A Remembrance of David J. Schurman MD (1940-2018)

David J. Schurman MD, Emeritus member of the Association of Bone and Joint Surgeons (ABJS), and long-time Professor in the Department of Orthopaedic Surgery at Stanford University, died on Monday, April 2, 2018, surrounded by his family. He was 77 years old.

Dr. Schurman graduated from Yale University and completed his medical education at Columbia University in New York City. After medical service in the Air Force, he completed both his residency and a NIH-supported postdoctoral fellowship at the University of California at Los Angeles in 1973. He subsequently joined Stanford University in the Division of Orthopaedic Surgery, where he established the Orthopaedic Research Laboratory and later became Chief of the Division. Dr. Schurman was a member of many prominent orthopaedic associations including the ABJS, where he served as President from 1997-1998.

A leader in arthroplasty and infection, Dr. Schurman (Fig. 1) was described as “ahead of his time” by his Stanford colleagues. Indeed, he was one of the first orthopaedic surgeons to create a comprehensive long-term outcomes database on patients who had undergone total joint replacements. At the time, there were very few databases in the country that went beyond patient demographics and why the patient had surgery. At Stanford University, Dr. Schurman overcame this data shortage by forming a unique collaboration with researchers from Stanford’s rheumatology and immunology departments.

Fig. 1.

Dr. Schurman was one of the first orthopaedic surgeons to create a comprehensive long-term outcomes database on patients who had undergone total joint replacements (Published with permission from Ed Souza/Stanford News Service).

“He created his databases based on the work by rheumatologists and immunologists at Stanford who were well known for doing outcomes studies,” Stuart Goodman MD, a Stanford colleague, told Clinical Orthopaedics and Related Research®. “Dr. Schurman shifted the focus of his work toward how patients with knee and hip arthroplasties functioned after surgery.”

According to Dr. Goodman, Dr. Schurman’s databases helped orthopaedic surgeons dive deeper into how their patients functioned postoperatively.

“This went beyond patient pain level,” Dr. Goodman said. “His databases used accepted criteria to offer a more-detailed picture of how a patient functions postoperation. He took the Harris Hip Score to a whole new level and was very forward thinking. Much of the data he wanted to gather 30 or 40 years ago we can now get in an instant. But at the time he was just so far ahead of us in terms of what data we needed and how to obtain it.”

Dr. Schurman was also well known for his work on the mechanical properties of bone cement [6, 8] and treating patients with infection [1, 2, 9, 13].

“Infection is something we always worried about, and even today, infection can ruin our patients’ lives,” Dr. Goodman told CORR®. “But Dr. Schurman was brave enough to take on not only the clinical, but also the baseline aspects of infection. Why do people get an infection? What are the bacteria? How do we both eradicate the infection and make the sequalae less painful and limiting for the patient? He wanted to answer those questions.”

His interest in infection was spurred by his postdoctoral studies that sought to determine what level of bacterial exposure led to frank infection. At Stanford, he completed pioneering studies that allowed accurate bacterial colony counts using zonal growth gradients to assess the relative efficacy of specific antibiotics [7]. He was also involved in studies of septic arthritis that established that early onset of antibiotic treatment decreased the degree of collagen degradation but had little effect of glycosaminoglycan loss [12].

Dr. Schurman collaborated with researchers outside of his specialty, working with mechanical engineers at Stanford to write key articles on biomechanics and prosthetic design [3, 5] and through collaboration with R. Lane Smith PhD and Dennis R. Carter PhD probed how biological and mechanical properties of articular cartilage reflected the load history of the joint. These computational studies examined how stresses and strains arising in the joint with loading impact cartilage in health and disease [4, 10, 11].

“His quest was to understand biomechanics of joint loading as an important stimulus for bone and cartilage differentiation,” Dr. Smith told CORR. “In this capacity, he clearly anticipated the unfolding role of mechanical forces in cell biology and tissue engineering. His interest in the mix of physical and biological processes was typical of his ability to focus on the heart of the problem. He never could tolerate avoidance of the key question.”

Dr. Schurman’s colleagues all acknowledged his dry humor that was often brought to bear during periods of research discussions or within a clinical or surgical setting.

“Usually his humor was intentional to restore the focus of what was being discussed and always came through constructively as part of his commitment to teaching and mentoring,” Dr. Smith said.

Commented Dr. William Maloney: “For me, David Schurman was a mentor and a friend. Early in my career Lane Smith and I would meet weekly with David and talk research and discuss project updates. Later, when I returned to Stanford as Department Chair, he was one of my biggest supporters. He is missed by all of us.”