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Dr. Eric L. Smith Research Laboratory

Relationship between Racial Ethnicity and Refusal of Total Joint Arthroplasty
Research Team: Eric Smith, MD (Primary Investigator), Daniel Hannon, PhD (Co-Investigator), Thomas James, PhD (Co-Investigator), Erin Davis (Co-Investigator), Stephanie Bassock (Co-Investigator), Jessica Dahle (Co-Investigator), Mary Pevear(SC)

The purpose of this study is to better understand patient perceptions and barriers to care when offered surgery for total joint replacement. There are many factors that may influence a patient's decision to have surgery and this research seeks to investigate and quantify these factors through the use of a questionnaire designed by students from Tufts University. Factors that may ultimately cause a patient to say accept or decline the surgeon's recommendation for surgery include their culture, family influences, desire to reduce pain, understanding of the surgery, and general comfort with surgery. The questionnaire measures the relationship between these potential factors and the patient's decision to either have surgery or decline surgery. This research will help to inform current clinical practice not only at Tufts Medical Center, but across the orthopaedics community.

Antibiotic Spacers for Infected Joint Protheses - A Pilot Study of Antibiotic Doses and Kidney Function
Research Team: Susan Hadley (Infectious Disease), MD (Primary Investigator), Madhumathi Rao, MD (Nephrology)(Co-Investigator), Eric Smith, MD (Co-Investigator)  

The purpose of this research study is to compare kidney function in subjects receiving one antibiotic alone or two antibiotics in a cement spacer for the first stage of treating an infected prosthetic (artificial) joint.

When an artificial joint becomes infected, the standard procedure is to remove the artificial joint by an operation and insert a mixture of antibiotics and cement in the joint (called a spacer) to deliver treatment and keep the joint space open.  This is combined with receiving antibiotics generally by vein for about 6 weeks.  The final step of the treatment is to replace the artificial joint with a new one that is cemented in place.  However, it is not known what the best dose type of antibiotics is for mixing in the cement in the first stage of the treatment. 

At Tufts Medical Center, both high doses and lower doses of the commonly used antibiotics (Vancomycin and Tobramycin) have been used in the cement in both high and low doses.  Occasionally vancomycin alone is used in the spacer cement.  The practice varies according to surgeon preference.  When antibiotic spacers are used, there may be leakage of the antibiotics from the joint space into the bloodstream that could cause damage to the kidneys because of high antibiotic levels.  So, it is important to understand what the best dose type of antibiotic is to use to avoid kidney problems. 

This research study is being conducted to compare 2 different kinds of concentrated antibiotics mixed in joint spacers for their ability to cure the infection and for evidence of kidney injury that may occur because the antibiotics could leak from the joint space into the bloodstream and cause kidney damage. By testing blood and joint drain samples for antibiotic levels, as well as testing blood for kidney function and urine samples to look for signs of kidney injury, we hope to be able to determine the right amount ofbest antibiotic or antibioticss mixed in joint spacers to that successfully treat infections of artificial joints, thus reducing the risk of acute kidney injury from the antibiotics and do not cause kidney injury.

Impact that advertisements have on a surgeons decision to use a product and the longevity of the device after advertisement
Research Team: Eric L. Smith, MD (Primary Investigator), Chris Damsgaard (Co-Investigator),  Mary Pevear (Study Coordinator), Jonas Miller (Tufts student), Taryn LeRoy (Medical Student), Roger Dunn (Medical student)

Peer reviewed medical journals serve as the primary advertising outlet for many pharmaceutical and medical device industries, primarily because physicians comprise a majority of readership. A survey of 125 pharmaceutical marketers revealed that journal advertising is considered to be one of the most effective promotional and educational vehicles.  

Despite what appears to be effective marketing, it has been observed, that device models featured in journal ads are many times discontinued soon after their release. The purpose of this research is to assess the longevity of knee and hip replacement devices after advertisement and to determine the reason for their demise. By means of a retrospective journal review we will evaluate the impact of these advertisements on a surgeon's decision to use the product. We will retrospectively collect advertisements from a popular orthopaedic journal, the Journal of Bone and Joint Surgery. Our sample will include only advertisements from volumes published between the years 2003 and 2008. We will then research each device to determine if it is still available under the same manufacturer. Information pertaining to the scientific accuracy of device marketing will also be recorded.  of  the device will be  also be collected including,  still sold under the same manufacturer.

