Oregon Journal Of Orthopaedics | Volume IX, 2020

Selections from the issue:

OJO 2020 cover image mount Hood
Click image to download complete OJO issue.

New Faculty Spotlight: A Q&A Session with Lara Atwater, MD

Dr. Lara Atwater and family

Hometown: Honolulu, Hawaii

Medical School: Georgetown University, Washington, DC

Residency: Johns Hopkins University, Baltimore, MD 

Fellowship: Institute for Foot and Ankle Reconstruction, Mercy Hospital, Baltimore, MD

Favorite Restaurant in Portland: Tasty n Alder

Go-to OR music? Kygo

Tell us a little about yourself. I am married to my college sweetheart and we have an 11-month-old son. I grew up surfing and kayaking but I’ve yet to try it here in Oregon.

What brought you to OHSU? I was looking for an academic job where I can teach and be involved with research. I was originally born in Hawaii but have lived/studied/trained on the East Coast since college. Oregon was completely different from both of these places and felt like a new adventure! I also felt that the department was filled with particularly kind and smart people – I was excited by the idea of becoming their colleague.

What made you choose foot and ankle as a specialty? It’s difficult and expansive - foot and ankle surgeons perform almost 500 different procedures. It’s also a decade or two behind other subspecialties from a research perspective. I knew I would never get bored from a technical or intellectual standpoint.

Favorite thing about Portland/PNW so far? Our favorite place in Portland so far is the Japanese Garden. We also love all the waterfalls and hikes!

What are some goals you have for your practice? I’d like my practice to be busy and broad: arthroplasty, sports, trauma, deformity. Hopefully a nice mix of both simple and complex cases.

What is the biggest difference between practicing in Oregon and where you were trained? When I ask people “what do you do“, they tell me what they like to do on weekends, not what they do for a living. I love the paradigm shift.

Do you have any research interests or projects you’re looking forward to pursuing? I’m grateful that OHSU has a weight bearing CT scanner, the research possibilities are very exciting!

Oregon Shoulder Fellowship Receives American Shoulder and Elbow Surgeons (ASES) Recognition

By: Elliott Cole, MD and Patrick Denard, MD

For Dr. Patrick Denard, a commitment to strengthening the craft of orthopaedic surgery has been a foundational value since his time in residency. As a native Oregonian, he received his undergraduate degree from the University of Puget Sound before attending medical school at Dartmouth and eventually returning to Oregon to complete his arthopaedic residency at Oregon Health & Science University (OHSU). As a senior resident, he was known for guiding junior residents through difficult cases, and as a chief he received the Research Award, given annually to the graduating resident who most exemplifies a commitment to furthering orthopaedic knowledge. As part of OHSU Chairman Dr. Jung Yoo’s first class of interns, the development of Denard’s technical and teaching capabilities made such an impression on the faculty that he was asked to join the staff after graduating. Denard instead chose to go into private practice, and he eventually settled in Medford, Oregon.

Even as he built a thriving private practice at Southern Oregon Orthopedics, Denard has remained extremely active in the orthopeadic academic world. He has over 130 publications listed on PubMed and has authored multiple book chapters. He has also co-authored a textbook on arthroscopic shoulder surgery principals (The Cowboy’s Companion: A Trail Guide for the Arthroscopic Shoulder Surgeon), and he continues to be invited to speak on a variety of shoulder related topics around the country.

While building his practice and pursuing his academic interests, Denard found himself drawn back to the mentorship and teaching experiences he had during his residency and fellowship training. Since residency, Denard has completed two fellowships: the first focusing on shoulder arthroscopy in San Antonio, Texas under the guidance of Dr. Stephen Burkhart and another program focusing on shoulder athroplasty under Dr. Gilles Welch in Lyon, France. Denard credits Dr. Burkhart with instilling in him the drive to be a productive researcher as well as showing him how to give feedback and motivate trainees. These experiences paired with his commitment to continuing orthopaedic education are what led Denard to start the Oregon Shoulder Fellowship five years ago. “I’ve always been interested in education, continuing to learn, and participating in teaching the next generation of orthopedic surgeons. The process makes me better, makes the next generation better, and strengthens the craft”, says Denard. His first fellow five years ago had already completed a fellowship but was looking for more shoulder training. That fellow spent six months training with Denard before going into practice, and Denard found the experience both personally and professionally rewarding.

