Week 6-Jonathan

I began this week sick (I had a bad cold and my asthma started flaring up) so I took off a couple of days to recover and keep anyone at HSS from getting sick. I spent one day this week working on my research project, one day in the OR and one day in the clinic with Dr. Bostrom. While the OR surgeries were interesting as they always are, there were no significant cases to report. 

In the clinic, I witnessed one very interesting case. A woman came in with a previously implanted hip replacement. She had been experiencing pain for quite some time and an MRI of her hip had revealed large amounts of polyethylene wear debris around her acetabulum. Polyethylene wear, while not as severe as metal wear, can cause local (painful) inflammation around the joint. This inflammatory process can result in the local bone resorption leading to loosening of the implant. From her symptoms and diagnostic images, it was clear that she needed a revision hip replacement; this time with an Oxinium bearing surface instead of cobalt chrome to improve wear properties. She is scheduled for a revision in a few weeks.

What made this case interesting was when she refused to have blood infusions due to being a Jehovah's witness. Revision hip replacement surgeries, unlike primary hip replacement surgeries, are associated with a large amount of blood loss. To make matters worse, she has a history of anemia; however, she said that her levels are currently normal. To perform a revision surgery without using blood transfusions is considerably more risky for the patient (who could die on the operating table due to blood loss) and the surgeon (whose career could be damaged by losing said patient on operating table). A a few minutes of consideration, Dr. Bostrom decided to go ahead with the revision. He decided not to remove the femoral stem during the surgery because that complication would result in blood loss and to focus solely on replaceing the acetabular cup. She also agreed to a procedure in which some of her cells are harvested and used to protect her in the case of massive blood loss. Given these preventative measures, she should be fine during the surgery. This case gave me great insight to the tough decisions doctors have to make in treating patients.

In other news, I am going to give a brief presentation to the Bostrom laboratory on Tuesday in which I will be describing the imaging machine used in my laboratory at Cornell. The serial milling epifluorescent microscopy machine allows us to examine bone and various bone stains at a submicron resolution and recreate a 3D image of the bone at a much higher resolution than micro-CT. I believe that this imaging modality could be very useful to a major research study the lab is about to begin. They will be studying the effects of PTH treatment in growing bone around titanium implants in a mouse model.