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other options exist — make joint replacements safe and last a lifetime. Among their many published studies this past year, a team of surgeons including Craig Della Valle, MD; Tad Gerlinger, MD; Brett Levine, MD; Scott Sporer, MD; and Denis Nam, MD, completed a noteworthy study of two methods for reducing infections after knee or hip surgery. In this seven-year effort, the team studied the effectiveness of two medicated solutions, a common sterile saline and a diluted betadine formula, to wash out the surgical site before wound closure. To give this study statistical power, the surgeons recruited over 400 patients and ultimately found that the betadine formula was five times more effective than the saline solution at reducing postoperative infection risk. This first-of-its-kind study has made waves in the field of reconstructive surgery, informing better care protocols worldwide. Studies like these are not possible without your support for the tremendous infrastructure needed to enroll patients, collect evidence and conduct statistical analyses. FAI Studies: Demystifying a Mysterious — and Common — Cause of Hip Pain In the world of orthopedic surgery, the hip abnormality known as femoroacetabular impingement, or FAI, is considered a recent — and still largely mysterious — condition. First described in 2003, FAI-related injuries are now one of the leading causes of hip surgery (especially in young people) and FAI is understood to accelerate the development of osteoarthritis. Although estimates of FAI’s prevalence in the U.S. population vary widely, somewhere between 40 and 50 percent of Americans are likely to have FAI. The condition presents itself in one of three ways: People with a cam lesion have bone overgrowth on the “ball” part of the hip’s ball-and-socket joint; people with a pincer lesion have bone overgrowth at the “socket;” and some people have both abnormalities. What makes FAI so perplexing is that a great number of individuals with FAI live long, active lives without experiencing problems. When symptoms do develop, however, it usually indicates that there is damage to cartilage and the disease is likely to progress. To demystify this condition, Shane Nho, MD, MS (pictured below), and his Rush collaborators are leading a multi-pronged FAI research effort, including the collection of MRI evidence before and after surgery. Collaborating with experts in computational modeling and scientists in the Joan and Paul Rubschlager Motion Analysis Laboratory, Dr. Nho’s team will also determine if patients with FAI-related hip problems exhibit a “movement signature” that may be to blame for their pain. Dr. Nho’s important research, backed by generous donors, may lead to new therapeutic interventions that help patients with FAI prevent pain and damage to cartilage in the hip joint. Shane Nho, MD, MS, is working with scientists across the Department of Orthopedic Surgery to shed new light on femoroacetabular impingement, or FAI, a hip abnormality that can lead to joint damage and pain. No Worse for Wear (Particles)? Research Into Artificial Joint Breakdown and Corrosion The artificial implants utilized in joint replacements are composed of materials such as metal alloys, plastic and ceramics. Unfortunately, all implanted joints break down in the body over time to varying degrees, with microscopic pieces of wear debris called nanoparticles coming off the implant and into other areas of the human body. Over the years, the design of implants used in surgery and their material composition have undergone improvements to reduce the amount of wear under normal use. Still, some wear debris cannot be entirely avoided. In fact, even under ideal conditions, millions (and perhaps even billions) of nanoparticles are generated each year. In some cases, implants undergo corrosion processes that can create an additional source of foreign particles within the body. Joint replacement patients are not the only people exposed to nanoparticles — they may be found in food, drinking water, beauty products and even the air we breathe. However, wear particles from artificial implants are a major area of focus for researchers who are just now beginning to understand the health risks triggered by these tiny potential toxins. Scientists in the Robbins and Jacobs Family Biocompatibility and Implant Pathology Laboratory are uniquely positioned to study these particles and their effects. Over 25 years ago, this lab established a postmortem tissue repository that is now one of the largest in the country, holding tissue samples from hundreds of joint replacement patients, including tissue samples from the joint capsule, liver, spleen, kidney, brain, bone marrow and heart. Over the past year, scientists in the lab have developed highly sophisticated techniques utilizing infrared spectroscopic imaging to characterize how wear particles get distributed throughout the body. Few institutions have this capability, and the researchers’ findings will inform the development of new artificial implants. Manipulating the Knee Environment to Prevent Osteoarthritis Progression Osteoarthritis, or OA, is the most common type of arthritis, characterized by progressive damage to cartilage and other joint tissues. In particular, the knee is the most prevalent joint for OA pain, affecting about 20 percent of adults over age 45. On
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