Research and Publications
CREATES Study
Total Joint Center in Landmark Study
The term “brain fog” has surged in popularity with its prevalence among some COVID-19 cases. However, brain fog, or long-lasting changes in memory or thinking abilities, has long been known to occur in some older adults after major surgery.
Now, some eager and inquisitive surgical patients of the Total Joint Center are giving back to science by participating in a landmark study of brain health and recovery after surgery. The study, which goes by the acronym CREATES (Cognitive Recovery after Elective Surgery) is led by Lori Daiello, PharmD, ScM, research scientist at the Rhode Island Hospital Alzheimer’s Disease and Memory Disorders Center (ADMDC). Dr. Daiello has been studying brain aging for more than a decade.
The Total Joint Center has teamed up with Dr. Daiello to enroll adults aged 65 and older who are scheduled to have a major surgery. The five-year study will be enrolling new patients until January 2024.
“The CREATES study will help us further understand the cognitive effects of both general and spinal anesthesia in older patients undergoing total joint surgery and elective surgery in general,” said Eric M. Cohen, MD, hip and knee orthopedic surgeon at the Total Joint Center. “By enrolling in this study, research participants are helping to advance medicine and help future patients in need of a total joint replacement.”
The CREATES study uses a new type of MRI brain imaging technique, developed at USC to investigate whether blood-brain barrier (BBB) dysfunction precedes development of postoperative cognitive disorders. The BBB is an important natural line of defense that protects the brain from attack by infections and inflammation.
Dr. Daiello noted, “Normally, the BBB protects brain cells from harmful substances circulating in the blood. A ‘leaky’ or damaged BBB is likely to be an important risk factor for postoperative memory problems by permitting high concentrations of circulating inflammatory factors to flood the brain during the perioperative period.”
Patients who volunteer for this study will be followed for a period of up to 18 months. “We all change cognitively as we age,” said Dr. Daiello. “This research will help us understand it and could stimulate development of interventions designed to prevent it from either occurring or getting worse.”
The CREATES study is funded by a $3.8 million grant from the National Institutes of Health (R01 AG058648).
Learn more about, and how to volunteer for, the CREATES study
Exploring a Molecule to Ease Arthritis
With degrees in both engineering and medicine, Derek Jenkins, MD, a hip and knee replacement specialist with the Brown University Health Total Joint Center at The Miriam and Rhode Island hospitals, and assistant professor of orthopedic surgery at The Warren Alpert Medical School of Brown University, brings a multidisciplinary perspective to his work.
He and colleague Gregory Jay, MD, PhD, co-founder of the Brown University Health Medical Simulation Center, are exploring the role of the molecule lubricin in the prevention and treatment of arthritis.
“Lubricin is an interesting molecule,” Dr. Jenkins said. “It’s a very slippery substance found in normal knees that may play a similar role to the way engine oil works in your car. Dr. Jay and I have had conversations over the years about looking at the potential effect of lubricin or the lack of lubricin in the development of hip and knee arthritis.” Dr. Jay is one of the world’s foremost experts on lubricin.
Their IRB-approved study is exploring the effect of this unique molecule on arthritis and could lead to the development of a novel new supplement that could be injected into a patient’s painful joint to potentially prevent arthritis from progressing or, if possible, from developing at all.
Dr. Jenkins’ clinical practice and intuitive interest in how things work along with Dr. Jay’s successful patents and pending patent applications for technologies that could treat joint issues are an example of the interdisciplinary research underway at Brown University Health. “While many studies involve the perfection of techniques and technologies, this study is examining a potential treatment to prevent the need for replacement in the first place,” Dr. Jenkins said.
Their study entails collecting synovial fluid and tissue, otherwise discarded, from patients undergoing knee and hip replacement surgery. The samples are then analyzed for molecular signatures of fibrosis which would be occurring in the synovium that is the lining of the joint capsule. Other studies have shown that lubricin prevents inflammation and may play a potent role in preventing synovial fibrosis which causes joint pain and stiffness. The production of lubricin decreases following joint surgery.
Dr. Jenkins reflected, “Brown University Health is a fulfilling community where like-minded individuals can share ideas and work together in the care of patients, the development of new treatments for disease, and together, tackle problems yet unsolved.”
Research continues with potential for the discovery of a medical treatment to prevent arthritis and to improve the longevity of the joint once it has been replaced. This research is supported in part through the generosity of Kay and Leon Cooper.