Denard has spent the last five years building the fellowship program, and one of his main goals has been to have the program formally recognized by the American Shoulder and Elbow Surgeons (ASES). Although Shoulder and Elbow fellowships do not receive accreditation from the American Council on Graduate Medical Education (ACGME), they can receive formal recognition from the ASES. The recognition is a seal of approval from one of the preeminent bodies of shoulder and elbow surgeons, and the formal sanctioning can help attract high quality applicants to the program. After years of hard work, the fellowship recently received formal ASES recognition, an achievement Denard is proud of and one he thinks will help both attract fellows and sustain the program. Formal ASES recognition allows the fellowship to participate in the ASES match, increasing the program’s visibility and likelihood of attracting high quality applicants. Denard admits, “it’s been a long process” and a considerable effort to achieve this recognition for the program. But he also says it’s been something he’s been interested in since the program’s conception. For a fellowship program to receive this recognition, it requires two ASES-registered surgeons be involved in the training, at least one of whom must be a full ASES member. Becoming a full member is itself a long process, requiring ASES membership for at least five years as well as making a “substantial contribution” to the ASES, which involves a point system that takes publications, leadership, and other criteria into account. Denard believes the effort to meet these requirements will pay off for the overall betterment of the program.

Having just finished interviewing a strong group of applicants, Denard is looking forward to bringing on a new fellow August 2021. The fellowship itself is a one-year program focusing on advanced arthroscopic techniques, arthroplasty, and shoulder and elbow trauma, with three dedicated operative days and two days of clinic each week. Fellows are also expected to make an academic contribution by completing at least two research projects during the year, either by collaboration with Denard’s ongoing research or through pursuing their own areas of interest. Funding for the program is through the Southern Oregon Orthopedic Research Foundation, with some contribution from hospital and industry groups. Training will take place at both Southern Oregon Orthopedics and Asante Health Systems locations. Dr. Matthew Nugent and Dr. Cameron Phillips will join Denard in training the fellows.

Denard says his goal with the program is to help fellows hone their surgical technique before entering independent practice, while also supporting their research interests and further promoting their professional development. He hopes that decades from now, he can look back at his efforts and see that he helped create an alumni network of well-trained, highly regarded shoulder and elbow surgeons, and he believes that formal ASES recognition for the program is an important step in achieving that goal.

For more information about the Oregon Shoulder Fellowship, please visit https://www.oregonshoulder.com/fellowship-patrick-denard.html

Innovation Meets Altruism

Image of orthopaedic surgery tools

By: Trevor Barronian, MD

Orthopaedics is a field heavily driven by innovation. Whether it is in techniques, medications, or orthopaedic implants there is a continuous push to improve upon what we have. This is an important attitude as forward progress directly benefits the patients who receive the care provided. By chance this article’s focus was directed to Sign Fracture Care International. Initially the intention was to highlight Acumed, LLC, an orthopaedic implant company headquartered in Hillsboro. However, I reached out to a former Acumed employee and found that he is currently working for SIGN Fracture Care International. This provided me with the opportunity to learn more about the exciting innovation going on there.

What is SIGN Fracture Care?

SIGN Fracture Care is an organization based in Washington State and was founded in 1997 by Dr Lewis Zirkle. The idea was born out of his exposure to local hospitals while serving in Vietnam during the 1960s. The poor condition of these hospitals and lack of supplies affected him deeply, prompting him to found a company to help with fracture care. The mission statement on SIGN’s website states “SIGN gives the injured poor access to fracture surgery by donating orthopaedic education and implant systems to surgeons in developing countries”. True to their statement, they provide supplies to more than 50 countries around the world. More than that however, they also provide education to local physicians in these countries to ensure a lasting impact.

The people they treat

When discussing innovation, it is important to remember that often the patients who are benefiting from the newest innovations are those with the resources to purchase the treatments. As recently as 2017, the World Health Organization estimates that 800 million people spend at least 10 percent of their income on their health expenses.This added burden of health care is enough to push 100 million people over the line into extreme poverty. In these settings, innovation has to take a slightly different form. The focus has to be on availability and cost in addition to outcomes and quality. This is where companies like SIGN can make a large impact on these patients’ lives.

