OREF grant recipient research improved durability of TJR

By Sharon Johnson

How did life on a working farm lead to a full-spectrum career in orthopaedic medicine—research, clinical practice, specialty orthopaedic organization leadership, and teaching—and more than 20 years of support for orthopaedic research? For Scoliosis Research Society past-president Marc A. Asher, MD, it was a logical path, eased by inspiration from a local physician and encouragement from the Orthopaedic Research and Education Foundation (OREF).

“I’m one of the farm boys who found his way to becoming an orthopaedic surgeon, which was a common pathway for people in my day,” Dr. Asher said. “I started college with the intention of becoming a veterinarian, but after three semesters I thought that might limit me too much. I had been impressed with the work of a general practice doctor in our small town, so I transferred to pre-med at Kansas State. An excellent orthopaedic rotation early in my internship solidified my decision to pursue orthopaedic surgery.”

Total joint solutions
An Annual Campaign donor since 1982 and a Shands member since 1998, Dr. Asher had a strong interest in research from the start, fuelled by witnessing the transition of orthopaedics to total joint solutions.

“I was educated as a general orthopaedic surgeon and a research fellow, doing work in tissue culture and bone culture. But the best experience I had was at Massachusetts General, where I was able to watch the evolution of total joint surgery. When I started my residency in 1967, the Smith-Petersen Vitallium® cup, introduced nearly 30 years prior, was the main treatment for arthritis of the hip.”

Credited with producing the first predictable results in interpositional hip arthroplasty, the Vitallium cup was introduced by Marius Smith-Petersen, MD, in 1938. The cup was a fourth-generation refinement of his original 1923 glass-mold prosthesis. By placing it between the femoral head and the acetabulum, Dr. Smith-Petersen hoped to “guide nature’s repair” of the joint.

“By 1970, Vitallium resurfacing had been supplanted by total hip arthroplasty, so I was able to see the rapid evolution of management of arthritis,” Dr. Asher recalled.

Bone cement studies
In 1973, Dr. Asher and two colleagues began research that helped refine total joint replacement. Assisted by an OREF grant, the team studied bone cement and how to optimize its use. “The purpose of our research was to learn if different bone cement kneading times, something the surgeon can control, affects bone cement fatigue life. And the answer was yes—longer is better,” said Dr. Asher.

“This line of research helped improve the durability of total joint replacement,” he continued. “Without the OREF grant, it probably would not have been done.”

A commitment to support the whole of the profession undergirds Dr. Asher’s reasons for putting his personal resources behind OREF. “Nothing changes for the better without education and research,” he said.

“Without research we would not have antibiotics, vaccines or orthopedic implants and prostheses. In our practice lifetime the scope and effectiveness of our surgical procedures and rehabilitation programs has dramatically expanded. This would not have been possible without research,” said Dr. Asher.

The need continues
Dr. Asher believes the need for orthopaedic research is more pressing than ever. “We are in a progressively difficult time. There is a fair amount of anti-intellectualism afoot and research will definitely be affected for two reasons,” he explained.

“First, funding will not be there in the carte-blanche way it has been in the past. Second, questions will become harder to ask and will require more and more sophisticated answers. The days of setting up a lab with basic tools are long past. Genomic research is very expensive,” he said.

As Dr. Asher sees it, the time is right for orthopaedic surgeons to support OREF. “Orthopaedic surgeons have so much to be thankful for. We’ve made a good living. This is our time to donate to OREF to secure the future of the next generation,” he said.

“Most orthopaedic research funds tend to go to about a dozen institutions. OREF research funds tend to go elsewhere. Big advances often come from the periphery, and OREF can help keep that path open. I strongly encourage giving to OREF,” he said.

The Shands Circle
The Alfred R. Shands, Jr. Circle is OREF’s high-recognition society for donors who have contributed $20,000 or more in cash gifts or $50,000 or more in deferred gifts such as trusts, bequests, and insurance policies.

Shands Circle members’ contributions fund the OREF Endowment, which is comprised of a general fund for OREF directed by the Board of Trustees and 29 other funds for specific causes that benefit the larger orthopaedic community. The endowment supports orthopaedic research in perpetuity, giving Shands members the satisfaction of knowing they have made a permanent investment in the future of orthopaedic knowledge.

Today, The Shands Circle includes more than 440 members, including 27 new members in 2005. As of Dec. 31, 2005, the approximate cash value of the OREF Endowment was $20.6 million.

Marc A. Asher, MD

1973 OREF Research grant recipient

Topic: Effect of mixing times on bone cement performance in total joint replacement

Results: Before the development of vacuum mixing, orthopaedic surgeons manually mixed bone cement. Testing 30-, 60- and 90-second mixing times determined that longer mixing times made the cement more homogeneous by dispersing air voids and reducing the incidence of crack flow.

Patient Care Application of Results: Longer mixing times for bone cement help prevent crack flow, making replacement joints more durable and diminishing the need for additional surgeries.

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