Pursuing the Promise of Anti-infective Joint Implants
Joint arthroplasty patients at The Miriam Hospital experience infections at a rate substantially below the national average, but even those few are too many for Valentin Antoci, MD, PhD, an orthopedic surgeon, researcher and assistant professor of orthopedics at The Warren Alpert Medical School of Brown University.
The hip and knee surgeon is pursuing avenues of research that will lead to better outcomes — both in the short and long terms — for patients treated at the Total Joint Center at The Miriam Hospital and beyond. Dr. Antoci’s research interests focus on “smart” joint implant design, tissue engineering, and biological interactions at the implant interface (such as coating titanium surfaces with the antibiotic Vancomycin to ward off infection).
In his research, Dr. Antoci collaborates with the Shukla Lab for Designer Biomaterials, headed by Anita Shukla, PhD, within the School of Engineering at Brown University. Engineering hydrogels for targeted delivery of antibiotics is among the lab’s pursuits. Dr. Antoci underscores the advantages of working across disciplines in “coming up with new solutions to problems.” The cross-pollination of ideas leads to novel approaches, he suggests.
Dr. Antoci also works with Christopher Born, MD, who heads the Diane N. Weiss Center for Orthopaedic Trauma Research at Rhode Island Hospital, and his collaborator, pharmacologist and microbiologist Dioscaris R. Garcia, PhD. Dr. Born’s research interests include the development of antimicrobial coatings for orthopedic trauma implants. His team also developed a rapid test to identify, during surgery, the bacteria causing an infection, allowing a more effective choice of treatment.
While these research endeavors are promising, Dr. Antoci emphasizes the importance of preventing infections in the first place. Taking steps in advance of surgery such as improving diet, quitting smoking, getting diabetes under control and losing weight, as well as using a special skin cleanser immediately before surgery, all contribute to a successful outcome.
Improving Surgical Results by Helping Patients to Reach Healthy Goals
In his study published in May 2016 in the Rhode Island Medical Journal “Modifiable Risk Factors in Total Joint Arthroplasty: A Pilot Study,” Dr. Jenkins reports his very promising results through helping patients improve their pre-operative risk before surgery and how that can improve their outcomes after surgery.
Dr. Jenkins was also recently published in orthopedic surgery’s most prestigious and highest-impact rated journal, the Journal of Bone and Joint Surgery, with his colleagues from the Mayo Clinic on techniques for complex Hip Revision Surgery. This is the second time that Dr. Jenkins has been published as first author in this prestigious peer-reviewed journal and this particular article “reports very important and useful information to the joint replacement community on the use of new technologies for hip revision surgery,” Jenkins says. The article titled “Minimum Five-Year Outcomes with Porous Tantalum Acetabular Cup and Augment Construct in Complex Revision Total Hip Arthroplasty” was Published in May 2017. “The good work that we all are doing here at the Total Joint Center for our patients is getting noticed on the National level. Being part of the teaching program at Brown University and involved in clinical research allows us to share our experience with the Orthopedic Community and contribute to the advancement of Science, Medicine, and Orthopedics. The end result is the most technologically-advanced, evidence-based care for our patients here in Rhode Island.”
Assistant Professor of Orthopedic Surgery at the Brown University Warren Alpert Medical School, Dr. Jenkins is actively involved in the education of Residents and Medical Students and was recently honored with a Brown University Certificate of Recognition for exemplary teaching “honoring teaching effort and dedication to the highest standards of teaching in the preclinical curriculum” as Course Leader in BIOL 3665 IMS II: Supporting Structures at Brown Medical School. His research interests focus on the incorporation of advanced techniques and technology in Joint Replacement Surgery including the direct anterior approach for minimally invasive hip replacement and is the Principal Investigator in multiple Research Review Board Approved Studies.
Dr. Jenkins, Dr. Antoci and the Brown University Health Orthopedics Institute are also dedicated to Community Service through work with the Arthritis Foundation. For his work on the advancement of arthritis treatments, Dr. Jenkins was chosen as the Medical Honoree at the 2016 Rhode Island Walk To Cure Arthritis and Dr. Antoci will be the Honoree this year in 2017. The Orthopedics Institute has been a proud gold level sponsor at both events.
Derek Jenkins, MD was published in JBJS as first author on an important article reporting long-term outcomes of complex hip reconstruction surgery: Minimum Five-Year Outcomes with Porous Tantalum Acetabular Cup and Augment Construct in Complex Revision Total Hip Arthroplasty.
