Joint Replacement Institute

History of JRI

In the 1980’s while still at UCLA, Dr. Harlan Amstutz began to consider various factors that ultimately led to the formation of the Joint Replacement Institute. The success of both the liver and heart transplant programs across the country pointed to the efficiency and productivity of employing a team approach to delivering patient care wherein all aspects are directed to the specific condition to be evaluated and treated. Orthopaedic Hospital, under the leadership of Dr. James Luck and with the support of its Board of Directors, offered a stellar arrangement including funding for research. The first joint replacement surgery performed at Orthopaedic Hospital under the auspices of the JRI occurred on August 6, 1991, and the outpatient clinic and research labs opened their doors on September 23, 1991. The centralized character of all the various activities was seen as an excellent step forward toward maximizing clinical efficiency and research productivity. This has proven to be correct. The proximity of scientists and physicians, clinics and offices has been most rewarding and beneficial.

In the Summer of 2005, Orthopaedic Hospital ceased to provide inpatient care, and the surgeons from the Joint Replacement Institute performed surgeries at Good Samaritan Hospital for the transition period leading to the current association with St. Vincent Medical Center. The reorganization of the operating facilities took place in April of 2007. The move to the new expansive JRI facility at St. Vincent Medical Center is complete and the clinic opened its doors in January 2008.

The term “center of excellence” has been used extensively in recent years to describe healthcare institutions that are at the “cutting edge” of medicine and foremost in the delivery of exceptional patient care. There are few institutions more deserving of this designation than the Joint Replacement Institute and its current partner: St. Vincent Medical Center. During its sixteen years of existence, JRI staff have provided the best of clinical care; trained numerous fellows and surgeons; organized conferences; written for a multitude of journals, news outlets and books; have been featured on television and in audiovisual materials; and presented at scores of meetings. Its visibility is international as well as national and local. Its research is both basic and clinical. Its focus has been on the design of prostheses and the development of more wear-resistant materials with an emphasis on improving their durability by understanding the causation of implant failure.

Our goals include: Premier Patient Care; Academic and Research Productivity; Education and Training; The desire to reach above and beyond; To constantly strive for improvement; To continually advance the science of orthopaedic surgery; To render excellent care to our patients. This is our combined mission, and this is the story of the Joint Replacement Institute at St. Vincent Medical Center as it looks to the future.

ACHIEVEMENTS and IMPORTANT EVENTS

1991 JRI opens at Orthopaedic Hospital; first surgery performed on 8-6-91; first “new patient” consultation performed on 9-23-01; Inaugural symposium entitled "Joint Replacement in the 21st Century" held on 12-7-91 to 12-8-91; Dr. Schmalzried receives the John Charnley Award from the Hip Society as co-author for work completed during MGH/Harvard Fellowship; Dr. Schmalzried receives the AOA-Zimmer Travel Award for Orthopaedic Fellows for paper entitled: “The New Number One Problem in Total Hip Replacement”.

1992 Polyethylene particles isolated and characterized; macrophages and wear particles studied; new hemi-surface and metal-metal surface arthroplasty implant and instrumentation designs initiated. Dr. Amstutz implants first U.S. Metal-Metal THR in revision situation.

1993 Statistical analysis (confidence intervals) applied to THR follow-up; Dr. Amstutz implants first metal-on-metal surface arthroplasty in the U.S. in October; first Transcend® Metal-Metal THR implanted; Dr Schmalzried awarded the John J. Fahey North American Traveling Fellowship; first “Joint Parade” fundraising “walk-a-thon” in the U.S., organized by JRI, is held; Dr. Amstutz serves as President of the American Orthopaedic Association.

1994 Paper entitled “The Origin of Sub-Micron Polyethylene Wear Particles in Total Hip Replacement” (Dr. McKellop – first author) wins coveted John Charnley Award; Dr. Schmalzried awarded $100,000.00 grant from Orthopaedic Research and Education Foundation to study the “Canine Model of the Effective Joint Space”; Osteonecrosis and THR studied; Bone mineral analysis of hemi-surface and surface arthroplasty implemented.

1995 JRI organizes groundbreaking international symposium and conference on Metal on Metal Hip Prostheses: Past Performance and Future Directions. Pat Campbell earns Ph.D. for studies of aseptic loosening and wear particles; Conserve® hemi-surface arthroplasty introduced; Transcend® metal-on-metal THR introduced nationwide in clinical studies; JRI organizes national groundbreaking Technology Transfer conference with AOA/AAOS sponsorship in effort to improve technology transfer process with FDA.

