Stewart Lee came to the University of South Carolina School of Medicine Greenville in 2013 with no interest in research; his dream was to become a doctor. However, now that he and fellow medical student Geevan George have just completed and published their first research project in a scientific journal, ISRN Biomaterials, Lee looks at research differently.
“I had no clue how powerful and practical research can be for physicians and their patients. It turns out I like research,” said Lee.
South Carolina’s newest medical school, the USC School of Medicine Greenville, requires all of its students to complete a patient-focused research project as part of their education. The prerequisite is an important part of the School of Medicine mission to create a new generation of physicians who don’t accept the status quo and instead rely on research and evidence-based medicine to determine the best care for patients and society.
Lee and George turned to Dr. Thomas Pace, a medical school faculty member and Greenville Health System orthopedic surgeon, for direction on their research project. He suggested they compare the performance of two knee joint devices, a traditional implant made of cobalt chrome,and another made of an advanced material, oxidized zirconium.
Dr. Pace explained his rationale for suggesting the study. “It gets down to doing what’s truly best for the patient and economics. In 2013, 450,000 total knee joint replacement surgeries were performed. By 2030, that number is expected to be 4.5 million. There’s a huge variation in the cost of knee joint devices; newer devices can cost as much as 50 percent more than traditional devices. Do outcomes justify the cost? That’s something we need to determine.”
D. Pace has performed total knee joint replacement surgeries for 20 years and maintains a database on his patients. He gave Lee and George access to data on 120 knee replacements using the two knee devices. Dr. Pace also enlisted Nicole Durig, then a Master’s candidate in Bioengineering at Clemson University, to assist Lee and George with their study based on her research, engineering and metallurgy experience.
“We didn’t have a clue at first,” said Lee. “With Nicole’s help, we learned the nomenclature and process of research.”
Laboratory simulations conducted by the manufacturer showed the more costly oxidized zirconium knee joint performed better than the cheaper device. How something works in a controlled lab setting can be very different than the real world. As part of their analysis, Lee and George reviewed patient outcome data with the two devices, including patient’s range of motion, flexion, pain, and overall movement. They also compared radiographic studies. What they learned about the devices’ performance surprised them.
“The lower cost device yielded the same result as the costly device,” reported Lee.
What they learned from the process of thoroughly analyzing both devices was perhaps even more important.
Lee explained. “The science behind the more expensive joint device is stout; you assume it’s better based on the metal and design. But when you put the device in a human, the difference in outcomes between it and the other device was negligible. It showed me that physicians have to do their homework.”
Added George, “As physicians, we can’t keep spending health care dollars like we did in the past. We have to identify products and procedures that are clinically effective and cost efficient.”
Dr. Pace is satisfied with the project’s results. “These young men learned they have to question, investigate, and become critical thinkers. It was a lesson well learned.”