Week 3 - Natalie

I had a great week, with lots of interesting clinical experiences. I was able to go into the OR to observe Dr. Parks. His first case was a bilateral knee replacement, with hardware removal of a patellofemoral replacement on the right knee and a primary total knee on the left. They began with the revision and I was able to see the removal of the patellofemoral replacement and the subsequent implantation of a total knee. This was a young patient, thirty-seven years old, and so Dr. Parks chose to use a fairly new bearing material known as Oxinium, or oxidized zirconium. This material hypothetically marries the toughness of a ceramic with the ductility of a metal. Thus, the femoral replacement was oxinium, with a polyethylene bearing surface and a titanium tibial baseplate. Once the first knee was implanted, Dr. Parks allowed the fellow in the room to close while he began on the other side. I was impressed at how quickly the process went, as the tourniquet time for the first knee was 42 minutes and it was 40 minutes for the second knee. The next case was a total hip replacement in a woman who had sickle cell anemia, and thus had avascular necrosis of her femoral head. This means that the blood supply to the femoral head is no longer intact and resulted in this case in complete collapse of her femoral head. Although it is much more difficult to see what is going on from a distance for a hip replacement, Dr. Parks made sure I was able to see the section of femoral head that was removed, and it truly just looked like mush. The third case I watched was a primary bilateral total knee replacement. This patient was relatively young as well, and Dr. Parks used Oxinium femoral components again. I have seen a lot of retrieved replacements, and x-rays of total joints, so it was very interesting to see the operation. I knew hypothetically that orthopedic joint replacement was quite barbaric, with large saws, chisels, reamers, and other carpenter-like tools, but seeing it in real-life really brought that home to me!

I was also able to go into clinic this week with my clinician mentor, Dr. Bostrom. We saw the entire range of patients, from people with hip or knee pain who were ready to schedule a joint replacement, to patients at their yearly follow-up after a surgery where everything was working well, to patients with pain or dysfunction after surgery that were coming for a consultation on whether to have a revision. Two different women came in who had had a total knee a few years earlier and were getting more and more pain in the opposite knee. What struck me about both women was how much they were dreading the second operation, even though they knew the end result had been excellent for the knee they already had replaced. They both spoke about the unbearable pain after the first operation, and that was something I had never realized – how much a total knee replacement hurts! It was really fun to hear each patient’s story, and to see Dr. Bostrom’s interaction with his patients. I really enjoyed the clinic experience, in ways even more than surgery because you get to see the person behind the joint replacement.

This week on the research front I performed the last step of RT-PCR, the actual PCR, with Alison. We were testing the primers she has chosen to ensure that the standard curves are good. We did two days of testing, and one primer was not good on the first day, and we were able to get good results the second day. I learned the actual method of preparing the 96 well plate and how to analyze the results.