Bio

Clinical Focus


  • Sarcomas
  • Orthopaedic Surgery

Academic Appointments


Administrative Appointments


  • Chief, Musculoskeletal Tumor Service (2005 - Present)

Honors & Awards


  • Saul Halpern, MD Orthopaedic Educator Award, Surgery Stanford University School of Medicine (2007)
  • National Research Service Award, NIH (1987)
  • Alpha Omega Alpha, Honor Medical Society (1983)

Professional Education


  • Fellowship:Memorial Sloan-Kettering Cancer Center (1989) NY
  • Residency:Hospital For Special Surgery (1988) NY
  • Board Certification: Orthopaedic Surgery, American Board of Orthopaedic Surgery (1991)
  • Internship:UCLA - School of Medicine (1984) CA
  • Medical Education:Cornell University Medical College (1983) NY
  • MD, Memorial Sloan-Kettering, Bone Disease/Bone Tumor (1989)
  • MD, Hospital for Special Surgery, Orthopaedic Surgery (1988)
  • MD, UCLA, General Surgery (1984)
  • MD, Cornell Univ. Medical College, Medicine (1983)

Research & Scholarship

Current Research and Scholarly Interests


Dr. Mohler is involved in gene expression in sarcomas, and innovative anatomy-preserving surgical management of low grade chondrosarcomas.

Teaching

2013-14 Courses


Publications

Journal Articles


  • Oncologic and Functional Results of Curettage and Cryosurgical Treatment of Low Grade Chondrosarcomas Clinical Orthopaedics and Related Research. (Accepted 10/2009) Mohler, D.G.,, Chiu, R, McCall, DA, Avedian, RS
  • Surgical Technique: Methods for Removing a Compress (R) Compliant Prestress Implant CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Abrams, G. D., Gajendran, V. K., Mohler, D. G., Avedian, R. S. 2012; 470 (4): 1204-1212

    Abstract

    The Compress® device uses a unique design using compressive forces to achieve bone ingrowth on the prosthesis. Because of its design, removal of this device may require special techniques to preserve host bone. DESCRIPTION OF TECHNIQUES: Techniques needed include removal of a small amount of bone to relieve compressive forces, use of a pin extractor and/or Kirschner wires for removal of transfixation pins, and creation of a cortical window in the diaphysis to gain access to bone preventing removal of the anchor plug.We retrospectively reviewed the records of 63 patients receiving a Compress® device from 1996 to 2011 and identified 11 patients who underwent subsequent prosthesis removal. The minimum followup was 1 month (average, 20 months; range, 1-80 months). The most common reason for removal was infection (eight patients) and the most common underlying diagnosis was osteosarcoma (five patients). Three patients underwent above-knee amputation, whereas the others (eight patients) had further limb salvage procedures at the time of prosthesis removal.Five patients had additional unplanned surgeries after explantation. Irrigation and débridement of the surgical wound was the most common unplanned procedure followed by latissimus free flap and hip prosthesis dislocation. At the time of followup, all patients were ambulating on either salvaged extremities or prostheses.Although removal of the Compress® device presents unique challenges, we describe techniques to address those challenges.

    View details for DOI 10.1007/s11999-011-2128-z

    View details for Web of Science ID 000301442800032

    View details for PubMedID 22002827

  • Curettage and Cryosurgery for Low-grade Cartilage Tumors Is Associated with Low Recurrence and High Function CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Mohler, D. G., Chiu, R., McCall, D. A., Avedian, R. S. 2010; 468 (10): 2765-2773

