2018-08-21T08:24:04-05:00 2017-12-31 720398470 HEARD MCELROY & VESTAL LLC 333 TEXAS STREET SUITE 1525 SHREVEPORT LA 71101 990 2017-01-01 760497352 INSTITUTE OF ORTHOPEDIC RESEARCH AND EDUCATION INST 7136104270 6550 FANNIN STREET SUITE 2512 HOUSTON TX 77030 JAMES BOCELL MD PRESIDENT 7136104270 2018-07-09 1 ROY E PRESTWOOD P00419967 3184291525 2018-07-11 2017 2022-09-23 18:48:47Z JAMES BOCELL MD 6550 FANNIN STREET SUITE 2512 HOUSTON TX 77030 1042844 0 X WWW.IORE.NET X 1995 TX IORE'S FUNDAMENTAL RESEARCH MISSION IS TO PROVIDE THE STAFF AND FACILITIES REQUIRED TO ENABLE ORTHOPEDIC FACULTY, RESIDENTS AND FELLOWS TO ACHIEVE NATIONAL AND INTERNATIONAL PROMINENCE THROUGH APPLIED RESEARCH OF THE VERY HIGHEST STANDARD. 5 5 12 10 0 0 930000 635888 472949 405995 106 128 161 833 1403216 1042844 0 0 0 0 896375 746211 0 0 0 389573 336071 1285948 1082282 117268 -39438 335387 291349 16095 11495 319292 279854 X IORE'S FUNDAMENTAL RESEARCH MISSION IS TO PROVIDE THE STAFF AND FACILITIES REQUIRED TO ENABLE ORTHOPEDIC FACULTY, RESIDENTS AND FELLOWS TO ACHIEVE NATIONAL AND INTERNATIONAL PROMINENCE THROUGH APPLIED RESEARCH OF THE VERY HIGHEST STANDARD. 1 0 189905 1. THE BIOMECHANICS OF CEMENTLESS AND CEMENTED FIXATION OF THE TIBIAL COMPONENT IN TOTAL KNEE REPLACEMENTTOTAL KNEE REPLACEMENTS CONSIST OF TWO MATING PROSTHETIC COMPONENTS THAT ARE FIXED TO THE FEMUR AND THE TIBIA. FIXATION OF THE TIBIAL COMPONENT OCCURS FAR MORE OFTEN THAN THE FEMORAL COMPONENT, IN PART, BECAUSE OF THE NON-UNIFORMITY OF THE STRENGTH AND STIFFNESS OF THE BONE UPON WHICH THE IMPLANT IS MOUNTED, AND BECAUSE OF THE MOVEMENT OF THE APPLIED LOAD DURING FUNCTIONAL ACTIVITIES. BUILDING ON PROJECTS PERFORMED AT IORE IN PREVIOUS YEARS, WE HAVE DEVELOPED A SERIES OF LOADING ROUTINES IN WHICH COMPLEX CYCLIC LOADS ARE APPLIED TO CADAVERIC SPECIMENS IMPLANTED WITH ARTIFICIAL KNEES, SIMULATING THE DEMANDS OF ACTIVITIES COMMONLY PERFORMED IN NORMAL LIFE. DURING THESE LOADING ROUTINES WE EMPLOY SOPHISTICATED OPTICAL METHODS TO MEASURE THE RELATIVE MOTION OF THE BONE AND THE ADJACENT IMPLANT AS AN INDICATOR OF THE STABILITY OF FIXATION OF THE IMPLANTED KNEE. DURING 2017, SEVERAL ASPECTS OF IMPLANT FIXATION WERE EXAMINED THROUGH THE FOLLOWING RESEARCH PROJECTS:1. HOW DO VARIATIONS IN THE SURGEON'S TECHNIQUE IMPACT THE INITIAL STABILITY OF CEMENTLESS TIBIAL PROSTHESES? TO WHAT EXTENT IS PRECISE PREPARATION OF THE BONY SURFACES NECESSARY?2. IS IT POSSIBLE TO PREDICT WHICH PATIENTS WILL ACHIEVE STABLE IMPLANT FIXATION WITH A CEMENTLESS IMPLANT, BASED UPON THE SIZE AND DENSITY OF THE BONES AND THE ACCURACY OF THE SURGICAL PROCEDURE?3. HOW IS THE PERFORMANCE OF CEMENTLESS IMPLANTS AFFECTED BY THE BONE DEBRIS GENERATED BY SURGICAL TOOLS USED TO PREPARE THE BONY SURFACES?4. WHEN SURGEONS FIX IMPLANTS TO BONE WITH ACRYLIC CEMENT (CEMENTED FIXATION), HOW DOES THE THICKNESS AND DISTRIBUTION OF THE CEMENT LAYER INFLUENCE THE STABILITY OF FIXATION?5. IF SURGEONS MAKE ERRORS IN BOTH THE ROTATION AND ORIENTATION OF HEIR CUTTING INSTRUMENTS DURING PREPARATION OF THE KNEE JOINT FOR JOINT REPLACEMENT, HOW DOES THIS AFFECT THE ALIGNMENT OF THE JOINT WITH RESPECT TO THE FORCES PASSING THROUGH THE ARTIFICIAL KNEE?ABSTRACTS ARISING FROM THIS WORK HAVE ALREADY BEEN SUBMITTED FOR PRESENTATIONS AT NATIONAL AND INTERNATIONAL CONFERENCES. 