Beyond the Exam Room: Physician Research and Presentations

1. Consulting with and caring for patients is life’s work for OrthoCarolina’s nearly 180 physicians, but the true scope of the work they do encompasses far beyond the doors of the clinic. Like many people in professional jobs, doctors and surgeons are always learning. Conceptualizing, researching and teaming up to develop innovative techniques and unprecedented treatments help keep OrthoCarolina on the forefront of orthopedic care. To get a broader perspective of a physician’s involvement in research, J. Ryan Martin, MD, hip and knee surgeon with OrthoCarolina Matthews, offered an insider’s view of his own research and presentation background.

Much of your day is spent seeing patients and in surgery. When do you work on research?
Dr. Martin: I come in early most mornings to do research. I review radiographs and clinical data points for ongoing projects and then after several hours begin seeing patients. I work closely with a research team that meets monthly. We all pitch ideas to the group about what we want to study and then work with OrthoCarolina Research Institute (OCRI) to get the research underway. Generally, we study patient radiographic and clinical outcomes, so lab research is somewhat minimal, but is also performed here at OrthoCarolina.

How do you tell people about your research?
Dr. Martin: Two main ways; published papers and research meetings. We have two annual meetings that hip and knee surgeons attend. One is the American Association of Orthopedic Surgeons (AAOS) and the other is the American Association of Hip and Knee Surgeons (AAHKS), both made up of surgeons from all around the world. At each of these, the most cutting edge research is being presented by the world’s top surgeons. If you’re chosen to present, you get the opportunity to give podium and/or poster presentations based on the quality of the research. At the last AAHKS meeting, I was selected for two podium and two poster presentations.

So, what are podium presentations?
Dr. Martin: A committee selects 60 podium presentations from approximately 1,380 applications. A podium presentation consists of the presenter going on stage and presenting his/her research to all the other hip and knee surgeons in a concise five-six minute presentation. For example, I recently was part of research project describing MRI findings in patients with common total hip arthroplasty implants. We studied what types of fluid collections are “normal” in routine total hip replacements. We were trying to see if patients that have ceramic-on-polyethylene total hip replacements form fluid similar to what we see in metal-on-metal hip replacements. Additionally, we were trying to figure out if fluid collections are dangerous or a common finding in total hip replacement.

The second podium presentation was a knee study that looked at patients who had had a revision knee replacement with substantial bone loss that required advanced reconstructive methods. We were studying the use of a specific implant called a metaphyseal sleeve, which improves implant fixation in patients with bone loss during revision surgery.

What are poster presentations, and how are they different?
Dr. Martin: A poster presentation is what it sounds like. The presenter stands next to a poster about their research and talks to any other physicians at the meeting about the work. The presenter routinely waits for a few hours and answer questions regarding the research project. It’s a great way to share with colleagues in other geographic areas the work that OrthoCarolina and OCRI are doing. At a recent meeting, I presented two posters. One was on total knee replacements after ACL reconstruction, tracking how those patients do after their knee replacements. The other study was on avascular necrosis of the femoral head, an issue we see in patients between 20-40 years old that can cause a collapse of the femoral head and lead to a total hip replacement at a young age. It’s a fascinating study to me because we’ve come up with a non-arthroplasty treatment. It involves taking the patients’ own blood and stem cells to heal the femoral head. We currently have six-year data on the first subset of patients. We can halt the progression of avascular necrosis by using the patients’ own STEM cells, concentrating them and injecting them back into the femoral head. This device is one of the few devices for STEM cell treatment. We have published three papers on the topic and are attempting to correlate the amount of stem cell populations with radiographic and clinical healing. Our studies have shown we can postpone surgery and improve healing in the correct patient population.

Why do you think research is so important?
Dr. Martin: Many of the great achievements in medicine are a result of physicians and researchers that have come before us. Due to this, many surgeons at OrthoCarolina feel compelled to continue to improve patient outcomes through research. It’s imperative to always focus on improving the quality of patient care, and research provides the perfect avenue.

J. Ryan Martin, MD, is a hip and knee surgeon with OrthoCarolina Matthews.