Hip & Knee Implants, Hip Revisions, Hip Surgeons, Medical College of Virginia, Medicine, Orthopedic surgery, Professor, UNited States, University of Rochester, University of Tennessee Health Science Center, VCU Medical Center
The Picture of Success
William M. Mihalko, M.D., Ph.D.
A father of five, Chief Science Officer at the InMotion Orthopaedic Research Center, and Associate Professor at the Campbell Clinic, University of Tennessee Health Science Center, Bill Mihalko has little time for what doesn’t balance. Perhaps he learned to understand the interplay of many moving parts from his father.
“I was born in Jamestown, NY and moved up and down the east coast while growing up. My dad had been born in a coal mining town in Pennsylvania and he grew up without indoor plumbing. As soon as he graduated from high school my dad immediately moved out of the house and found a job in Jamestown where he met my mom. He worked in a steel forge shop by day and earned his business degree at night which eventually landed him a job as VP of Manufacturing in Buffalo, NY.”
Visits to the nexus of healthcare activity—his local hospital—left William Mihalko wanting to know more about medicine. “My mother was (and still is) a nurse and she worked at a nearby hospital. I recall the exciting times when we would all pile into the car to go pick her up at the hospital. It was obvious that she worked in a stimulating environment, and I could see that medicine was something very special and that not everybody was cut out for it.”
He had started asking “why” during his visits to the hospital. Bill Mihalko decided that his next step would lead him closer to the world of research…and more “whys.” “I developed a strong interest in using engineering principles to further medicine and enrolled in an interdisciplinary engineering program at the University of Rochester. I had completed all of my premed requirements but even after I graduated I was still uncertain about making a lifetime commitment to medicine. My fallback plan was to attend a masters program which was associated with a medical school in order to get more exposure and help me determine if medicine was ‘it.’”
In 1987 Bill Mihalko began a masters in biomedical engineering at the Medical College of Virginia (MCV), and soon had the MCV M.D./Ph.D. program in his sights. “Along the way, I always had orthopedics in the back of my mind. I had torn my ACL in high school and ended up under the care of the famed Dr. Ken DeHaven at the University of Rochester. I took part in the ACL deficiency studies in his gait lab which further sparked my interest in engineering and orthopedics. The more I thought about this while walking the halls of MCV, the more I felt that orthopedics was my future. I began participating in orthopedic grand rounds and after the first year of my masters I was completely sold on the field.”
Not content to “just” pursue an M.D., Bill Mihalko had the interest, confidence, and patience to earn a Ph.D. at the same time. “Dr. John Cardea was the chair of orthopedics and he sat on my masters thesis committee. He was terrifically supportive of the combined degree pathway and toward the end of the program he assured me that I would have a spot in his residency. Bill Krause, Ph.D. and Dr. Wilhelm Zuelzer were my research mentors and they opened my eyes to the rigors—and wonders—of research. I spent six years in the orthopedic biomechanics lab where I got to watch as investigations and answers were produced to many questions in orthopedics.”
Love and duty then came calling. “I did my internship year at MCV, but both of my parents soon became ill. Dr. Cardea graciously helped me transfer to SUNY Buffalo, where by chance I met Ken Krackow. He had ideas that he wanted to pursue in the lab…and I had the expertise. SUNY Buffalo did not have an immediate opening in their residency program, so I did a research fellowship with Ken. It was a prolific year as I ended up generating ten publications with Ken on soft tissue balancing and the effects of different techniques. During this research year I married the love of my life and fell in love with adult reconstructive surgery.”
Then it was the balancing of the knee that concerned Dr. Mihalko.
During residency I continued work that I had done in my research year, which involved a system I created to measure the kinematics of the knee. Ken could see the potential in this, and said, ‘We need to get this into the OR to help align the knee during surgery.’ It was an electromagnetic system, however, and had some issues. So I found a company in Ontario, Canada, just across the border that made infrared tracking systems; Ken purchased it and much of my work transferred to the infrared system. In 1997 I participated in the first computer-assisted total knee replacement in the U.S.
