It all started in the mid-'70s on scrap paper: cocktail napkins, lined yellow paper, whatever was near.
Frederick Buechel '67, M.D., and Michael Pappas, Ph.D., were designing artificial joints. They worked on schematics wherever they were, sometimes even at a bar near their homes in northern New Jersey. For Buechel, the work has never been far from mind.
"To this day, you'll see a piece of paper on his desk with a drawing on it," says his son, Frederick Buechel, Jr., M.D.
That's no surprise. His father is the co-inventor of one of the world's best-known artificial knees. It was one of the first to truly simulate the real thing — bending up and down while also twisting a little left and right as people walk. A version of it has been sold by DePuy Orthopaedics for more than 30 years. First known as the New Jersey Knee, it's now called the LCS Complete Knee System.
"You should allow the ligaments and muscles to act in their own normal way," says Buechel the elder, 67.
While DePuy, now part of Johnson & Johnson, doesn't discuss market share, it has reported that the LCS Knee has been chosen by a million people worldwide. That's a number that could grow rapidly. Knee replacements are increasingly common. Between 2000 and 2011, the number of operations grew almost 130 percent, the American Academy of Orthopaedic Surgeons says, with more than 600,000 done each year in the U.S. alone.
"It's a hot topic," says Daniel Brown, an orthopedic devices analyst at Millennium Research Group.
There are at least two reasons. People younger than 65 increasingly want to temper sport and other high-impact injuries, and those who are older are staying active longer.
But, in 1974, none of that was true yet.
Buechel, then a 28-year-old orthopedic resident at New Jersey Medical School, was overseeing a research project on an ankle replacement device.
"Many of these were developed in personal labs, almost in garages," says Stuart Hirsch, M.D., 70, a clinical professor of orthopedics at Seton Hall's School of Health and Medical Sciences.
The orthopedic surgeon has known Buechel since organizing a panel of knee designers for the New Jersey Orthopaedic Society about 30 years ago. Other presenters had more elite credentials, but Buechel’s dynamic, data-driven presentation stood out. "I immediately switched over to the New Jersey Knee," says Hirsch.
When Buechel first began work on his ankle replacement he sought help from Pappas, at the time a 41-year-old mechanical engineer teaching at New Jersey Medical School. "Any problem that I’m capable of solving is of interest," says Pappas, now 80.
Buechel's decision to ask for help wasn't entirely surprising. The young doctor, who won four New Jersey Amateur Athletic Union and three Metropolitan Intercollegiate Wrestling Championships while at Seton Hall, liked a challenge — if evenly matched. Once he started working on the replacement ankle, he realized he wasn't well matched; he hadn’t thought about the technical aspects of building the device.
Pappas's engineering know-how evened the odds.
By 1976, the two men were building joints on their own time. Their focus shifted to shoulders, and they were also considering the knee. Then, good luck struck. Buechel presented a paper about their shoulder at a conference, and caught the attention of an executive from DePuy, who wanted to license it.
Buechel saw his shot, and made DePuy promise to sign a contract to sell his artificial knee too. Bold move, as there was no knee yet. But DePuy agreed.
"You can't live without being a business person," says Buechel.
Development began. Buechel defined problems, Pappas designed solutions. At the time, artificial knees had two major components. One attached to the femur, a hip-to-knee bone; the other to the tibia, a knee-to-ankle bone. These "fixed-bearing knees" bent like a hinge, but Buechel and Pappas weren't satisfied by the results.
Then a new idea arrived from a group from Oxford in the United Kingdom. It offered a way to make a knee that could both bend and turn a bit. Buechel and Pappas quickly adopted this "mobile-bearing" design, and worked to improve it.
By 1977, their mobile-bearing knees were a lot like the real thing, and in theory, would last longer than the fixed-bearing kind. DePuy, which sells both types, says one independent study found that, after 15 years of use, Buechel's LCS Knee still was in good shape 97 percent of the time.
(The Buechel-Pappas partnership with DePuy ended some time ago, but the men still work together on their own.)
Still, knees are big business, and the technology keeps improving. Debates about which type is best remain some of the hottest at orthopedic conferences today, says Millennium's Brown, the device analyst.
Buechel, always ready for a good challenge, is prepared to defend the merits of his knee.
The doctor clearly likes his odds.
This article originally appeared in Seton Hall Magazine.
Categories: Health and Medicine