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000
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X, IN
C.
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and
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el T
estin
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etho
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urab
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of N
ovel
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tial T
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fem
oral
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tilag
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plac
emen
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pone
nts”
$
60,
000
AR
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X, IN
C.
Phas
e II:
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erm
inin
g th
e Fa
tigue
Str
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Nov
el P
artia
l Fem
oral
an
d Ti
bial
Uni
-Com
part
men
tal C
artil
age
Repl
acem
ent K
nee
Com
pone
nts”
$
8
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GR
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TS, F
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AN
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ICA
L ED
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actu
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Re
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X, IN
C.
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BIO
MET
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C.
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face
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plan
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CR
Tota
l Kne
e Re
plac
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TOTA
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DU
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GR
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NA
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PR
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SOU
RCES
FO
R A
VA
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AN
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part
men
t als
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aint
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-end
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fund
s at
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Uni
vers
ity o
f Neb
rask
a Fo
unda
tion
in O
mah
a. S
ome
fund
s ha
ve b
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esta
blis
hed
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ener
ous i
ndiv
idua
ls fo
r spe
cific
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pose
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hile
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rtm
ent’s
Dev
elop
men
t Fun
d is
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part
men
t-wid
e, u
nres
tric
ted
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urce
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imar
ily
for r
esid
ent t
rain
ing
activ
ities
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h as
sup
port
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resi
dent
s w
ho p
rese
nt re
sear
ch p
roje
cts
at n
atio
nal m
eetin
gs; b
ringi
ng re
now
ned
spea
kers
to
cam
pus
to s
hare
thei
r kno
wle
dge
with
resi
dent
s, fa
culty
, and
sta
ff; a
nd h
elpi
ng to
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side
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radu
atio
n a
mem
orab
le c
eleb
ratio
n. A
lthou
gh
this
fund
is n
ot la
rge
or e
ndow
ed, i
t pro
vide
s vi
tal,
flexi
ble
reso
urce
s to
sup
port
a v
arie
ty o
f res
iden
t edu
catio
n an
d fa
culty
-rela
ted
proj
ects
.
Jack
son
Benc
e, M
.D. E
duca
tion
an
d Re
sear
ch F
und
*Res
iden
t edu
catio
n, re
sear
ch a
nd
rela
ted
activ
ities
Jam
es R
. Nef
f, M
.D. M
uscu
losk
elet
al F
und
*Est
ablis
hmen
t of J
ames
R. N
eff,
M.D
., C
hair
of
Mus
culo
skel
etal
Onc
olog
y Th
e N
ebra
ska
Art
hriti
s O
utco
mes
Re
sear
ch C
ente
r*E
stab
lishm
ent,
bene
fit a
nd s
uppo
rt
of th
e N
ebra
ska
Art
hriti
s O
utco
mes
Re
sear
ch C
ente
r
L. T
hom
as a
nd H
erm
an Jo
hnso
n
Exce
llenc
e Fu
nd*F
acul
ty s
uppo
rt/p
rofe
ssor
ship
Dr.
Fost
er M
atch
ett R
esea
rch
Ass
ista
ntsh
ips
*Res
earc
h as
sist
ants
hips
Fran
k P.
Ston
e Pr
ofes
sors
hip
of
Ort
hopa
edic
Sur
gery
*Fac
ulty
sup
port
/pro
fess
orsh
ip H
. Win
nett
Orr
Mem
oria
l Res
earc
h Fu
nd*R
esea
rch
and
teac
hing
sup
plie
s an
d m
ater
ials
Jam
es R
. Nef
f, M
.D.,
Chi
ldre
n’s
Ort
hopa
edic
C
ance
r and
Mol
ecul
ar G
enet
ics
Fund
*Ort
hopa
edic
sur
gery
and
reha
bilit
atio
n Je
an B
rug
Jard
on E
ndow
men
t Fun
d*R
esid
ents
libr
ary
and
teac
hing
reso
urce
s
Robe
rt C
. Hen
dler
, M.D
., Fu
nd*C
ente
r for
Exc
elle
nce
in M
uscu
lar
Skel
etal
Dis
ease
s
Robe
rt G
. Vol
z, M
.D. R
esea
rch
Fund
*Res
earc
h an
d ed
ucat
ion
The
Cha
pin
Endo
wm
ent M
emor
ial F
und
*Ost
eopo
rosi
s re
sear
ch s
uppo
rt O
rtho
paed
ic O
ncol
ogy
Rese
arch
D
evel
opm
ent F
und
*Onc
olog
y re
sear
ch s
uppo
rt C
hris
tina
M. H
ixso
n:*E
ndow
men
t Sub
-fund
for R
esea
rch
in
Ort
hopa
edic
Sur
gery
and
Reh
abili
tatio
n M
edic
ine
Dr.
Rich
ard
and
Kath
ryn
Pett
ee:
*Ort
hopa
edic
Exc
elle
nce
Fund
(a
cade
mic
rese
arch
) W
ayne
and
Eile
en R
yan:
*Ort
hopa
edic
Res
earc
h D
evel
opm
ent F
und
Con
nolly
Ort
hopa
edic
Sur
gery
and
Re
habi
litat
ion
Fund
*D
epar
tmen
t Dev
elop
men
t Fun
d Jo
hn F.
Con
nolly
Res
iden
t Exc
elle
nce
Fund
*Res
iden
t Fun
d O
rtho
paed
ic S
urge
ry D
epar
tmen
t D
evel
opm
ent F
und
TOTA
L O
F EN
DO
WM
ENTS
/DO
NA
TIO
NS:
G
REA
TER
THA
N $
10,0
00,0
00
Thos
e w
ho c
ontr
ibut
ed to
the
Dep
artm
ent
of O
rtho
paed
ic S
urge
ry D
evel
opm
ent F
und
durin
g ca
lend
ar y
ears
200
8 –
2009
are
in
clud
ed in
the
depa
rtm
ent’s
Hon
or R
oll
of C
ontr
ibut
ors
liste
d on
pa
ge
87.
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T9
1
PE
RFO
RM
AN
CE
IN M
OTIO
N9
2U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
93
KEV
IN L
. G
AR
VIN
, M.D
.R
ese
arc
h In
tere
sts:
Adu
lt re
cons
truc
tion
Prev
entio
n an
d m
anag
emen
t of m
uscu
losk
elet
al in
fect
ions
Refe
reed
Art
icle
s:
Ga
rvin
, K.;
Ba
ckst
ein
, K.;
Pel
leg
rin
i, J.
, V; K
im, R
.; a
nd
Lew
alle
n, D
.: D
ealin
g w
ith C
ompl
icat
ions
. J B
on
e Jo
int S
urg
, 91A
(Sup
pl.5
): 18
-21, A
ugus
t 200
9.
Lia
n, J
.; Z
ha
ng
, J.;
Na
ma
var,
F.;
Zh
an
g, Y
.; Lu
, F.;
Ha
ider
, H.;
Ga
rvin
, K.;
Web
er, W
.; a
nd
Ew
ing
, R.:
Ion
Beam
-indu
ced
Am
orph
ous-
to-te
trag
onal
Ph
ase
Tran
sfor
mat
ion
and
Gra
in G
row
th o
f Nan
ocry
stal
line
Zirc
onia
. Nan
ote
chn
olo
gy,
20:
1-7,
June
17,
200
9.
Ga
rvin
, K.;
Ha
rtm
an
, C.;
Ma
ng
la, J
.; M
urd
och
, N.;
an
d M
art
ell,
J.: W
ear A
naly
sis
in T
HA
Util
izin
g O
xidi
zed
Zirc
oniu
m a
nd C
ross
linke
d Po
lyet
hyle
ne. C
linic
al O
rth
op
aed
ics
and
Re
late
d R
ese
arch
, 467
(1):
141-
5, Ja
nuar
y 20
09.
So
o, Y
L; C
hen
, PJ;
Hu
an
g, S
H; S
hiu
, TJ;
Tsa
i, T
Y; C
ho
w, W
H; L
in, Y
C; W
eng
, SC
; Ch
an
g, S
L; W
an
g, G
; Ch
eun
g, C
L; S
ab
iria
nio
v, R
F; M
ei, W
N;
Na
ma
var,
F; H
aid
er, H
; Ga
rvin
, KL;
Lee,
JF;
Lee,
HY;
Ch
u, P
P: L
ocal
Str
uctu
res
Surr
ound
ing
Zr in
Nan
ostr
uctr
ually
Sta
biliz
ed C
ubic
Zirc
onia
: St
ruct
ure
Orig
in o
f Pha
se S
tabi
lity.
J. A
pp
l. P
hys
., 10
4, D
ecem
ber 2
008.
Ha
ider
, H.,
an
d G
arv
in, K
.: Ro
tatin
g Pl
atfo
rm v
ersu
s Fi
xed-
bear
ing
Tota
l Kne
es: A
n In
Vitr
o St
udy
of W
ear.
Pape
rs p
rese
nted
at t
he a
nnua
l mee
ting
of T
he K
nee
Soci
ety.
Clin
ical
Ort
ho
pae
dic
s an
d R
ela
ted
Re
sear
ch, 4
66(1
1): 2
677-
85, N
ovem
ber 2
008.
Ma
cau
lay,
W.;
Nel
lan
s, K
.; G
arv
in, K
.; Lo
rio
, R.;
Hea
ley,
W.;
Ro
sen
wa
sser
, M.;
and
Con
sort
ium
, and
oth
er m
embe
rs o
f the
DEF
ACTO
Con
sort
ium
: Pr
ospe
ctiv
e Ra
ndom
ized
Clin
ical
Tria
l Com
parin
g H
emia
rthr
opla
sty
to T
otal
Hip
Art
hrop
last
y in
the
Trea
tmen
t of D
ispl
aced
Fem
oral
Nec
k Fr
actu
res:
W
inne
r of t
he D
oor A
war
d. J
Art
hro
pla
sty,
23:
2-8
, Sep
tem
ber 2
008.
