TJA Projects

Current Projects

  • Journey TKA RCT (2019-Present)
    Gait following TKA may be affected by the type of knee prosthesis utilized. The primary objective of this randomized, comparative trial is to demonstrate that total knee arthroplasty (TKA) performed using medial pivot TKA is superior to standard TKA prostheses in terms of knee biomechanics (knee kinematics and kinetics) and spatio-temporal gait parameters at 1-year post-TKA using the Computer-Assisted Rehabilitation Environment (CAREN). Edmonton has 1 of 3 CAREN that can assess gait on variable terrain. We are evaluating gait parameters for level treadmill walking as well as for treadmill walking with various slopes (inclines, declines, and cross-slopes). We can also perform simple functional tasks (e.g., sit to stand) with the treadmill stationary. This study is funded by Smith and Nephew Inc.
  • Decreasing OR Traffic in Total Joint Arthroplasty: An Analysis of an Educational Intervention for OR Staff (2018-Present)
    This study proposes that an educational intervention for OR personnel will reduce the number of door openings. The educational intervention will include presentations on the association between door openings and risk for increased postoperative infections, patient experience with PJI as well as door signs and new processes to enhance communications. OR door openings will be assessed in a blinded fashion before and after the intervention period using data capture door modules. This study is funded by the Covenant Health.
  • Cementless Versus Cemented Total Knee Arthroplasty in High Demand Patients: A Retrospective Review (2018-Present)
    Cemented TKA have become the usual standard of care; however recent advancements in prosthetic design, instrumentation and operative technique support the use of cementless TKA with a press-fit tibial component as they appear to survive longer than cemented TKA. This is a retrospective review of patients who have undergone press-fit TKA to determine clinical outcomes after TKA such as survivorship, aseptic loosening, pain, revision surgery (if applicable), and post-operative complications within 1 year of surgery. We will also examine the association with characteristics of patients who are receiving press-fit TKA to determine eligibility for a planned randomized trial comparing clinical and radiographic outcomes in young, high demand patients who receive either a cemented or press-fit TKA.
  • 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 funded through a Glenrose Rehabilitation Hospital Foundation Research grant.

 

Projects Completed in the last Five Years 

  • Impact of Steroid Injection in the Hip on Development of Avascular Necrosis (2018-2021)
    This study investigated the incidence of AVN following hip cortisone injections using population-based administrative health data. Radiographic images were examined for arthritis stage before injection and presence of AVN after injection for those diagnosed with AVN or who undergo THA.
  • COACH Study (2016-2020)
    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 assessed 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 wore an activity monitor so both the patient and physiotherapist could monitor activity, informing goal-setting and action planning. Patients were interviewed before and after the intervention. We  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 (2018)
    Smoking is associated with adverse outcomes following arthroplasty surgery, including prosthesis failure, wound infection and death. Our goal was to design, operationalize and evaluate a sustainable and transferable pre-arthroplasty tobacco cessation intervention that could be integrated into a high volume central intake clinic. This study was 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 (2017)
    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. This work was supported by the Alberta Innovates Health Solutions.
  • Pre-operative Exercise for total knee arthroplasty (PREP Study) (2017)
    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 was supported by Alberta Innovates Health Solutions and Canada Institutes of Health Research.
  • Comorbidity and TJA (2017)
    Co-existing medical conditions have detrimental effects on pain and functional recovery after joint arthroplasties. We evaluated patients to determine which comorbid conditions were risk factors of pain and poor functional recovery after total hip and knee arthroplasty. These data have been analyzed and manuscripts are under review. This work was supported by the Alberta Innovates Health Solution and the University of Alberta Hospital Foundation.