1996 Dr. Amstutz inducted as a Fellow in the Royal College of Surgeons of England; Dr. Schmalzried assists in development and implants first Scorpio® Total Knee Replacement; Dr. Amstutz performs first surface arthroplasty with the Conserve® Plus Metal-Metal device; CORR publishes Metal-Metal Symposium proceedings; Drs. Amstutz, Schmalzried and Campbell invited to participate in conference entitled: “Implant Wear: The Future of Total Joint Replacement” sponsored by the American Academy of Orthopaedic Surgeons(AAOS); The AAOS organizes and convenes first quarterly FDA/Orthopaedic Device Forum originally envisioned by Dr. Amstutz and promulgated by the 1995 Technology Transfer conference; JRI web page created.

1997 Indomethacin effects on THR studied; Pedometer quantification of walking & activity in THR patients initiated.

1998 Dr. Schmalzried elected as youngest member of Board of Directors of the American Academy of Orthopaedic Surgeons and elected to active membership in the Hip Society; Metal particles characterized; Dr. Harry McKellop and members of JVL/JRI research team win AAOS’ prestigious Kappa Delta Award for studies leading to development of cross-linked polyethylene; Dr. Schmalzried chairs AAOS “Internet” task force.

1999 Refinement of patient activity assessment continues; Use of computer scanned forms for follow-up initiated; Monitoring of patient metal ions started; Dr. Amstutz becomes President of the International Hip Society for a three year term. Dr. Schmalzried elected to active membership in the American Orthopaedic Association; DatelineNBC story featuring JRI patient, William Starrett, appears on 8-6-99 generating 15,000 website “hits” during the month (and innumerable e-mails and telephone calls).

2000 Paper entitled “Wear is a Function of Use, Not Time” (Schmalzried – first author) wins John Charnley Award; Metal-metal tribological studies continue; JRI patients begin submission of follow-up data via website; Conserve® Plus hybrid surface arthroplasty multicenter clinical trials begin with Dr. Schmalzried and Beaule included; William G. McGowan Foundation awards JRI $70,000 grant to study biocompatibility of metal-metal hip implants; JRI organizes and hosts Annual Meeting of the International Hip Society in Los Angeles.

2001 JRI Implant Lab undertakes analysis of recalled Sulzer components; JRI organizes successful symposium held in Quebec entitled “Joint and Bone Preserving Surgery of the Hip” (Dr. Beaule is Course Director); JRI celebrates 10th Anniversary.

2002 International Hip Society meets in San Diego in conjunction with SICOT arranged by JRI. Pat Campbell identifies cause of Sulzer InterOp- Socket loosening. Initial cohort of 294 Multi-Center Trial of Conserve Plus patients enrolled in the USA.

2003 Conserve Plus Socket approved by the FDA for use with a large uni-polar (BFH)

ball to treat and prevent dislocation after THR. First 600 Cohort of Conserve Plus completed by Dr. Amstutz. The second symposium on Joint and Bone Preserving Surgery of the Hip was held in Montreal in conjunction with the second international conference on Metal-Metal Hip Prostheses: Past Performance and Future Directions. Wright Medical submits data to FDA for Premarket Approval for Conserve Plus.

2004 Third Symposium on Joint Preserving and Minimally Invasive Surgery of the Hip was held in Montreal.

2005 Parting of JRI and Orthopaedic Hospital, Good Samaritan Hospital provides the interim surgical facility.

2006 Paper entitled “A study of implant failure in metal-on-metal surface arthroplasties” (Pat Campbell – first author) wins John Charnley Award.

2006 Dr Amstutz implants the 1000th Conserve Plus Hip Resurfacing on Sept 6th

2007 Dr Amstutz is the fifth recipient of the prestigious American Orthopaedic Association - Zimmer Award at the AOA meeting in Ashville for Life Long Outstanding Contributions to Orthopaedics.

JRI joins St. Vincent Medical Center.

SELECTED PUBLICATIONS

1991

Schmalzried, T. P.; Amstutz, H. C.; and Dorey, F. J.: Nerve palsy associated with total hip replacement. Risk factors and prognosis. J Bone and Joint Surg, 73A: 1074-1080, 1991.Schmalzried, 1991

Kilgus, D. J.; Dorey, F. J.; Finerman, G. A. M.; and Amstutz, H. C.: Patient activity, sports participation, and impact loading on the durability of cemented total hip replacements. Clin Orthop,269:25-31, 1991.

1992

Amstutz, H. C.; Campbell, P.; Clarke, I. C.; and Kossovsky, N.: Mechanism and clinical significance of wear debris-induced osteolysis. Clin Orthop,276:7-18, 1992.

