Collaborative Orthopaedic Research (CORe)

TJA Projects

Current Projects

  • Impact of Obesity on Gait Biomechanics after Total Knee Arthroplasty (TKA+Gait Study) (2017-Present)  Quantitative gait analysis has shown altered gait biomechanics between individuals with 1) obesity compared to those of normal weight; and 2) TKA compared to those without TKA. But, there is a paucity of research on the effect of obesity on knee biomechanics following TKA, particularly in patients living with Class II obesity (BMI 35.00-39.99 kg/m2). It is unclear how TKA biomechanics, especially in patients with obesity, affect walking during the post-acute recovery phase, including walking over uneven terrain encountered in the community. If knee biomechanics are negatively affected by obesity in dynamic walking conditions such as walking in the community, this may reduce physical activity levels post-TKA in those who would most benefit from increased activity. This work is currently funded through a Glenrose Rehabilitation Hospital Foundation Research grant.
  • Operating Room Traffic in Periprosthetic Total Joint Arthroplasty Infection (2015-Present)  Periprosthetic joint infection is a devastating complication of an otherwise highly successfully operation. Operating room sterility is key in the prevention of postoperative joint infection. Our study aims to describe patterns of door opening during total joint procedures, and to identify a possible association between the number and duration of door openings and the incidence of PJI in the 90 day post-operative period.
  • COACH Study (2016-Present)  Physical activity is a treatment goal for patients with total joint arthroplasty (TJA). Although improvements in pain and disability are achieved, minimal gains in physical activity occur. We will assess the feasibility of a physiotherapist-led telephone-based coaching intervention to promote physical activity in 80 older patients with TKA who reside in rural Alberta. Over 3-months, patients will wear an activity monitor so both the patient and physiotherapist can monitor activity, informing goal-setting and action planning. Patients will be interviewed before and after the intervention. We have developed a practical intervention that expands physiotherapists’ role beyond the walls of the hospital/clinic to serve older adults in their local community. Enrollment commenced in 2017.This study was funded by the Network of Excellence in Senior’s Health and Wellness (Covenant Health).
  • 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.
 

Projects Completed in the last Five Years

  • 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 were 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 were modelled using a software program to determine if there is a critical ratio beyond which a different surgical reference point is required. These data are currently under analysis. This work was supported by the ECE Charitable Foundation.
  • 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(2005-2015) 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 evaluated health-related quality of life (HRQL) with the PROSTALAC in situ for infected total hip arthroplasty (THA), determined infection resolution, and compared subjects who underwent second stage surgery with those who retained the PROSTALAC on a longer term basis. Twenty-five of 29 (86%) subjects’ infections resolved. After PROSTALAC insertion, pain and function improved within 3–6 months and was retained at 24 months. 7/22 (32%) subjects underwent second stage surgery. They were higher physical demand subjects than those not undergoing second stage surgery. We found no difference in WOMAC scores at 24 months between those who underwent second stage surgery and those who retained the PROSTALAC. The PROSTALAC system for THA appears to allow acceptable HRQL while in situ for at least 2 years in low physical demand patients. Subjects with higher physical demand levels are more likely to undergo second stage surgery. This work was supported by an unrestricted research grant from DePuy INC and the Edmonton Orthopaedic Research Committee. These results have been published in the Journal of Orthopaedic Surgery.
  • 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 was supported by the Alberta Innovates Health Solution and the University of Alberta Hospital Foundation.
  • 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 and 10-year results were published in the Journal of Arthroplasty. 
  • 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 were published in the Journal of Bone and Joint Surgery (American) and the 10-year results were published in the Journal of Arthroplasty.
  • Impact of Total Knee Arthroplasty (TKA) on Bone Mineral Density (BMD)(2003) 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 was published in the Journal of Arthroplasty.