Carmel Valley Orthopaedic surgeon who found his niche in researchwins prestigious award for his work with the ‘e-knee’
By Arthur Lightbourn
Scripps Clinic researcher Dr. Darryl D’Lima is a tall, good-looking chap, born in India, whose love of sports initially inspired him to become a physician specializing in orthopaedic surgery, but it didn’t stop there.
His introspective nature and intellectual curiosity drew him into research, inspired him to earn a Ph.D. in bioengineering and led him to the forefront of knee replacement research in the U.S.
The 51-year-old D’Lima, director of orthopaedic research at Scripps Clinic’s Shiley Center for Orthopaedic Research and Education (SCORE), was recently honored with the prestigious Nicolas Andry Award for his extensive body of research using an electronic knee prosthesis known as the “e-knee.”
The $15,000 award, presented by The Association of Bone and Joint Surgeons on June 11 in Dublin, Ireland, will be used for further research into knee replacements at SCORE.
The e-knee is a customized knee replacement, costing about $75,000, designed specifically for research and outfitted with electronics that measure forces inside the knee while a patient participates in various activities such as walking, climbing stairs, exercising and even swinging a golf club.
Scripps made history in 2004 when Dr. Clifford Colwell, current medical director of SCORE, implanted the world’s first e-knee into a patient at Scripps Green Hospital.
Since 2004, three additional patients have received e-knees and have participated in Dr. D’Lima’s research. The newer implants measure forces in the knee during a patient’s rehabilitation after surgery.
We interviewed D’Lima recently at Scripps Clinic’s research lab in La Jolla.
D’Lima was born in Mangalore, India, His father was an artist who later went into business as a textile designer and his mother, who had two bachelor’s degrees, three master’s degrees and a Ph.D. in education, was dean of St. Xavier’s Institute of Management in Mumbai.
He earned his medical degree and his specialist training in orthopaedic surgery from Bombay University, India, in 1982 and 1987 respectively.
Asked if he enjoyed being a physician and surgeon, he said, “I did, although I didn’t enjoy treating patients as much as I thought I would. I enjoyed the technical aspects of surgery…As for my personality, I’m not an extrovert, so talking to 50 strangers every day, which is what you have to do as a physician, was another thing.”
Turning to research, he signed on for a two-year orthopaedic research fellowship at Scripps Clinic in La Jolla in 1994, after which, he was asked to stay on initially as head of the joint mechancs lab and later as adjunct assistant professor in the arthritis research division. In 2001, he was appointed director of orthopaedic research.
While at Scripps Clinic, he earned a master’s and Ph.D. in bioengineering from UCSD.
Data gleaned from e-knees by Dr. D’Lima and his 20-person research team have already led to the development of improved knee implants and rehabilitation protocols; and has also resulted in a number of surprises.
For instance, cycling on an indoor stationary bike, has been shown to be a very acceptable low impact exercise.
“The forces on the knee never went above one multiple of your body weight,” D’Lima said.
“We expected jogging and tennis to be high impact, but we never expected golf to be high impact. It turns out that when you swing a club, it puts as much force on your knee as serving at tennis or when you are jogging at a fairly modest pace of five or six miles an hour.
“We took our patients to a golf course and to TaylorMade to monitor their golf hits’ speed. Our patients were swinging at between 40 and 70 mph.
So at 70 mph, our patients were putting five times their body weight on their leading knee.”
Repetition and frequency are other factors to be considered, he said.
If you hit a golf ball 150 times, it may not be as wearing as jogging 10 miles and putting your weight on the knees thousands of times.
“We tell knee-replacement patients to jog on tread mills where they can control their speed and the surface is more impact-absorbent; and we tell them to play doubles tennis, and give up singles tennis, so they won’t have to run as much.”
The data gathered were also used to develop the first computer model of the knee to be validated with measurements from live patients, to develop patient gait modifications and to test braces and orthotics that can reduce knee loads in patients with arthritis.