Local involvement

Locally, SIGN is situated in an unassuming building in the southeast of Portland. This building is owned by Randy Huebner, the founder of Acumed. The building serves as a warehouse, office space, machine shop and design space for product development and manufacture. As previously mentioned, one of the ways in which SIGN provides aid is through the donation of implants. The implants are donated from companies, such as Acumed, or are designed and created by SIGN itself. Looking specifically at the donation side of their supply chain, there is a large variety of individuals and companies who contribute these implants. I had the chance to visit SIGN at the Portland location. SIGN

contributors and employees develop custom sets of instrumentation made up of a variety of parts for use, which may even be originally from different companies. This ensures that when they are sent overseas there is a wide assortment of components to allow the surgeons to safely perform the necessary surgeries. Two local individuals are intimately involved with SIGN Fracture Care and serve on the board. The first is Randy Huebner, mentioned above, In addition to serving on the board, he supplies

implants and physical working space to SIGN in cooperation with Acumed. The second individual is Richard Gellman MD, a prominent orthopedic traumatologist practicing at Emanuel Hospital. Dr Gellman frequently participates in trips with the organization to provide aid and training, and also recruits doctors from many other countries to help with education.


One of SIGN’s more well-known products is the intramedullary nail, designed so that a single nail can be used in the femur or the tibia. This is an important consideration as getting supplies to more remote locations or impoverished regions can be difficult. Another impressive design of the nail is that it can be placed without fluoroscopy, which is required with standard intramedullary devices. This design feature addresses the fact that fluoroscopy is not often available in poorer regions. SIGN created a custom attachment to their nail insertion handle which puts the surgeon in the general area of the screw hole. Then, with a series of drills and an instrument called a slot finder, the hole is localized by feel and the screw is placed. Then, furthering the idea of this design and to help decrease operative time and blood loss, they developed a nail that replaces the screw holes with distal fins. These fins allow the nail to bind within the bone and helps prevent the fracture from rotating.

Orthopaedic innovations are crucial in getting care to the parts of the world that often need it most. There will always be a need for surgeons, engineers and others involved in the field to critically analyze the tools and techniques they use with the mindset of how these can be improved. And the importance of having spaces like the one in Portland where people have the equipment and space to let their creative juices flow cannot be overstated.

The John and Susan Hayhurst Distinguished Scholar

Pictured in back, left to right: Dr. Jung Yoo and Susan Hayhurst. Pictured in front: Provost Elena Andresen, MD, Dr. John Hayhurst, and Dr. Jacqueline Brady
Pictured in back, left to right: Dr. Jung Yoo and Susan Hayhurst. Pictured in front: Provost Elena Andresen, MD, Dr. John Hayhurst, and Dr. Jacqueline Brady.

By: Jacqueline Brady, MD

On Sept 30, 2019, the OHSU Orthopaedics and Rehabilitation Department gathered at the Multnomah Athletic Club with representatives of the OHSU Foundation to celebrate the investiture of Dr. and Mrs. Hayhurst in support of orthopaedic research and innovation, in the form of the newly established John and Susan Hayhurst Professorship. The evening was unforgettable; we as an orthopaedic department are floored by their generosity and goodwill, and it was wonderful to have members of the OHSU Foundation present to give a more global perspective on the meaning of gifts like this one. Dr. Jung Yoo gave his thoughts as chairman on the lasting impact made by this donation, and Dr. Dennis Crawford commented as surgical director of the sports division. We learned that the origin of the funds is in large part due to Dr. Hayhurst’s own innovation in the creation of arthroscopic tools. The gift has been turned into an endowment that will benefit numerous surgeons in my department going forward. I am the lucky first beneficiary, and I am committed to making sure the Hayhurst family feels their gift was worthwhile.

Dr. Hayhurst is a self-taught arthroscopist who remembers the days when the arthroscope was not attached to a camera—surgeons looked through the end to visualize the joint, then made open incisions to address the pathology they identified. The earnings that prompted this gift originated largely from innovations of his own creation that advance our techniques in arthroscopic surgery. It is fitting, then, that we start by using his generosity to support our efforts in arthroscopic simulation training. The VirtuOHSU laboratory on campus is a perfect setting in which to teach arthroscopic skills: we have a robust and well-run Body Donations Program housed within the center, so residents can practice surgeries in a realistic “wet lab” environment. VirtuOHSU is a Center of Excellence for Storz, one of the makers of imaging technology for visualizing the inside of joints using an arthroscope.