Ha
ider
, H.,
an
d G
arv
in, K
.: Ro
tatin
g Pl
atfo
rm v
ersu
s Fi
xed-
bear
ing
Tota
l Kne
es: A
n In
Vitr
o St
udy
of W
ear.
Clin
ical
Ort
ho
pae
dic
s an
d R
ela
ted
R
ese
arch
, Onl
ine
publ
icat
ion
Aug
ust 2
9, 2
008.
Ba
rrer
a, O
.; H
aid
er, H
.; a
nd
Ga
rvin
, K.:
Tow
ards
a s
tand
ard
in a
sses
smen
t of b
one
cutt
ing
for T
otal
Kne
e Re
plac
emen
t. P
roc.
IMe
chE
, Par
t H:
J.
Eng
ine
eri
ng
Me
dic
ine,
222
(H1)
: 63-
74, 2
008.
Na
ma
var,
F.;
Ch
eun
g, C
.; S
ab
iria
no
v, R
.; M
ei, W
.; Z
eng
, X.;
Wa
ng
, G.;
Ha
ider
, H.;
an
d G
arv
in, K
.: Lo
tus
Effe
ct in
Eng
inee
red
Zirc
onia
. Nan
oLe
tte
rs,
Apr
il 20
08; W
eb R
elea
se D
ate:
Mar
ch 1
4, 2
008.
Wa
ng
, G.;
Bre
wer
, J.;
Na
ma
var,
F.;
Sa
bir
ian
ov,
R.;
Ha
ider
, H.;
Ga
rvin
, K.;
an
d C
heu
ng
, C.:
Stru
ctur
al S
tudy
of T
itani
um O
xide
Film
s Sy
nthe
size
d by
Ion
Beam
-Ass
iste
d D
epos
ition
. Sca
nn
ing
30:
59-
64, 2
008.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Ga
rvin
, K.,
an
d H
art
ma
n, C
.: C
emen
tless
Ace
tabu
lar F
ixat
ion.
In S
urg
ical
Tre
atm
en
t of t
he
Hip
, Art
hri
tis:
Re
con
stru
ctio
n, R
ep
lace
me
nt,
Re
visi
on
. 18
:151
-155
. Eds
. Hoz
ack,
W.;
Parv
izi,
J.; a
nd B
ende
r, B.
, Sau
nder
s El
sevi
er, S
epte
mbe
r 200
9.
Ga
rvin
, K.,
an
d H
art
ma
n, C
.: N
euro
vasc
ular
Com
plic
atio
ns in
Tot
al H
ip A
rthr
opla
sty.
In S
urg
ical
Tre
atm
en
t of t
he
Hip
, Art
hri
tis:
Re
con
stru
ctio
n,
Re
pla
cem
en
t, R
evi
sio
n. 5
5: 4
07-4
13. E
ds. H
ozac
k, W
.; Pa
rviz
i, J.;
and
Ben
der,
B., S
aund
ers
Else
vier
, Sep
tem
ber 2
009.
Ga
rvin
, K.,
an
d C
ord
ero
, G.:
Infe
cted
Tot
al K
nee
Art
hrop
last
y: D
iagn
osis
and
Tre
atm
ent.
In In
stru
ctio
nal
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urs
e L
ect
ure
s, (5
7)30
: 305
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. Edi
tor:
D
uwel
ius,
P., a
nd A
ssis
tant
Edi
tor:
Aza
r, F.,
Am
eric
an A
cade
my
of O
rtho
paed
ic S
urge
ons,
Mar
ch 2
008.
Ga
rvin
, K.,
an
d C
ord
ero
, G.:
Infe
cted
Tot
al K
nee
Art
hrop
last
y, D
iagn
osis
and
Tre
atm
ent.
In In
stru
ctio
nal
Co
urs
e L
ect
ure
s: D
VD
Sup
plem
enta
l C
onte
nt fe
atur
ing
vide
o co
vera
ge o
f act
ual s
urgi
cal p
roce
dure
. Am
eric
an A
cade
my
of O
rtho
paed
ic S
urge
ons,
Mar
ch 2
008
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Boar
d M
embe
r (el
ecte
d), C
ounc
il of
Ort
hopa
edic
Res
iden
cy D
irect
ors
(CO
RD),
Am
eric
an O
rtho
paed
ic
Ass
ocia
tion,
200
9-20
12
Boar
d of
Spe
cial
ty S
ocie
ties
(BO
S)
Exec
utiv
e C
omm
ittee
repr
esen
tativ
e fr
om
the
Hip
Soc
iety
, Am
eric
an A
cade
my
of
Ort
hopa
edic
Sur
geon
s, 2
009-
2012
Adu
lt Re
cons
truc
tion
Knee
Pro
gram
Su
bcom
mitt
ee, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
200
9-20
10
Am
eric
a’s
Top
Doc
tors
, Cas
tle C
onno
lly
Med
ical
Ltd
. 200
7-20
08; 2
009-
2010
Best
Doc
tors
in A
mer
ica,
200
7-20
08;
2009
-201
0
Pass
ed th
e 20
09 R
ecer
tifica
tion
Exam
inat
ion;
ABO
S ce
rtifi
ed th
roug
h 20
20
Ora
l Exa
min
er, A
mer
ican
Boa
rd o
f O
rtho
paed
ic S
urge
ry, J
uly
14-1
7, 2
008;
Ju
ly 2
0-2
3, 2
009
Fina
nce
Com
mitt
ee M
embe
r, H
ip S
ocie
ty, 2
008-
2009
20 Y
ears
of S
ervi
ce, U
NM
C, A
ugus
t 200
8
Prog
ram
Cha
ir, R
esid
ent L
eade
rshi
p Fo
rum
, Am
eric
an O
rtho
paed
ic
Ass
ocia
tion
Ann
ual M
eetin
g, Q
uebe
c C
ity, Q
uebe
c, C
anad
a, Ju
ne 3
-5, 2
008
Com
mitt
ee M
embe
r, G
uide
line
on
Perip
rost
hetic
Infe
ctio
ns o
f the
Hip
an
d Kn
ee, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
200
8
Mem
ber a
t Lar
ge; B
oard
of
Dire
ctor
s, H
ip S
ocie
ty, 2
008
Secr
etar
y, Ex
ecut
ive
Boar
d,
UN
MC
Phy
sici
ans,
200
8
Med
ical
Dire
ctor
, Oly
mpi
c Sw
im
Tria
ls, O
mah
a, N
E, 2
008
Boar
d of
Tru
stee
s, U
nive
rsity
of S
outh
D
akot
a Fo
unda
tion,
200
6-pr
esen
t
MIG
UEL
D
AC
CA
RE
TT,
M.D
.R
ese
arc
h In
tere
sts:
Trea
tmen
t of p
elvi
s an
d pe
ri-a
rtic
ular
frac
-tu
res,
as
wel
l as
arth
rosc
opic
ass
essm
ent o
f fr
actu
res
com
prom
isin
g th
e ar
ticul
ar jo
int
Trea
tmen
t of s
port
s-re
late
d in
jurie
s an
d m
ulti-
ligam
ento
us in
jurie
s of
the
knee
, inc
lud-
ing:
AC
L an
d PC
L re
cons
truc
tion,
car
tilag
e re
pair
proc
edur
es, o
steo
artic
ular
car
tilag
e tr
ansf
er (O
ATS)
and
men
isca
l rep
air a
nd
tran
spla
ntat
ion,
as
wel
l as
auto
logo
us
chon
droc
yte
tran
spla
ntat
ion
(AC
I)
FULL
-TIM
E FA
CU
LTY
AC
TIV
ITIE
SU
NM
C D
EPA
RTM
ENT
OF
ORT
HO
PAED
IC S
URG
ERY
AN
D R
EHA
BILI
TATI
ON
FU
LL-T
IME
FAC
ULT
Y AC
TIVI
TIES
(200
8-EA
RLY
2010
)
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Team
Lea
der,
Ort
hopa
edic
Tra
uma
Surg
eon,
IL
AC
/Cre
ight
on U
nive
rsity
/IM
A, J
iman
i, D
omin
ican
Rep
ublic
, Feb
ruar
y 8-
15, 2
010
Ort
hopa
edic
Tra
uma
Surg
eon,
Med
isha
re/
Uni
vers
ity o
f Neb
rask
a M
edic
al C
ente
r, L’H
ôpita
l de
la C
omm
unau
té H
aïtie
nne,
Po
rt a
u Pr
ince
, Hai
ti, Ja
nuar
y 23
-31,
201
0
Prom
oted
to a
ssis
tant
pro
fess
or,
Dep
artm
ent o
f Ort
hopa
edic
Sur
gery
and
Re
habi
litat
ion,
UN
MC
, Jul
y 1,
200
8
Facu
lty M
embe
r, A
O N
orth
Am
eric
a (A
ON
A),
Mar
ch 2
008-
pres
ent
Mem
ber,
Ort
hopa
edic
Tra
uma
Ass
ocia
tion,
200
8-pr
esen
t
Mem
ber,
UN
MC
Tra
uma
Revi
ew
Com
mitt
ee, 2
008-
pres
ent
Patie
nt’s
Cho
ice
Aw
ard,
A
mer
ican
Reg
istr
y, 20
08
MAR
K
DIE
TRIC
H, M
.D.
Rese
arc
h In
tere
sts:
Spor
ts-re
late
d in
jurie
s
Hip
art
hros
copy
Art
hros
copi
c kn
ee a
nd s
houl
der
reco
nstr
uctio
n
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Beca
me
boar
d ce
rtifi
ed b
y th
e A
mer
ican
Bo
ard
of O
rtho
paed
ic S
urge
ry, A
ugus
t 200
9.
PAU
L
ESP
OSI
TO, M
.D.
