Looking to revolutionize canine orthopedics

COLUMBIA, MO. — While Dr. James Cook decided early on in life to tackle joint replacements, it was a circuitous route—a path that involved professional water skiing, substitute teaching and a man named Robert Gordon—that led him to the brink of a major discovery.

After years of research, Cook and his team have engineered functional biologic joints. Those joints have been implanted successfully in research rabbits and dogs and a small number of clinical canine patients. Some day, Cook and his team hope the same technology can be used for humans.

"So far the outcomes have been very good, and we feel that the technology is ready for clinical trials," Cook says. "We hope to do more canine patients that really need this technology and eventually get it into humans."

While Cook says the technology appears ready, safe and effective, they have just started with the FDA-approval process. A process that could take seven to 10 years, he says.

"If we are successful, it would absolutely revolutionize orthopedics and delivery of care for patients with arthritis," he says. "Instead of metal and plastic joints that wear out, cannot sustain high-level athletic function and can have major complications, the biologic joints would be replacing arthritic joints with 'new, young' completely functional cartilage and bone."

Joints and how they work have captivated Cook since he watched his grandfather—Robert Gordon—use crutches, canes and eventually a wheelchair.

Cook calls his grandfather an "amazing man."

"He was a self-made businessman who, with a high school education, went from sweeping the shop floors to being the president of a large pneumatic tool company," Cook says. "He helped raise me as my father was not in the picture.

"He had seven knee replacement surgeries in his life, so I grew up seeing him go through surgeries and helping him rehab by going on bicycle rides where we would talk about life—he would teach me all kinds of things," Cook says. "So, from as early as I can remember, I wanted to help him by curing arthritis and/or finding better ways to treat knee problems than metal and plastic joints."

Growing up in Ohio, Indiana, Illinois and Florida, Cook says he had every animal imaginable—dogs, cats, horses, lizards, alligators and sheep. "I never thought about being a veterinarian until after college," he says. "I always had the thought about orthopedics, but always thought it would be via the doctor route."

Veterinary school remained on the back burner for awhile as Cook embraced his first career—water skiing.

"I started water skiing when I was 4 years old, thanks to my grandpa and uncles, and had some talent for it," he says.

By the time he was 16 years old, Cook reached the highest level of amateur status and went to Florida State University to be on the water-skiing team. At that point, coming from a family of teachers, he studied education and planned to pursue a water-skiing career.

After two years of college skiing, Cook turned pro. He finished his degree in mathematics education and then skied professionally while working as a carpenter for four years.

Life had other plans, and after two severe injuries, Cook moved to St. Louis where his sister Julie lived.

"I was substitute teaching, waiting tables and doing odd jobs as a carpenter when I got a full-time job as an animal control officer," he says.

It was there that he met veterinarian Dan Knox.

"He showed me what a neat profession veterinary medicine is and got me hooked up with a St. Louis practice where I worked as a volunteer kennel boy and assistant," Cook says.

Veterinarians at the practice told him about the specialties in veterinary medicine, including orthopedics.

He finished up some science classes at the University of Missouri-St. Louis and applied to medical schools and veterinary schools. After much thought, talking with veterinarians, doctors and his family, Cook decided on veterinary school.

He graduated from the University of Missouri-Columbia College of Veterinary Medicine in 1994 and went straight to a small-animal internship at the University of Minnesota and then to a residency back at Missouri.

During veterinary school, Cook did research to help pay the bills and met Eileen Hassor.

"She inspired me in the realm of research," he says. "So when I came back to Mizzou for my residency, I pursued setting up a combined doctorate program."

With some help from Dr. John Kreeger, Cook received a doctorate in pathobiology. "This was the first step in pursuing my childhood dream, as my dissertation work was in developing a system to culture chondrocytes in pursuit of 'growing cartilage' and making biologic total joint replacements."

After his residency, Cook also took and passed the boards for the American College of Veterinary Surgeons. He was included as a charter diplomate in the American College of Veterinary Sports Medicine and Rehabilitation.

Today, Cook is the William and Kathryn Allen Distinguished professor in Orthopaedic Surgery and director of the Comparative Orthopaedic Laboratory at the University of Missouri.

"I have the best team in the whole world, and we have such fun working together," Cook says, adding when at clinics he usually performs 12 to 20 surgeries—primarily on dogs, but also cats—a week. "We also do some unique surgeries for zoos, rescue groups, NASA, etc., where we have worked on snow leopards, tigers, chimps, otters, eagles, falcons and coyotes," he says.

At the same time, Cook and his team also have about 15 to 20 research projects going on in the lab.

The team includes the Comparative Orthopaedic Laboratory and the Department of Orthopaedic Surgery (human) at the University of Missouri, plus primary collaborators from Dr. Clark Hung's laboratory at Columbia University in New York City.

"We have doctors, veterinarians, PhDs, fellows, residents, interns, professional students, graduate students and technicians—plus there are molecular biologists, pathologists and engineers," he says.

So far, knees and shoulders have been replaced in research dogs and rabbits, with the team working on replacing hips in research dogs now. "In the clinical patients, I have done two knees, an elbow and a hock," he says.

Cook and his team also were funded by NFL Charities to see if they can use ultrasonography to make on-the-field diagnoses for meniscal problems. The ultrasonography would deliver answers quicker and be more cost-effective than an MRI, which is currently used, he says.

Cook and his wife, Dr. Cristi Cook, developed the technique and have used ultrasound to diagnose meniscal problems in dogs. "(We) have shown it to be the standard for diagnostic imaging of the menisci in dogs and proven its clinical utility. We are now applying that veterinary tool to humans," he says.

Despite the long hours, Cook says he loves his job.

He has traveled all over the United States, Europe, Japan, Canada and Brazil for presentations, lectures, labs and meetings about his team's clinical and research work in orthopedics for humans and animals.

"I always say I have the best job in the whole world, because I get to do research, teach and practice orthopedics that change lives, medicine and science for people and animals," he says.

Helping patients—whether they are four-legged or two-legged—keeps him coming back every day. "And," he adds, "trying to do better for the millions of people, like my grandpa, who suffer from debilitating arthritis."

Ms. Fellenstein is a freelance writer in Cleveland.