The innovative approach to joint repair initiated by the University of Missouri Department of Orthopaedic Surgery and directed by Dr. James Stannard and Dr. James Cook is to treat joint disease with the use of joints taken from cadavers.

I reviewed the process of placing joints from cadavers into human subjects and realized that they were violating all the principles of safety that I had accepted as the standard practice of medicine.

As a medical examiner, I realized that after death, the decomposition process starts almost immediately and bacteria from the gut spread through the body.

Further, the surgeons established the practice of placing these joints in a special media that contains antibiotics, antifungal and growth factors to keep the bone alive. While the joints are cleaned and certified as safe, they are not sterile and may contain spores that are resistant to local antibiotics.

Patients have had numerous infections. The surgeons then felt that they could keep these bone grafts for over 60 days at room temperature. Blood, which is a similar allograft when taken out of refrigeration, must be discarded if out more than four hours.

I became concerned and contacted the legal department to carefully explain the consequences of this surgery. I showed them a failed, unlabeled, unidentified graft, and they assured me that this was a lawyer-to-client confidential conversation.

The next day I was ordered to return the unlabeled joint failure and show it to no one. A local lawyer was hired who had access to all my emails so as to charge me with a HIPAA violation.

The university lawyers took the first step in a serious conspiracy to avoid liability for a dangerous procedure. If you wonder why the University of Missouri ranks No. 139 in U.S. World & News Report, look no further.

I also contacted the president and chancellor, and they never returned my calls or emails. I brought this to the attention of the risk manager at the hospital, and she also took no action.

Although small bone grafts have been successfully used in joint repair from cadaver donors, the use of large entire joints will eventually stimulate an immune response and over a relatively long period destroy the joint replacement.

Apparently, their failure rate was high enough that the surgeons recently decided to take bone marrow (stem cells) from the recipient and seed the new joint. I believe that even a high school biology student would realize that taking immune bone marrow cells that are programmed to destroy foreign substances would quickly and efficiently recognize these grafts as foreign and work to destroy them.

The Orthopaedic Surgery Department does not send the failed joints to pathology for study, but in two cases where the bio joints were replaced with prosthetic joints, the inflammatory response was severe and consistent with a graft-vs.-host response.

In the past, since the bone transplants were not very vascular, they often did well for six months and even a year. However, I believe that this time will be shortened now that they are placing the immune cells in and around the graft.

The Department of Orthopaedics continues to promote and use cadaver joints. They have caused great pain and suffering to at least 17 patients, and I would expect more in the near future.

I believe that they are afraid to stop this procedure as to admit that it is dangerous and scientifically unsound.

Since the university shows no signs of acknowledging these failures, it will be up to the courts to determine the outcome of this procedure. It has been the mantra of all physicians to do no harm, and that has been violated.

Eddie Adelstein is a pathologist and medical examiner.


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