73214 2. IMPROVING THE OUTCOMES OF REVISION TOTAL KNEE REPLACEMENT.OVER A 10-YEAR PERIOD, 5-8% OF TOTAL KNEE REPLACEMENTS FAIL, LEADING TO EXPENSIVE SURGERY TO REMOVE THE IMPLANTED DEVICE AND REPEAT THE ORIGINAL PROCEDURE WITH MODIFIED DESIGNS OF IMPLANTS. AVERAGED ACROSS THE POPULATION, REVISION KNEE REPLACEMENT IS NOT NEARLY AS SUCCESSFUL AS THE INITIAL (PRIMARY) KNEE REPLACEMENT PROCEDURE, WITH FAILURE RATES OF 3-4 TIMES HIGHER AND A SUBSTANTIAL INCIDENCE OF ONGOING SYMPTOMS, CHIEFLY PAIN, SWELLING AND STIFFNESS. TO A SIGNIFICANT EXTENT, THESE INFERIOR OUTCOMES ARE DUE TO THE ABSENCE OF EVIDENCE-BASED APPROACHES TO THE DIAGNOSIS AND TREATMENT OF THE FAILED INITIAL SURGERY, AND A LACK OF RIGOROUS TRAINING PROGRAMS THAT TEACH THE UNDERLYING PRINCIPLES OF REVISION SURGERY TO NEW SURGICAL TRAINEES SPECIALIZING IN JOINT REPLACEMENT. IN ATTEMPTING TO ADDRESS THIS DEFICIENCY, WE HAVE STARTED A RESEARCH PROGRAM FOCUSING ON IMPROVING THE QUALITY AND EFFECTIVENESS OF THE TRAINING RECEIVED BY SURGEONS SPECIALIZING IN JOINT REPLACEMENT. DURING 2017, 3 PROJECTS WERE INITIATED AS PART OF THIS EFFORT:1. WE DEVELOPED AN ON-LINE SURVEY TO ASSESS THE DIFFICULTY OF ALL ASPECTS OF REVISION KNEE REPLACEMENT, CONSISTING OF 69 ITEMS WITHIN FOUR DOMAINS: CLINICAL/COGNITIVE (N=9), CLINICAL/INTERPERSONAL (N=7), SURGICAL/COGNITIVE (N=35), AND SURGICAL/TECHNICAL (N=18). 109 US SURGEONS COMPLETED THE SURVEY: 31 FELLOWS IN TRAINING, AND 78 YOUNG SURGEONS WITHIN 10 YEARS OF GRADUATING FROM A JOINT FELLOWSHIP PROGRAM. FELLOWS AND SURGEONS REPORTED WIDE VARIATIONS IN THE DIFFICULTY OF TASKS IN EACH DOMAIN. BOTH GROUPS EXPRESSED DIFFICULTY WITH INTERPERSONAL INTERACTIONS WITH PATIENTS (FELLOWS: 34.6% VS SURGEONS: 34.3%, P=0.93), WHEREAS FELLOWS FOUND TECHNICAL ASPECTS OF REVISION SURGERY MORE CHALLENGING THAN SURGEONS (38.5% VS 28.7%, P<0.001). FELLOWS AND SURGEONS DIFFERED SIGNIFICANTLY IN REPORTED DIFFICULTY OF SURGICAL DECISION-MAKING (P<0.001) AND TO A LESSER EXTENT IN CLINICAL DECISION-MAKING RELATED TO PATIENT CARE (P=0.0251). A MAJOR FACTOR DRIVING SURGEONS' UNEASE WITH THE PROCEDURE WAS THE LACK OF ACCEPTED GUIDELINES AND A STANDARD APPROACH TO TASKS INVOLVING CLINICAL DECISION-MAKING AND OPERATIVE PERFORMANCE. OUR FINDINGS HIGHLIGHT THE NEED FOR IMPROVED SURGEON TRAINING TO ENHANCE DECISION-MAKING AND PROCEDURAL SKILLS.2. WE DEVELOPED A NEW SYSTEM FOR CLASSIFYING THE QUALITY AND INTEGRITY OF THE BONE PRESENT DURING REVISION KNEE REPLACEMENT SURGERY TO INTRAOPERATIVE DECISION-MAKING, INCLUDING THE SELECTION OF THE