    Abstract

    Chondrosarcomas of bone traditionally have been treated by wide or radical excision, procedures that may result in considerable lifelong disability. Grade 1 chondrosarcomas have little or no metastatic potential and are often difficult to distinguish from painful benign enchondromas. Curettage with adjuvant cryosurgery has been proposed as an alternative therapy for Grade 1 chondrosarcomas given the generally better function after the procedure. However, because it is an intralesional procedure, curettage and cryosurgery may be associated with higher rates of recurrence.We asked whether Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery are associated with low recurrence rates and high functional scores.We retrospectively reviewed the records of 46 patients with Grade 1 chondrosarcomas and enchondromas of uncertain malignant potential treated by curettage and cryosurgery. Forty-one patients had tumors of the long bones. Patients were followed a minimum of 18 months (average, 47.2. months; range, 18-134 months) for evidence of recurrence and for assessment of Musculoskeletal Tumor Society (MSTS) functional score.Two of the 46 patients had recurrences in the original tumor site (4.3% recurrence rate), which subsequently were removed by wide excision, and both patients were confirmed to be disease-free 36 and 30 months, respectively, after the second surgery. The mean MSTS score was 27.2 of 30 points (median, 29 points).Our observations show curettage with cryosurgery is associated with low recurrence of Grade 1 chondrosarcoma and high functional scores. Curettage with cryosurgery is a reasonable alternative to wide or radical excision as the treatment for Grade 1 chondrosarcomas, and allows for more radical surgery in the event of local recurrence.Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

    View details for DOI 10.1007/s11999-010-1445-y

    View details for Web of Science ID 000281843200028

    View details for PubMedID 20574801

  • EXTERNAL BEAM RADIATION THERAPY ENHANCES LOCAL CONTROL IN PIGMENTED VILLONODULAR SYNOVITIS INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Horoschak, M., Tran, P. T., Bachireddy, P., West, R. B., Mohler, D., Beaulieu, C. F., Kapp, D. S., Donaldson, S. S. 2009; 75 (1): 183-187

    Abstract

    Pigmented villonodular synovitis (PVNS) is a rare proliferative disorder of the synovium with locally aggressive behavior. We reviewed our experience using radiation therapy in the treatment of PVNS.Seventeen patients with 18 sites of PVNS were treated with radiation between 1993 and 2007. Cases were retrospectively reviewed for patient information, treatment parameters, complications, and outcome. Seven sites were primary presentations and 11 were recurrent with an average of 2.5 prior surgical interventions. The most common location was the knee joint (67%). Cytoreductive surgery was performed before radiation therapy in 16/18 sites with all having proven or suspected residual disease. Radiation was delivered using 4-15 MV photons with an average total dose 34 Gy (range, 20-36 Gy). Seventeen of 18 sites (94%) had postradiotherapy imaging.With average follow-up of 46 months (range, 8-181 months), initial local control was achieved in 75% (12/16) of the sites with prior cytoreductive surgery (mean time to recurrence, 38 months). Ultimate local control was 100% after repeat resection (mean follow-up, 61 months). Two additional sites without prior cytoreductive surgery showed growth after radiotherapy (mean time to documented growth, 10.5 months). Seventeen of the 18 involved joints (94%) were scored as excellent or good PVNS-related function, one site (5%) as fair function, and no site with poor function. No patient required amputation; and there were no Grade 3/4 treatment-related complications.Postoperative external beam radiation is effective in preventing disease recurrence and should be offered following maximal cytoreduction to enhance local control in PVNS.

    View details for DOI 10.1016/j.ijrobp.2008.10.058

    View details for Web of Science ID 000269328700031

    View details for PubMedID 19211195

  • Hunting Injuries In Wilderness Medicine, Editor Auerbach, P. Elsevier Press Mohler, D., Otes, D 2007
  • Failure of medullary tubes - A materials analysis INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED Taub, M., Wera, G., Dauskardt, R. H., Mohler, D. G. 2004; 35 (9): 878-882

    Abstract

    The objective of this study is to determine the effects of autoclaving on the stress, strain, ultimate tensile strength (UTS), fracture strain, modulus, and yield stress of nylon medullary tubes. There are three reports describing nylon medullary tube failure in the literature. All cases involved the use of nylon medullary tubes during open reduction internal fixation of fractured long bones. We demonstrated increased brittleness and decreased strength with increased exposure of medullary tubes to autoclaving, most dramatically after 100 autoclave cycles. Visual inspection of tubes is a clear indication of material degradation after repeated autoclaving. Furthermore, there is a significant difference in ultimate tensile strength (P < 0.0001) between tubes exposed to less than 100 sterilization cycles compared to tubes exposed to greater than 100 cycles. Likewise, there is a significant decrease in yield stress (P < 0.0004) between the same groups. We recommend disposal and replacement of nylon medullary tubes before they are exposed to 100 autoclaving cycles in order to avoid failure of the device.