Rese
arc
h In
tere
sts:
Ost
eoge
nesi
s im
perf
ecta
and
m
etab
olic
bon
e di
seas
e
Refe
reed
Art
icle
s:
Esp
osi
to, P
., a
nd
Esp
osi
to, L
.: Re
emer
genc
e of
the
Tram
polin
e as
a R
ecre
atio
nal
Act
ivity
and
Com
petit
ive
Spor
t. C
urr
en
t S
po
rts
Me
dic
ine
Re
po
rts,
8(5
): 27
3-27
7, S
epte
mbe
r/O
ctob
er 2
009.
Na
tara
jan
, N.;
Ho
sko
pp
al,
A.;
Ch
att
erje
e,
A.;
Va
rma
n, M
.; M
cCa
nn
, R.;
Esp
osi
to, P
.;
an
d G
ord
on
, B.:
Neu
robl
asto
ma
in a
chi
ld
with
per
sist
ent h
ip p
ain.
Co
nsu
ltan
t fo
r P
ed
iatr
icia
ns,
18(
5): 1
75-1
81, M
ay 2
009.
Va
rma
n, M
.; R
om
ero
, J.;
Cu
sick
, R.;
Esp
osi
to, P
.; a
nd
Arm
stro
ng
, D.:
Poly
mic
robi
al W
ound
Infe
ctio
n an
d N
erve
In
jury
Sec
onda
ry to
a N
onhu
man
Prim
ate
Bite
. In
fect
Me
d, (
25):
120
-122
, Mar
ch 2
008.
Esp
osi
to, P
., a
nd
Plo
tkin
, H.:
Surg
ical
Tr
eatm
ent o
f Ost
eoge
nesi
s Im
perf
ecta
: C
urre
nt C
once
pts.
Cu
rr O
pin
Pe
dia
tr
20(1
): 52
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Feb
ruar
y 20
08.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Esp
osi
to, P
.: M
onte
ggia
and
Gal
eazz
i Fr
actu
re D
islo
catio
ns o
f the
For
earm
in
Chi
ldre
n. In
Su
rgic
al M
anag
em
en
t o
f Pe
dia
tric
Lo
ng
Bo
ne
Fra
ctu
res
Mo
no
gra
ph
, 5:4
3-57
. Edi
tor:
Sche
rl,
S., C
hica
go, I
L, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
Feb
ruar
y 20
09.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
One
Wor
ld H
ealth
Cen
ter,
Om
aha,
NE
»C
hairm
an-e
lect
, Exe
cutiv
e
C
omm
ittee
, Mar
ch 2
010
-pre
sent
»Bo
ard
of D
irect
ors,
Mar
ch 2
008-
pres
ent
Boar
d of
Dire
ctor
s, C
hild
ren’
s H
ospi
tal a
nd
Med
ical
Cen
ter
»Ex
ecut
ive
Com
mitt
ee, J
anua
ry 1
,
2009
-201
0
»Q
ualit
y an
d Pa
tient
Saf
ety
Com
mitt
ee,
20
08-p
rese
nt
Pres
iden
t of M
edic
al S
taff
Serv
ices
, Chi
ldre
n’s
Hos
pita
l and
Med
ical
Cen
ter,
2008
-201
0; e
x of
ficio
201
0-2
012
Chi
ldre
n’s
Hos
pita
l and
Med
ical
Cen
ter
Med
ical
Sta
ff C
omm
ittee
s
»Et
hics
Com
mitt
ee, 2
010
-pre
sent
»C
linic
al S
ervi
ce C
hief
, 200
9- p
rese
nt
»In
form
atio
n Te
chno
logy
Ove
rsig
ht
C
omm
ittee
, 200
9-pr
esen
t
»A
llied
Hea
lth C
omm
ittee
, 200
8-pr
esen
t
»By
law
s C
omm
ittee
, 200
8-pr
esen
t
»C
rede
ntia
ls C
omm
ittee
, 200
8-pr
esen
t
»Su
rgic
al S
ervi
ces
Com
mitt
ee, 2
008-
pres
ent
»In
fect
ion
Con
trol
Com
mitt
ee, 2
008-
2009
»Ph
arm
acy
and
Ther
apeu
tics
Com
mitt
ee,
20
08-2
009
»Q
ualit
y Sa
fety
Lea
ders
hip
Team
,
2006
- pre
sent
App
oint
ed to
the
Boar
d of
the
US
Bone
an
d Jo
int D
ecad
e: S
ervi
ng a
s th
e lia
ison
re
pres
enta
tive
of th
e A
mer
ican
Aca
dem
y of
Pe
diat
rics
and
co-c
hairm
an o
f the
Ped
iatr
ic
Stra
tegi
c Pl
anni
ng G
roup
, 200
9 &
201
0
Best
Doc
tors
in A
mer
ica,
200
7-20
08;
2009
-201
0
Spec
ial P
rofe
ssio
nal A
chie
vem
ent a
war
d,
AO
A/F
acul
ty H
onor
s C
onvo
catio
n, U
NM
C
Col
lege
of M
edic
ine,
Om
aha,
NE,
Mar
ch 2
6,
2009
Con
sulta
nt R
evie
wer
, Jo
urn
al o
f Pe
dia
tric
O
rth
op
aed
ics,
200
8-pr
esen
t.
PE
RFO
RM
AN
CE
IN M
OTIO
N9
4U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
95
20 Y
ears
of S
ervi
ce, T
he N
ebra
ska
Med
ical
Cen
ter,
May
200
8
RVU
Com
mitt
ee, A
mer
ican
A
cade
my
of P
edia
tric
s, 2
008
Com
plet
ed th
e A
OA
Kel
logg
Le
ader
ship
Ser
ies,
200
6-20
09
Con
sulta
nt R
evie
wer
, PED
IAT
RIC
S,
2005
-pre
sent
EDW
ARD
V.
FEH
RIN
GER
, M.D
.R
ese
arc
h In
tere
sts:
Rota
tor c
uff t
ears
and
thei
r ass
ocia
tion
with
agi
ng a
nd o
ther
co-
mor
bidi
ties
Shou
lder
soc
ket r
econ
stru
ctio
n in
sho
ulde
rs w
ith a
rthr
itis
Refe
reed
Art
icle
s:
Feh
rin
ger
, E.;
Mik
uls
, T.;
Mic
ha
ud
, K.;
Hen
der
son
, W.;
an
d O
’Del
l, J.
: Sho
ulde
r A
rthr
opla
stie
s ha
ve F
ewer
Com
plic
atio
ns
than
Hip
or K
nee
Art
hrop
last
ies
in U
S Ve
tera
ns. C
linic
al O
rth
op
aed
ics
and
Re
late
d
Re
sear
ch, 4
86(3
): 71
7-22
, Mar
ch 2
010.
Arn
old
, R.;
Web
er, J
.; S
un
, J.;
an
d F
ehri
ng
er,
E.:
Eval
uatio
n of
a C
uff T
ear A
rthr
opat
hy
Hem
ipro
sthe
sis
for t
he T
reat
men
t of
Gle
nohu
mer
al A
rthr
itis
in th
e Pr
esen
ce o
f a
Chr
onic
Rot
ator
Cuf
f Tea
r. J
Sho
uld
er E
lbo
w
Surg
Bri
tish
, 2(1
): 13
-16,
Janu
ary
2010
.
Arn
old
, R.,
an
d F
ehri
ng
er, E
.: D
ispl
aced
Ba
sal C
oron
oid
Frac
ture
and
Fix
atio
n in
a 7
yea
r old
: a c
ase
repo
rt a
nd re
view
of
the
liter
atur
e. J
Sho
uld
er E
lbo
w S
urg
B
riti
sh, 1
(2):
105-
107,
Oct
ober
200
9.
Feh
rin
ger
E.;
Su
n J
.; C
ott
on
J.;
Ca
rlso
n
M.;
Bu
rns
E.:
Hea
led
Cuf
f Rep
airs
H
ave
Scor
es E
qual
to U
ntor
n Sh
ould
ers
in T
hose
65
Year
s an
d O
lder
. Clin
ical
O
rth
op
aed
ics
and
Re
late
d R
ese
arch
, Se
ptem
ber 2
009.
[Epu
b ah
ead
of p
rint]
Feh
rin
ger
, E.;
Bu
rns,
E.;
Kn
ieri
m, A
.; S
un
,
J.; A
pke
r, K
.; a
nd
Ber
g, R
.: Ra
diol
ucen
cies
Su
rrou
ndin
g a
Smoo
th-S
tem
med
Rad
ial
Hea
d C
ompo
nent
May
Not
Cor
rela
te
with
For
earm
Pai
n or
Poo
r Elb
ow F
unct
ion.
T
he
Jo
urn
al o
f Sh
ou
lde
r an
d E
lbo
w
Surg
ery
, 18(
2): 2
75-8
, Mar
ch-A
pril
2009
.
Sa
mu
elso
n, E
.; C
ord
ero
, G.;
an
d
Feh
rin
ger
, E.:
Frac
ture
of a
Rev
erse
Tot
al
Shou
lder
Art
hrop
last
y Re
tent
ive
Line
r. O
rth
op
ed
ics,
32(
3): 2
11, M
arch
200
9.
Feh
rin
ger
, E.;
Su
n, J
.; V
an
Oev
eren
, L.;
Kel
ler,
B.;
an
d M
ats
en, F
. I.:
Full
Thic
knes
s Ro
tato
r Cuf
f Tea
r Pre
vale
nce
and
Cor
rela
tion
with
Fun
ctio
n an
d C
o-M
orbi
ditie
s in
Pa
tient
s 65
Yea
rs a
nd O
lder
. Th
e J
ou
rnal
o
f Sh
ou
lde
r an
d E
lbo
w S
urg
ery
, 17(
6):
881-
85, N
ovem
ber-
Dec
embe
r 200
8.
Feh
rin
ger
, E.;
Ro
sip
al,
C.;
Rh
od
es,
D.;
Lau
der
, A.;
Pu
um
ala
, S.;
Fesc
hu
k, C
.;
Mo
rmin
o, M
.; a
nd
Ha
rtig
an
, D.:
The
Radi
ogra
phic
Acr
omio
hum
eral
Inte
rval
is
Aff
ecte
d by
Arm
and
Rad
iogr
aphi
c Be
am P
ositi
on. T
he
Jo
urn
al o
f Ske
leta
l R
adio
log
y, 3
7(6)
: 535
-39,
June
200
8.