Schmalzried, T. P.; Amstutz, H. C.; Au, M.K.; and Dorey, F. J.: Etiology of deep sepsis in total hip arthroplasty. The significance of hematogenous and recurrent infections. Clin Orthop,280:200-207, 1992

Dorey F, Nasser S, Amstutz HC: The Need for Confidence Intervals in the Presentation of Orthopaedic Data. J Bone Joint Surg 75A:1844-1853, 1993.

1994

Amstutz, H.C.; Grigoris, P.; Safran, M.; Grecula, M.J.; Campbell, P.A., and Schmalzried, T.P.: Precision-fit surface hemiarthroplasty for femoral head osteonecrosis. Long-term results. J. Bone and Joint Surg. 76-B:423-427, May 1994.

Grigoris, P.; Grecula, M. J.; and Amstutz, H. C.: Tripolar hip replacement for recurrent prosthetic dislocation. Clin.Orthop.,148-155, 1994.

Campbell, P.; Ma, S.; Schmalzried, T., and Amstutz, H.C.: Tissue digestion for wear particle isolation. J. Biomed. Mat. Res. 28:523-526, 1994.

Schmalzried, T.P.; Guttmann, D.; Grecula, M., and Amstutz, H.C.: The relationship between the design, position, and articular wear of acetabular components inserted without cement in the development of pelvic osteolysis. J. Bone and Joint Surg. 76-A:677-688, 1994.

Dorey F, Grigoris P, Amstutz H: Making Do Without Randomized Trials. J Bone Joint Surg 76B:1-3, 1994

1995

McKellop, H. A.; Campbell, P.; Park, S. H.; Schmalzried, T. P.; Grigoris, P.; Amstutz, H. C.; and Sarmiento, A.: The origin of submicron polyethylene wear debris in total hip arthroplasty. Clin Orthop,311:3-20, 1995

1996

Mai, M.T.; Schmalzried, T.P., and Amstutz, H.C.: The contribution of frictional torque to loosening at the cement-bone interface in THARIES hip replacements. J. Bone and Joint Surg., 78-A:505-511, 1996.

Schmalzried, T.P.; Szuszczewicz, E.S.; Akizuki, K.H.; Petersen, T.D., and Amstutz, H.C..: Factors correlating with long-term survival of McKee-Farrar total hip prostheses. Clin. Orthop. 329S:S48-S59, 1996.

Schmalzried, T.P.; Fowble, V.A.; Ure, K.J., and Amstutz, H.C..: Metal on metal surface replacement of the hip: technique, fixation and early results. Clin. Orthop. 329S:S106-S114, 1996.

Jacobs, J.J.; Skipor, A.; Doorn, P.F.; Campbell, P.; Schmalzried, T.P.; Black, J., and Amstutz, H.C. Cobalt and chromium concentrations in patients with metal on metal total hip replacements. Clin. Orthop. 329S:S256-S263, 1996.

Amstutz, H. C.; Campbell, P.; McKellop, H.; Schmalzried, T. P.; Gillespie, W. J.; Howie, D.; Jacobs, J.; Medley, J.; and Merritt, K.: Metal on metal total hip replacement symposium, consensus document, 1996

Doorn, P. F.; Campbell, P. A.; and Amstutz, H. C.: Metal versus polyethylene wear particles in total hip replacements. A review. Clin. Orthop,329 Suppl:S206-216, 1996. Clin. Orthop,329 Suppl:S297-303, 1996.

1997

Amstutz, H.C.; Fowble, V.; Schmalzried, T.P., and Dorey, F.J.: Short-course indomethacin prevents heterotopic ossification in a high-risk population following total hip arthroplasty. J. Arthroplasty 12:126-132, 1997.

Schmalzried, T.P.; Campbell, P.; Schmitt, A.K.; Brown, I.C., and Amstutz, H.C.: Shapes and dimensional characteristics of polyethylene wear particles generated in vivo by total knee replacements compared to total hip replacements. J. Biomed. Mater. Res. (Appl. Biomater.) 38:203-210, 1997.

Szuszczewicz, E.S.; Schmalzried, T.P., and Petersen, T.D.: Progressive bilateral pelvic osteolysis in a patient with McKee-Farrar metal-metal total hip prostheses. J. Arthroplasty 12:819-824, 1997.

Schmalzried, T.P.; Akizuki, K.H.; Fedenko, A.N., and Mirra, J.: The role of access of joint fluid to bone in periarticular osteolysis. J. Bone and Joint Surg. 79-A:447-452, 1997.