One look at a very special machine and it was love. “For fellowship I was torn between the Anderson Orthopaedic Clinic in Northern Virginia with Charlie and Jerry Engh or the Missouri Bone and Joint Center with Leo Whiteside. Once I visited the latter site, however, it was settled. Dr. Whiteside was extremely entrepreneurial, held multiple patents, and had the most unbelievable biomechanics lab. His advanced knee testing machine blew me away. I could immediately see that I could do the kinematic work that I was doing in Buffalo but to a more precise standard. (He ended up donating the knee machine to my lab years later.) Dr. Whiteside taught me to balance research and practice. (Most people I knew in academics did clinical research but weren’t going to the lab to perform basic science research.) Dr. Whiteside cautioned me against the temptation to ‘book one more case,’ and emphasized the importance of protected time for research.”
Choosing to be close to home, in 2000 Dr. Mihalko accepted a position at a private practice in Syracuse, New York. “This group was willing to give me at least half a day per week to do research at Syracuse University. I spent a lot of time at the school and became an adjunct professor in the department of neuroscience and bioengineering. My own research wasn’t exactly on fire at the time because while Syracuse had a lot of equipment, getting time on those machines was hard as a ‘lowly’ adjunct professor. I was only there one year when the University of Buffalo called and asked me to be Director of Orthopaedic Research. It was a smaller program, but it was home.”
But even home can be lonely sometimes. “I really could have used a senior research mentor there because I was literally the only one performing basic science research in the department. I had to wade through grant applications and funding issues solo. I was also Director of the Center for Advanced Technology at Buffalo, and had a substantial state grant to run the center. The purpose of the facility was to spawn new small business opportunities from joint ventures between the university and companies in the university’s incubator. Although this position distracted me in many ways it gave me experience as an administrator at an early point in my career, something which has been valuable.”
With no one to turn to and say, “Wow. We just discovered something amazing,” Dr. Mihalko was a bit disheartened. “In 2006 I left Buffalo in part because I didn’t have any research collaborators or mentors. I found my research home at the University of Virginia where Dr. Cato Laurencin was Chair at the time. He was heavily funded by the NIH and had an extensive biomedical engineering lab. While there I began collaborating with a Ph.D. colleague, Yusuf Khan, and looking at the mechanical aspects of the incorporation of a bone healing scaffold. We put rats on a mechanical testing and simulation machine and cycled the load across the scaffold on the tibia. About that time Cato announced that he was leaving. Shortly thereafter Dr. Jim Beaty here at the Campbell Clinic called and asked me to join their practice. They were starting an independent orthopedic research center and wanted me to come and be one of the directors. This was a plum opportunity and I accepted immediately.”
Now happily ensconced in his advanced laboratory, Dr. Mihalko spends his protected research time on two lines of inquiry, both of which are related to total knee arthroplasty outcomes. “We have a new retrieval program that was established with the Medical Education and Research Institute in Memphis. We learned that of their 1,000 cadaver donations a year between 200 and 300 have well functioning total knees in place.”
Using our knee testing machine and knee simulator we are analyzing the kinematic patterns, soft tissue balancing, wear scars and surgical techniques that are associated with total knees that have functioned well over time. We map out the wear patterns and determine how much wear has occurred over the years that the implant has been in use. Then we plug the parameters into a 3D model and try to predict wear pattern.
“We also take a 3D CT scan of the lower extremities, along with the implant information from the mechanical testing and plug it into a 3D dynamic computer model. Our goal is to get the model to come up with the same wear patterns as the retrieval specimens.”
“In addition, we are using interoperative data from computer-assisted knee surgery, taking the kinematics that I record in the OR, along with the position of the implants and anatomic registration data, to help validate the model. We recently began using a local gait lab and are taking postop patients there to see if the model can predict gait patterns as well.”
As much as he likes predictability, Dr. Mihalko knows that there is no predictive model for one’s family. “My wife and I have decided that at this point in life it’s all about balance. Between being a dad to five children, and trying to keep my clinical and research career as a top priority, it is difficult to say the least. My wife, a speech pathologist, has been unbelievably supportive. She has packed up the family and moved countless times and I am truly in her debt.”
Dr. William Mihalko…testing, re-testing, and then balancing—it’s about knees but also about life.
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