During Mineralized Tissue Journal
Club, researchers from Cornell Engineering and Hospital for Special Surgery
discuss relevant literature in the realm of bone mechanics, diseases, and
in-vitro modeling. This week, I was able to attend the monthly meeting from the
HSS side with Adele Boskey and colleagues. The paper up for discussion
highlighted a new approach to intrafibrillar mineralization of collagen both
in-vitro and in-vivo and also alluded to research efforts I was a part of
during my undergraduate career. I was excited to see so many of my experiences
coming full circle during immersion.
On that note, I finally got to
see a total knee replacement, which I had been itching to see since working for
a prosthetic company last summer. The patient had always had a high blood
pressure so that didn’t make for a welcoming start to surgery. She bled
profusely until the anesthesiology team was able to bring her under control. I
inched my way around the OR technician’s table of Stryker instruments and
implants, making sure not to contaminate anything but still trying to get the
best view. The patient appeared to have a lot of bone removed relative to the
average patient. Her pre-operative x-rays showed a tibial plate eroded down to
about a 20-30 degree angle that needed a lot of correcting before inserting the
tibial component. I believe this was due to a joint infection. My overall
impression of the surgery was the color red, because I saw a lot of blood from
my vantage point. The smaller details were harder to take in behind a team of
three surgeons but I did get to see the trial implantation and final cementing
of the prosthesis. The longest part of the surgery, aside from controlling the
blood, involved alignment and resection of the bones with Stryker’s guides.
Later in the week, I observed a
kyphoplasty. This procedure utilizes cement to help fractured vertebrae heal. A
‘needle’ is placed into the vertebrae of interest with the help of
anterior/posterior and medial/lateral x-ray images being acquired frequently.
Then, a cement gun is placed into the needles hollow center so that it can be
delivered to the exact site accurately. Dr. Lane tasked me with taking pictures
of cement preparation so that the process would be easier to remember for
future procedures.
The rest of the week was spent
observing patients with Dr. Lane. He has a very interesting patient population
that constantly presents new opportunities to learn about bone pathologies. One
case that stood out in particular was a patient that he deemed would be ideal
for a new drug called anti-sclerostin antibody but is still undergoing FDA
clearance. This may be the osteoporotic drug of the future in that sclerostin
is bone specific and trials have demonstrated a greater increase in BMD
compared to bisphosphonates and teriperatide.
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