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
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.
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.
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 .
Relationship Of The Anabolic And Catabolic Responses In Healing A Critical Sized Defect In Rats
Funder
National Health and Medical Research Council
Funding Amount
$329,750.00
Summary
Delayed bone healing after trauma is a large clinical problem. Figures suggest up to 60,000 fractures result in a delay in healing in Australia per year. Bone healing can also fail to occur in other circumstances, such as after an operation. Research effort into new approaches to solving these problems is clearly justified. We believe that in some situations, bone healing fails due to the body's healing response, the anabolic response, being insufficient. In some other situations, the body's bon ....Delayed bone healing after trauma is a large clinical problem. Figures suggest up to 60,000 fractures result in a delay in healing in Australia per year. Bone healing can also fail to occur in other circumstances, such as after an operation. Research effort into new approaches to solving these problems is clearly justified. We believe that in some situations, bone healing fails due to the body's healing response, the anabolic response, being insufficient. In some other situations, the body's bone resorbing response, the catabolic response, may be too high and prevent healing from occurring. In normal bone healing, there is a balance between the anabolic and catabolic response. In disordered bone healing, these responses are out of balance. Several reasonably new treatments are available which can increase the anabolic response or decrease the catabolic response. We have preliminary results showing that with these agents we can bring these elements into better control, and thus drive bone healing. We have optimised an animal model where both the anabolic and catabolic responses can be controlled. In this project, we explore the optimisation of the timing and magnitude of anabolic and catabolic responses in bone healing.Read moreRead less
Examining Psychological State In Patients Presenting For Arthritis Surgery
Funder
National Health and Medical Research Council
Funding Amount
$347,792.00
Summary
Total joint replacement (TJR) is a common surgical procedure in Australia (80,000 per year). Pre-operative psychological distress has been reported to be between 30-60% in TJR patients and is associated with pain and poor recovery. Little is known about the nature of psychological distress in those presenting for TJR. This study aims to identify the psychological profile of TJR patients who experience suboptimal recovery and in doing so inform future programs that aim to enhance psychological we ....Total joint replacement (TJR) is a common surgical procedure in Australia (80,000 per year). Pre-operative psychological distress has been reported to be between 30-60% in TJR patients and is associated with pain and poor recovery. Little is known about the nature of psychological distress in those presenting for TJR. This study aims to identify the psychological profile of TJR patients who experience suboptimal recovery and in doing so inform future programs that aim to enhance psychological well-being in patients on waiting lists for TJRRead moreRead less
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
The Role Of Muscle And The Application Of Muscle-cell Therapies In Bone Repair
Funder
National Health and Medical Research Council
Funding Amount
$438,936.00
Summary
Muscle is often close to bone and we have found that muscle cells can directly contribute to bone repair. We are examining importance of muscle cells in orthopaedic repair and whether new methods for mobilizing muscle cells can improve healing.
Randomized Controlled Trial Of Hip Arthroscopy For Femoroacetabular Impingement
Funder
National Health and Medical Research Council
Funding Amount
$1,010,588.00
Summary
Femoroacetabular impingement (FAI) occurs as a consequence of abnormal contact between the pelvis and femoral head–neck junction, resulting in damage to the hip joint. Because FAI is associated with symptoms and may play a role in predisposing to osteoarthritis, new surgical techniques have been developed to correct this anatomic abnormality. However, the disease modifying benefits of surgery are unknown. We therefore propose a randomized controlled trial to evaluate its efficacy and to determin ....Femoroacetabular impingement (FAI) occurs as a consequence of abnormal contact between the pelvis and femoral head–neck junction, resulting in damage to the hip joint. Because FAI is associated with symptoms and may play a role in predisposing to osteoarthritis, new surgical techniques have been developed to correct this anatomic abnormality. However, the disease modifying benefits of surgery are unknown. We therefore propose a randomized controlled trial to evaluate its efficacy and to determine the mechanisms of effect.Read moreRead less