APPROPRIATE FEMORAL AND TIBIAL IMPLANTS. WE STARTED BY EXAMINING 103 COMPLETE SETS OF PRE- AND POST-REVISION TKA RADIOGRAPHS WERE OBTAINED FROM 7 EXPERIENCED SURGEONS FROM 5 JOINT REPLACEMENT PRACTICES. TO QUANTIFY CHANGES ASSOCIATED WITH FAILURE OF THE PRIMARY PROCEDURE, MULTIPLE PARAMETERS WERE MEASURED ON AP AND LATERAL PRE-REVISION RADIOGRAPHS, INCLUDING COMPONENT POSITION, MIGRATION, BONE DENSITY AND PATTERNS OF BONE LOSS. THIS ANALYSIS LED TO THE CREATION OF A GRADING SCHEME EXPRESSING THE INCREMENTAL LOSS OF SUPPORTIVE BONE STOCK NECESSARY TO SUPPORT THE DEMANDS GENERATED BY PHYSIOLOGIC ACTIVITY. THIS SCHEME CONSISTED OF 4 GRADES OF INCREASING EXTENT OF BONE LOSS ON THE TIBIA AND 5 ON THE FEMUR. THIS GRADING SCHEME IS NOW BEING DEVELOPED FURTHER THROUGH LINKAGE TO TREATMENT STRATEGIES AND IMPLANT SELECTION THROUGH ACTIVE COLLABORATION WITH LEADING SURGEONS SPECIALIZING IN REVISION SURGERY. 3. WE CREATED ACCURATE SURROGATE MODELS OF THE FEMUR AND THE TIBIA THAT REPRODUCE THE 3D MORPHOLOGY OF THE CORTICAL AND CANCELLOUS BONE REMAINING AFTER REMOVAL OF THE PRIMARY IMPLANTS DURING REVISION KNEE REPLACEMENT PROCEDURES. THESE MODELS WERE FABRICATED IN TWO FORMS TO SIMULATE THE TWO MOST COMMON PATTERNS OF RESIDUAL BONE SEEN AT SURGERY. THIS WAS UNDERTAKEN THROUGH AN ITERATIVE PROCESS THAT COMMENCED WITH A REVIEW OF PUBLISHED PHOTOGRAPHS OF THE FEMUR AND TIBIA AT REVISION TKR, AND WAS FURTHER REFINED THROUGH IN-DEPTH REVIEWS, IN COLLABORATION WITH HIGHLY EXPERIENCED SURGEONS, OF INITIAL PROTOTYPES OF EACH MODEL AND SUBSEQUENT MODIFICATIONS. 40773 3. DEVELOPMENT OF A TEST METHOD FOR SIMULATION OF REAL-WORLD LOADING OF LOWER-LIMB PROSTHESESINTRODUCTION: ADVANCES IN 3D PRINTING HAVE POTENTIALLY REVOLUTIONIZED THE FITTING AND FABRICATION OF PROSTHETIC LIMBS. PROSTHETISTS ARE NO ABLE TO DESIGN AND PRESCRIBE THESE DEVICES ON A FACTORY-CONTROLLED, REPRODUCIBLE BASIS WITHOUT DEPENDING UPON THE MANUAL SKILLS OF INDIVIDUAL PRACTITIONERS. HOWEVER, WHILE 3D PRINTING DOES LEND ITSELF TO ARTIFICIAL LIMBS FOR THE UPPER EXTREMITY, THE MECHANICAL AND ENVIRONMENTAL DEMANDS PLACED ON LOWER-LIMB PROSTHESES BRING INTO QUESTION THE COMPATIBILITY OF PRINTABLE POLYMERS WITH CURRENT PROSTHETIC DESIGNS. TO ADDRESS THIS ISSUE, WE PERFORMED 2 COMPLEMENTARY RESEARCH STUDIES:1. COMPUTATIONAL MODELING. WE DEVELOPED A COMPUTATIONAL MODEL OF A GENERIC TRANS-TIBIAL SOCKET AND APPLIED EXTERNAL FORCES AND INTERFACE PRESSURES REPRESENTATIVE OF MID-STANCE AMBULATION. FINITE ELEMENT ANALYSIS WAS PERFORMED TO PREDICT THE DISTRIBUTION OF STRESSES DEVELOPED WITHIN THE WALL OF THE SOCKETS FABRICATED FROM TWO SOCKET MATERIALS USED IN CLINICAL PRACTICE, AND TWO POLYMERS COMMONLY USED FOR SOCKET FABRICATION USING 3D PRINTING. THE RESULTS OF THIS ANALYSIS SHOWED THAT SOCKETS FABRICATED FROM THE CURRENT CARBON-FIBER REINFORCED MATERIALS HAD A FACTOR OF SAFETY OF APPROXIMATELY TEN TIMES THAT OF POLYMERS COMPATIBLE WITH 3D PRINTING. GIVEN THE MAGNITUDE OF THIS DIFFERENCE, WE CONCLUDED THAT THE CURRENT GENERATION OF POLYMERS USED FOR FUSED DEPOSITION MODELING MAY NOT BE ADEQUATE FOR USE IN LOWER-LIMB PROSTHETIC DEVICES THAT ARE EXPOSED TO CYCLIC IMPACT LOADING UNDER DEMANDING ENVIRONMENTAL CONDITIONS. 