May 10, 2004

Surgeries born in Ashland

By Steve Zimmerman
Ashland Daily Tidings

Dr. John Maurer, of Ashland Orthopedic Associates, LLP, has been on the cutting edge, no pun intended, of joint replacement surgery since he started in medicine in the early 1970s. His specialty is in the field of hip replacement.

	Ashland orthopedic surgeon John Maurer helped lead research into new ceramic hip replacement joints that eventually led to FDA approval of the product in 2002. Denise Baratta | Ashland Daily Tidings

While John Charnley developed the total hip replacement in England, the materials for the operation became finely tuned in this country.

"Charnley used a material on the socket side that was actually Teflon," Maurer noted. "You have to admire his courage. He was taking out Teflon sockets as fast as he was putting them in, it performed so poorly. But, nonetheless, the pain relief was so outstanding that this was the direction people with painful hips were going."

Maurer said three options developed for those with hip problems. The first was steel or metal on metal, the second was polyethylene (a type of plastic), which had evolved and was looking like it was going to be the material of choice to be mated with a highly polished metal.

But it was the Germans who first dev-eloped the third choice using ceramics.

"The Germans did a considerable amount of work with ceramic on ceramic and had a lot of success with it," Maurer said. "But there were also several catastrophic failures such as breakage of ceramics. And that was all the U.S. population needed to see before we shifted away from ceramics and, by the early '70s in this country, polyethylene was the material of choice for the liner of the socket or the socket itself and a metal ball was on the femoral side."

By the mid-'70s, doctors were finding the results of the hip replacement surgeries were outstanding. Maurer was working in Boston at the time and was working with doctors who had developed early hip surgery in the U.S. At that time, it was one of the most monumental occurrences in orthopedics of the 20th century.

"It wasn't until probably the early '80s that, other than the occasional report of a recurrence of pain, they were reoperating and finding this peculiar membrane had developed between the prosthesis and the bone. We had been securing these prostheses to the bone with an intermediate material, a

cement, that is known in the commercial world as Plexiglas."

It took nearly 10 years to recognize a problem and by 15 years, a predictable pattern was developing. The mistake was to jump on the Plexiglas, and so the medical community decided to forego using it.

It was during the '80s that Maurer became impressed with the work of an engineer at UCLA, Ian Clarke. Clarke found the polyethylene was the culprit in the wearing out of the replaced hip joints. So he began touting the benefits of ceramic as a much harder surface that would shed debris at a much smaller rate.

Maurer became part of a study after moving to Ashland that was commissioned by the Food and Drug Administration to see if ceramic was indeed the way to go in hip replacement surgery. The first part of the study was to develop a ceramic cup. He was using a ceramic ball mated with a polyethylene cup. In the '90s, Maurer - with Wright Manufacturing, an orthopedic implant device producer - developed the ceramic cup. He then sought FDA approval to use the ceramic on ceramic.

"They needed 10 investigational sites to go through the investigational device protocol," Maurer explained. "So, in 1997, I became one of those sites in Ashland. I take a certain amount of pride in being the first to offer ceramic-on-ceramic surgery west of Dallas, Texas. There was a long battle and there was no surprise that the multi-million dollar industry that is tied up with polyethylene, challenged these findings on many fronts ... It was not until last February that the release of ceramic-on-ceramic surgery was [approved]."

Maurer was allowed to perform the surgery while working with the FDA on its study. At the same time, he was still performing the surgery with the polyethylene.

"Is this going to be the end-all for hip replacement surgery?" Maurer asked. "I don't know. I was caught up in the enthusiasm of the '70s only to find out it didn't work in the '80s. Orthopedics is much like forestry. We don't know what kind of forest we are going to have until we get almost a generation out."

Vision specialties

At the Retina and Vitreous Center of Southern Oregon, P.C., Dr. William Rodden and his associate Yujen Wang, perform various types of eye surgery. Before talking about the surgeries he performs, Rodden first explained the term vitreous.

"The vitreous is the gel that fills the eye," he explained. "It is made mostly of fluid but is irrigated and percolates through the eye constantly. The reason it becomes important is when we are young and healthy, it is crystal and clear and possibly offers a little cushioning but is only useful in the development of the eye. With trauma or just with age, it will tend to break down and potentially be a scaffold for problems such as scar tissue that can cause retinal detachment or wrinkle the retina."

The specialties the center handles are diabetic retinopathy, macular degeneration and other macular problems and retinal detachments.

"When I came down here 12 years ago, I worked as a team with the hospital and we developed the first vitreal-retinal service in all of Southern Oregon," Rodden noted. "At that time, only Portland and Salem had developed centers. Before we started, patients were generally referred to Portland or San Francisco.

"I teamed up with Ashland Community Hospital because they had experience with doing very high level services and yet had a small, high patient-care quality about them. The experience with Dr. Maurer and the neurosurgeons that had been doing fine work showed [the hospital] had both a dedication and the expertise to do this kind of work."

Rodden said ACH gave him the best of both worlds.

"My field has worked toward outpatient surgery but it has been a huge benefit to have the support and backup of a hospital for trauma or very sick, older patients and all the unusual pharmacy-related therapys that are new and related to what we do."

While his practice does see patients of all ages, Rodden sees a larger percentage of older patents.

"More of the diseases we deal with are related to the older population," he said. "What we have also found is that we have a very healthy older population so we actually see a lot of healthy individuals with more wear-and-tear problems like macular degeneration and retinal detachment."

Diabetic retinopathy is also a major part of Rodden's practice and continues to grow.

"The most important thing in diabetic retinopathys in this day and age is that the therapies are pretty phenomenal," he said. "The risk of loss of vision is very low as long as someone is being checked. So the national standards and our local standards are that diabetics should have a dilated retinal exam at least once a year." Rodden added that it was just a few short years ago that there was a very high incidence of vision loss due to diabetes. He said the main focus is in educating the public to the new and improved eye care available to diabetics.