Maximum Acceptable Risk Of Complication In Total Knee Arthroplasty (MARKA) Study: Using Discreet Choice Experiments To Elicit Patient And Surgeon Perception Of Acceptable Risk In Total Knee Arthroplasty
Funder
National Health and Medical Research Council
Funding Amount
$465,199.00
Summary
Patient expectation is the strongest predictor of satisfaction following total knee replacement. Dissatisfaction with surgery is reported in approximately 1 in 5 patients undergoing knee replacement. Unrealistic patient expectations and uninformed perceptions of potential benefits, risks and limitations of surgery lead to dissatisfaction in many cases. This study will examine the “risk-benefit” preferences in patients and surgeons considering total knee replacement as a treatment option for end- ....Patient expectation is the strongest predictor of satisfaction following total knee replacement. Dissatisfaction with surgery is reported in approximately 1 in 5 patients undergoing knee replacement. Unrealistic patient expectations and uninformed perceptions of potential benefits, risks and limitations of surgery lead to dissatisfaction in many cases. This study will examine the “risk-benefit” preferences in patients and surgeons considering total knee replacement as a treatment option for end-stage osteoarthritis.Read moreRead less
Combined Randomised And Observational Study Of Type B Ankle Fracture Treatment
Funder
National Health and Medical Research Council
Funding Amount
$117,331.00
Summary
Ankle fractures are frequently seen in emergency departments, and isolated AO type B fibula fractures are the most common type of ankle fracture. Current treatment is equally divided between surgical, and non-surgical, as per surgeon preference. When managed surgically, these fractures consume considerable healthcare resources and expose patients to risks. This study will determine if surgery improves outcomes for patients with type B ankle fractures when compared with non-surgical management.
Why Macrophages Promote Heterotopic Ossifications Following Spinal Cord Injuries
Funder
National Health and Medical Research Council
Funding Amount
$586,950.00
Summary
A frequent complications of brain and spine injuries is the formation of bones outside of the skeleton called "heterotopic ossifications", particularly around joints such as the knee, hip, elbow or shoulder. They grow over a few months to become so large (up to 2 kg) that they block muscles and joints, increasing pain, morbidity and dependance. This project is to understand why heterotopic ossifications form in patients with spine injuries aiming to discover effecttive treatments.
Economic Evaluation And Health Outcomes Of Arthritis And Its Treatments
Funder
National Health and Medical Research Council
Funding Amount
$360,660.00
Summary
Musculoskeletal diseases are the most common single cause of chronic disability in Australia and total joint replacement is rapidly becoming one of the most commonly performed operations. This burden of illness is likely to increase with our ageing population and there is an urgent need to obtain data relating to the costs and outcomes in the Australian context so that appropriate planning of health services and resources can be carried out. The WHO (World Health Organisation) has declared 2000 ....Musculoskeletal diseases are the most common single cause of chronic disability in Australia and total joint replacement is rapidly becoming one of the most commonly performed operations. This burden of illness is likely to increase with our ageing population and there is an urgent need to obtain data relating to the costs and outcomes in the Australian context so that appropriate planning of health services and resources can be carried out. The WHO (World Health Organisation) has declared 2000 to 2010 the Bone and Joint Decade, recommending that research into musculoskeletal disorders be a priority. We have been recruiting and following a unique cohort of osteoarthritis and rheumatoid arthritis patients, from both the public and private health sectors, who have been carefully documenting their health outcomes, health care costs (including primary, revision and bilateral hip and knee joint replacement surgery), out-of-pocket and indirect costs related to their arthritis. Long-term follow-up is now essential to obtain a clear picture of the impact of living with arthritis over time and the cost-effectiveness and predictors of good and bad outcomes of joint replacement surgery. The information derived from this study will be useful for patients and doctors in making their decisions about treatments, as well as for health care providers in planning of health services for arthritis sufferers. Given that the cohorts are already established, the study is in a unique position to provide ongoing important longer-term data for relatively low cost.Read moreRead less
