Collaborative Orthopaedic Research (CORe)

TJA Projects

Current Projects

  • Impact of Body Habitus on Cup Alignment in Total Hip Arthroplasty (THA). (2015-Present).  During THA, alignment of surgical implants is critical to lead to a good patient outcome.  Patients are positioned on their side to optimize the surgeon's view of their hip joint. Patients with large differences in hip to shoulder ratios (i.e. narrow shoulders with broad hips or broad shoulders with narrow hips) may experience a pelvic tilt leading to mal-placement of the THA cup.  Subjects waiting for THA will be examined with a single low dose CT scan performed in a side-lying position to determine if shoulder to hip ratio affects pelvic positioning and alignment.  These data will be modelled using a software program to determine if there is a critical ratio beyond which a different surgical reference point is required.  This work is being supported by the ECE Charitable Foundation.
  • Evaluating smoking cessation as a preoperative standard of care for total hip or knee arthroplasty in a centralized intake clinic model. (2014-Present). Smoking is associated with adverse outcomes following arthroplasty surgery, including prosthesis failure, wound infection and death.  Our goal is to design, operationalize and evaluate a sustainable and transferable pre-arthroplasty tobacco cessation intervention that can be integrated into a high volume central intake clinic. This study is supported by a Global Research Awards for Nicotine Dependence (GRAND) award.
  • Moving Research to Practice: Development of Quality Indicators for Hip and Knee Arthroplasty Rehabilitation (2011-Present)  Marked variation in clinical practices, outcomes and resources allocated to rehabilitation services for total joint arthroplasties exist. This project developed core sets of quality indicators (QIs) reflecting the minimum acceptable standard of rehabilitation care before and after elective THA and TKA for osteoarthritis. Using national expert panelists, a set of QIs  was developed to measure, report and benchmark quality of care in patients receiving rehabilitation before and after THA/TKA surgery. We are now pilot testing these QI in clinical rehabilitation settings to determine their clinical feasibility.  This work is supported by the Alberta Innovates Health Solutions.
  • Pre-operative Exercise for total knee arthroplasty (PREP Study) (2008-Present) We examined whether a pre-operative 8 week home rehabilitation exercise program designed for TKA delivered by a physical therapist improved pre-operative knee function as compared to pre-operative usual care  in patients with arthritis who report the severe dysfunction. Findings from the qualitative component of the study found that delivering a pre-operative program for TKA was well-received by patients and physical therapists.  Participants who did not understand the purpose of the pre-operative program also had difficulty with adherence.  Overall, participants felt they were better prepared for their surgery although preparation was compounded by personal factors individual to the patients.  This work is supported by Alberta Innovates Health Solutions and Canada Institutes of Health Research
  • Infection Resolution and Function using the PROSTALAC Hip System  (2005-Present)  Periprosthetic joint infection (PPJI) is a significant complication following total hip arthroplasty and the PROSTALAC THA assists in resolving infection while retaining the soft tissue space and allowing patients reasonable function.  We are evaluating a cohort of patients who had an infected THA and have the PROSTALAC in situ to determine their function and quality of life as well as infection resolution.  This work is supported by an unrestricted research grant from DePuy INC and the Edmonton Orthopaedic Research Committee.
  • Comorbidity and TJA (2003-Present)  Co-existing medical conditions have detrimental effects on pain and functional recovery after joint arthroplasties. We are evaluating 710 patients to determine which comorbid conditions are risk factors of pain and poor functional recovery after total hip and knee arthroplasty. This work is supported by the Alberta Innovates Health Solution and the University of Alberta Hospital Foundation.
     

Projects Completed in the last Five Years

  • Ceramic on Ceramic (CoC) Bearing versus Ceramic on Crossfire® Highly Cross-Linked Polyethylene (CoP) Bearing in Primary Total Hip Arthroplasty: A Randomized Controlled Trial. (2014)  This trial compared functional outcomes and implant longevity between subjects who received either the CoC or CoP bearing surface at 5 and 10 years postoperatively.  All subjects were 60 years old or younger on entrance to the trial.  We found no group differences in function or longevity related to bearing surfaces at 5 or 10 years postoperatively.  This work was supported by the Edmonton Orthopaedic Research Committee.The 5-year results are published in the Journal of Arthroplasty and the 10-year results are currently in analysis. 
  • A Randomized Clinical Trial of Posterior Cruciate Stabilizing (PCS) versus Posterior Cruciate Retaining (PCR) Prostheses in Primary Total Knee Arthroplasty (TKA) (2014).  This trial compared functional outcomes and implant longevity between subjects who received either a PCS or PCR TKA at 2 and 10 years postoperatively.  We found no group differences in function or longevity related to implant design at 2 or 10 years postoperatively.  This work was supported by the Edmonton Orthopaedic Research Committee.The 2-year results are published in the Journal of Bone and Joint Surgery (American) and the 10-year results are currently in analysis.
  • Impact of Total Knee Arthroplasty (TKA) on Bone Mineral Density (BMD). (2013). We examined the changes in hip and spine BMD over the first year after primary TKA in 100 subjects (67 females; 33 males). We found that hip BMD changed more than that expected with age over the first year, particularly in older men and younger women.  The study was supported by the University Hospital Foundation and Alberta Arthroplasty Research Group.  This work is in press at the Journal of Arthroplasty.
  • A randomized controlled trial comparing patellar retention versus patellar resurfacing in primary total knee arthroplasty (TKA): 10 year follow-up (2011).  We compared knee-specific outcomes (stiffness, pain, function) and re-operation rates between patellar retention and patellar resurfacing up to 10 years after primary TKA.  We found no differences in knee-specific results between groups 10 years postoperatively. The patellar retention group had revisions due to anterior knee pain that were similar to existing literature.  This work was funded by Smith and Nephews Richards and was published in BMC Research Notes. 
  • A Pilot Study of the Effect of Exercise and Gait Re-Education on Functional Outcomes following Total Hip Arthroplasty (THA) in Patients Less than 65 Years of Age (2010).  This randomized pilot study explored the feasibility of comprehensive postoperative rehabilitation compared to usual care following primary THA in subjects <65 years, including the selection of appropriate outcome measures and timing of assessments.  Our recommendations were that performance-based strength measures should be considered for the primary outcome in this younger cohort and a minimum one-year follow-up as strength improved after four months in both groups.  This work was supported by the Royal Alexandra Hospital Foundation and was published in BMC-MSK Disorders.
  • Femoral Block in Total Knee Arthroplasty (TKA): A Pilot Study. (2010).  We compared Pre-emptive Multi-Modal Analgesia (PMMA) without Femoral Nerve Blocks (FNB)  to PMMA including FNB following TKA.  Both groups achieved satisfactory analgesia, but the FNB group was more likely to experience a quadriceps motor block that hindered rehabilitation.  This work was supported by the Edmonton Civic Employees (ECE) Charitable Foundation and was published in BMC-MSK Disorders.