Feh
rin
ger
, E.;
Bu
ck, D
.; C
lare
, D.;
an
d
Cla
re, P
.: O
pen
Ant
erio
r Rep
air w
ithou
t Ro
utin
e C
apsu
lorr
aphy
for T
raum
atic
Ant
erio
r Sh
ould
er In
stab
ility
by
a C
omm
unity
Sur
geon
. O
rth
op
aed
ics,
41(
4): 3
65, A
pril
2008
.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Feh
rin
ger
, E.:
Book
Rev
iew
/Edi
t: T
he
Sh
ou
lde
r, 4
th E
dit
ion
. Phi
lade
lphi
a,
PA, S
aund
ers,
Feb
ruar
y 20
09.
Ma
tsen
, F. I
.; Fe
hri
ng
er, E
.; Li
pp
itt,
S.;
Wir
th,
M.;
an
d R
ock
wo
od
, C. J
.: Ro
tato
r Cuf
f. In
T
he
Sh
ou
lde
r, 4
th E
dit
ion
, pgs
.15.
Roc
kwoo
d,
C. J
.; M
atse
n, F.
I.; W
irth,
M.;
and
Lipp
itt, S
., Ph
ilade
lphi
a, P
A, S
aund
ers,
Feb
ruar
y 20
09.
Feh
rin
ger
, E.,
an
d M
ats
en, F
.: Sh
ould
er
Art
hrop
last
y O
utco
mes
. In
Sho
uld
er
Art
hro
pla
sty,
Co
mp
lex
Issu
es
in th
e P
rim
ary
an
d R
evi
sio
n S
ett
ing
, pgs
.10
-13.
Eds
. Fea
ly,
S., S
perli
ng, J
, War
ren,
R, a
nd C
raig
, E, N
ew
York
, NY,
Thi
eme
Publ
ishe
rs, M
arch
12,
200
8.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Spec
ial P
rofe
ssio
nal A
chie
vem
ent,
AO
A/
Facu
lty H
onor
s C
onvo
catio
n, U
NM
C C
olle
ge
of M
edic
ine,
Om
aha,
NE,
Mar
ch 2
010
Ass
ista
nt E
dito
r, Jo
urn
al o
f Sh
ou
lde
r an
d E
lbo
w S
urg
ery
, Jan
uary
1, 2
010
Pres
iden
t-Ele
ct o
f the
Neb
rask
a O
rtho
paed
ic S
ocie
ty, 2
009-
2010
Best
Doc
tors
in A
mer
ica,
200
7-20
08; 2
009-
2010
New
Inve
ntio
n N
otifi
catio
n A
war
d fo
r a
nove
l dia
gnos
tic a
id fo
r the
det
ectio
n of
ear
ly
perip
rost
hetic
com
pone
nt lo
osen
ing,
UN
MC
an
d U
NeM
ed C
orp.
, Oct
ober
1, 2
009
Indu
cted
as
mem
ber,
Am
eric
an
Ort
hopa
edic
Ass
ocia
tion,
June
200
9
Ass
ocia
te E
dito
r, T
he
Sh
ou
lde
r, 4
th e
dit
ion
; Sa
unde
rs, P
hila
delp
hia,
PA
, Feb
ruar
y 20
09
Indu
cted
as
asso
ciat
e m
embe
r, A
mer
ican
Sh
ould
er a
nd E
lbow
Soc
iety
, Sep
tem
ber 2
008
5 Ye
ars
of S
ervi
ce, U
NM
C, A
pril
2008
Spec
ial P
rofe
ssio
nal A
chie
vem
ent,
AO
A/
Facu
lty H
onor
s C
onvo
catio
n, U
NM
C C
olle
ge
of M
edic
ine,
Om
aha,
NE,
Mar
ch 2
7, 2
008
GLE
N M
. G
INSB
UR
G, M
.D.
Rese
arc
h In
tere
sts:
Gai
t dis
orde
rs
Spin
al d
efor
miti
es
Cu
rren
t R
ese
arc
h G
ran
ts:
Dev
elop
men
t of t
he M
unro
e M
eyer
Inst
itute
M
ulti-
disc
iplin
ary
Clin
ic S
ervi
ng P
edia
tric
Pa
tient
s W
ho R
equi
re a
Pro
sthe
tic D
evic
e du
e to
Ana
tom
ical
Los
s du
e to
Tra
uma,
D
isea
se, o
r Con
geni
tal C
ondi
tions
, Ker
ry
Pros
thes
is F
und,
Sep
tem
ber 2
009
Refe
reed
Art
icle
s:
Nys
tro
m, A
.; G
insb
urg
, G.;
Stu
ber
g, W
.;
an
d D
ejo
ng
, S.:
Pre-
and
Pos
t-ope
rativ
e G
ait A
naly
sis
for E
valu
atio
n of
Chr
onic
N
eck
Pain
in C
hron
ic W
hipl
ash.
J B
rach
ial
Ple
x P
eri
ph
er N
erv
e In
j, 4(
1):1
0, Ju
ly 2
009
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Patie
nt E
duca
tion
Com
mitt
ee, S
colio
sis
Rese
arch
Soc
iety
, Sep
tem
ber 2
009-
2010
Best
Doc
tors
in A
mer
ica,
200
7-20
08; 2
009-
2010
Cha
irman
, Pre
vale
nce
and
Nat
ural
H
isto
ry C
omm
ittee
, Sco
liosi
s Re
sear
ch S
ocie
ty, 2
007-
2009
HAN
I H
AID
ER, P
H.D
. R
ese
arc
h In
tere
sts:
Ort
hopa
edic
impl
ant s
imul
atio
n an
d te
stin
g
Tech
nolo
gy fo
r com
pute
r-ai
ded
orth
opae
dic
surg
ery
Cu
rren
t R
ese
arc
h G
ran
ts:
Knee
Sim
ulat
or T
est t
o D
eter
min
e W
ear P
rope
rtie
s of
Con
form
Kne
e.
Biom
et In
c., W
arsa
w, I
ndia
na, P
rinci
pal
Inve
stig
ator
, Apr
il 20
10 –
Janu
ary
2011
.
Prel
imin
ary
Expl
orat
ory
Ass
essm
ent o
f the
Lo
ngev
ity o
f a N
ovel
Hyd
rosw
ella
ble
Poly
ethe
r U
reth
ane
Ure
as In
terp
ositi
onal
Fem
oral
Hea
d Im
plan
t. So
ftJo
int I
nc.,
Iow
a C
ity, I
A, P
rinci
pal
Inve
stig
ator
, Mar
ch 2
010
- Aug
ust 2
010.
An
In-v
itro
Stud
y to
Det
erm
ine
the
Wea
r D
urab
ility
of S
urfa
ce E
ngin
eere
d an
d Io
n Im
plan
ted
Tita
nium
Van
guar
d C
R To
tal
Knee
Rep
lace
men
t Sys
tem
s. B
iom
et In
c.,
War
saw
, Ind
iana
, Prin
cipa
l Inv
estig
ator
, Fe
brua
ry 2
010
– D
ecem
ber 2
010
A B
atte
ry o
f Ste
ady
Stat
e In
-vitr
o C
hara
cter
izat
ion
Test
s fo
r a N
ew T
otal
Kn
ee R
epla
cem
ent S
yste
m b
y Sy
nerg
y.
Empi
rical
Tes
ting
Cor
pora
tion,
Col
orad
o
Sprin
gs, C
O, P
rinci
pal I
nves
tigat
or,
Janu
ary
2010
– O
ctob
er 2
010
In-V
itro
Dur
abili
ty S
imul
atio
n an
d Ev
alua
tion
of a
New
Tot
al K
nee
Repl
acem
ent S
yste
m
by S
yner
gy. E
mpi
rical
Tes
ting
Cor
pora
tion,
C
olor
ado
Sprin
gs, C
O, P
rinci
pal I
nves
tigat
or,
Janu
ary
2010
– O
ctob
er 2
010
Sim
ulat
ion
and
Sim
ulat
or W
ear T
estin
g of
a
New
Tot
al H
ip R
epla
cem
ent D
esig
n by
Sy
nerg
y, Em
piric
al T
estin
g C
orpo
ratio
n.
Col
orad
o Sp
rings
, CO
, Prin
cipa
l Inv
estig
ator
, Ja
nuar
y 20
10 –
Oct
ober
201
0
Cha
ract
eriz
atio
n of
Vita
min
E B
lend
ed
UH
MW
PE a
s a
Bear
ing
with
CoC
r and
Bi
olox
Del
ta F
emor
al H
ip C
ompo
nent
s.
Col
labo
rativ
e re
sear
ch w
ith E
xpon
ent
Inc.
and
Ste
lkas
t (PA
), Pr
inci
pal
Inve
stig
ator
, Aug
ust 2
009
to M
ay 2
010.
An
In-v
itro
Stud
y of
Wea
r of t
he Im
plan
et
Gen
ou P
oste
rior-
stab
ilize
d M
obile
Bea
ring
Knee
Sys
tem
. Col
labo
rativ
e re
sear
ch w
ith
and
Impl
anet
/Fra
nce
and
Empi
rical
Tes
ting
Cor
pora
tion
(Col
orad
o Sp
rings
), Pr
inci
pal
Inve
stig
ator
, Aug
ust 2
009
to M
ay 2
010.
Refe
reed
Art
icle
s:
Lia
n, J
.; Z
ha
ng
, J.;
Na
ma
var,
F.;
Zh
an
g, Y
.;
Lu, F
.; H
aid
er, H
.; G
arv
in, K
.; W
eber
, W.;
an
d E
win
g, R
.: Io
n Be
am-in
duce
d A
mor
phou
s-to
-tetr
agon
al P
hase
Tr
ansf
orm
atio
n an
d G
rain
Gro
wth
of
Nan
ocry
stal
line
Zirc
onia
. Nan
ote
chn
olo
gy,
20
:1-7
, Jun
e 17
, 200
9.