Role Of Bone-associated Macrophages In Bone Remodelling And Bone Disease
Funder
National Health and Medical Research Council
Funding Amount
$564,963.00
Summary
Musculoskeletal diseases, including osteoporosis and osteoarthritis, are a national and international health and research priorities. Over 3 million Australians suffer from arthritis and musculoskeletal conditions and their social and economic impact is expected to dramatically increase in the next 20 years as a result of the aging population. Early diagnosis, prevention and treatment of many musculoskeletal diseases are currently inadequate. Consequently, there is a high demand for effective tr ....Musculoskeletal diseases, including osteoporosis and osteoarthritis, are a national and international health and research priorities. Over 3 million Australians suffer from arthritis and musculoskeletal conditions and their social and economic impact is expected to dramatically increase in the next 20 years as a result of the aging population. Early diagnosis, prevention and treatment of many musculoskeletal diseases are currently inadequate. Consequently, there is a high demand for effective treatment options. This project grant application proposes a novel line of scientific investigation that will provide greater understanding of the contribution of macrophages (a cell type that has important roles in normal tissue maintenance and defense against infection) in bone remodelling and disease. Bone is continuously remodelled and replaced to maintain skeletal strength and mineral metabolism. We have shown that a population of macrophages is intimately associated with bone and propose that these cells play an important part in regulating bone remodelling. Macrophages have been implicated in many diseases that have damaging consequences on bone, including osteoporosis and several forms of arthritis, linking aberrant macrophage function to disease-associated bone damage. This project aims to characterize this population of bone-associated macrophages and determine their ability to influence the function of other cells integrally involved in bone remodelling. We will also undertake studies in animal models to determine whether these cells are required for bone remodelling and-or damage. Detailed description of the novel role of macrophages in bone biology will facilitate the development of superior therapeutics, preventatives and cures for bone diseases.Read moreRead less
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
The Role Of P62/A170 In Pathological Bone Destruction
Funder
National Health and Medical Research Council
Funding Amount
$276,000.00
Summary
Approximately up to 30% of patients are admitted to public hospitals in Australia for reasons related to skeletal disorders, including trauma, osteoarthritis, osteoporosis, primary and secondary bone tumours, genetic and metabolic disorders. Abnormal bone resorption contributes to most of these diseases and conditions. Based on the clinical evidence of P62 mutation in patients with Paget's Disease of bone and our observation of the involvement of P62 in RANKL-induced NF-Kb signaling, we propose ....Approximately up to 30% of patients are admitted to public hospitals in Australia for reasons related to skeletal disorders, including trauma, osteoarthritis, osteoporosis, primary and secondary bone tumours, genetic and metabolic disorders. Abnormal bone resorption contributes to most of these diseases and conditions. Based on the clinical evidence of P62 mutation in patients with Paget's Disease of bone and our observation of the involvement of P62 in RANKL-induced NF-Kb signaling, we propose that intracellular molecule P62-A172 may play an important part in the switch off-on signals necessary for bone resorbing cells to resorb bone. To this end, we will study the molecular mechanism of P62 in action, and the interaction with its possible partners for the facilitation of abnormal bone resorption. The clinical significance of this project is to: 1) enhance understanding of abnormal bone resorption in Orthopaedic related diseases and conditions. 2) provide a strategy of drug development for the treatment of these disease and conditions.Read moreRead less
The Risks And Benefits Of Contemporary Total Hip Replacement
Funder
National Health and Medical Research Council
Funding Amount
$493,530.00
Summary
The number of hip replacements undertaken in Australia is steadily increasing. The most common complications of hip replacements are dislocation and loosening due to bone loss around the implant, requiring complex and expensive revision surgery. This study will investigate the incidence of dislocation and, using a new diagnostic imaging technique, the incidence and amount of bone loss around a relatively new prosthetic material, the outcomes of which are not known despite its increasing use.