Research and Publications
2024 Brown Health Research on Adult Reconstruction
Anticoagulation in patients with atrial fibrillation undergoing inpatient total knee arthroplasty: A matched analysis
Daher M, Balmaceno-Criss M, Liu J, Singh M, Kuharski MJ, Daniels AH, Cohen EM
Journal of Orthopaedics
Machine learning to predict length of stay following revision hip arthroplasty
Johnson K, Orfanos A, Chen E, Cohen E.
Journal of Hip Surgery
The impact of patient grit, resilience, and ability to cope with stress on outcomes following total joint arthroplasty
Liu J, Callanan T, Daher M, Gilreath N, Criddle S, Milner J, Cohen E, Antoci V
Journal of Orthopaedics
Formal physical therapy may be unnecessary following total knee arthroplasty: A prospective randomized study
Liu J, Clippert D, Daher M, Gilreath N, Milner J, Cohen EM, Antoci V
Journal of Orthopaedics
Chronic Anticoagulation in Patients Who Have Atrial Fibrillation Undergoing Outpatient Total Knee Arthroplasty: A Retrospective Matched Cohort Study
Singh M, Balmaceno-Criss M, Liu J, Daher M, Kuharski MJ, Daniels AH, Cohen EM
Journal of Arthroplasty
Postoperative delirium following total joint arthroplasty: epidemiology, risk factors, and associated complications
Knebel A, Singh M, Rasquinha R, Daher M, Nassar JE, Hanna J, Cohen EM, Diebo BG, Daniels AH
Hip Journal
Evolution and Hotspots in Bilateral Total Joint Arthroplasty Research: A Bibliometric Analysis
Aoun M, Chalhoub R, Nham FH, Kassis E, Daher M, El-Othmani MM
Clinics in Orthopedic Surgery
Nutritional Considerations in Hip and Knee Arthroplasty: A Critical Analysis of Current Evidence
Arapovic AE, Nham FH, Darwiche H, El-Othmani M
The Journal of Bone and Joint Surgery
Frailty Among Revision Total Knee Arthroplasty Recipients: Epidemiology and Propensity Score-weighted Analysis of Effect on In-hospital Postoperative Outcomes
Arapovic AE, Zalikha AK, Zamzam M, Keeley J, Hajj Hussein I, El-Othmani MM
Journal of the American Academy of Orthopaedic Surgeons
Bibliometric Analysis of Outpatient Hip and Knee Arthroplasty Research Evolution
Boutros M, Nham FH, Corsi MP, Aoun M, Lopez J, Kassis E, Daher M, El-Othmani MM
The Archives of Bone and Joint Surgery
Bibliometric analysis of machine learning trends and hotspots in arthroplasty literature over 31 years
Corsi MP, Nham FH, Kassis E, El-Othmani MM
Journal of Orthopaedics
Indications and Outcomes of Conversion Total Hip Arthroplasty via the Anterior and Posterior Approaches
Crockatt WK, El-Othmani MM, Sarpong NO, Neuwirth AL, Cooper HJ, Herndon CL
Journal of Arthroplasty
Total Hip Arthroplasty in Patients with Hip Osteoporosis: A Narrative Review
Daher M, BSc, Mekhael E, BSc, El-Othmani MM, MD
Hip and Pelvis
Primary Total Hip Arthroplasty Outcomes for Labral Tears are Comparable to Advanced Osteoarthritis
Gorur A, El-Othmani MM, Xu W, Herndon CL, Cooper HJ, Geller JA
Outcomes of Image-Free Robotic Assisted Total Knee Arthroplasty in Patients Who Have Valgus Knee Deformities
Gorur A, Czerwonka N, El-Othmani MM, Held MB, Neuwirth AL, Geller JA
Journal of Arthroplasty
Perioperative nutritional, functional and bone health optimization in spine surgery: spine surgeons’ perceptions and practices