Professor Dennis Crawford MD, PhD articulating the confluence between Dr. John Hayhurst’s vision and Dr. Jaqueline Brady’s research, in celebration of her appointment as the first John and Susan Hayhurst Professorship award recipient
Professor Dennis Crawford MD, PhD articulating the confluence between Dr. John Hayhurst’s vision and Dr. Jaqueline Brady’s research, in celebration of her appointment as the first John and Susan Hayhurst Professorship award recipient.

We have been working on knee and shoulder simulation for several years now, but with the collaboration of my partner, Dr. Andrea Herzka, we have added hip arthroscopy to the curriculum. This is a boost to our simulation activities for two main reasons: 1) Residents get more practice with a 70-degree arthroscope, which is less commonly encountered in knee and shoulder surgery, and 2) Residents get more exposure, in a safe environment, to a very difficult skill with a very steep learning curve. We measure resident motion patterns as they work their way through six wet labs over the course of their 10-11 week rotation on orthopaedic sports surgery. Having validated a model showing that motion patterns correlate with level of expertise in arthroscopy, we are now investigating whether we can track improvement over the course of the sports rotation. Recently, we have made two improvements: 1) We upgraded the sensors to a technology that does not require the usual lengthy intermediate step, to process the firestorm of data points recorded as the residents complete the tasks; and 2) We added a sensor to track motions of the head and neck in addition to the original focus on the trunk and upper extremities. Medical education research is often a lengthy process, because the accumulation of data is necessarily slow, but we are already seeing consistencies in motion patterns that correlate with what we see on the video screen and on direct observation of resident movements.

OHSU is also a collaborator in a multicenter study to validate dry tools to develop arthroscopic skills. Simulation efforts can be varied and inevitably expensive. Standardized, validated trainers are needed to develop basic skills before launching into the more advanced world of wet simulation, virtual reality, and ultimately the clinical setting. The general surgery community has had laparoscopic trainers as part of their credentialing process for several years now, in a program called the Fundamentals of Laparoscopic Surgery (FLS). Arthroscopic trainers with various modules that comprise the Fundamentals of Arthroscopic Surgery Training (FAST) program are of great interest as a similar set of standardized and validated tools for basic arthroscopic skills. OHSU led phase 1 of the multicenter study, in order to establish benchmarks and evaluate how a PGY-1 resident should perform on a ring transfer task compared to a PGY-5 resident, for instance.

OHSU residents and faculty studying and practicing arthroscopic skills at the Orthopaedic Learning Center in Rosemont, IL
OHSU residents and faculty studying and practicing arthroscopic skills at the Orthopaedic Learning Center in Rosemont, IL

Recently, three of our faculty traveled with six residents to the Orthopaedic Learning Center (the laboratory at the headquarters of our American Academy of Orthopaedic Surgeons) in Rosemont, IL to study the transfer validity of the FAST tools for performance in simulated and clinical environments. The residents and faculty met with others from 8 programs around the country. The residents were “pre-tested” in the operating room ahead of the trip, with a focus on diagnostic arthroscopy and simple procedures such as partial meniscectomy and subacromial decompression. Then at the Orthopaedic Learning Center, they spent a full day working with the FAST tools to develop skills that progressed from horizon control and periscoping with the angled camera to biting simulated meniscus and passing sutures through targets in simulated tissue. They were then tested on dry shoulder models, virtual reality simulators, and donor tissue to establish their arthroscopic skills before heading home. In the final portion of this phase 2 of the study, they will be post-tested in the clinical environment to determine how the practice with the FAST tools affected their performance in the operating room.

I have also been tapped via the Arthroscopy Association of North America to be a member of the task force to implement these FAST tools into the virtual reality environment. The Virtamed simulator is the most popular virtual reality trainer for arthroscopy skills, and building the FAST tools into its software affords us a new level of ability to evaluate and direct resident training. For instance, if the simulator recognizes that a resident has trouble maintaining the horizon level with the camera, it can direct the resident to modules to practice this specific skill before allowing progress through the remainder of the curriculum.

The “holy grail” of surgical simulation is to prove that our practice in a laboratory setting makes trainees safer and more efficient. With the aid of Dr. and Mrs. Hayhurst’s generous donation, OHSU arthroscopy simulation is well on its way to making this a reality.

National VA Database Driven Clinical Research – Annual Report Update

By: Kenneth Gundle, MD

The Veterans Healthcare Administration (VHA) is collectively the largest health system in the country. As a result, the VA databases contain an ever-expanding set of information that can be harnessed for impactful clinical research. Granular data exists for all patient encounters, including skilled nursing facility stays and information on Veterans treated outside of VHA. Each day over a million new points of clinical information are entered into the vast relational data architecture.

