Accelerating Orthopedic Innovation Through Research

This Clinician's View is written by Amir Kachooei, MD, PhD, Director of Research, Rothman Orthopaedics Florida at AdventHealth.

I have always been driven by curiosity and questions:

How can we improve care for our patients?

Why do we do things a certain way?

Is there a more efficient or effective approach?

Could different tools, technologies, or protocols enhance our work and outcomes?

Simply put, I don’t believe in taking “that’s just how it’s always been done” for an answer. I want to continually learn, explore, discover, and innovate. And I’m not alone – this passion and drive lie at the heart of every clinician scientist.

Creating a “Science Factory”

I feel fortunate to have joined Rothman Orthopaedics Florida at AdventHealth in 2022, where I am surrounded by an entire community that is committed to fostering a culture of evidence-based practice, seamlessly incorporating innovative research and education into the patient care we provide. Our Associate Director of Orthopedic Research Ram Yakkanti, MD, and Research Scientists Ibrahim Zeini, PhD, PMP, SA, CCRP, and Kassem Ghayyad, MD, play essential roles in this work.

We are a TEAM: Together, Each Achieves More.

Our team is cultivating what we call our “Science Factory” and through it, creating science we can rely on and build upon to advance orthopedics not only in Central Florida, but nationally and globally. This work encompasses a full range of research -- clinical trials, industry-sponsored studies, investigator-initiated trials, mechanical and engineering studies, and even basic science -- across all orthopedic subspecialty areas from shoulder, elbow, spine, and joint reconstruction to sports medicine and trauma.

Tackling the Greatest Challenges in Orthopedics Through Research

From total joint implants to minimally invasive surgical techniques, the field of orthopedics has made incredible strides in the last century and even more so over the past two decades. However, challenges and opportunities remain, especially in the following areas:

• Regenerating tissue
• Preventing infection in joint replacement
• Determining the role of robotics in orthopedic surgery
• Enhancing value-based care through remote monitoring and wearable devices
• Customizing care approaches to meet individual patient goals

Our Rothman Orthopaedic/AdventHealth research teams are actively involved in exploring potential improvements and solutions, including projects that incorporate motion analysis, BioSkills and biomechanics, prototyping and 3D printing, and surgical simulation. Some of our ongoing clinical trial topics include:

• Selective Versus Non-selective COX2 Inhibitors on Heterotopic Ossification (HO) After Elbow Surgery
• Post-traumatic Elbow Stiffness Rehabilitation with and without Blood Flow Restriction (BFR)
• Biceps and Triceps Muscle Oxygenation with and without Blood Flow Restriction Around the Elbow in the Healthy Population
• Loose-fit versus Press-fit Radial Head Arthroplasty in Elbow Fracture-Dislocations
• Deep Vein Thrombosis (DVT) Prediction Using Near Infrared Spectroscopy (NIRS) Compared to Color Doppler Ultrasound
• Assessing the Role of Gabapentin in Reducing Oxycodone Refills After Hand and Upper Extremity Surgery: A Randomized Controlled Trial

In addition, we’re about to begin two other new trials:

• Remote Monitoring for Post-Operative Recovery After Total Knee Arthroplasty – In collaboration with our physical therapy (PT) team, this randomized controlled trial will evaluate the use of TracPatch, a remote monitoring tool designed to customize a patient’s post-op recovery and monitor them through objective measures.
• Optimal Dosing for Low-Dose Aspirin Chemoprophylaxis for VTE Following Total Joint Arthroplasty (NCT04295486) – This research study is attempting to answer the question of whether 81 mg aspirin once daily is as effective as 81 mg aspirin twice daily in preventing blood clots after total joint replacement surgery.

Furthermore, Rothman Orthopaedics Florida at AdventHealth has been pioneering work on the use of 3D printing and casting, and we look forward to continuing to research the potential impacts and uses of this new technology.

Connecting to real-world challenges ensures that our research remains relevant and impactful. Many of our projects also foster collaboration along the continuum of care for orthopedic patients, encompassing rehabilitation and pain medicine as well.

The Power of Collaboration – Building an Academic Ecosystem

The cornerstone of Rothman Orthopaedics Florida at AdventHealth’s “Science Factory” is an academic ecosystem that integrates both exceptional research and engaging education into our clinical model. This combination fosters a culture of continuous learning and development amongst our entire team.

Our research learners run the gamut of educational levels from undergraduate students, medical students, and gap-year students to research interns, residents, and fellows. We work alongside one another, and everyone is empowered to share and explore research ideas as well as potential partnerships and collaborations. The learners gain research experience with real-world orthopedic challenges while also directly contributing to the science, and the more senior members of our research team benefit from their fresh perspectives and ideas.

For medical students, we currently have five full-year positions and plan to expand that to six next year. We also have about 30 medical students who serve as part-time collaborators. Undergraduate students from Florida State University (FSU), the University of Central Florida (UCF) and Loma Linda University come to us for a “summer camp” and participate in short-term studies. Residents, especially at the PGY-1 level, have a dedicated research rotation with our research team and can also apply for research grants through the Orthopaedic Research and Education Foundation (OREF). Funding received from OREF, as well as organizations like The Arthroscopy Association of North America (AANA), The American Orthopaedic Foot & Ankle Society (AOFAS), and the Rothman Orthopaedic Institute Foundation for Opioid Research & Education (ROIFORE), supports our Orthopedic Surgery Residency Program and Richard H. Rothman Research Fellowship. This positions us as a highly attractive destination for high-caliber applicants engaged in contributing to our research efforts.

In addition, our diverse team of learners and clinician scientists is committed to sharing their research ideas and findings through participation in national and international orthopedic medical conferences. Last year alone, we had teams attend more than 10 meetings throughout the U.S., including several close to home such as the Florida Orthopedic Society Annual Scientific Meeting, the Clinical Orthopedic Society Conference, the Eastern Orthopedic Association Annual Meeting, and the Shoulder 360 Meeting in Miami.

Another strength of the Rothman Orthopaedics Florida at AdventHealth academic ecosystem has been our ability to bring new research into the Central Florida community. Collaborations with prestigious academic institutions like Thomas Jefferson University, Harvard University, Vanderbilt University Medical Center, University of Alabama, Villanova University, Embry-Riddle University, and Full Sail University have significantly expanded our research capabilities in both basic and clinical realms.

Accelerating Ahead and Aiming High

As scientists, our work is never done. We are always evolving. Every day I wake up with more questions, and new technologies and advancements continually emerge. That is what makes orthopedic research exciting.

Looking into the future, we have big plans, including:

• Expanding the facilities and staff at our Science Factory
• Integrating cutting-edge technologies like machine learning and artificial intelligence into the research we do
• Utilizing data analytics to customize care
• Enhancing our in-house biomechanical and bioengineering laboratories
• Spearheading international multicenter clinical trials
• Developing innovative products
• Establishing a Center for Excellence in elbow care

At the center of it all is our patients. We remain driven by the desire to revolutionize care and recovery that will help them feel whole.

Learn more about the AdventHealth Orthopedic Institute.