2. EXPERIMENTAL SIMULATION. IN PARALLEL WITH OUR COMPUTATIONAL STUDIES, WE PROSED AN EXPERIMENTAL METHODOLOGY TO ENABLE US TO PHYSICALLY TEST PROSTHETIC DEVICES TO CONFIRM THE PREDICTIONS OF COMPUTER MODELING AND TO EVALUATE PROSTHESES DERIVED FROM ALTERNATIVE SOURCES. TO ACHIEVE THIS GOAL, WE DESIGNED A MULTI-AXIAL TESTING FRAME CAPABLE OF IMPOSING ON A PROSTHETIC SOCKET THE FORCES AND MOMENTS GENERATED DURING ACTIVITIES OF DAILY LIVING WHILE SIMULTANEOUSLY MEASURING THE DEFORMATION OF ITS OUTER SURFACE. THE COMPLETE EXTERNAL SURFACE USING DIGITAL IMAGE CORRELATION (DIC). DURING 2017, A PILOT STUDY WAS PERFORMED TO DEMONSTRATE PROOF OF CONCEPT AND A REQUEST FOR FUNDING WAS SUBMITTED TO BAYLOR COLLEGE OF MEDICINE FOR SUPPORT OF THIS WORK. AN ABSTRACT DESCRIBING THE COMPUTATIONAL COMPONENT OF THIS PROJECT WAS PREPARED AND SUBMITTED FOR PRESENTATION AT A NATIONAL CONFERENCE. 440142 406428 OTHER ORTHOPEDIC RESEARCH PROJECTS. 440142 406428 744034 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 7 0 1 12 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X KIM MCCONN 7136104270 6550 FANNIN STREET SUITE 2512 HOUSTON TX 77030 X JAMES BOCELL MD PRESIDENT 1.00 X X 0 0 0 BRADLEY WEINER MD VICE PRESIDENT 1.00 X X 0 0 0 STEVEN INCAVO MD DIRECTOR 0.50 X 0 0 0 KENNETH MATHIS MD DIRECTOR 1.00 X 0 0 0 WILLIAM J BRYAN MD DIRECTOR 0.50 X 0 0 0 0 0 0 0 0 0 0 0 635888 635888 RESEARCH SERVICES 541700 405995 405995 405995 128 128 400 400 MISCELLANEOUS 900099 433 433 433 1042844 406428 0 528 591531 473225 118306 27604 22083 5521 87716 70173 17543 39360 31488 7872 42000 42000 11120 11120 126 126 1379 1379 3313 3313 98101 78481 19620 36207 28966 7241 49895 49895 23644 23644 SUPPLIES 42722 34178 8544 SERVICES - COMMUNICATIO 9276 9276 SERVICES - REPAIRS 6024 6024 EQUIPMENT RENT 3113 3113 9151 5440 3711 1082282 744034 338248 0 198022 143925 56284 57200 661784 571560 81081 90224 335387 291349 16095 11495 16095 11495 X 0 0 0 0 319292 279854 319292 279854 335387 291349 -39438 0 X 0 0 0 X 738000 850000 850000 930000 635888 4003888 472084 554560 399798 472949 405995 2305386 1210084 1404560 1249798 1402949 1041883 6309274 0 0 0 6309274 104004 108 1253 260 528 106153 104004 108 1253 260 528 106153 1446 678 365 7 433 2929 1315534 1405346 1251416 1403216 1042844 6418356 0.98300 0.98350 0.01650 0.01600 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 90000 41637 48363 571784 529923 41861 90224 FORM 990, PART III, LINE 2 PLEASE SEE FORM 990, PAGE 2, PART III FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE ORGANIZATION'S GOVERNING BODY BEFORE IT IS FILED. 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