A Comparative Gait Study of Allograft vs. Metallic Prosthesis in Distal Femoral and Proximal Tibial Replacements
Utilizing Motion Capture, EMG and Force Plates
H. Thomas Temple, M.D. – Chief of Service
Patients who underwent radical surgery of the distal femur for bone tumors underwent one of two different types of limb reconstruction, metal
prosthesis and bone allograft. These two groups of patients was evaluated and data was analyzed to detect differences in gait patterns for these
two types of reconstruction.
Individuals with allografts tended to have a gait pattern that was closer to normal control subjects than those with metal prostheses.
Enrollment of additional patients and further analysis is ongoing.
Inadvertant Fixation of Primary Bone Malignancies: Case Summaries
Because primary tumors of bone are rare, they are often unsuspected causes of bone fracture. For this reason, the Orthopaedic Oncology Service at the
Miller School of Medicine has observed, evaluated and treated a series of patients who have undergone inappropriate surgery for these tumors.
This study defines the problem and identifies clinical and radiographic features that help orthopaedic surgeons to recognize this problem and to avoid
inappropriate surgery that may compromise the patient’s limb or life.
Retrospective Review of Neurogenic Tumor Cases Treated by the University of Miami Orthopaedic Oncology Service 1991-2006
We have identified over 100 patients with neurogenic tumors, both benign and malignant. From these data, we have identified clinical and radiographic
features that assist the practicing orthopaedic surgeon in correctly diagnosing and treating these tumors.
The Use of Megaprostheses for Reconstruction of Non-Neoplastic Conditions
In this study, we are collecting clinical data to assess the outcomes of patients who have undergone major bone and joint reconstruction for non-tumorous
conditions of bone. The need for major revision surgery for patients with failed knee and hip implants with massive bone loss is increasing. The use of
modular endoprosthetic devices provides a means of restoring function in these patients.
Collection of Tissue, Blood and Clinical Data from Patients with Musculoskeletal Tumors
The University of Miami has one of the largest tumor services in the United States treating over 1,000 patients a year with tumor and tumor-related
conditions of bone. The collection of tissue and blood will allow orthopaedic oncologists and scientists at the Miller School of Medicine to identify genes
or gene products that may have implications for patient prognosis and treatment.
Distal Tibial Osteoarticular Allografts After Resection of Bone Tumors
The UM tumor service in conjunction with the UM Tissue Bank have collaborated on a number of clinical projects assessing the efficacy of bone and soft
tissue transplantation following tumor resection. This study identified patients who underwent resection of the distal tibia and ankle, and then had the joint
and bone defect reconstructed with osteoarticular distal tibial allografts. This was a multi-institutional study evaluating the benefits and complications of
this rare form of reconstruction.
Giant Cell Tumor of Bone: Long Term Follow-Up Following Curetting and Cement Reconstruction
The UM tumor service has treated patients with giant cell tumor of bone with extended curetting (maintaining the joint and continuity of bone) and filling
of the defect with acrylic bone cement. This is a study that spans several decades.
Mark D. Brown, M.D., Ph.D.
Recurrent Resection of Intraspinal Extradural Pigmented Vilonodular Synovitis
Case report of a patient who had recurrent PVS requiring re-excision and radiation and long-term follow-up. Study to be published along with
A Retrospective Study of Blood Transfusion Patterns in Lumbar Spine Surgery
Submitted to Spine and co-authored with Kathleen Brookfield, Jon Roper et.al. In a retrospective matched cohort review of 50 patients who pre-deposited
their own blood versus 50 patients who did not for major spine surgery, it was shown that the former group who pre-donated lost more blood and received
more allogenic blood.
Delayed Spinal Fluid Leak Following Lumbar Spine Surgery
Two patients, possibly a third of delayed spinal fluid leakage from a spike of bone eroding the dura. To be reported with Kathleen Brookfield, Seth Williams,
Frank Eismont and possibly Barth Green.
Genotyping Disc Degeneration and Phenotypic Correlations
To determine the genetic linkage to disc degeneration, back pain and herniated discs, the presence of genetic markers will be correlated with phenotypic
expression of disc degeneration on MRI scans of 20 people representing three generations of the same family. Historical data and blood samples have been
collected from all 20 participants. Analysis of genetic markers and MRIs still necessary.
A Prospective Randomized Study to Compare Local and Autogenous Bone Graft Versus Allograft with Local Bone in Posterior
Lateral Lumbar Fusion with Instrumentation
This prospective randomized study will determine the safety and efficacy of autogenous (AIBG) iliac bone graft to powdered cortical allograft (PCA) in
patients undergoing posterior lateral lumbar spine fusion with instrumentation. Outcomes will be validated, clinical outcome measured, X-ray and CT evidence of fusion or non-fusion over a two-year follow-up. There are many expensive bone substitutes available that are allegedly as good as AIGB, but they are approximately ten times more expensive than PCA. If PCA is equivalent to AIGB in instrumented spine fusion, it will supplant the more expensive bone substitutes. Documentation for the study has been submitted to our IRB. The study design, informed consent and submission to the IRB was completed by
Resident Alejandro Pino under my guidance. We hope to have several other spine surgeons in the Spine Institute participate once we obtain IRB approval for the study.
Factors Determining Clinical Outcomes with Low Back Pain Disorders
A prospective study of outcomes using validated outcome measures on 100 patients undergoing treatment for low back pain disorders. The objective of this study is to validate the computerized quantitative pain drawing as an outcome-measure instrument and to determine if there are quantitative differences in abnormal sensations produced by nerve injury from herniated discs versus spinal stenosis. This study is being performed by resident Chad Aarons under my
tutelage. The data are currently being analyzed.
Utilizing the same data set another pilot study comparing validated risk indices to outcome measure in patients undergoing treatment for low-back pain is
being performed. James Bostwick, a UM medical student, is performing this study under my tutelage. This study has the potential for major funding of a
prospective outcome study to develop a risk index for patient undergoing major elective reconstructive surgery.