Orthopaedic Research Institute

Funded Projects

Determination of Localized Bone Quality: Correlation of Bone-Screw Pullout and Bone Microindentation to Bone Mineral Density Background and Significance

PI, Thomas R. Bowen, MD

Overall objectives include collecting 30 proximal femoral head specimens from healthy (femoral neck fractures) and osteoporotic populations, perform matched screw-pullout and micro-indentation techniques on each bone specimen, correlate experimental measurements of screw-pullout and micro-indentation measurements with results from radiographic or experimental measurements of bone mineral density and identify a preliminary "health" threshold for screw-pullout and/or micro-indentation as compared to other quantified determinants of bone health. 

Regenerex Tibial Tray Multi-Center Data Collection

PI, G. Dean Harter, MD

The purpose of this data-collection effort is to perform a five-year evaluation of the Regenerex Tibial Tray, which has been cleared by the FDA and has been on the market since 2004. This data collection effort will document the clinical outcomes of the Regenerex Tibial Tray. The data gathered will be collated and used to provide feedback to designing engineers; support marketing efforts, and answer potential questions from reimbursement agencies.

Prospective Multicenter Open Market Study of the Encore Reverse Shoulder Prosthesis

PI, G. Dean Harter, MD

Purpose of the study is to evaluate the use and efficacy of the Reverse Shoulder Prosthesis for treatment of rotator cuff deficiency in subjects who are candidates for a total shoulder replacement (primary and revision subjects).

FAITH - Fixation Using Alternative Implants for the Treatment of Hip fractures: A Multi-Centre Randomized Trial Comparing Sliding Hip Screws and Cancellous Screws on Revision Surgery Rates and Quality of Life in the Treatment of Femoral Neck Fractures. 

PI, Daniel S. Horwitz, MD

The primary objective of the study is to assess the impact of sliding hip screws vs. cancellous screw fixation on rates of revision surgery at two years in individuals with femoral neck fractures. The secondary objective is to evaluate the impact of sliding hip screw vs. cancellous screws on complications, including mortality, avascular necrosis, nonunion, implant breakage or failure, and infection.

Use of a Registry on Infection to Improve Subject Outcomes and Research Efforts

PI, Michael Suk, MD 

The purpose of this study is to create an international registry on musculoskeletal infection cases. The registry will collect information and specimens that will be used in future studies looking at trends in infection rates and treatments as well as the effectiveness of different treatments.

Orthopaedics Trauma Registry

PI, Daniel S. Horwitz, MD

Establish a database of all orthopaedic trauma patients at Geisinger Health System and follow the health information for the lifetime of the patient. The database is used for future IRB approved research protocols and QI/QA projects.

Pediatric ATV Injuries: Incidence and Cost in the State of Pennsylvania

PI, Thomas R. Bowen, MD

To analyze the severity and incidence of ATV related pediatric injuries in the state of Pennsylvania and correlate these with a cost model generated from admission to Geisinger Medical Center.

Total Joint Replacement in the Obese: The BMI a Threshold A Collaborative Research Project between Geisinger Health System and FORCE-TJR

PI, Thomas R. Bowen, MD

Purpose of this study is to establish a threshold by which the risk of elective total joint arthroplasty outweighs the benefit in the obese patient population, and to risk stratify patients based upon their medical comorbidities and compare it to their functional outcomes. 

Redefining the Mechanical Alignment "Safe Zone" in Total Knee Arthroplasty

PI, Michael Suk, MD

The goal of primary total knee arthroplasty is to achieve a postoperative limb alignment in the neutral mechanical axis. Previous investigations have observed less favorable outcomes associated with increased deviation from a neutral mechanical alignment. At present there is not a well established target range for postoperative coronal alignment, or "safe zone." The purpose of this study is to investigate the relationship, if any, in a relatively large patient group, between post-operative coronal alignment, or "safe zone," and clinical outcomes in patients undergoing total knee arthroplasty. 

Evaluation of Ankle Fracture Results using a Novel Fracture Fixation Method: Sidewinder Plate

PI, Gerard Cush, MD

There are several approved surgical fixation techniques for displaced malleolar fractures. New techniques in plate and screw design have recently emerged. Many specific to the treatment of displaced malleolar fractures. The Sidewinder plate (TriMed, Valencia CA) is on of these novel plate designs. The purpose of this retrospective chart review is to analyze the clinical and radiographic outcomes of this novel plating system.