Higginbotham DO, El-Othmani MM, Nham FH, Alsoof D, Diebo BG, McCarty SA, Daniels AH
The Spine Journal
Perioperative Nutritional, Functional, and Bone Health Optimization in Spine Surgery: A National Investigation of Spine Surgeons' Perceptions and Practices
Higginbotham DO, El-Othmani MM, Nham FH, Alsoof D, Diebo BG, McCarty SA, Daniels AH
Journal of the American Academy of Orthopaedic Surgeons
Race and ethnic disparities arthroplasty trends and hotspots: Bibliometric analysis
Nham FH, Kassis E, Xu W, El-Othmani MM, Sarpong NO
Journal of Orthopaedics
Genicular nerve radiofrequency ablation: a systematic review of application for perioperative pain control in total knee arthroplasty and as treatment for chronic pain in well-appearing total knee arthroplasty
Knee Surgery and Related Research
Nnake CO, El-Othmani MM, Cooper HJ, Shah RP, Geller JA, Neuwirth AL
Metabolic syndrome in the setting of obesity: impact on in-hospital complications and outcomes after total knee and hip arthroplasty
Zalikha AK, Waheed MA, Twal C, Keeley J, El-Othmani MM, Hussein IH
Bone and Joint Open
Positive Culture of Atypical Mycobacterium Avium Following Revision Total Knee Arthroplasty
Liu J, Laperche J, Neill M, Jenkins D
Rhode Island Medical Society
Tibial Component Revision Arthroplasty Using Porous Tantalum Cone for Symptomatic Progressive Periprosthetic Proximal Tibial Ganglion Cyst about All-Polyethylene Tibia Primary Total Knee Replacement: A Case Report and Review of Literature
Liu J, Zhao L, Chang K, Laperche J, Smith N, Jenkins D
Journal of Orthopaedics
Peripheral arterial pathology and osteoarthritis of the knee: US examination of arterial wall stiffness, thickness, and flow characteristics
Olansen JB, Yin M, Molino J, Carruthers T, Jenkins D, Karniadakis G, Aaron RK
Osteoarthritis and Cartilage Open
Predicting Outcome of Total Knee Arthroplasty by Cluster Analysis of Patient-Reported Outcome Measures
Littman JL, Molino J, Olansen JB, Antoci V, Aaron RK
Journal of Arthroplasty
Similar Pathophysiological Mechanisms Between Osteoarthritis and Vascular Disease
Olansen J, Aaron RK
Frontiers in Bioscience-Landmark
Is Osteoarthritis a Vascular Disease?
Olansen J, Dyke JP, Aaron RK
Frontiers in Bioscience-Landmark
Management of Garden-I and II Femoral Neck Fractures: Perspectives on Primary Arthroplasty
Olansen J, Ibrahim Z, Aaron RK
Orthopedic Research and Reviews
The effects of pre-operative anti-osteoporotic use on total joint arthroplasty complications: A national database study
Katz L, Zhang H, Ireland P, Anuszewski M, Milner JD, Liu J, Daniels AH, Antoci V
Journal of Orthopaedics
A Proposed Patient Selection Algorithm for Total Joint Arthroplasty Same-Day Discharge From an Ambulatory Surgery Center
Liu J, Gilmore A, Daher M, Liu J, Barrett T, Antoci V, Cohen EM
Journal of Arthroplasty
Does Metal Allergy to Total Knee Arthroplasty Components Exist?
Mortazavi SMJ, Antoci V, Hosseini-Monfared P, Razzaghof M, Tsiridis E, Tarabichi S, Tsai SW, Smailys A, Socorro NEM, Gavrankapetanovic I
Journal of Arthroplasty
Should Routine Radiographic Screening for Spino-pelvic Relationship Be Performed in Patients Undergoing Primary Total Hip Arthroplasty?
