The impact of some research may not be immediately obvious, even to the individual participating in the study. The patient participating in the study may experience pain relief or increased mobility as the result of a new therapy or treatment. In other cases, the patient may not get a direct benefit from their participation, but the value comes from the surgeon who changes their clinical practice based on the results from a particular study.
Below are some examples of how the research conducted by the OrthoCarolina Research Institute, Inc (OCRI) provides personal benefits and a better quality of life for everybody.
Study Title: The Safety of Liposomal Bupivacaine in Simultaneous Bilateral Total Knee Arthroplasty
Subspecialty: Hip & Knee
Primary Coordinator: Rebecca
Principal Investigator: Bryan D. Springer, MD
Total knee arthroplasty (TKA) is a commonly performed surgical procedure that has been shown to dramatically decrease pain and improve a patient’s function and quality of life. Due to pain and limitations in both knees, some patients may be candidates for having both knees replaced in the same surgery. The safety and efficacy of simultaneous bilateral total knee arthroplasty has been well documented; however, many patients still complain of inadequate pain control after surgery. Traditionally, pain has been managed with oral narcotics. Recently, a number of studies have demonstrated the efficacy of multimodal (different types) pain control following a variety of surgical procedures. These multimodal regimens vary and consist of any number of medications including non-steroidal anti-inflammatories, anti-epileptics, and peripheral nerve blocks among others.
One of the newest modalities introduced on the market is liposomal bupivacaine (Exparel). Exparel is an extended-release formulation of bupivacaine consisting of microscopic lipid (fat)-based particles that diffuse (spread out) over an extended period. The result is pain relief that can last up to 96 hours after surgery. A potential risk, although low, is the concern for bupivacaine toxicity. Toxicity from bupivacaine is associated with central nervous system issues (seizures) and cardiac toxicity. The purpose of this study is to evaluate the blood serum levels of bupivacaine in a series of patients undergoing bilateral TKA with the use of a standardized periarticular injection containing free bupivacaine and liposomal bupivacaine.
Study Title: Limited Incision Calcaneus Fracture with a Low-profile Anatomically Designed Calcaneal Plating System
Subspecialty: Foot & Ankle
Primary Coordinator: Katherine
Principal Investigator: Carroll P. Jones, MD
Fractures of the calcaneus (heel bone) are usually caused by significant trauma; for example, a motor vehicle collision or a fall from a significant height. Many surgeons believe that these injuries are best treated surgically with an open reduction and internal fixation (ORIF) technique. The traditional operative treatment is a lateral extensile approach. This approach provides the best visualization for reducing the fractured heel bone, but there is a risk of wound complications in as high as 25% of cases.
The purpose of this study is to see if using a limited incision sinus tarsi approach has better outcomes for the patient than the traditional method.
Study Title: Celestone versus Ketoralac Injection for the Treatment of DeQuervain’s Tenosynovitis
Primary Coordinator: Priscilla
Principal Investigator: Christopher Chadderdon, MD
DeQuervain’s tenosynovitis is a very common disorder of the tendons in the hand, second only in incidence to trigger finger. It occurs across a wide age-range (although typical in middle-aged adults) and usually affects women three times as often as men. Most cases are associated with presumed overuse; however, local trauma can be a factor in causing the disorder. The two most commonly used non-operative (conservative) treatments are splint immobilization and corticosteroid injections. Surgery is typically only done for patients who fail conservative treatment for several weeks.
This study aims to find out if using a corticosteroid injection versus a toradol injection modifies the natural course of DeQuervain’s tenosynovitis.
Study Title: Prospective Evaluation of an Angular Correction Formula For Limb Malalignment in High Tibial And Distal Femoral Opening Wedge Osteotomy
Subspecialty: Sports Medicine
Primary Coordinator: Caleb
Principal Investigator: James Fleischli, MD
High tibial osteotomy (HTO) and distal femoral osteotomy (DFO) are common surgeries performed for young, active patients with isolated arthrosis of the knee. These procedures are also effective for patients with osteochondral lesions of the medial compartment or knee ligamentous instability. Because of the degeneration in the knee, there may be a deformity resulting in an incorrect angulation of the limb. Angulation is measured before surgery with the goal to correct the limb alignment. There are several ways to measure this, but there is no consensus as to the most effective technique. Looking at patients that have had these procedures in the past, we found that the combined use of pre-operative and intraoperative measurements led to an undercorrection error of 2.1 degrees. We theorize that adding 2 degrees to the pre-operative measurement of the planned correction on long-leg alignment films will be more reliable, quicker, and more closely result in the amount of intended correction.
The purpose of this study is to evaluate the validity and reliability of our current formula to predict the amount of post-operative correction after high tibial (HTO) and distal femoral (DFO) opening wedge osteotomy using pre-operative and post-operative radiographs.
Study Title: Radiographic Sagittal Alignment in the Asymptomatic Adult: What is Normal for Age?
Primary Coordinator: Melissa
Principal Investigator: Brad Segebarth, MD
Sagittal Vertical Axis (SVA) is the distance between the last cervical (neck) vertebrae and the first sacral (tailbone) vertebrae of the spine. This can be measured by a doctor using an x-ray. Over time, SVA in an individual can increase. Increased SVA in the aging population is normal due to common degenerative changes in the spine over time.
In patients with spinal pathology requiring surgery, the accepted practice is to bring the SVA back into normal parameters for a young adult; however, this may not always be beneficial for older patients that already have increased SVAs. The current thought is that it can be more helpful for older patients with increased SVA to be corrected to an SVA that is normal for their age; however, there is limited information on what this SVA should be.
The purpose of this study is to determine the age-related normal ranges for SVA in an asymptomatic (experiencing no symptoms), aging popluation.
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