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UW Researchers awarded five-year $3 million NIH R01 to develop novel treatment for pediatric limb-length discrepancy


This fall, the National Institutes of Health (NIH) awarded Christopher Brace, PhD, UW School of Medicine and Public Health (SMPH) associate professor, Departments of Radiology and Biomedical Engineering, and Kenneth Noonan, MD, MHCDS, professor, Department of Orthopedics and Rehabilitation, a five-year, $3 million R01 grant for a research project that aims to revolutionize the treatment of limb-length discrepancy (LLD) – a common disability in which one leg is longer than the other.

Small differences in leg lengths affect roughly 23% of the world’s population. For children with moderate (3-5 cm) LLD, surgical removal of a growth plate – a painful procedure performed with drills and mechanical scraping – is the current gold standard treatment. However, with this method, these young patients require significant pain medicine and experience an arduous six-week recovery before they can fully bear weight on the affected limb. This extended healing period poses physical and psychological challenges for pediatric patients and their families. Further, the procedure is associated with complications, including incomplete growth arrest, angular deformity, bleeding, and the risk of infection.

In a groundbreaking effort to develop a less invasive, more efficient LLD treatment, Dr. Brace, principal investigator (PI), and Dr. Noonan, the project’s co-PI, are turning to microwave ablation, a method that is well tolerated and already being used successfully to treat malignant and benign tumors throughout the body.

The team’s preliminary studies in animals employed this minimally invasive technique to slow the growth plate by delivering microwave energy via a small probe. Early data demonstrated the effectiveness of this approach when using clinical microwave tumor ablation systems to treat laboratory animals with LLD.

The next phase of their research will focus on developing more optimal devices and techniques to arrest bone growth using precise microwave heating. The team is working on directional antennas that target microwave energy to the growth plate while minimizing collateral damage. They will also employ dynamic positioning and multi-applicator techniques to enhance the precision of energy delivery, ensuring complete and uniform growth arrest.

Ultimately, the goal of this study is to refine the probes that would eventually be used to control bone growth in children, assess the safety and efficacy of these optimized tools and techniques, and compare their application with the current approach of surgical drilling in various regions, including the distal femur, proximal tibia, and fibula.

If successful, these developments and studies would transform the treatment of LLD in children by offering an innovative and exciting alternative to traditional surgical procedures that would significantly improve the lives of young patients who experience this challenging medical condition.

“Our team believes that this methodology will become the standard of care for the treatment of limb-length discrepancy in children within five to ten years,” says Dr. Noonan. “We also feel that this technology could be used to correct other skeletal deformity such as bowed legs and even scoliosis.”

In February 2023, during the early stages of their research, the team received essential funding via a Freedom of Movement Fund Grant from the UW SMPH Department of Orthopedics and Rehabilitation, enabling them to expand their microwave ablation experience to the femur – proving indications and methods in the more powerful femoral growth plate. Department Vice Chair for Research Bryan Heiderscheit, PhD, PT, notes that this project is “an excellent example of the valuable research conducted by our faculty and the important role that early support from the Freedom of Movement Fund has in making that research possible.”

 


The research reported in this article was supported by the National Institute Of Arthritis And Musculoskeletal And Skin Diseases of the National Institutes of Health under Award Number R01AR082375. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

UW Orthopedics and Rehabilitation Department welcomes two new faculty physicians


Lindsey Boyke, MD, joins our faculty as a Non-operative Pediatric Physician. A Verona, Wisconsin native, she completed her pediatric residency at Michigan State University and Helen DeVos Children’s Hospital, Spectrum Health. Dr. Boyke went on to do her non-operative pediatric orthopedic fellowship here at UW and we were thrilled to have her return on August 14, 2023.
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James Bernatz, MD, joined our Spine Surgery team on September 1, 2023. Originally from Delafield, Wisconsin, Dr. Bernatz completed medical school and his orthopedic surgery residency at UW-Madison – going on to do a fellowship in spine surgery at the Mayo Clinic in Minnesota. We are excited to welcome him back to Wisconsin.

Dr. Tamara Scerpella appointed Interim Chair of the UW Department of Orthopedics and Rehabilitation


On June 29, 2022, Tamara Scerpella, MD, was named Interim Chair of the Department of Orthopedics and Rehabilitation at the University of Wisconsin School of Medicine and Public Health.

Dr. Scerpella earned her medical degree at the University of Iowa and completed her residency in orthopedic surgery at UW-Madison. Following residency, she was in private practice for three years before completing a fellowship in sports medicine and arthroscopic surgery at Union Memorial Hospital in Baltimore. From there, she spent the next 16 years on the orthopedic faculty at SUNY Upstate Medical University in Syracuse, NY, where she rose to the rank of tenured professor and served as Chief of Sports Medicine.

In August 2010, Dr. Scerpella returned to the UW as Professor of Orthopedic Surgery. Five years later, she was named Chief of the Division of Sports Medicine and the following month, she was awarded the Ballantine Endowed Professorship for Orthopedic Research. She was named Vice Chair of the UW Department of Orthopedics and Rehabilitation in 2016, and three years later, Senior Vice Chair of the department – charged with overseeing the educational, research, and clinical missions of the orthopedic surgery faculty.