Direct anterior approach total hip arthroplasty requires less supplemental screw fixation than posterior approach
Research Team: Eric L. Smith, MD (Primary Investigator) Nicholas Colacchio, MD (Co-I)  ,Mary Pevear (Study Coordinator), Mark Cleary (medical student), Daniel Reid (medical student), David Trofa (medical student)

There is no universal consensus among surgeons when it comes to deciding the most effective approach or implants used during total hip arthroplasty (THA). Considerable research is focused around this area, including methods for improving patient results. The purpose of this study is to evaluate whether the need for supplemental acetabular cup screw fixation during THA differs in an anterior versus a posterior surgical approach through a retrospective chart and radiographic review of all primary THA’s performed by a single fellowship trained total joint surgeon at an academic medical center between January 2010 and January 2013

Reduction in Surgical Site Infection (SSI) Following Total Joint Arthroplasty (TJA) using a three-pronged prophylaxis approach

Surgical site infections (SSI) following total joint arthroplasty is a devastating complication, which can lead to additional operative intervention, long-term antibiotic treatment and extended hospital stays for patients. In many cases, SSI can be prevented, and in recent years there has been a great emphasis in reducing preventable causes of SSI in TJA.  The purpose of this study is to investigate one such approach that Dr. Eric Smith, Chief of Arthroplasty has been using —a three pronged prophylaxis, which includes a preoperative administration of vancomycin as well as an intra-operative betadine wash.

Pain Control Post Total Joint Replacement in Patients Requiring Methadone Pre-Operatively
Research Team: Eric Smith, MD (Primary Investigator), Lauren Hansen, MD (Co-Investigator), Chris Matson (med stu) Mary Pevear

A retrospective chart and radiographic review of patients requiring total joint replacement, who were also taking Methadone preoperatively, looking at the outcomes following their surgery.  Outcomes look at length of stay, amount and types of pain medication and any perioperative or postoperative complications.

Length of Stay after Total Joint Surgery: Does Day of Surgery Matter?
Research Team: Elizabeth Matzkin, MD (Primary Investigator) Eric Smith, MD  (Co-Investigator) Charles Cassidy, MD (Co-Investigator) Raghuveer Muppavarappu (Co-Investigator), Mary Pevear (Study Coordinator)

The current body of research has established that accelerated perioperative hospital care leads to at least as quick a recovery as an extended hospital postoperative recovery, and in some cases has in fact led to a quicker recovery after returning home. However, there are no studies that could be found in the literature to compare the length of postoperative hospital stay for total joint replacement patients in terms of the day of the week on which the operation was performed.

The issue of shortened hospital stay is at the forefront of modern medicine. Many articles have been published concerning benefits of a shorter hospital stay when augmented with better preoperative education in terms of patient recovery and in terms of reduction in cost to the hospital and healthcare system in general, while not increasing adverse postoperative outcomes.The allocation of health resources is a mainstay of current healthcare policy making and is implicated in the general reform of the healthcare system. By studying in particular the role of selection of an operative day in terms of shortening hospital stay for orthopedic patients and hence reducing cost, one can contribute to a body of knowledge that would allow for a vast reduction in healthcare spending overall. **To be presented at 2013 AAOS Annual Meeting

Efficacy of Short Term Intraarticular Corticosteroid Injections in Patients with Symptomatic Osteoarthritis
Research Team: Eric Smith, MD (Co-Primary Investigator) Elizabeth Matzkin, MD (Co-Primary Investigator) Emily Curry (Study Coordinator-Brigham and Women’s) Mary Pevear  (Study Coordinator-Tufts Medical Center) Michael Henry (med student) Qingwu Kong (med student), Miranda Rogers (med student) (\

Intra-articular corticosteroid injections are a common nonsurigcal alternative for painful osteoarthritic knees. However, greater evidence of corticosteroid efficacy in relieving short term osteoarthritis-realted pain is needed. The purpose of this study is to investigate whether corticosteroids do provide significant short-term pain relief in the clinical setting through the use of various pain and functional outcome scoring systems. The hypothesis being tested is that corticosteroid injections are beneficial in the short-term pain relief associated with osteoarthritis.

Blood Usage After Total Joint Arthroplasty-Validation of the Blood Transfusion Equation
Research Team: Eric Smith, MD (Primary Investigator), Owen McGonigle, MD (Co-Investigator)  Yung-Chi Sung, PhD (Statistician), Brian Schurko (med student), Mary Pevear (Study Coordinator)  

Blood loss during Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA) and subsequent treatment options has been a focus in orthopaedic surgery for some time. In recent years, there has been an increase in the use of blood salvaging devices in which the patient receives autologous blood transfusions from the salvaged blood thereby removing the need for allogenic blood transfusions. In a previous study, we conducted a retrospective chart review of 516 patients: 246 total knee arthroplasties, 150 total hip arthroplasties, 64 total knee-revision, 56 total hip-revision taking into account daily hematocrit levels during each patients’ length of stay and the hematocrit associated with transfusions. The post-op day of transfusion was noted as well as wasted autologous units and transfused units past the autologous donation. Medical complications were noted to evaluate any correlation between health of patient and transfusion status. Patient demographics such as age and gender were analyzed. An equation was created based on the demographic and medical history collected. The purpose of the equation is to predict the liklihood that a patient will require a blood transfusion following a TKA or THA procedure. In the second phase of the study, we will test the equation by retrospectively reviewing the charts of 500 of Dr. Smith's patients.