At the time of our last update, we were focusing on metastatic disease in the femur. That work has led to over a dozen presentations at annual meetings, and several publications. One our residents, class of 2019 Dr. Travis Philipp, was lead author in the Clinical Orthopaedics & Related Research publication entitled, “Is there an association between prophylactic femur stabilization and survival in patients with metastatic bone disease?” OHSU School of Medicine Class of 2020 Dr. Jacob Mikula, who starts his orthopaedic surgery residency at Johns Hopkins this summer, was also a co-author. Relatedly, Dr. David Putnam from our residency class of 2020 published a systematic review entitled, “Treatment modalities for pathologic fractures of the proximal femur pertrochanteric region” in the Journal of Arthroplasty. The newly minted Dr. Phillip Lam (OHSU SOM ’20) is joining our residency in June and co-authored that paper. OHSU SOM class of 2021 Sarah Hanna, along with graduating chief resident Dr. Duncan Ramsey, have two additional manuscripts under review about perioperative radiation referrals and how best to identify impending pathologic fractures within databases.

The Clinical Data Science Research Group at the Portland VA was joined by a data scientist last year, and she has been a huge help. Cecelia Madison completed a graduate program with the OHSU Department of Medical Informatics and Clinical Epidemiology, and is now fully immersed in the world of VA data. She helps residents and staff with cohort creation and data wrangling through programming in SQL and R. We have also collaborated on natural language processing tools and determining consistent objective means of calculating key variables such as inpatient length of stay. We’ve also had the ongoing support of Tahnee Groat, research manager for the Operative Care Division.

In addition to metastatic disease of the femur, we are investigating the care of sarcomas within VHA and have proposals to partner with industry to study the uptake and outcomes of new devices. We are also studying the impact of clinical trial publications on the rates of partial meniscectomy, and have applied for extramural funding to investigate the impacts of COVID-19 on musculoskeletal care nationwide.

We have made some progress since the last update, but there is so much more to be done. Reach out if you would like to learn more!

Orthopaedic Surgery Interest Group (OSIG) Engages Medical Students Interested in Orthopaedics at OHSU

A Review of Programming, Involvement, and Impact

By: Zachary Goldstein, BS; Tasha McKibben, BS; David Cornwell, BS; Kenneth Gundle, MD

The goal of the Orthopaedic Surgery Interest Group (OSIG) is to cultivate interest in the field of orthopaedics and engage medical students interested in orthopaedic surgery. This mission is achieved through collaboration with the Department of Orthopaedics and Rehabilitation at OHSU. OSIG hosts activities including monthly research meetings, surgical simulations, sterile technique workshops, and first assist opportunities that expose students to different aspects of a career in orthopaedic surgery. The diversity of OSIG events and strong partnership with OHSU has allowed it to remain one of the largest and most active student interest groups. This year OSIG’s membership increased from 199 to 237, including 45 new members from the M.D. class of 2023. The following is a review of this year’s programming and impact.

Early in their first year at OHSU, medical students are invited to attend the OSIG “Research Trajectory” talk hosted by OSIG faculty advisor Dr. Kenneth Gundle. This talk highlights the optimal time to complete research and prepare for a strong application into a competitive specialty. The content of this talk is reinforced by monthly research meetings led by Dr. Natalie Zusman, a PGY-3 orthopaedics resident. OSIG research meetings provide students with opportunities to learn about ongoing projects in the department, discuss and overcome obstacles inhibiting productivity, and present progress

and ideas for new studies. The engagement of OSIG with research is outstanding, evidenced by 22 posters and projects presented at the 2019 OHSU Research Symposium. Additionally, OSIG continues to guide projects towards successful acceptances to national journals and conferences throughout the year. New this year, OSIG student leaders constructed an orthopaedic conference calendar with abstract deadlines and conference locations to be used by students, residents, and faculty. This calendar, updated quarterly, is available to the public on the OSIG website: https://www.ohsu.edu/ortho/orthopaedicsurgery-interest-group.

