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August 3, 2011

COLUMBUS - Assistant Professor Robert Siston of the Department of Mechanical and Aerospace Engineering has been awarded a four-year, $1.134 million National Institutes of Health grant to study patient functionality and clinical outcomes following total knee replacement (also known as total knee arthroplasty, TKA), a common surgical procedure used to treat degenerative joint diseases such as osteoarthritis. 

Working in collaboration with his co-investigators from The Ohio State University College of Medicine, Siston will explore potential causes for the wide gap that separates those patients who cannot perform the basic activities of daily living, like comfortably climbing stairs, to those who can go back to activities they enjoy such as hiking, golfing or playing tennis after a total knee replacement procedure. Siston reported that following total knee replacement, many patients have functional challenges that are not seen in aged-matched controls, such as climbing stairs more slowly, stiff-knee gait, quadriceps weakness and abnormal knee motion.

This award, granted through the National Institute of Arthritis and Musculoskeletal and Skin Diseases Division of the National Institutes of Health, is called an R01 Research Project grant, the original grant mechanism used by the NIH to support health-related research and development.

The grant Siston received will fund his research group’s proposed study to determine if and how surgical technique, specifically intra-operative management of soft tissues surrounding the knee and passive kinematics, relates to patient functional and clinical outcomes following total knee replacement. As principal investigator for the project titled “Using Intraoperative Measurements to Predict Postoperative Outcomes of TKA,” Siston will be joined by co-investigators Ajit Chaudhari, assistant professor of orthopaedics and sports medicine; Laura Schmitt, assistant professor of physical therapy; Andy Glassman M.D., Jeff Granger M.D., and Matt Beal M.D., all faculty in orthopaedics; and Xueliang “Jeff” Pan, a research scientist in biostatistics.

Siston reports that the source of abnormal knee motion (kinematics) and the variability in clinical outcomes following total knee replacement remains largely unknown.

“Even though surgical technique is believed to be important to the outcome of the operation, key decisions are subjectively and qualitatively performed during surgery, representing a significant gap in the current knowledge of the procedure,” he said. “This lack of objective and quantitative, intra-operative measurements makes it difficult to consistently apply the same technique to different patients. Studies of function and clinical outcomes of patients following total knee replacement have typically lacked the measurements of patient-specific surgical technique or the pre-operative condition of the joint. While surgeons obviously have a keen sense of what is ‘good’ and ‘unacceptable’ surgical technique, it remains unknown how subtle differences in their actions during surgery influence post-operative outcome.”

It is anticipated that results of the study will enable surgeons to make more informed, evidence-based, intra-operative decisions; physical therapists to individualize rehabilitation programs; and patients to attain realistic expectations of their own specific outcomes.

"The work by Robert Siston and his team demonstrates the power of collaboration between engineers and surgeons to improve patient outcomes,” said Jason H. Calhoun, M.D., FACS, professor and chair of the Department of Orthopaedics and the Frank J. Kloenne Chair in Orthopaedic Surgery. “A research university like Ohio State can bring together people from many different disciplines, such as the Colleges of Engineering and Medicine, to find new ways to solve problems that affect the thousands of U.S. citizens who undergo procedures such as total knee replacement."

To underscore the significance of the collaborative effort and Siston’s achievement in receiving the award, Department of Mechanical and Aerospace Engineering Chair K. (Cheena) Srinivasan stated, “The award recognizes the potential benefits that could be realized by bringing the quantitative and analytical approach employed by engineering to bear on this significant health care issue. Further, NIH R01 awards are typically awarded to more senior researchers. For Rob Siston to receive a grant of this type at the age of 33 is quite impressive.”

About Total Knee Replacement

Total knee replacement (arthroplasty) is a common surgical procedure used to treat degenerative joint diseases such as osteoarthritis. Over 500,000 total knee replacements are annually performed in the United States, and approximately 3.5 million annual procedures are expected by the year 2030. While the success of the operation depends on many factors including patient selection, prosthesis design, the pre-operative condition of the joint, and post-operative rehabilitation, proper surgical technique is believed to be critically important.

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Editors:

Robert Siston can be reached at siston.1@osu.edu or (614) 247-2721.

Media Contacts:

Joan Slattery Wall, College of Engineering, (614) 292-4064, wall.107@osu.edu
Doug Flowers, Medical Center Public Affairs and Media Relations, (614) 293-3737, Doug.Flowers@osumc.edu