Reverse Total Shoulder Arthroplasty in Morbidly Obese Patients

PI, G. Dean Harter, MD

Retrospective review of patients who underwent reverse total shoulder arthroplasty over a 6-year period to determine if morbidly obese patients have a significantly greater rate of complications following reverse total shoulder arthroplasty. 

Epidemiology and Outcomes of Clavicle Fractures

PI,Daniel S. Horwitz, MD

Purpose of the study is to investigate the epidemiology of clavicle fractures in a central Pennsylvania settings and the outcomes of high energy and low energy mechanisms in clavicle fractures.

Nailed Diaphyseal Fractures of the Tibia With and Without Associated Ipsilateral Tibia-fibula Fractures: Surgical Technique and Outcomes

PI, Daniel S. Horwitz, MD

The objective of this investigation is to retrospectively analyze records at GMC to evaluate the effect of nailing of these diaphyseal fractures of the tibia with and without associated fractures on fracture healing and overall functional outcome. 

Ankle Fractures with Syndesmotic Injuries: Is Implant Removal Essential?

PI, Daniel S. Horwitz, MD

The objective of this retrospective study is to evaluate the various implants used for surgical management, the radiologic, clinical and functional results as well as hardware related effects like implant related pain, implant loosening, implant breakage and the need for implant routine removal.

Determinants of Outcomes After Femur Fracture

PI, Daniel S. Horwitz, MD

The purpose of this study is to determine rate of complications and the risk factors for poor outcomes after surgery for a fracture of the femur and to assess the effectiveness of post-fracture care.

Outcomes and Complications of Acetabular Fractures

PI, Daniel S. Horwitz, MD

The purpose of this study is to evaluate all patients of operatively treated acetabular fractures with primary focus on the documented neurologic injury. We aim to draw a possible relationship between fracture pattern, displacement and severity of neurologic problems, so that physicians can provide patients with prognostic data.

Clinical Performance of the Malleolar Sled Fixation Device versus the Conventional Two Lag Screw Technique

PI, Daniel S. Horwitz, MD

The aim of this study is to compare the effectiveness of the TriMed malleolar sled versus conventional lag screw fixation in treating medial malleolar fractures using retrospective data analysis and analysis of prospective data collected through telephone surveys.

Outcomes of Tibia and Fibula Fractures

PI, Daniel S. Horwitz, MD

Tibial fractures with or without associated fibula fractures are very common orthopaedic injuries requiring operative interventions. Different methods of fixation depending upon anatomical site and fracture patterns exist. These can be intramedullary nails, plates or casts. Though these surgeries generally result in excellent functional outcomes, complications do arise from these surgeries. The purpose of this retrospective study is to examine the outcomes of tibia fractures managed using different surgical techniques.

Use of Small Bone Innovations/Avanta SR Proximal Interphalangeal (PIP) Joint

PI, Joel Klena, MD

The Small Bone Innovations PIP finger prosthesis is authorized be Federal law for use in arthroplasty surgery of the PIP joint when either the patient is in need of a revision of failed PIP prosthesis or the patient expects to place his/her hands under loading situations which preclude the use of an alternative implant in the painful osteoarthritic and post traumatic arthritic PIP joint.

Use of Small Bone Innovations/Avanta SR Metacarpophalangeal (MCP) Joint

PI, Joel Klena, MD

The Small Bone Innovations proximal MCP finger prosthesis is authorized by Federal law for use in arthroplasty surgery of the PIP joint when either the: patient is in need of a revision of failed MCP prosthesis or the patient expects to place his/her hands under loading situations, which preclude the use of an alternative implant in the painful osteoarthritic and post traumatic arthritic MCP joint. 

Clinical Outcomes of Locked Circular Plate Fixation in Four Corner Arthrodesis

PI, Joel Klena, MD

A number of plating systems are currently used to achieve four-corner arthrodesis. To date, no study has documented the clinical outcomes of the locked circular plate fixation system. We aim to establish the clinical results of the locked circular plate fixation in four-corner arthrodesis in patients 18 years of age and older.

Flexor Tendon Irritation with Volar Locked Plating

PI, Joel Klena, MD

We aim to establish the incidence of flexor tendon complications for patients who have undergone operative fixation of distal radius fractures using either the Synthes' variable angle volar distal radius plate or Synthes' juxta-articular volar distal radius plate. In addition, we plan to evaluate other demographic factors to see if they were independent risk factors for flexor tendon complications.

