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It All Begins With Research

Musculoskeletal disorders and diseases are the leading cause of disability in the United States and account for more than one-half of all chronic conditions in people over 50 years of age in developed countries. The economic impact of these conditions is substantial as people require medical care and often cannot work.

Beyond the statistics, the human toll in terms of the diminished quality of life is immeasurable. This situation is unlikely to improve in the foreseeable future and will likely be intensified by current demographic trends, including the graying of the baby boomer population, the epidemic of morbid obesity and the higher recreational activity levels of our elderly population.

Research is the key to improving the lives of these people. When most people hear the word "research" they think of something boring, but research has a very real and a very human impact. The research efforts at the American Academy of Orthopaedic Surgeons (AAOS) make patients better by making doctors better, making the treatments doctors give to their patients better, making the implants they receive safer, and by making surgery safer.

Research touches on all aspects of a patient's experience with the healthcare system, starting with the first visit. Initially, research helps doctors make the correct diagnosis. Research, at least at the AAOS, guides doctors on which of the many diagnostic tools they should use with a particular patient, when they should use them, and how to best interpret the results of a diagnostic test. It also tells doctors whether further tests are needed.

Once a diagnosis is made, an orthopaedist will treat the patient using drugs, surgery, physical therapy, or some combination of these options. Again, research helps doctors choose which drugs to use and which not to use. Patients who receive surgery will often receive an implant. Sometimes the implant is a device, like a knee replacement. Sometimes the implant is biological, like a tendon. Regardless, research helps make these implants safer. Surgery is not without risks so, at the AAOS, research helps to make surgery safer. Finally, some patients may benefit from physical therapy. Again, research tells the clinician which patients these might be.

Some of the most recent and dramatic results of orthopaedic research have been the use of stem cells and tissue engineering for developing new ligaments and cartilage. The discovery of bone morphogenic proteins allowed us to understand fracture healing and get patients walking more quickly after they break a bone. Research into the condition of clubfoot has led to a casting technique that restores the normal appearance and function of the foot without surgery. Research into different metals, plastics and other biomaterials has led to longer lasting joint replacements. Essentially every major area of orthopaedics and much of our current understanding of the biomechanics of hip/knee/hand, bone biology, cartilage biology, low back pain, muscle/tendon injury/repair, and osteomyelitis has been the result of musculoskeletal research by talented investigators.

The area of war injury research, particularly for extremity injuries has produced wonderful discoveries in recent years. Examples include advancements in the function of prosthetic limbs, improved bone and soft tissue healing after injuries from explosive devices, and treatments that minimize infection in contaminated war wounds.

These new findings help real people. A recipient of a Bronze Star Medal, Capt. Raymond O'Donnell was injured during a routine combat patrol in August 2007 in Afghanistan. "My vehicle was split in half. I was ejected and two of my fellow soldiers died. As a result of the accident, I sustained several severe injuries, including a left hip dislocation that also fractured my pelvis and hip joint, a fracture and dislocation of my right wrist, a bladder rupture, several facial bone fractures, and a collapsed lung".

Capt. O'Donnell also sustained a severe concussion that required extensive treatment for traumatic brain injury when he returned to the United States. With intensive treatment, he has fully recovered from the traumatic brain injury, but his musculoskeletal injuries continue to present problems. "I no longer have full range of motion in my right wrist or in my hips, or the use of my left leg below the knee," he said.

Capt. O'Donnell discussed the frustration he experienced during his recuperation. Although he did not sustain the loss of any limbs, his left leg was completely paralyzed from the knee down, leaving him unable to walk on his own. Ultimately, Capt. O'Donnell opted to rehabilitate his injured leg and was fitted for a custom orthotic device that now allows him to walk without assistance, despite significant paralysis of his left leg below his knee. Now, after training and rehabilitation, he walks with only a slight limp, runs regularly, and recently completed a biathalon. Perhaps best of all, thanks in no small part to orthopaedic advancements, Capt. O'Donnell has now returned to active duty.

Without the groundbreaking research of the orthopaedic community, Capt. O'Donnell would not be walking on his own right now, let alone running. All members of the Armed Forces deserve treatment as good as his. It is this kind of success story that underscores exactly why we need continued funding for musculoskeletal research.

For more information on the research activities of the American Academy of Orthopaedic Surgeons and updated statistics on orthopaedic conditions, please visit our websites at aaos.org/research.