In addition to developing research within the department, OSIG has continued to host sterile technique workshops that allow students to familiarize themselves with the sterile field and operating environment. During these workshops OHSU perioperative staff train students on how to properly scrub, gown and glove, and navigate the operating room during a case. OSIG leaders teach students how to operate scrub machines, locker rooms, and navigate the surgical floor. In response to student feedback, a third workshop was added this year increasing our total capacity to 45 students. Surveys were distributed before and after workshops to measure the participants’ level of comfortability with tasks such as scrubbing in and gloving (Figure 1).

Graph How comfortable do 1st year medical students feel doing various tasks

Notably, the average student comfortability with navigating scrub lockers, surgical floors, and operating rooms rose from 1.5/10 to 7.6/10. The average student comfortability with being in a sterile field increased from 3.6/10 to 5.9/10. Before entering the wards in their second year, students do not receive formalized sterile technique training through the university. Orientation to the surgical floor, operating rooms, and sterile field helps prepare students for clinical exposure. This organized training facilitated by OSIG not only aids students as they begin preceptorships, but also alleviates pressure from staff who share the responsibility of helping new students navigate the OR safely.

This year through OSIG’s Surgical Simulation Labs (Simlabs), students were provided early, supervised exposure to both suturing and common orthopaedic surgical approaches. The Simlabs allow students to hone their skills tying knots, develop muscle memory involved in suturing, and elevate general surgical knowledge before working directly with patients. Simlabs make use of OHSU’s Virtu-OHSU surgical simulation environment, and immediately follow orthopaedic resident’s arthroscopic training. Hands-on manipulation of fresh cadaveric tissue is preceded by an educational lecture on surgical approaches and common anatomical landmarks. These lectures are taught by department faculty and allow students to ask questions about the worksheets they complete before entering the Simlab. Each of the three yearly Simlabs accommodates 12 students from the first and second year classes and is a unique opportunity to work directly with orthopaedics attendings and residents.

Beyond research, surgical simulations, and sterile technique workshops, OSIG has also continued to expand the First Assist Program. First Assist is coordinated with department administrators and allows students to work in the operating room with specified attending surgeons. This year 6 preclinical and clinical students were able to participate, more than doubling the number of students involved in this highly sought-after program. Through First Assist, students receive unparalleled hands-on experience in the care of orthopaedic patients while also providing assistance at times when residents are unavailable.

With the help of the Department, faculty, and residents, OSIG continues to provide opportunities for medical students to gain early exposure to and develop a passion for the field of orthopaedic surgery.

2019-2020 OSIG Student Leads: Tasha McKibben, Zachary Goldstein, David Cornwell Resident Lead and Research Advisor: Natalie Zusman, MD Faculty Sponsor and Research Advisor: Kenneth R. Gundle, MD

Presented at OHSU’s Research Week - 2020

Comparing BMP-9 with TGF-β1 for Tissue Engineering Stable Articular Cartilage. Cory Kim, BS

Does Surgical Delay Impact Blood Loss During Acetabular Fracture Surgery? Natasha McKibben, BS

Multimodal Preoperative Screening for Recent Nicotine and Marijuana Use in Hip and Knee Arthroplasty Patients at the Portland VA Medical Center. John Tabb, BA

Orthopaedic Care of the Transgender Patient. Ariana Stuart, BA Pivot Kick Study: Can a Novel Physical Exam Maneuver for Medial Meniscus Tears Predict Improvement After Partial Medial Meniscectomy? Jorge Walker, MS

Readmission Rates After Total Hip and Knee Arthroplasty Vary Across Different Datasets. Stephanie Zhao, MSL

A Systematic Review of Tuberosity Healing and Outcomes Following Reverse Shoulder Arthroplasty for Fracture According to Humeral Inclination of the Prosthesis. Joe O’Sullivan BS

Is the Iliac Cortical Density Similarly Positioned in the Non-Dysmorphic Developing Pelvis? Benjamin Watzig, BS

Definitive Treatment? Risk Factors for Reoperation Within One Year of Below Knee Amputation. Liam Wong, BS

Methamphetamines & Acetabular Reoperation Rates: Poor Outcomes From the Front Lines. David Gallacher, BS

Location-specific differentiation potential of clonal articular cartilage progenitor cells. Leah Snyder, BS