So
o, Y
L; C
hen
, PJ;
Hu
an
g, S
H; S
hiu
, TJ;
Tsa
i,
TY;
Ch
ow
, WH
; Lin
, YC
; Wen
g, S
C; C
ha
ng
,
SL;
Wa
ng
, G; C
heu
ng
, CL;
Sa
bir
ian
iov,
RF;
Mei
, WN
; Na
ma
var,
F; H
aid
er, H
; Ga
rvin
,
KL;
Lee,
JF;
Lee,
HY;
Ch
u, P
P: L
ocal
Str
uctu
res
Surr
ound
ing
Zr in
Nan
ostr
uctr
ually
Sta
biliz
ed
Cub
ic Z
ircon
ia: S
truc
ture
Orig
in o
f Pha
se
Stab
ility
. J. A
pp
l. P
hys
.,104
, Dec
embe
r 200
8.
Ha
ider
, H.,
an
d G
arv
in, K
.: Ro
tatin
g Pl
atfo
rm v
ersu
s Fi
xed-
bear
ing
Tota
l Kne
es:
An
In V
itro
Stud
y of
Wea
r. Pa
pers
pre
sent
ed
at th
e an
nual
mee
ting
of T
he K
nee
Soci
ety.
C
linic
al O
rth
op
aed
ics
and
Re
late
d R
ese
arch
, 46
6(11
):267
7-85
, Nov
embe
r 200
8.
Ha
ider
, H.,
an
d G
arv
in, K
.: Ro
tatin
g Pl
atfo
rm v
ersu
s Fi
xed-
bear
ing
Tota
l Kne
es: A
n In
Vitr
o St
udy
of W
ear.
Clin
ical
Ort
ho
pae
dic
s an
d R
ela
ted
Re
sear
ch, O
nlin
e pu
blic
atio
n A
ugus
t 29,
200
8.
Na
ma
var,
F.;
Ch
eun
g, C
.; S
ab
iria
no
v, R
.;
Mei
, W.;
Zen
g, X
.; W
an
g, G
.; H
aid
er, H
.;
an
d G
arv
in, K
.: Lo
tus
Effe
ct in
Eng
inee
red
Zirc
onia
. Nan
oLe
tte
rs, A
pril
2008
; Web
Re
leas
e D
ate:
Mar
ch 1
4, 2
008.
Ba
rrer
a, O
.; H
aid
er, H
.; a
nd
Ga
rvin
, K.:
Tow
ards
a s
tand
ard
in a
sses
smen
t of b
one
cutt
ing
for T
otal
Kne
e Re
plac
emen
t. P
roc.
IM
ech
E, P
art H
: J.
En
gin
ee
rin
g M
ed
icin
e,
222(
H1)
:63-
74, 2
008.
Pa
l, S
.; H
aid
er, H
.; La
z, P
.; K
nig
ht,
L.;
an
d
Ru
llko
ett
er, P
.: Pr
obab
ilist
ic C
ompu
tatio
nal
Mod
elin
g of
Tot
al K
nee
Repl
acem
ent W
ear.
J.
We
ar, 2
64:7
01-7
07, 2
008.
Wa
ng
, G.;
Bre
wer
, J.;
Na
ma
var,
F.;
Sa
bir
ian
ov,
R.;
Ha
ider
, H.;
Ga
rvin
, K.;
an
d
Ch
eun
g, C
.: St
ruct
ural
Stu
dy o
f Tita
nium
O
xide
Film
s Sy
nthe
size
d by
Ion
Beam
-Ass
iste
d D
epos
ition
. Sca
nn
ing
30:
59-6
4, 2
008.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Ha
ider
, H.:
Trib
olog
ical
Ass
essm
ent o
f U
HM
WPE
in th
e Kn
ee, C
hapt
er 2
6 in
: “U
HM
WP
E B
iom
ate
rial
s H
and
bo
ok
” (S
eco
nd
Ed
itio
n),
Stev
en M
. Kur
tz, P
h.D
., Ed
itor(s
), A
cade
mic
Pre
ss, 2
009,
pp
381-
408.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Reci
pien
t of t
he “A
STM
Inte
rnat
iona
l Man
ny
Hor
owitz
Aw
ard”
whi
ch “r
ecog
nize
s th
e m
ost
hono
red
com
mitt
ee m
embe
r in
the
gene
ral
inte
rest
cat
egor
y w
ho h
as c
ontr
ibut
ed to
the
stan
dard
s de
velo
pmen
t and
/or r
elat
ed a
ctiv
i-tie
s”, A
STM
Com
mitt
ee F
04 is
on
Med
ical
and
Su
rgic
al M
ater
ials
and
Dev
ices
, May
201
0.
Co-
Cha
ir: S
ympo
sium
on
Mob
ile B
earin
g To
tal K
nee
Repl
acem
ent D
evic
es, S
pons
ored
by
AST
M C
omm
ittee
F04
Med
ical
an
d Su
rgic
al M
ater
ials
and
Dev
ices
, M
ay, S
t Lou
is, M
O, M
ay 1
8, 2
010.
App
oint
ed M
embe
r/C
onsu
ltant
, Bio
med
ical
En
gine
erin
g C
omm
ittee
, The
Am
eric
an
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s (A
AO
S), N
ew O
rlean
s, L
A, M
arch
201
0
App
oint
ed c
hair,
Edu
catio
n C
omm
ittee
, 22
nd A
nnua
l Con
gres
s of
the
Inte
rnat
iona
l So
ciet
y fo
r Tec
hnol
ogy
in A
rthr
opla
sty
- Pa
st, P
rese
nt a
nd F
utur
e of
Art
hrop
last
y,
Haw
aii.
Oct
ober
22-
24, 2
009
Prog
ram
Dire
ctor
and
Mem
ber o
f the
Ex
ecut
ive
Com
mitt
ee, I
nter
natio
nal S
ocie
ty fo
r Te
chno
logy
in A
rthr
opla
sty,
Mar
ch 1
4, 2
009
Reci
pien
t of t
he “I
raqi
Aca
dem
ic C
onfe
renc
e A
war
d” g
iven
to fo
ur o
f the
mos
t dis
tin-
guis
hed
acad
emic
s of
Iraq
i orig
in in
the
Uni
ted
Stat
es, i
n re
cogn
ition
of a
ccom
plis
h-m
ents
in E
ngin
eerin
g. P
rese
nted
at t
he Ir
aqi
Aca
dem
ic C
onfe
renc
e jo
intly
hos
ted
at th
e U
S N
atio
nal A
cade
mie
s an
d th
e Ira
qi C
ultu
ral
Offi
ce, W
ashi
ngto
n, D
C. M
arch
200
9
Cha
irman
, Bio
tech
nolo
gy C
omm
ittee
, Ira
qi
Am
eric
an A
cade
mic
and
Pro
fess
iona
l C
omm
unity
Pro
gram
, org
aniz
ed b
y th
e Ira
qi
Cul
tura
l Cen
ter,
Was
hing
ton,
DC
, 20
09
Prom
oted
to P
rofe
ssor
, UN
MC
D
epar
tmen
t of O
rtho
paed
ic S
urge
ry
and
Reha
bilit
atio
n, Ju
ne 1
, 200
8
Edito
rial B
oard
Mem
ber,
Jou
rnal
o
f En
gin
ee
rin
g In
Me
dic
ine
, Par
t H
, IM
ech
E P
art H
.
CU
RTIS
W.
HA
RTM
AN
, M.D
.R
efe
reed
Art
icle
s:
Ga
rvin
, K.;
Ha
rtm
an
, C.;
Ma
ng
la, J
.;
Mu
rdo
ch, N
.; a
nd
Ma
rtel
l, J.
: Wea
r A
naly
sis
in T
HA
Util
izin
g O
xidi
zed
Zirc
oniu
m
and
Cro
sslin
ked
Poly
ethy
lene
. Clin
Ort
ho
p
Re
lat R
es,
467
(1):
141-
5, Ja
nuar
y 20
09.
Ma
ho
ney
, C.;
Ha
rtm
an
, C.;
Sim
on
,
P.; B
axt
er, T
.; a
nd
Neff
, J.:
Vasc
ular
M
anag
emen
t in
Rota
tionp
last
y. C
lin O
rth
op
R
ela
t Re
s, 4
66: 1
210
-121
6, M
ay 2
008.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Ga
rvin
, K.,
an
d H
art
ma
n, C
.: C
emen
tless
A
ceta
bula
r Fix
atio
n. In
Su
rgic
al T
reat
me
nt
of t
he
Hip
, Art
hri
tis:
Re
con
stru
ctio
n,
Re
pla
cem
en
t, R
evi
sio
n. 1
8:15
1-15
5. E
ds.
Hoz
ack,
W.;
Parv
izi,
J.; a
nd B
ende
r, B.
, Sa
unde
rs E
lsev
ier,
Sept
embe
r 200
9.
Ga
rvin
, K.,
an
d H
art
ma
n, C
.: N
euro
vasc
ular
C
ompl
icat
ions
in T
otal
Hip
Art
hrop
last
y.
In S
urg
ical
Tre
atm
en
t of t
he
Hip
, Art
hri
tis:
R
eco
nst
ruct
ion
, Re
pla
cem
en
t, R
evi
sio
n. 5
5:
407-
413.
Eds
. Hoz
ack,
W.;
Parv
izi,
J.; a
nd
Bend
er, B
., Sa
unde
rs E
lsev
ier,
Sept
embe
r 200
9.
BRIA
N P.
H
AS
LEY,
M.D
.R
ese
arc
h In
tere
sts:
Spin
e de
form
ity
Refe
reed
Art
icle
s:
Sie
ble
r, J
.; H
asl
ey, B
.; a
nd
Mo
rmin
o, M
.: Fu
nctio
nal O
utco
mes
of D
enis
Zon
e III
Sa
cral
Fra
ctur
es T
reat
ed N
onop
erat
ivel
y.
