Regulation Of Key Pathways Causing Peri-implant Bone Loss.
Funder
National Health and Medical Research Council
Funding Amount
$403,639.00
Summary
The failure of bone prostheses is becoming a major health problem in our aging population. Despite the impressive success of joint replacement surgery, a significant number of arthroplasties fail. It is now apparent that most implants fail due to bone loss around them which leads to loosening. This project aims to obtain a better understanding of the causes of implant failure and find ways to extend the life of these implants .
In Vivo Patellofemoral Joint Measurement Using Kinematic Radiostereometric Analysis (RSA)
Funder
National Health and Medical Research Council
Funding Amount
$141,000.00
Summary
Complications following total knee joint replacement continue to be a major cause for revision surgery and leads to a significant financial burden in terms of health care expenditure. Recent studies suggest that many of these complications are associated with post-surgical pain from the patella knee cap joint, commonly termed anterior knee pain (AKP). Post-surgery AKP may be influenced by the motion of the patella. Recent prospective, randomised trials have compared clinical outcomes between peo ....Complications following total knee joint replacement continue to be a major cause for revision surgery and leads to a significant financial burden in terms of health care expenditure. Recent studies suggest that many of these complications are associated with post-surgical pain from the patella knee cap joint, commonly termed anterior knee pain (AKP). Post-surgery AKP may be influenced by the motion of the patella. Recent prospective, randomised trials have compared clinical outcomes between people with TKA in which the patellar surface is replaced (patellar resurfacing) or retained, but have been unable to accurately account for differences in patellar movement in those people with post-surgery complications. To date, studies of patellar motion after total knee replacement have been limited to two-dimensional analyses. This study addresses the technological limitations of previous trials by utilising accurate techniques for directly measuring skeletal motion using kinematic radiostereometric analysis (RSA). These data will measure patellar kinematics in three-dimensions for the first time. This information will allow optimisation of the design of TKA and the surgical techniques required for their implantation. Furthermore, the results will assist in the identification of surgical indications for patellar resurfacing, and the kinematic factors associated with anterior knee pain following total knee replacement surgery.Read moreRead less
Reverse Or Anatomical (replacement) For Painful Shoulder Osteoarthritis: Differences Between Interventions -Aus
Funder
National Health and Medical Research Council
Funding Amount
$1,540,874.00
Summary
Shoulder osteoarthritis is common in older adults, causing severe pain and making daily life difficult. Shoulder replacement is an effective treatment - it replaces the damaged joint with metal and plastic implants. Two types of shoulder replacement exist, but the best option is uncertain as they have not been compared in randomised trials. We will produce evidence about the benefits, harms and cost-effectiveness of each shoulder surgery to enable patients to receive the best type of surgery.
QUANTITATIVE ASSESSMENT OF LOOSENING IN HIP ARTHROPLASTIES USING MECHANICAL VIBRATION DIAGNOSTICS
Funder
National Health and Medical Research Council
Funding Amount
$185,665.00
Summary
Recent advances and improvements made to the mechanical design of artificial joints have led to greater strength, fatigue life and wear resistance. However, this extension to the working life of joint replacements has led to patients becoming increasingly vulnerable to the problem of joint loosening. There are over 500 000 hip joint replacements performed every year, on a worldwide basis. Of these 7 to 13% will require revision surgery because of loosening at some stage of their working life. Th ....Recent advances and improvements made to the mechanical design of artificial joints have led to greater strength, fatigue life and wear resistance. However, this extension to the working life of joint replacements has led to patients becoming increasingly vulnerable to the problem of joint loosening. There are over 500 000 hip joint replacements performed every year, on a worldwide basis. Of these 7 to 13% will require revision surgery because of loosening at some stage of their working life. This is becoming a major concern to health services around the world since revision surgery is associated with a higher risk to the patient and costs are far greater than for the primary operation. Current diagnostic techniques using radiographic imaging are both invasive and lack diagnostic accuracy. The ability to detect joint loosening and to discriminate between the various causes of joint loosening following arthroplasty is of great importance to the success of subsequent care plans. This study will be the first in the world to assess the validity of a new diagnostic test that uses low energy mechanical vibration to quantify the degree of loosening in both components of the implanted hip joint. Once the technique has been proven it could readily be extended to evaluate the degree of fixation of other implanted prostheses used to replace the knee, ankle or joints of the upper limbs.Read moreRead less
The Prognostic Significance Of Obesity In Joint Arthroplasty
Funder
National Health and Medical Research Council
Funding Amount
$57,803.00
Summary
There are over 55,000 hip and knee joint replacements performed in Australia every year and the number is rising. The incidence of obesity is also rising. Higher risk of surgical complications following joint replacement surgery has been reported in obese patients. It is therefore imperative that we determine the impact obesity has on the outcome of joint replacement surgery in order to determine if treatment needs to be modified.
