October 1 2008: I’m real excited to share the 3rd annual Arthritis Foundation “Joints in Action” Golf Tournament. This (Thursday, October 23rd) event scheduled at the Redstone Tournament Golf Course will be a great deal of fun and generate much needed research funds for the Arthritis Foundation. I’m very pleased that Jeff Bagwell has agreed to attend along with several other prominent Houston sports figures. This tournament is open to anyone but we particularly honor those who conquer arthritis with total joint replacements. The rules are simple! A four person Shamble, where each foursome must have a patient with total joint replacement. Last years event was a blast whereupon, I trust you golfers with total joint replacements (or friends with such) will sign up ASAP. Foursomes are limited as we head down the homestretch Raffle tickets are available for a fantastic Pebble Beach golfing experience. The silent auction will feature sports memorabilia and several “wine libraries” to create your instant wine cellar. Look forward to seeing you out there! Sincerely, Bill Bryan, M.D. For information on participating in this event or to request a registration go to website

June 16 2008: Dr. Bryan was recently elected the 2008 Chairman of the National Orthopaedic Educational Society (NOES), a group of Orthopedic Specialists whose mission is the "promotion of scientific advancement and the exchange of ideas in the practice of orthopedic knowledge".

June 16 2008: Dr. Bryan will be presenting a lecture titled, "The Difficult Proximal Biceps Tendon" at Minute Maid Park's 7th Annual Sports Update June 24th. Check back soon for the lecture online!

June 16 2008: A drug study will begin this week that investigates the safety and effectiveness of a new drug used to thin the blood after knee replacement surgery.

May 27 2008: Casey Griffin has recently joined our research team! To contact her you can email her at ctgriffin@tmhs.org.

October 1 2008: Recent Happenings with anterior cruciate ligament Anterior cruciate ligament tears continue to plague young and mature athletes alike. The ACL is a critical cable in the center of our knee which controls rotation and translation when doing any more than simple walking. Leaving an ACL tear unattended brings the threat of secondary tears in the all important meniscus and articular cartilage structures. It’s therefore advised that once initial swelling and discomfort subsides (around three weeks following injury) that the ACL be reconstructed. As with any topic there is always “new news” about ACL reconstruction. Our practice favors central quadriceps tendon autografts (from the patient’s body) for young aggressive male athletes and the use of stronger than life allograft (from a donor bank) tissue in most other patients. The use of allograft should not be concerning and allows for a less painful, smoother recovery. For almost two decades, we have been futuristic in placing our ACL grafts in a “hybrid” position. This allows the graft to control both rotation and translation. You might have heard about the new “double bundle technique.” This technique is being heavily promoted by some charismatic members of our profession and the companies which make equipment necessary to perform that surgery. Repeated articles in our peer reviewed medical journals, state that while in the laboratory double bundle techniques appear superior, there is no clinical difference in actual patient outcomes. The downside of the double bundle technique is that if the construct fails, for whatever reason, revision surgery is extremely difficult. For that reason, most orthopedic surgeons who are highly skilled in ACL reconstruction are not jumping on the “double bundle band wagon.” Rest assured, that hybrid allograft techniques are providing high level amateur and professional athletes alike an excellent chance at returning to their sport on a long term basis

September 6 2007: Gender Specific Implants: Part II The FDA recently approved the Journey, Genesis II and Legion Total Knee Systems for use as gender-specific devices. Essentially, this means that these implants have been acknowledged to adequately address subtle differences between the involved male and female skeletal structures; by using these implants, we can ensure that patients receive good anatomical fit regardless of gender. More than anything, however, the recent FDA designation underscores the importance of understanding the difference between true innovation and savvy marketing-- the recent media frenzy over gender specific implants muddled the observation that we have been performing "gender-specific" knee replacements for some time!

August 2 2007: Improving the Function of Knee Replacement Implants - The Importance of the Anterior Cruciate Ligament The normal knee flawlessly bends, straightens and slightly rotates because of two ligaments deep in the knee – the anterior and posterior cruciate ligaments. These act like guiding cables and prevent abnormal motion. When conservative measures fail to treat knee osteoarthritis, surgery is often contemplated. Traditional total knee replacements require removal of the anterior cruciate ligament. The geometry of the inserted metal and plastic components substitutes rather poorly for anterior cruciate ligament function. Traditional total knee replacements are well received as mechanical devices, which decrease standing pain and allow patients to walk greater distances. Therefore, total knee replacements are well tolerated until the patient demands a certain level of activity beyond simple walking and climbing stairs. By the end of the day, many active total knee replacement patients will complain that their knees don’t do well with complex tasks such as coming down stairs/stepping off curbs, rising from a sitting position, playing racquet sports, or gardening. During flexion, or bending, of the knee, sophisticated movie x-rays (fluoroscopy) have shown that paradoxically the thigh bone (femur) slides forward on the leg bone (tibia) rather than the normal backward femur on tibia motion. The result is inhibition of the thigh muscles and this accounts for difficulty in performing complex tasks. Knee implant surgery, which spares the anterior cruciate ligament, is therefore desirable for the active patient with severe knee arthritis. The Oxford prosthesis is appropriate when arthritis is limited to the inside (medial) knee compartment. In fact, the anterior cruciate ligament must be present for the Oxford prosthesis to work. Our experience over the last three years is that patients with Oxford prostheses perform extremely well and carry out complex tasks without difficulty – thanks to the still-present ACL! Patients with severe arthritis behind the kneecap (patello-femoral arthritis) and medial compartment arthritis need not undergo traditional anterior cruciate ligament sacrificing total knee replacements. The Deuce prosthesis resurfaces the arthritic areas while allowing the surgeon to spare the anterior cruciate ligament. We expect these patients to tackle complex activities without difficulties. The challenge of a total knee replacement which mimics normal knee motion is best met by the Journey total knee replacement. The groundbreaking geometry of the Journey prosthesis substitutes for both the anterior cruciate ligament and posterior cruciate ligament. Studies start this summer between our orthopedic group and the Texas Women’s University gait lab to study muscle function after a Journey total knee replacement. We also expect to study patients with the Triathlon total knee replacement – another advanced design for active patients. The hypothesis of this study is that muscle function is very near normal in Journey total knee replacements – in that the implant is behaving as if the anterior cruciate ligament is still in place. Similar findings are expected for the Triathlon knee. My extensive sports medicine expertise shows that an anterior cruciate ligament tear is poorly tolerated when occurring as a soft tissue injury. In almost all circumstances, anterior cruciate ligament reconstruction is warranted. It makes sense that patients with traditional total knee replacements who are without anterior cruciate ligament function will also experience difficulties with complex tasks.

November 20 2006: Gender specific total knee replacements—Is there a need?? The need for a gender specific knee replacement is a new concept – despite thirty years of total knee replacements-- and is largely driven by industry advertising. In fact, it is the opinion of the American Association of Hip and Knee surgeons that this is inappropriate advertising. While there are cadaveric differences in men and women, there is no evidence that introducing new total knee implants (which will cost more!) will in any way provide a benefit to women. Despite anatomical differences, the outcomes of total knee replacements performed in the past have shown no difference in the tremendous success of either men or women. Until long term studies show benefit in providing narrower femoral components for female patients, it is unnecessary to add this type of total knee replacement to our present (and excellent) array of total knee replacements. The introduction of the “gender specific knee” was not supported by any medical studies that showed that women were fairing poorly when compared to men. Rather, it is part of an ever- increasing direct-to-consumer advertising (DTCA) on the part of a total joint replacement company – NOT surgeons.