J. O
rth
op
Tra
um
a, M
ay 2
010.
Ger
ma
in, M
.; K
ren
zer,
K.;
Ha
sley
, B.;
Va
rma
n, M
.: 11
-mon
th O
ld C
hild
Ref
uses
to
Sit
Up.
Pe
dia
tr A
nn
37(
5):2
90-3
, 200
8.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Ha
sley
, B.:
Frac
ture
s of
the
Wris
t and
Fo
rear
m. I
n S
urg
ical
Man
age
me
nt
of P
ed
iatr
ic L
on
g B
on
e F
ract
ure
s M
on
og
rap
h, 6
:59-
83. E
ds. S
cher
l, S.
, C
hica
go, I
L, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
Feb
ruar
y 20
09.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Best
Doc
tors
in A
mer
ica,
200
7-20
08; 2
009-
2010
Boar
d C
ertifi
ed, A
mer
ican
Boa
rd o
f O
rtho
paed
ic S
urge
ry, S
epte
mbe
r 200
8
Fello
w, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
Feb
201
0
PE
RFO
RM
AN
CE
IN M
OTIO
N9
6U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
97
BEAU
S.
KON
IGSB
ERG
, M.D
.R
ese
arc
h In
tere
sts:
Adu
lt Re
cons
truc
tion
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Mem
ber,
Mid
-Am
eric
a O
rtho
paed
ic
Ass
ocia
tion,
200
9
Mem
ber,
Neb
rask
a M
edic
al
Ass
ocia
tion,
200
8
Mem
ber,
Met
ro O
mah
a M
edic
al S
ocie
ty, 2
008
Can
dida
te M
embe
r, A
mer
ican
A
cade
my
of O
rtho
paed
ic S
urge
ons
ANTH
ON
Y J.
LA
UD
ER, M
.D.
Rese
arc
h In
tere
sts:
Han
d an
d w
rist
Refe
reed
Art
icle
s:
Fire
sto
ne,
D.,
an
d L
au
der
, A.:
Che
mis
try
and
Mec
hani
cs o
f Com
mon
ly U
sed
Sutu
res
and
Nee
dles
. J H
and
Su
rg
(Am
), 35
(3):4
86-8
, Mar
ch 2
010.
Luri
a, S
.; La
ud
er, A
.; a
nd
Tru
mb
le, T
.: C
ompa
rison
of U
lnar
Sho
rten
ing
Ost
eoto
my
with
a N
ew T
rimed
Dyn
amic
Com
pres
sion
Sy
stem
ver
sus
the
Synt
hes
Dyn
amic
C
ompr
essi
on S
yste
m: C
linic
al S
tudy
. J H
and
Su
rg (A
m) 3
3(9)
:149
3-14
97, N
ovem
ber 2
008.
Feh
rin
ger
, E.;
Ro
sip
al,
C.;
Rh
od
es,
D.;
Lau
der
, A.;
Pu
um
ala
, S.;
Fesc
hu
k, C
.;
Mo
rmin
o, M
.; a
nd
Ha
rtig
an
, D.:
The
Radi
ogra
phic
Acr
omio
hum
eral
Inte
rval
is
Aff
ecte
d by
Arm
and
Rad
iogr
aphi
c Be
am P
ositi
on. T
he
Jo
urn
al o
f Ske
leta
l R
adio
log
y, 3
7(6)
:535
-39,
June
200
8.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Pett
ron
e, S
.; La
ud
er, A
.; a
nd
Tru
mb
le, T
.: U
lnar
Impa
ctio
n Sy
ndro
me.
In A
rth
riti
s an
d A
rth
rop
last
y: T
he
Han
d, W
rist
, an
d
Elb
ow
, 7. E
ds. C
habr
a, A
., an
d Is
aacs
, J.,
Phila
delp
hia,
PA
, Sau
nder
s El
sevi
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009.
Lau
der
, A.,
an
d T
rum
ble
, T.:
The
Uln
ar
Shor
teni
ng O
steo
tom
y. In
Fra
ctu
res
and
Inju
rie
s o
f th
e D
ista
l Rad
ius
and
C
arp
us
– T
he
Cu
ttin
g E
dg
e, 3
2. E
ds.
Slut
sky,
D.,
and
Ost
erm
an, A
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lphi
a,
PA, S
aund
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, 200
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Lau
der
, A.:
Car
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vasc
ular
Nec
rosi
s -
Kien
böck
’s D
isea
se a
nd P
reis
er’s
Dis
ease
. In
Pri
nci
ple
s o
f Han
d S
urg
ery
an
d
Th
era
py,
24.
Eds
. Tru
mbl
e, T
.; Ra
yan,
G.;
Budo
ff, J.
; and
Bar
atz,
M.,
Phila
delp
hia,
PA
, Sau
nder
s El
sevi
er, 2
009.
Do
dd
s, S
.; La
ud
er, A
.; a
nd
Tru
mb
le, T
.: H
and
and
Wris
t Tra
uma.
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rth
op
aed
ic
Kn
ow
led
ge
Up
dat
e 9
, 28.
Ed.
Fis
chgr
und,
J.,
Ros
emon
t, IL
, Am
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an A
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my
of O
rtho
paed
ic S
urge
ons,
200
8.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Act
ive
Fello
w, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
Sep
tem
ber 2
009
Mem
ber,
Prod
ucts
and
Pub
licat
ions
A
dvis
ory
Com
mitt
ee, A
mer
ican
Soc
iety
fo
r Sur
gery
for t
he H
and,
200
9
Boar
d C
ertifi
ed, A
mer
ican
Boa
rd o
f O
rtho
paed
ic S
urge
ry, S
epte
mbe
r 200
8
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s N
ew T
echn
olog
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d Pr
oduc
ts C
omm
ittee
, The
Neb
rask
a M
edic
al
Cen
ter,
Sept
embe
r 200
8 - p
rese
nt
Mem
ber,
Am
eric
an S
ocie
ty fo
r Sur
gery
of t
he
Han
d Yo
ung
Lead
ers
Prog
ram
, Aug
ust 2
008
Aw
ard
for F
acul
ty E
xcel
lenc
e in
Tea
chin
g,
Uni
vers
ity o
f Neb
rask
a-C
reig
hton
U
nive
rsity
Hea
lth F
ound
atio
n O
rtho
paed
ic
Surg
ery
Resi
denc
y Pr
ogra
m, J
une
2008
SEA
N V
. M
CG
AR
RY,
M.D
.R
ese
arc
h In
tere
sts:
Clin
ical
out
com
es in
ort
hopa
edic
onc
olog
y
Refe
reed
Art
icle
s:
Levi
ng
s, P
.; M
cGa
rry,
S.;
Cu
rrie
, T.;
Nic
kers
on
, D.;
McC
lella
n, S
.; G
hiv
izza
ni,
S.;
Ste
ind
ler,
D.;
an
d G
ibb
s, C
.: Ex
pres
sion
of
an e
xoge
nous
hum
an O
ct-4
pro
mot
er id
enti-
fies
tum
or-in
itiat
ing
cells
in o
steo
sarc
oma.
C
ance
r Re
s, 6
9(14
):564
8-55
, Jul
y 7,
200
9.
McG
arr
y, S
.; M
org
an
, S.;
Gro
sskr
eu
z,
R.;
Will
iam
s, A
.; a
nd
Sm
ith
, W.:
Seru
m T
itani
um L
evel
s in
Indi
vidu
als
Und
ergo
ing
Intr
amed
ulla
ry F
emor
al
Nai
ling
with
a T
itani
um Im
plan
t. Jo
urn
al
of T
rau
ma
-In
jury
Infe
ctio
n a
nd
Cri
tica
l C
are, 6
4(2)
:430
-433
, Feb
ruar
y 20
08.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Act
ive
Fello
w, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
Sep
tem
ber 2
009
Boar
d C
ertifi
ed, A
mer
ican
Boa
rd o
f O
rtho
paed
ic S
urge
ry, S
epte
mbe
r 200
8
Mem
ber,
Byla
ws
Com
mitt
ee, C
hild
ren’
s H
ospi
tal a
nd M
edic
al C
ente
r, 20
08
MAT
THEW
A.
MO
RM
INO
, M.D
. R
ese
arc
h In
tere
sts:
Infe
cted
non
unio
ns
Hum
erus
frac
ture
s
Sacr
al fr
actu
res
Refe
reed
Art
icle
s:
Sie
ble
r, J
.; H
asl
ey, B
.; a
nd
Mo
rmin
o, M
.: Fu
nctio
nal O
utco
mes
of D
enis
Zon
e III
Sa
cral
Fra
ctur
es T
reat
ed N
onop
erat
ivel
y.
J. O
rth
op
Tra
um
a, M
ay 2
010.
Va
nd
enb
urg
, E.;
Tweete
r, K
.; a
nd
Mo
rmin
o,
M.:
Hip
Fra
ctur
e C
are:
Per
iope
rativ
e an
d Re
habi
litat
ive
Man
agem
ent.
AA
MC
Me
dEd
PO
RTA
L, 2
010.
Reed
, L.,
an
d M
orm
ino
, M.:
Dis
tal
Tibi
a N
onun
ions
and
Mal
unio
ns.
Op
era
tive
Te
chn
iqu
es
in O
rth
op
aed
ics,
18
(2):1
28-1
35, A
pril
2009
.
Reed
, L.,
an
d M
orm
ino
, M.:
Dis
tal
Tibi
a N
onun
ions
. Fo
ot a
nd
An
kle
Clin
ics,
13
(4):7
25-7
35, D
ecem
ber 2
008.