    View details for DOI 10.1016/S0020-1383(03)00307-3

    View details for Web of Science ID 000223692100007

    View details for PubMedID 15302240

  • Intercalary tibial allografts following tumor resection: The role of fibular centralization ORTHOPEDICS Mohler, D. G., Yaszay, B., Hong, R., Wera, G. 2003; 26 (6): 631-637

    Abstract

    Options to reconstruct intercalary tibial defects include allografts, vascularized bone transfers, autogenous cortical grafts, endoprostheses, and Ilizarov bone transport. Five patients underwent intercalary bulk allograft reconstruction following en bloc resection of tibial sarcomas. Two patients underwent immediate fibular centralization and iliac crest bone grafting in addition to the allograft. Two patients who underwent fibular centralization during primary reconstruction united uneventfully. The remaining three patients developed nonunion, of which one was successfully salvaged by fibular centralization. A combined allograft transplant and fibular centralization with iliac crest bone grafting is an effective procedure to reconstruct the tibial diaphysis, as well as a salvage procedure for allograft nonunion.

    View details for Web of Science ID 000183456200007

    View details for PubMedID 12817729

  • Multifocal pseudoaneurysmal bone cysts in sickle cell disease ORTHOPEDICS Kim, S. S., Fernando, T. L., Mohler, D. G. 2001; 24 (5): 489-491

    View details for Web of Science ID 000168761800015

    View details for PubMedID 11379999

  • Multiple fracture of medullary tube during intramedullary nailing of long bone fractures JOURNAL OF ORTHOPAEDIC TRAUMA Vakharia, M. R., Lehto, S. A., Mohler, D. G. 2000; 14 (7): 514-517

    Abstract

    Intramedullary nailing is an accepted treatment for the fixation of femoral and tibial shaft fractures. There is a low but significant incidence of intraoperative complications during intramedullary nailing. During this procedure, a medullary tube may be used to exchange the bent olive-tipped reaming guidewire for the straight guidewire. A review of the literature found only one report of a fracture of the medullary tube. Two cases in which the medullary tube fractured into multiple pieces are presented.

    View details for Web of Science ID 000165097300011

    View details for PubMedID 11083617

  • Augmented amputations of the lower extremity CLINICAL ORTHOPAEDICS AND RELATED RESEARCH Mohler, D. G., Kessler, J. I., Earp, B. E. 2000: 183-197

    Abstract

    Ten patients who had amputations of a lower extremity for high-grade sarcomas underwent bone augmentation with either allograft or autograft between 1988 and 1996. There were eight transfemoral amputations and two transtibial amputations. The transferred segments consisted of one proximal tibia and six distal tibia autografts, two allografts, one autograft talar dome and first metatarsal, and one with a patellar cap of a supracondylar amputation. The average length of followup was 54 months. There were no nonunions of any of the grafts. There were three wound problems requiring additional operations. One autograft resorbed, and one autograft had a late infection. There was one local recurrence. Augmentation to provide length resulted in a 42% increase in bone length in those performed purely for length. All patients were able to use standard prostheses. Functional outcome was appropriate to the amputation level. Half of the patients avoided more proximal levels of amputation because of the ability to augment the osteotomy. The use of nonvascularized structural autografts or allografts is a simple procedure that can produce a superior residual limb in patients undergoing amputation. Its use should be considered in patients for whom traditional amputation techniques will result in poor function, difficulty in fitting a prosthesis, or greater than necessary anatomic loss.