Determination Of Irradiation Dose Efficacy For Use In Impaction Grafting At Revision Joint Replacement
Funder
National Health and Medical Research Council
Funding Amount
$411,517.00
Summary
Primary hip replacement is a successful intervention for hip disease, but 10-15% of hip prostheses fail and require revision surgery within 10-15 years. At the time of revision, significant bone loss around the failed prosthesis is not uncommon. A bone reconstruction procedure, called impaction grafting, where donor bone is minced and placed in the areas of deficient bone before implanting the new prosthesis, has shown to give good results at more than ten years in some centres. A high incidence ....Primary hip replacement is a successful intervention for hip disease, but 10-15% of hip prostheses fail and require revision surgery within 10-15 years. At the time of revision, significant bone loss around the failed prosthesis is not uncommon. A bone reconstruction procedure, called impaction grafting, where donor bone is minced and placed in the areas of deficient bone before implanting the new prosthesis, has shown to give good results at more than ten years in some centres. A high incidence of early complications of this procedure have included loss of fixation within the bone. Fracture of the bone around prostheses has also reported in some centres. These events require more surgery, putting the patient at higher risk greater complications and longer rehabilitations. Recent improvements in surgical technique and donor bone preparation have improved results. A current debate questions whether the dose of irradiation can be reduced from 25 kGy, while maintaining sterility of allografts. The risk of bacterial contamination in allografts is low, and irradiation reduces the mechanical strength of the graft, contributing to complications when irradiated bone is used. The benefits of decontaminating the bone may be outweighed by the higher risk for failure due to poor bone quality and resulting prosthesis instability. We will use ISO standards to test the validity of radiation dose for sterilising bone ex vivo. In the absence of controlled human studies, our aim is also to compare the results of impaction grafting with non-irradiated bone versus bone irradiated at current doses used by Australian bone banks, and lower doses indicated by ex vivo testing. We will use a large animal model of revision hip replacement, with precise measures of prosthesis stability. The results of this study will guide clinical decisions regarding the efficacy of current bone graft preparation procedures and the use of irradiated bone in human hip replacement surgery.Read moreRead less
Improving The Prevention And Outcomes Of Knee And Hip Osteoarthritis
Funder
National Health and Medical Research Council
Funding Amount
$421,747.00
Summary
Osteoarthritis is a major public health problem. No current treatment slows disease progression with end-stage osteoarthritis treated by joint replacement surgery. This project will identify new approaches for the prevention and treatment of osteoarthritis and the improvement of patients’ outcomes after total joint replacement surgery. The findings will have both public health and clinical impact, informing clinical practice of strategies to improve the prevention and outcomes of osteoarthritis.
Femoroacetabular impingement (FAI) is a common cause of hip pain characterised by extra bone formation at the hip, called a cam-deformity. FAI is thought to create hip joint damage and osteoarthritis. Our 5 year longitudinal study of people with FAI in two (Melbourne and Brisbane) sites will investigate whether factors (such as cam-deformity size, hip contact force, muscle strength and joint range) can predict hip joint damage (measured with magnetic resonance imaging) over two years.
Prevention And Treatment Of Bone Infection With CSA-90
Funder
National Health and Medical Research Council
Funding Amount
$350,983.00
Summary
Bone infections are a major challenge to treat, especially with the rise of drug resistant “superbugs”. We have access to a new agent, CSA-90, that has dual properties of being anti-microbial (antibiotic) and helps encourage bone growth. This project aims to expand upon our prior research and test CSA-90 for the treatment of chronic bone infections. We will also look at applying this technology to joint replacements and this drug may be particularly useful for coating orthopaedic implants.