Flexor Tendon Complications with the Use of Volar Distal Radius Plates

PI, Joel Klena, MD

Purpose of the study is to establish the incidence of flexor tendon complications for patients who have undergone operative fixation of distal radius fractures using either the Synthes variable angle volar distal radius plate or the Synthes juxta-articular volar distal radius plate.

Tibial Shaft Fracture and Thrombosis: Is Chemical Prophylaxis Necessary for Prevention?

PI, Joel Klena, MD

Assess the rate of deep venous thrombosis (DVT) and pulmonary embolism (PE ) in the treatment of tibial shaft fractures.

Outcomes After Comminuted Fracture of the Distal Radius

PI, Joel Klena, MD

The objective of this study is to conduct a retrospective analysis of data contained in the GMC electronic health record between June 1, 2004 to December 31, 2013 in addition to a 12-month review of prospectively collected data collected from standard of care outcome measures of patients treated surgically and non-surgically for distal radius fractures by a single fellowship trained hand surgeon.

Epidemiology and Cost Analysis of Orthopaedic Injuries Associated with Farming and Agricultural Accidents

PI, Joel Klena, MD

The objective of this study is retrospectively review medical records at Geisinger Medical Center to analyze the epidemiology and the cost of traumatic musculoskeletal injuries sustained by adult and pediatric patients resulting from farming and agricultural related accidents.

Repair of Ulnar Collateral Ligament Injuries to the Thumb

PI, Joel Klena, MD

The purpose of this study is to retrospectively analyze medical records at GMC to assess outcomes and complications of the direct repair of both acute and chronic ulnar collateral ligament injuries of the thumb. 

Epidemiology, Outcomes, and Economic Analysis of Orthopaedic Injuries in the Amish Community

PI, Michael Suk, MD

The objective of this study is to retrospectively review medical records at Geisinger Medical Center (GMC) to analyze the epidemiology and cost of traumatic musculoskeletal injuries sustained by adult and pediatric members of the Amish and Mennonite communities.

The Effect of Surgical Approach on Total Brake Time in Total Hip Arthroplasty Patients

PI, James C. Widmaier, Jr., MD

This prospective study will compare the total break time of patients (>18 years of age) undergoing total hip replacement surgery performed either with a direct anterior approach or a posterior approach.

Three-Dimensional Computed-Tomography Reconstruction for the Classification of Acetabular Fractures

PI, Michael Suk, MD

The purpose of this prospective study is to determine the reliability and clinical utility of 3D CT reconstructions of acetabular fractures compared to plain radiographs and 2D CT images when determining the classification and subsequent treatment of acetabular fractures.

Major Extremity Trauma Research Consortium (METRC): Streamlining Trauma Research Evaluation with Advanced Measurement: STREAM Study

PI, Michael Suk, MD.

The Major Extremity Trauma Research Consortium (METRC) Streamlining Trauma Research Evaluation with Advanced Measurement (STREAM) Study is a multi-center prospective study.  PROMIS (patient reported outcomes measurement information system) has developed tools, such as item banks, short forms, and computer-adaptive tests (CATs) that can help standardize measurements for many health-related quality of life domains related to physical mental, emotional, and social functioning.  The proposed project will examine the reliability, validity, and responsiveness of the PROMIS tools for clinical research following orthopaedic trauma.

Major Extremity Trauma Research Consortium (METRC): A Prospective Randomized Trial to Assess Fixation Strategies for Severe Open Tibia Fractures: Modern Ring External Fixators vs. Internal Fixation (FIXIT Study)

PI,  Michael Suk, MD.

The primary aim of the study is to compare the outcomes associated with modern ring external fixators versus standard internal fixation techniques in treating “severe” open tibia shaft or metaphyseal fractures with or without a bone defect of any size.  The hypothesis is among patients with open tibia shaft or metaphyseal fractures (with or without a bone defect of any size), the rate of re-hospitalization for major limb complications will be lower for patients treated with ring fixators than those treated with standard internal fixation.

Blunt Cerebrovascular Injury in Cervical Trauma Patients

PI, Michael Haak, MD.

The purpose of this retrospective study with a prospective data collection arm is to determine the incidence of vertebral artery injury in cervical spine injuries and assess neurological outcomes in patients with cervical spine fractures diagnosed with asymptomatic BCVI.

SWIFT Trial: Surgical Weight-loss to Improve Functional status Trajectories following Total Knee Arthroplasty

PI, Christopher Still, MD.

The purpose of this study is to determine whether weight-loss surgery prior to total knee replacement surgery reduces risk and improves long-term outcomes including measures of orthopedic outcomes (e.g., knee range of motion and knee pain) as well as physical function (e.g., ability to walk 400 meters).