D’Lima’s team is also working on ways to repair cartilage lesions before a knee replacement is needed; and how to turn stem cells into cartilage-producing cells.
“Research like ours is going to become increasingly important as health care reform begins and insurance companies demand proof of efficacy before offering reimbursement for treatment,” D’Lima said.
One goal, D’Lima said, is to develop a “smart knee,” that will collect data and transmit it directly to patients on their cell phones so they can monitor their knee wear, make any changes in their activities necessary to lessen knee wear, detect infection, sound an alarm if there is a problem and forward the data to patients’ doctors and therapists.
D’Lima anticipates that smart-knee prostheses will be available within three to five years, “if the FDA doesn’t make things too difficult for us.”
“In the 1990s, engineers were designing knees to put in patients, but they didn’t know what sort of forces the patients would put on the knees.
“They were designing knee replacements by trial and error.”
And when a knee replacement failed, surgeons would have to re-operate on a patient.”
For instance, D’Lima explained, if you design a bridge, you want to know what kind of loads it can carry.
Unlike bridges and buildings, where you can put sensors and measure the loads, in the knees nobody had been able to put any sensors inside a living person. So all the data was either from cadaver research or mathematical computations.
With cadavers, you couldn’t do anything active; you couldn’t simulate walking and mathematical models were only as good as the assumptions which were sometimes contradictory.
One mathematical model predicted that every time you took a step, you put twice your body weight on your knee joint. Another model predicted seven times your body weight.
Data gathered from e-knees in live patients confirmed that it was actually closer to twice your body weight.
Knee replacements have been around since the 1800s.
“They said, if a knee is diseased, we’ll take it out and put something new in. At that time, they worked with biological tissue such as pig bladder, and in the early 1900s, they tried wood and glass.”
The first reasonably successful knee replacements were designed in the 1950s by British-born surgeon/inventor/teacher John Insall in New York City.
Today, knee replacements have an 80 percent chance of lasting from 15 to 20 years, D’Lima said.
According to the American Academy of Orthopaedic Surgeons, approximately 581,000 knee replacements were performed last year in the U.S. and by 2014 more than half of those needing total knee replacements will be younger than 65 years old.
Why so many?
“Partly because of evolution,” D’Lima said. “From an evolutionary perspective, the average age of a human is [supposed to be] 30 years…so the body never evolved to the point where it had to survive past 30 years.
Secondly, cardiovascular and neurological advances are keeping people alive longer. But the bones and joints are wearing out. It’s a mechanical problem.”
The third problem has to do with lifestyle — more people getting into exercising; weekend warriors, people getting into marathons, biking, and wanting to continue these activities into retirement— so more people are suffering knee injuries.
As a result, according to a study published in the Journal of Bone and Joint Surgery, we can anticipate the number of primary total knee replacements in the U.S. will to soar to an estimated 3.48 million annually by 2030.
Name: Darryl D’Lima, M.D., Ph.D.
Distinction: Director of Orthopaedic Research at Scripps Clinic’s Center for Orthopaedic Research and Education (SCORE)
Resident of: Carmel Valley
Born: Mangalore, India, 51 years ago. Grew up in Mumbai, India.
Education: M.B.B.S. (M.D.), Bombay University, India, 1982; M.S. orthopaedic surgery, Bombay University, 1987; M.S., bioengineering, University of California, San Diego, 2006; Ph.D., bioengineering, UCSD, 2007.
Family: He and his wife, Amy, have two children, David, 12, and Dominique, 10.
Interests: Runs five miles, three to four days a week, and on alternate days, he does upper-body weight-resistance exercises.
Recent reading: “The Accidental Billionaires: The Founding of Facebook,” 2009 book by Ben Mezrich.
Favorite films: “The Blind Side,” a 2009 semi-biographical film about NFL player Michael Oher, starring Quinton Aaron and Sandra Bullock; and “The Social Network,” the film adaptation of “The Accidental Billionaires.”
Favorite TV: “House,” “Big Bang Theory.”
Philosophy: “Find what you want to do and figure out how to get paid for it.”
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