Sunday, June 27, 2010

Katie - week 2

Hello readers! This second week of summer immersion gave me experience meeting with patients and helped to further define my research project. On Monday, I had the opportunity to meet with Joe Lipman, the director of device development in biomechanics at HSS. Since my summer project is going to be focusing on total joint replacement, I wanted to understand an engineer's perspective. He helps to design custom made implants for the knee and hip. At the meeting, I was able to hold actual knee and hip replacement parts and saw the software that he uses to design the implants. Most often, one of the common manufactured implants will suffice for a patient's case, but in very complicated situations other design considerations are made.

After meeting with a fellow engineer, I set up a meeting with Dr. Wright to help guide me in my literature reading. He gave me a lot of guidance, and so I have been reading up on chapters about design considerations for the knee. I have learned how to define a load-sharing implant and a load-transferring implant. Also, it was interesting to learn the different designs that are available for total knee replacements. Some are very constrained, for when the collateral ligaments cannot be saved. These structures act more like hinges. Other designs, where the ligaments can remain intact, are less constrained. Through the literature review, I also saw variations in stem vs. no stem, cement vs. no cement, thickness of the metal cap, and many others.

Throughout the week I continued to attend many meetings - the biomechanics meeting, Dr. Bostrom's lab meeting, Dr. Boskey's lab meeting, grand rounds for arthroplasty, and TERR. From these meetings, I have been making connections with residents and post docs to get some experience with different lab techniques, such as learning RT-PCR, immunohistochemistry, and histomorphometry. Furthermore, I met a few new doctors to widen my clinical experience. Hopefully next week I will be attending a spine clinic and viewing a couple different surgeries.

On Friday, I went to Dr. Padgett's weekly meeting with Dr. Wright and the biomechanics lab, where he further identified the type of project I will be working on. With a medical student, I will be comparing the wear and tear of mobile bearing knee implants to non-mobile bearing knee implants. I hope to find out more about this next week. Also, I am interested in seeing the lab simulations that are done to replicate joint wear in the body to demonstrate the effectiveness of new designs.

Also on Friday I accompanied Dr. Padgett for five hours of visiting patients. It was a really neat experience, and I was really surprised that none of the patients minded having a few extra people in the room. During this time, he met with a total of twelve patients. Some were new consults, some had just received a total knee or hip replacement a few months ago, and some were years out from their surgeries. I was surprised to see a couple patients who had bilateral hip replacements! It is the wonder of modern medicine - these patients (at least the ones I saw) were able to walk normally without a cane. And some of the patients with just a single hip or knee replacement were quite active. One woman was a ballet choreographer.

Next week I hope to see a few surgeries, visit more patients, and learn more about the mobile bearing knee implants and how they will be compared to the standard knee replacements.

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