As a clinician, Dr. Scerpella specializes in arthroscopic shoulder and knee surgeries. She treats injuries in elite athletes through her role as team physician for the UW Badger Women’s Hockey and Softball teams. Specific areas of expertise include the care of patients with patellofemoral instability and those with multidirectional instability of the shoulder. The most involved patients within the latter group are those with Ehlers-Danlos Syndrome (EDS). Dr. Scerpella receives referrals of EDS patients from around the Midwest, surgically stabilizing their shoulders to give them a new lease on life.

On the research side, Dr. Scerpella has spent 25 years evaluating the role of childhood physical activity in lifelong bone health. Her longitudinal study following over 100 young women from childhood to young adulthood has been funded by the NIH and now by her Ballantine Professorship; it is the longest running, most extensive study of its kind. Dr. Scerpella has published nearly 50 peer-reviewed articles, over 60 abstracts, multiple book chapters, and has given over 200 presentations. She has received numerous honors and awards, including the 2017 American Medical Women’s Association Woman in Science Award and the 2020 UW-Madison Slesinger Award for Excellence in Faculty Mentoring.

Dr. Scerpella is a member of six professional associations, including The Forum – an advocacy group and society for women orthopedic sports medicine specialists. She is proud to have served as president of The Forum from 2017 to 2019. This past year, Dr. Scerpella authored an invited manuscript for the Journal of the American Academy of Orthopedic Surgeons, examining the underrepresentation of women in orthopedic surgery and illustrating strategies to address the significant gender gap in the field.

When Dr. Scerpella began her career 32 years ago, there were fewer than 100 female orthopedic surgeons in the country. She has not only watched that number grow but has actively sought to change the landscape for women in orthopedic surgery and for those who aspire to join the field.

December 12, 2022

Creating stem cells from minipigs offers promise for improved treatments


 
Cells from miniature pigs are paving the way for improved stem cell therapies.

A team led by University of Wisconsin–Madison Stem Cell & Regenerative Medicine Center researcher Wan-Ju Li offers an improved way to create a particularly valuable type of stem cell in pigs – a cell that could speed the way to treatments that restore damaged tissues for conditions from osteoarthritis to heart disease in human patients.

Read the full story here.

 

 

September 15, 2022

Joseph Mitchell, MD, joins the UW Department of Orthopedics and Rehabilitation


Joseph Mitchell, MD, joined the Department of Orthopedics and Rehabilitation at the University of Wisconsin School of Medicine and Public Health on May 1, 2022. Originally from Milwaukee, Wisconsin, Dr. Mitchell earned his BS in Biology from the University of Wisconsin-Parkside. He then completed medical school and residency at the University of Wisconsin School of Medicine and Public Health. Following his residency, Dr. Mitchell went on to fellowship for one year at the University of California-San Diego, where he broadened and further honed his joint replacement skills.

After completing his fellowship, Dr. Mitchell practiced with Aurora Orthopedics in Sheboygan, WI. However, not long after he had begun to practice outside of academics, Dr. Mitchell discovered that he missed the curiosity and engagement of the medical students, residents, and fellows he had worked with throughout residency and fellowship.

Thus, when he learned of an opening for a joint replacement specialist in our department, he was thrilled at this opportunity to return to what he feels is his “medical home.”

An orthopedic surgeon specializing in adult reconstruction of the hip and knee, Dr. Mitchell is highly skilled in both primary and revision hip and knee replacement surgery. He has specific expertise using the anterior approach for hip replacement – a technique known to have a steep learning curve. Dr. Mitchell has performed over 800 joint replacements, using the anterior approach in many of these cases. In fact, because of his extensive training and experience – and because this approach expedites patient recovery by as much as three months, according to some studies – Dr. Mitchell uses this technique almost exclusively when performing a hip replacement.

Also certified to do robotic knee and hip replacement, Dr. Mitchell is trained in patient-specific instrumentation, or patient-specific implants, using their own anatomy to create the ultimate implants that are used.

Reflective of his goals and passions, Dr. Mitchell’s research interests include comparing the advantages of anterior approach hip replacement vs. the traditional posterior approach. He is also investigating the use of robotic navigation vs. traditional instruments (manual instrumentation) to determine if computer navigation makes a difference in patient outcomes. In addition, he plans to both study and work toward increasing diversity within the orthopedic field.

The factor that initially drew Dr. Mitchell to the orthopedics specialty – and why he is so passionate about both practicing and teaching in the field today – is that “more than any other specialty, orthopedics enables a physician to quickly improve a person’s quality of life with a short procedure.”

“What really drives me is knowing that, although the surgical procedure itself is the same every time, for that individual, you are putting them back to a place they were 10, 15, maybe 20 years ago, in terms of their mobility and their quality of life. You give them back their ability to get out and just enjoy the things they enjoy doing. Seeing those patients at follow up and having them do very well, that is what motivates me to keep doing what I’m doing.”

 

June 13, 2022