Feh
rin
ger
, E.;
Ro
sip
al,
C.;
Rh
od
es,
D.;
Lau
der
, A.;
Pu
um
ala
, S.;
Fesc
hu
k, C
.;
Mo
rmin
o, M
.; a
nd
Ha
rtig
an
, D.:
The
Radi
ogra
phic
Acr
omio
hum
eral
Inte
rval
is
Aff
ecte
d by
Arm
and
Rad
iogr
aphi
c Be
am P
ositi
on. T
he
Jo
urn
al o
f Ske
leta
l R
adio
log
y, 3
7(6)
:535
-39,
June
200
8.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Pass
ed th
e 20
09 R
ecer
tifica
tion
Exam
inat
ion;
ABO
S ce
rtifi
ed th
roug
h 20
19
Best
Doc
tors
in A
mer
ica,
200
7-20
08;
2009
-201
0
Prog
ram
Com
mitt
ee C
hairm
an, M
id-
Am
eric
a O
rtho
paed
ic A
ssoc
iatio
n A
nnua
l Mee
ting
2007
-200
8
Boar
d M
embe
r, M
id-A
mer
ica
Ort
hopa
edic
Soc
iety
, 200
6-20
10
FERE
YDO
ON
N
AM
AVA
R, S
C.D
. R
ese
arc
h In
tere
sts:
App
licat
ion
of n
anot
echn
olog
y in
tota
l joi
nt a
rthr
opla
sty:
Con
trol
ling
the
bone
gro
wth
; 2) D
evel
opm
ent
of a
ntib
acte
rial s
urfa
ces
for s
hort
and
long
-te
rm a
pplic
atio
ns; 3
) Red
ucin
g th
e w
ear o
f or
thop
aedi
c im
plan
ts a
nd re
visi
on s
urge
ry
Inte
ract
ion
of s
tem
cel
ls a
nd o
rgan
ism
s w
ith m
icro
and
nan
ostr
uctu
red
engi
neer
ed
mat
eria
ls (h
ard
tissu
e en
gine
erin
g)
Effe
ct o
f ele
ctric
al s
timul
atio
n on
gro
wth
an
d di
ffer
entia
tion
of (a
dult)
ste
m c
ells
on
nan
o-en
gine
ered
sur
face
s (c
ombi
ning
na
note
chno
logy
with
ste
m c
ell t
echn
olog
y;
(adu
lt) s
tem
cel
l pur
ifica
tion
and
prol
ifera
tion)
Dev
elop
men
t of s
mar
t coa
tings
for
orth
opae
dic
and
dent
al im
plan
ts
Refe
reed
Art
icle
s:
Lia
n, J
.; Z
ha
ng
, J.;
Na
ma
var,
F.;
Zh
an
g, Y
.;
Lu, F
.; H
aid
er, H
.; G
arv
in, K
.; W
eber
, W.;
an
d E
win
g, R
.: Io
n Be
am-in
duce
d A
mor
phou
s-to
-tetr
agon
al P
hase
Tr
ansf
orm
atio
n an
d G
rain
Gro
wth
of
Nan
ocry
stal
line
Zirc
onia
. Nan
ote
chn
olo
gy,
20
:1-7
, Jun
e 17
, 200
9.
So
o, Y
L; C
hen
, PJ;
Hu
an
g, S
H; S
hiu
, TJ;
Tsa
i,
TY;
Ch
ow
, WH
; Lin
, YC
; Wen
g, S
C; C
ha
ng
,
SL;
Wa
ng
, G; C
heu
ng
, CL;
Sa
bir
ian
iov,
RF;
Mei
, WN
; Na
ma
var,
F; H
aid
er, H
; Ga
rvin
,
KL;
Lee,
JF;
Lee,
HY;
Ch
u, P
P: L
ocal
Str
uctu
res
Surr
ound
ing
Zr in
Nan
ostr
uctr
ually
Sta
biliz
ed
Cub
ic Z
ircon
ia: S
truc
ture
Orig
in o
f Pha
se
Stab
ility.
J. A
pp
l. P
hys
., 10
4, D
ecem
ber 2
008.
Na
ma
var,
F.;
Ch
eun
g, C
.; S
ab
iria
no
v, R
.;
Mei
, W.;
Zen
g, X
.; W
an
g, G
.; H
aid
er, H
.;
an
d G
arv
in, K
.: Lo
tus
Effe
ct in
Eng
inee
red
Zirc
onia
. Nan
oLe
tte
rs, A
pril
2008
; Web
Re
leas
e D
ate:
Mar
ch 1
4, 2
008.
Wa
ng
, G.;
Bre
wer
, J.;
Na
ma
var,
F.;
Sa
bir
ian
ov,
R.;
Ha
ider
, H.;
Ga
rvin
, K.;
an
d C
heu
ng
, C.:
Stru
ctur
al S
tudy
of T
itani
um
Oxi
de F
ilms
Synt
hesi
zed
by Io
n Be
am-A
ssis
ted
Dep
ositi
on. S
can
nin
g 3
0:59
-64,
200
8.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Feat
ured
in th
e fa
ll 20
08 is
sue
of U
NM
C
Dis
cove
r mag
azin
e fo
r his
team
’s w
ork
on
‘Mim
icki
ng th
e pr
oper
ties
of th
e lo
tus
leaf
to
cre
ate
a no
vel n
anos
truc
ture
coa
ting
for
orth
opae
dic
impl
ants
.’
Spec
ial P
rofe
ssio
nal A
chie
vem
ent,
AO
A/
Facu
lty H
onor
s C
onvo
catio
n, U
NM
C C
olle
ge
of M
edic
ine,
Om
aha,
NE,
Mar
ch 2
7, 2
008
N. Å
KE
NYS
TRÖ
M,
M.D
., PH
.D.
Rese
arc
h In
tere
sts:
Col
d in
tole
ranc
e af
ter h
and
trau
ma
Mic
rova
scul
ar s
urge
ry
Surg
ical
trea
tmen
t of c
hron
ic p
ain
in th
e he
ad
and
neck
aft
er w
hipl
ash
Refe
reed
Art
icle
s:
Nys
tro
m, A
.; G
insb
urg
, G.;
Stu
ber
g, W
.;
an
d D
ejo
ng
, S.:
Pre-
and
Pos
t-ope
rativ
e G
ait A
naly
sis
for E
valu
atio
n of
Chr
onic
N
eck
Pain
in C
hron
ic W
hipl
ash.
J B
rach
ial
Ple
x P
eri
ph
er N
erv
e In
j, 4(
1):1
0, Ju
ly 2
009.
Freem
an
, M.;
Cen
ten
o, C
.; H
an
d, M
.;
an
d N
ystr
om
, A.:
Chr
onic
Whi
plas
h an
d C
entr
al S
ensi
tizat
ion;
an
Eval
uatio
n of
th
e Ro
le o
f a M
yofa
scia
l Trig
ger P
oint
s in
Pai
n M
od
ula
tio
n 2
3(4)
:2, A
pril
2009
.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Best
Doc
tors
in A
mer
ica,
200
7-20
08;
2009
-201
0
Inno
vatio
n in
Clin
ical
Med
icin
e A
war
d, D
ean’
s C
linic
al E
xcel
lenc
e A
war
ds, A
OA
/Fac
ulty
H
onor
s C
onvo
catio
n, U
NM
C C
olle
ge o
f M
edic
ine,
Om
aha,
NE,
Mar
ch 2
7, 2
008
LORI
K.
REE
D, M
.D.
Rese
arc
h In
tere
sts:
Post
-trau
mat
ic h
indf
oot r
econ
stru
ctio
n
Refe
reed
Art
icle
s:
Reed
, L.,
an
d M
orm
ino
, M.:
Dis
tal
Tibi
a N
onun
ions
. Fo
ot a
nd
An
kle
Clin
ics,
13
(4):7
25-7
35, D
ecem
ber 2
008.
Reed
, L.,
an
d M
orm
ino
, M.:
Dis
tal
Tibi
a N
onun
ions
and
Mal
unio
ns.
Op
era
tive
Te
chn
iqu
es
in O
rth
op
aed
ics,
18
(2):1
28-1
35, A
pril
2009
.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Mem
ber,
Foot
and
Ank
le E
valu
atio
n Su
bcom
mitt
ee, A
mer
ican
Aca
dem
y
of O
rtho
paed
ic S
urge
ons,
200
8 - 2
012
Act
ive
Mem
ber,
Mid
-Am
eric
a O
rtho
paed
ic A
ssoc
iatio
n, M
ay 2
009
Act
ive
Fello
wsh
ip, A
mer
ican
Aca
dem
y
of O
rtho
paed
ic S
urge
ons,
Feb
ruar
y 20
09
SUSA
N A
. SC
HER
L, M
.D.
Rese
arc
h In
tere
sts:
Pedi
atric
ort
hopa
edic
trau
ma,
es
peci
ally
fem
ur fr
actu
res
Non
–acc
iden
tal p
edia
tric
or
thop
aedi
c tr
aum
a
Neu
rom
uscu
lar d
isor
ders
Med
ical
stu
dent
and
resi
dent
edu
catio
n
Refe
reed
Art
icle
s:
Sch
erl,
S.,
an
d S
chm
idt,
A.:
Pedi
atric
Tr
aum
a: G
ettin
g th
roug
h th
e N
ight
. J B
on
e
Join
t Su
rg, 9
2(A
-3):7
56-7
64, M
arch
201
0.
Sch
erl,
S.:
Pedi
atric
Ort
hopa
edic
Em
erge
ncie
s in
Inst
ruct
iona
l Cou
rse
Lect
ures
. J A
m A
cad
Ort
ho
p S
urg
, 59,
201
0.
Bo
ok
Ch
ap
ters
& R
evie
ws:
Sch
erl,
S.:
Edito
r: S
urg
ical
Man
age
me
nt
of
Pe
dia
tric
Lo
ng
Bo
ne
Fra
ctu
res
Mo
no
gra
ph
. C
hica
go, I
L, A
mer
ican
Aca
dem
y of
O
rtho
paed
ic S
urge
ons,
Feb
ruar
y 20
09.