Determinants of Outcomes after fracture of the humerus

PI, Daniel Horwitz, MD.

The purpose of this study is to determine rate of complications and the risk factors for poor outcomes after surgery for a fracture of the humerus and to assess the effectiveness of post-fracture care.

Suture-Button Fixation Compared with Screw Fixation of Isolated Lisfranc Ligament Injuries

PI, Gerard Cush, MD.

The objective of this retrospective chart review with a prospective data collection arm via telephone surveys is to analyze records at GHS and compare the clinical results of the screw fixation to tightrope fixation for Lisfranc injuries.

Comparison of Alignment Achieved Using Single-Use versus Reusable Instrumentation in Total Knee Arthroplasty (TKA): A Prospective, Non-Randomized Multi-Center Investigation

PI, David Kolessar, MD.

The purpose of this study is to evaluate knee alignment after using ATTUNE® Single Use Instruments compare to ATTUNE® reusable instruments.  Also, this study is looking to see if using ATTUNE® Single Use Instruments can increase operating room efficiency by reducing operating room set up and clean down times and or by making surgery more predictable through eliminating last minute missing or non-sterile instruments.

PEDSCOLI - Multicenter, prospective, partially randomized, controlled trial of robotic-guided vs. freehand corrective surgery for pediatric scoliosis

PI, Meagan Fernandez, MD

The purpose of this prospective, partially randomized, controlled study is to compare the accuracy and clinical outcomes of scoliosis correction performed with versus without Renaissance-guidance, in pediatric and adolescent scoliosis patients.

Preservation of Thoracic Kyphosis and Coronal Curve Correction as a Function of Rod Stiffness in the Surgical Treatment of Adolescent Idiopathic Scoliosis with the Use of the K2M MESA Rail Deformity System

PI, W Fred Hess, MD.

The purpose of this study is to collect data on clinical and radiographical outcomes after spine surgery to correct Adolescent Idiopathic Scoliosis (AIS) utilizing the K2M MESA Rail™ system as compared to literature reported outcomes for standard Colbalt Chrome rod systems in the treatment of AIS.  This implant is commercially available and is currently used throughout the United States, Europe, Australia, and a number of other countries.

Determinants of Outcomes After Intertrochanteric Femur Fracture

PI, Daniel Horwitz, MD.

The purpose of this retrospective review is to determine rate of complications and risk factors for poor outcomes after surgery for a fracture of the femur and to assess the effectiveness of post-fracture care.

Tibial Plateau Fractures and Outcomes

PI, Daniel Horwitz, MD.

This study will examine the outcomes of tibia fractures managed using different surgical techniques.

Knee Arthrodesis with Lateral Locking Compression Plating for Failed Total Knee Arthroplasty

PI, Daniel Horwitz, MD.

The aim of this study is to describe the technique of staged procedure of knee arthrodesis involving placement of antibiotic loaded cement spacer followed by knee arthrodesis with lateral locking compression plating. Also with this study we intend to evaluate the radiological outcomes, clinical outcomes and complications in the patients who underwent this procedure for failed total knee arthroplasty.

The Plantar vs. Dorsal Approach in Lesser Metatarsal Head Resection for Rheumatoid Patients

PI, Gerard Cush, MD. 

The purpose of this retrospective cohort study is to compare patients who have undergone the plantar approach to metatarsal head resection with a matched cohort of patients who have undergone the dorsal approach to metatarsal head resections.

The Treatment of the Diabetic Ankle Fracture Patients with Diabetic Comorbidities by Ankle Fusion with Nail

PI, Daniel Horwitz, MD.

The objective of this investigation is to analyze retrospective records at GMC to assess outcomes in a cohort of ankle fracture patients with diabetic comorbidities treated with a hindfoot intramedullary nail. We will set up a protocol and hypothesize that the use of a hindfoot fusion nail is safe and successful in treating ankle fractures in patients with diabetes mellitus or Charcot arthropathy at GMC.

Scaphotrapeziotrapezoid Arthritis: Radiographic Prevalence and Clinical Correlation

PI, Joel Klena, MD.

The objective of this investigation is to retrospectively analyze medical records at GMC for patients who have underwent a CMC arthroplasty to assess the incidence of scaphotrapeziotrapezoid (STT) arthritis both radiographically and intraoperatively. We also plan to evaluate for risk factors for the development of STT arthritis in this patient population.