Mortazavi SMJ, Poursalehian M, Crestani M, Di Martino A, Antoci V, Murylev V, Delgado-Martinez A, Sahebi M
Journal of Arthroplasty
Predicting Outcome of Total Knee Arthroplasty by Cluster Analysis of Patient-Reported Outcome Measures
Littman JL, Molino J, Olansen JB, Antoci V, Aaron RK
Journal of Arthroplasty
Patient-reported Physical and Mental Health Outcomes Following Lumbar Spinal Fusion versus Total Hip and Total Knee Replacement
Daher M, Liu J, Baroudi M, Alsoof D, Balmaceno-Criss M, Diebo BG, Antoci V, Daniels AH
World Neurosurgery
Silver carboxylate-TiO2/polydimethyl siloxane is a safe and effective antimicrobial with significant wound care potential
Allu S, Whitaker C, Stone B, Vishwanath N, Clippert D, Jouffroy E, Antoci V, Born C, Garcia DR
Open Access Journal of Orthopaedic Trauma
The Immediate Impact of Total Knee Arthroplasty Removal From the Medicare Inpatient-Only List on Patient Derived Functional Outcomes and Hospital Satisfaction
Barrett CC, Laperche J, Clippert D, Glasser J, Garcia D, Antoci V
Journal of Arthroplasty
Mechanically stable rifampin antibiotic cement inhibits Pseudomonas aeruginosa biofilm surface growth
Laperche J, Barrett CC, Boduch A, Glasser J, Clippert D, Garcia DR, Antoci V
Journal of Orthopaedic Research
The Effect of Surgical Approach on the Outcomes of Same-Day Discharge Outpatient Total Hip Arthroplasty at a Single Ambulatory Surgery Center
Dove JH, Laperche JM, Kutschke MJ, Painter DF, Antoci V Jr, Cohen EM
Journal of Arthroplasty
Improving Diagnostic Efficiency for Knee Osteoarthritis with the Knee Intake Patient Survey (KIPS)
Liu J, Daher M, Callanan T, Gilreath N, Milner J, Caus S, Molino J, Antoci V
Rhode Island Medical Society
Trunnion Fracture
Liu J, Smith N, Gilreath N, Cohen E
Rhode Island Medical Society
Investigating the Effect of Elevation and Sex-Based Differences on Shoulder Proprioceptive Accuracy
Alexandrov A, Morton A, Molino J, Pelusi J, Chrostek C, Crisco J, Arcand M, et al.
Orthopaedic Journal of Sports Medicine
Testosterone Replacement Therapy and Associated Rates of Trigger Finger, de Quervain Tenosynovitis, and Their Subsequent Management
Barhouse PS, Albright JA, Rebello E, Chang, K, Quinn M, Daniels A, Arcand M, Gil J
Journal of Hand Surgery
Testosterone Replacement Therapy Is Associated With Increased Incidence Rate of Vertebral Fractures: A Matched Retrospective Analysis
Singh M, Daher M, Diebo BG, Daniels AH, Arcand MA
Journal of the American Academy of Orthopaedic Surgeons
Testosterone: A Review for Orthopaedic Surgeons
Arcand MA, Poulin D, Testa EJ, Lemme NJ
The Journal of Bone and Joint Surgery
The Relationship Between Exogenous Testosterone Use and Risk for Primary Anterior Cruciate Ligament Rupture
Quinn M, Albright A, Lemme NJ, Testa E, Morrissey P, Arcand M, Daniels AH, Fadale P
Orthopaedic Journal of Sports Medicine
Decision-Making in Total Hip and Knee Arthroplasty: Understanding Surgeon Patient Perspectives Regarding When It Is Time for Surgery
Kroll EA, Warren CE, Schlegel R, McCollister Evarts C, Franklin PD, Persels C, Mullen NA, Crummer MB, Seeley SP, Lockett S, Moschetti WE, Nace J, Cohen EM, Lanting B, Iorio R, Chen AF, Browne JA, Lindsey BA, Kain MS, Fillingham YA, Terek RM, Garvin KL, Huddleston JI 3rd, Chomos SF, Lewis KM, Lambourne CA, Pellegrini VD Jr
The Journal of Bone and Joint Surgery
IlluminOss photodynamic bone stabilization system improves pain and function in the treatment of humeral metastatic disease
Terek RM; IlluminOss Study Group; McGough R, Fabbri N, Cheung F, Brigman B, Wittig J, Emory C, Aboulafia A, Avedian R, Mayerson J, Henshaw R, Reimer N, Eward W, Weiss K, Healey J, Mohler D, Adams B
Bone and Joint Journal
Distal Fibular Metastasis of Colorectal Carcinoma: A Case Report
Luther L, McGlone PJ, Hardacker KD, Alsoof D, Hayda RA, Terek RM
Orthopedic Review
How do US orthopaedic surgeons view placebo-controlled surgical trials? A pilot online survey study
Bernstein MH, Rosenfield MN, Blease C, Magill M, Terek RM, Savulescu J, Beaudoin FL, Rich JD, Wartolowska K
Journal of Medical Ethics
ASPH Is a Metastatic Factor and Therapeutic Target in Chondrosarcoma
Sun, X., Hart, J., Taliano, R., Molino, J., Schwab, J. H., Nota, S., Nagaoka, K., Zhang, S., Olsen, M., Carlson, R., Wands, J., Terek, RM
Molecular Targeted Therapy in Cancer, a Special Issue of Cancers