Talking Innovation with Dr. Steven Madey

By: Connor Pihl, MD

In practice as a hand and microvascular specialist with Summit Orthopaedics since 1997, Dr. Steven Madey MD has served in a variety of roles throughout his career, including site director for OHSU and Samaritan Health Services orthopaedic surgery residency rotations at Legacy Emmanuel Hospital. During ten-week blocks, OHSU (2nd and 4th years) and Samaritan (4th year) orthopaedic surgery residents have the opportunity to share in and benefit from Dr. Madey’s unique measure of knowledge, surgical skill, business acumen, and enthusiasm for innovation. Inspired by this last quality as the theme of the current volume of the OJO, I was thankful to have the chance to get his unique take on orthopaedic innovation in the state of Oregon. Motivated by his fruitful work as an University of Iowa orthopaedic resident and Hand Fellow, Dr. Madey founded the Legacy Biomechanics Laboratory in 1999 with his Iowa collaborator Dr. Michael Bottlang, PhD. Oriented to the design and evaluation of new treatment modalities that advance patient care, the lab has matured and expanded over the last two decades, seeing much success along the way. With over 50 publications and many innovative technologies and products brought to market - such as the Pelvic sling, MatrixRIB plating system, far cortical locking constructs, active plating constructs, a mechanoactive transduction and evaluation tissue bioreactor, and most recently advanced helmet technology- it’s fair to say the Legacy Biomechanics Laboratory has been a pioneering player in Oregon’s history of orthopaedic innovation.

Faced with questions like “why would you do that (in Portland), it’s impossible”, at the outset, Drs. Madey and Bottlang leveraged Legacy Health support, NIH grants, DoD grants, and creative ingenuity to establish the State’s first private basic and applied orthopaedic research lab. Reflecting on the early years, Dr. Madey identified niche focus, “grit”, and a collaborative spirit driven by deep respect for interdisciplinary perspectives as key to early progress in a region that lacked the “history and architecture” of places like Boston, Texas, and the North Carolina Research Triangle. “Knowing exactly who we were and what we could and couldn’t do”, allowed Drs. Madey and Bottlang to carve out a space for the lab initially focused on evaluating industry devices in an Oregon landscape with few other players.

Through this early work, Drs. Madey and Bottlang steadily built up the experience, infrastructure, talented team, financial support, and both local and national relationships to allow their expansion into the novel design sphere. With a simple mantra of - identify a single problem, understand that problem, and leverage your unique capabilities to engineer a solution – they have carefully grown their intellectual and onmarket portfolio. Seeing success right alongside the Legacy Biomechanics Lab, the greater Portland and Oregon biotech industry at large has also grown and flourished, due in no small part to significant advances such as Dr. Brian Druker’s use of Imatinib (Gleevec) to treat CML, investments and basic science breakthroughs by OHSU and the Phil Knight Institute, and relocation and expansion of Acumed, LLC in Beaverton, OR just to name a few.

Bicycle helmet insert material

Pressed to share his thoughts on the future of orthopaedic innovation in Oregon, Dr. Madey was bullish about what could be achieved by “any driven individual who wants to make it happen”. To those so inclined, in addition to now being able to realize the benefits of operating within a maturing biotech landscape, Dr. Madey noted first-hand the assistance aspiring innovators can gain through State established and/or supportedprograms such as the Oregon Manufacturing Extension Partnership (OMEP). With OMEP’s “phenomenal” support, Drs. Madey and Bottlang have most recently set out on a new endeavor, actually manufacturing the innovative technology they have created through their game-changing helmet company WaveCel.

The company’s helmet insert product, which is uniquely able to flex, crumple and glide to divert rotational impact forces away from the head in a crash, was awarded with the highest possible safety rating (5 stars) by Virginia Tech University’s helmet testing facility and has disrupted the industry. The public’s response to Madey’s partnership with bicycle giant Trek Bontrager has been so enthusiastic that the company relocated from their original five-thousand square foot manufacturing space in Milwaukie to a nearly fifty-thousand square foot facility in Wilsonville that will allow them to fulfill an estimated demand for 1.5 million helmets over the next year. If you haven’t already, the next time you’re out on the road or trail you may just notice the company’s characteristic neon green honeycomb-esque material on a fellow rider’s helmet!

Dr. Steven Madey

Asked if he could have imagined his career unfolding in this way as he took his first steps towards establishing the Legacy Biomechanics Laboratory over 20 years ago, Dr. Madey’s response was simple - “of course not”. It appears to me that with his example of what can be achieved by staying both curious and committed to an iterative process of improvement, growth, adaptation, and redefinition throughout a career, future orthopaedic innovators have much to look forward to as we venture into a new decade in an Oregon landscape that’s never looked so promising.