    View details for Web of Science ID 000085397700024

    View details for PubMedID 10693566

  • Open synovectomy with cryosurgical adjuvant for treatment of diffuse pigmented villonodular synovitis of the knee. Bulletin (Hospital for Joint Diseases (New York, N.Y.)) Mohler, D. G., Kessler, B. D. 2000; 59 (2): 99-105

    Abstract

    Pigmented villonodular synovitis (PVNS) is an uncommon, benign disorder usually affecting the synovial membrane of large joints. The diffuse form of PVNS is extremely difficult to control, and long-term recurrence inevitably results in arthrodesis or arthroplasty. Current treatments include surgical, chemical, and radiation synovectomy, but all have significant failure rates. In hope of obtaining a more complete synovectomy, we used cryosurgery as an adjuvant to open synovectomy in three patients. Two patients presented with multiple failed arthroscopic synovectomies, and one patient presented with arthroscopically unresectable PVNS. The surgical approach involved take down and repair of the anterior meniscal attachments, and direct entry into the posterior space through medial and lateral femoral capsular attachments. Cryosurgical surface spray was used on all non-cartilaginous surfaces. At follow-up of 14, 30, and 31 months, all three patients remained symptom-free and there were no indications of clinical recurrence. There were no obvious complications or morbidity from the cryosurgical procedure and all patients had excellent functional recovery. All patients returned to sports and their jobs without restrictions. In the past, it has been shown that cryosurgery is a safe and effective treatment modality for proliferative joint disease. We propose the use of adjuvant cryosurgery for PVNS patients selected for open synovectomy.

    View details for PubMedID 10983259

  • Complete pelvic ring failure after posterior iliac bone graft harvesting SPINE Fernando, T. L., Kim, S. S., Mohler, D. G. 1999; 24 (20): 2101-2104

    Abstract

    Case report.To present a rare complication of posterior iliac bone graft harvesting.Although iliac bone graft harvesting is a common procedure in spinal surgery, it is not without complications. One such complication is fracture of the ilium that is seen most often in older women with osteopenia.In this case a severe complication of posterior iliac bone graft harvesting was identified in a patient with steroid-induced osteoporosis that led to multiple pelvic fracture, nonunions, and eventual failure of the entire pelvic ring. Imaging studies showed osteoporotic bone and multiple nonunions of the pelvis with structural collapse.Staged sequential platings of the iliac wings were performed to stabilize the pelvis. The initial fixation of the left iliac wing apparently united after hardware failure. The right iliac wing was successfully fixed with plates supplemented with bone cement and allograft. Anterior fixation was planned.Care should be taken when considering autograft harvesting in patients with risk factors for osteoporosis. The outcome could be debilitating.

    View details for Web of Science ID 000083124400006

    View details for PubMedID 10543005

  • Angiosarcoma of the hand associated with chronic exposure to polyvinyl chloride pipes and cement - A case report JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME Mohler, D. G., Chen, W. W., Bloom, H. 1998; 80A (9): 1349-1354
  • Adamantinoma arising in the distal fibula treated with distal fibulectomy: A case report and review of the literature FOOT & ANKLE INTERNATIONAL Mohler, D. G., Cunningham, D. C. 1997; 18 (11): 746-751

    Abstract

    Adamantinoma is a rare primary bone tumor occurring in the mandible and the long tubular bones. The diaphysis of the tibia is the most common site of extragnathic presentation. Fibular involvement is rare and usually has coexisting tibial involvement. Adamantinoma arising in the distal fibular metaphysis has not been previously reported. This is a case of a teenage boy presenting with a cystic lesion of the distal fibula, initially diagnosed and treated as a unicameral bone cyst. Aggressive behavior ultimately led to a diagnosis of adamantinoma. He was treated with distal fibulectomy without surgical reconstruction with good functional outcome.

    View details for Web of Science ID A1997YF98100012

    View details for PubMedID 9391822

  • Glomus tumor of the plantar arch: A case report with magnetic resonance imaging findings FOOT & ANKLE INTERNATIONAL Mohler, D. G., Lim, C. K., Martin, B. 1997; 18 (10): 672-674

    Abstract

    A 55-year-old woman with a 12-year history of a painful nodule in the subcutaneous fat layer of the plantar arch was evaluated with magnetic resonance imaging, followed by excisional biopsy. Pathology revealed a glomus tumor, which is extremely rare in the plantar surface of the foot. The magnetic resonance imaging studies are presented. The literature on glomus tumors in the foot is reviewed. This entity should be considered in the differential diagnosis of solitary plantar nodules when marked sensitivity to temperature or pressure is exhibited.

    View details for Web of Science ID A1997YB59300014

    View details for PubMedID 9347308

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