Ho
no
rs, A
wa
rds
& O
ffice
s H
eld
:
Prom
oted
to P
rofe
ssor
in th
e D
epar
tmen
t of O
rtho
paed
ic S
urge
ry
and
Reha
bilit
atio
n, Ju
ly 2
010
Am
eric
an A
cade
my
of O
rtho
paed
ic
Surg
eons
Ach
ieve
men
t Aw
ard,
Am
eric
an
Aca
dem
y of
Ort
hopa
edic
Sur
geon
s A
nnua
l M
eetin
g, N
ew O
rlean
s, L
A, M
arch
201
0
Best
Doc
tors
in A
mer
ica,
200
7-20
08; 2
009-
2010
Educ
atio
n C
omm
ittee
, Ped
iatr
ic O
rtho
paed
ic
Soci
ety
of N
orth
Am
eric
a, 2
009-
2010
Lead
ersh
ip D
evel
opm
ent C
omm
ittee
, A
mer
ican
Aca
dem
y of
Ort
hopa
edic
Su
rgeo
ns,
2009
-201
0
Mem
ber S
ervi
ces
Proj
ect T
eam
, Ort
hopa
edic
Tr
aum
a A
ssoc
iatio
n, 2
009-
2010
Mem
bers
hip
Com
mitt
ee, O
rtho
paed
ic
Trau
ma
Ass
ocia
tion,
200
9-20
10
Spec
ialty
Day
Pla
nnin
g C
omm
ittee
, O
rtho
paed
ic T
raum
a A
ssoc
iatio
n, 2
009-
2010
Cha
ir, W
orkf
orce
Pro
ject
Tea
m,
Am
eric
an A
cade
my
of O
rtho
paed
ic
Surg
eons
, 200
8-20
10
Edito
rial B
oard
, ‘Re
side
nt R
evie
w,’
Pedi
atric
Ort
hopa
edic
Soc
iety
of
Nor
th A
mer
ica,
June
200
9-pr
esen
t
Spec
ialty
Day
Com
mitt
ee, P
edia
tric
O
rtho
paed
ic S
ocie
ty o
f Nor
th A
mer
ica,
20
09-2
012,
Cha
ir 20
10-2
011.
Am
eric
an O
rtho
paed
ic A
ssoc
iatio
n A
ustr
ian-
Swis
s-G
erm
an T
rave
ling
Fello
wsh
ip, A
pril
2010
.
PE
RFO
RM
AN
CE
IN M
OTIO
N9
8U
NM
C O
RTH
OPA
EDIC
BIE
NN
IAL
RE
PO
RT
99
Left
to
rig
ht:
Rec
ent g
radu
ates
, Drs
. Rya
n A
rnol
d, K
urt B
orm
ann,
Gus
tavo
Cor
dero
, and
M
icha
el S
hevl
in, a
ll ge
ared
up
for a
roun
d of
go
lf at
the
Play
ers
Clu
b at
Dee
r Cre
ek d
urin
g th
is y
ear’s
gra
duat
ion
even
ts (J
une
2010
).
Dr.
Bria
n A
dam
s (left
), pr
ofes
sor i
n th
e D
epar
tmen
t of O
rtho
paed
ics
and
Reha
bilit
atio
n an
d pr
ogra
m d
irect
or o
f the
ha
nd s
urge
ry fe
llow
ship
at t
he U
nive
rsity
of
Iow
a, w
ith D
r. Ti
mot
hy F
itzgi
bbon
s, fo
ot a
nd
ankl
e sp
ecia
list a
t GIK
K O
rtho
Spe
cial
ists
an
d U
NM
C o
rtho
paed
ic v
olun
teer
cl
inic
al a
ssoc
iate
pro
fess
or, a
t the
201
0 an
nual
gra
duat
ion
post
-gol
f bar
bequ
e.
Dr.
Bria
n A
dam
s w
as th
e de
part
men
t’s
2010
gra
duat
ion
visi
ting
spea
ker.
Left
to
rig
ht:
Ort
hopa
edic
resi
dent
s D
rs.
Nol
an M
ay (H
OII)
, Kha
lid A
zzam
(HO
II),
Eric
Sam
uels
on (H
OIII
), an
d Ke
vin
Lind
gren
(H
OII)
, with
201
0 gr
adua
tes
Drs
. Kur
t Bo
rman
n, M
icha
el S
hevl
in a
nd R
yan
Arn
old,
an
d or
thop
aedi
c re
side
nt D
r. Ry
an H
ess
(HO
IV),
at th
e 20
10 g
radu
atio
n ba
nque
t he
ld a
t the
Om
aha
Cou
ntry
Clu
b in
June
.
Left
to
rig
ht:
John
Wie
belh
aus,
B.S
./C
linic
al R
esea
rch
Ass
ocia
te, C
hris
tine
Julia
n, M
.A.,
Stan
Vog
el (h
usba
nd o
f Mar
y Pe
ters
on),
Mar
y Pe
ters
on, R
.N.,
Dan
a Sc
hwar
z, R
.N./c
linic
al re
sear
ch c
oord
inat
or,
Am
ie R
uffc
orn,
R.N
., an
d M
itzi J
ohns
on,
B.S.
/ort
hopa
edic
sur
gery
clin
ic m
anag
er,
at th
e 20
10 g
radu
atio
n ba
nque
t hel
d at
the
Om
aha
Cou
ntry
Clu
b in
June
.
In 2
009,
Dr.
Susa
n Sc
herl
was
cho
sen
by th
e A
mer
ican
Ort
hopa
edic
Ass
ocia
tion
(AO
A)
to b
e a
2010
AO
A –A
SG (A
ustr
ian,
Sw
iss,
G
erm
an) T
rave
ling
Fello
w. B
egin
ning
in A
pril
of th
is y
ear,
she
spen
t fou
r wee
ks to
urin
g or
thop
aedi
c in
stitu
tions
thro
ugho
ut A
ustr
ia,
Switz
erla
nd a
nd G
erm
any.
Thi
s ph
oto
was
take
n at
the
Pedi
atri
c O
rtho
paed
ic
Clin
ic in
Bas
el, S
witz
erla
nd, w
ith (l
eft
to
rig
ht)
Bri
tish
Fello
w D
r. Ra
ghur
am T
hons
e,
Dr.
Susa
n Sc
herl,
Dr.
Fritz
Hef
ti (C
hief
of
Ort
hopa
edic
s at
the
Uni
vers
ity C
hild
ren’
s H
ospi
tal i
n Ba
sel,
Switz
erla
nd),
and
Am
eric
an F
ello
w D
r. Sc
ott S
tein
man
n.
DEP
ARTM
ENT
LIFE
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T9
9P
ER
FO
RM
AN
CE
IN M
OTIO
N9
8
PE
RFO
RM
AN
CE
IN M
OTIO
N1
00
UN
MC
OR
THO
PAED
IC B
IEN
NIA
L R
EP
OR
T1
01
PE
DIA
TRIC
OR
THO
PAE
DIC
STA
FF:
Left
to
rig
ht,
Fro
nt ro
w: D
ebbi
e Kn
owlto
n an
d Ri
ta H
aver
man
; Ba
ck r
ow
: She
lly R
icha
rds,
Lin
da K
raut
, Cyn
di T
arbo
x-W
hitm
yre,
and
Sta
cy T
wee
dt.
Not
pic
ture
d: R
enee
Jack
son,
Em
ily S
choe
ch, M
ary
Jo A
nzel
one,
Kat
hy H
ash,
Lau
ri W
est,
Gin
a Be
dfor
d, a
nd M
ikal
ee S
mith
.
OR
THO
PAE
DIC
BIO
ME
CH
AN
ICS
AN
D N
AN
O-B
IOTE
CH
NO
LOG
Y L
AB
STAF
F:Le
ft t
o r
igh
t: T
ravi
s Ja
ckso
n, O
sval
do A
ndre
s Ba
rrer
a, K
evin
Sw
ierc
zek,
Rob
ert J
acob
berg
er, J
oel W
eise
nbur
ger,
Tyle
r Lee
, and
Jenn
ifer B
ruce
. N
ot P
ictu
red:
Uts
av P
okha
rel.
OR
THO
PAE
DIC
AC
AD
EM
IC S
TAFF
: Le
ft t
o r
igh
t, F
ron
t ro
w: D
avid
Sta
iert
, Pat
Run
ning
, Sus
an S
iebl
er, E
lise
Bala
ban,
and
Mik
e C
ihal
; Ba
ck r
ow
: Ger
i Mill
er, J
ohn
Wie
belh
aus,
Tam
i Je
nson
, and
Dan
a M
eyer
. Not
pic
ture
d: E
ileen
Roo
ney,
Chr
istin
e Pr
acht
, and
Dan
a Sc
hwar
z.
OR
THO
PAE
DIC
CLI
NIC
STA
FF:
Left
to
rig
ht,
Fro
nt R
ow
: Sha
ne H
uggi
ns, H
eath
er O
skey
, Ste
phan
ie S
chel
ler,
Lori
Daw
son,
and
Ron
alee
Vin
sonh
aler
; Ba
ck r
ow
: Mar
y C
hadw
ell,
Kari
Ruff
corn
, Mitz
i Joh
nson
, Am
ie R
uffc
orn,
Mar
y Pe
ters
on, C
hris
tine
Julia
n, Je
ff O
hmbe
rger
, and
Ker
by S
elm
er. N
ot p
ictu
red:
Brid
get B
urke
, Nan
cy
And
rew
s, N
icol
e M
onag
han,
Kim
Wel
ls, S
teph
anie
Cas
tillo
, Dea
na S
orge
nfre
i, D
onna
Win
chel
l, an
d Kr
is B
row
n.
PERFORMANCE IN MOTION102
Department of Orthopaedic Surgery and Rehabilitation
981080 Nebraska Medical Center, Omaha, NE 68198-1080
Phone: (402)559-8000 | Fax: (402)559-5511
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08/09 BIENNIAL REPORT
PERFORMANCE IN MOTION