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Arthroplasty Research at Concordia adopts a national strategy for ambitious research projects

A 2.5-year bilateral knee study to develop guidelines on whether to operate on one or two knees at the same time.

Another study at Concordia’s Orthopaedic Innovation Centre aims to assess CT scans’ benefits when monitoring the slightest microscopic movement in a joint implant.

These are just some of the exciting projects underway or being planned under the auspices of the Concordia Arthroplasty Research Chair that promise continuous improvements that may well contribute to the invaluable gift of movement for well over 2,000 hip and knee patients at the Concordia Hospital alone – in addition to others in operating rooms across Canada and beyond once data is ultimately collated and shared.

Trevor Gascoyne explains the priorities for 2023-2025

Research at Concordia’s hip and knee institute, which opened in 2009, is guided by Dr. Thomas Turgeon, arthroplasty research chair, and also includes participation by doctors David Hedden, Eric Bohm, Colin Burnell, Bryan Flynn, Jhase Sniderman (Concordia Joint Replacement Group); research staff including engineers; administrators and other key health care professionals.

Together, they conduct a variety of projects in two distinct categories: clinical research, like those mentioned above, and projects conducted by engineers who conduct research on medical devices that want to improve their joint implants, among other engineering investigations.

Trevor Gascoyne, president and CEO of the Orthopaedic Innovation Centre, an engineer himself, notes that the strong focus on continuous improvement and patient safety has resulted in new medical knees that now last up to 25 years, more than double those of past years.

Still, another far-reaching project is planned to create a first-in-Canada orthopedic analytic hub (national database on why joints fail) at the Concordia Hip and Knee Institute research centre near the Concordia Hospital.

Implant migration study – benefits of CT scan

This is to assess the benefits of CT scans when used to monitor the critical questions of if and how much a joint has moved.

Dr. Righolt points out, “One way to ensure patient safety is to make sure the implants don’t move less than the width of a hair in the first few years after surgery.”

As incredible as the statement may sound, both the CEO and clinical director agree that most implants function efficiently for years without movement. However, there could be undocumented benefits to using a CT scan.

“Currently, we study this using a dual stereo x-ray system (radiostereometric analysis), and we have a dedicated set-up to do this,” he adds. However, “a CT may give us a better 3-D view of the joint, and there would not be a specialized surgical set-up needed.”

Use of CT scans could result in cost savings in equipment, time efficiencies, and potentially spark related studies and permit the OIC to help other medical centres.

“Other centres can perform the CT imaging for the surgeries, but the specialty is going to be in how they analyze the results,” adds Trevor.

“Building that knowledge and capacity here means we can help Toronto with their analysis; we can help Vancouver, because they are now able to send us the scans, and we can do the analysis and provide the data for them.”

First in Canada – national database – a future project

The researchers refer to the database they are in the process of setting up as a “national orthopedic analytic hub.” “The centre will analyze data across Canada on failed joints, (OIC does this now but on a local basis). But it will provide analysis that could lead to other beneficial outcomes,” says Dr. Righolt.

“It’s not unlike our own clinical data,” adds Trevor. “But we could ask far greater questions, possibly leading to beneficial surgical techniques. The difference is the order of magnitude.”

The ambitious project could also eventually help surgeons and researchers across the country understand the design details of the implant, the manufacturer, and, most importantly, patient satisfaction with the medical implant.

With vision and resolve, the promising projects will put Concordia proudly at the forefront of patient-centred care, and Manitobans stand to be among the first to benefit.

Bilateral knee study led by Dr. Eric Bohm

Trevor explains that Dr. Bohm’s study is centred on the question of: “What do I tell patients who ask if they should get one knee done or should I get both done at the same time? If both knees require surgery, he was unsure how to respond because there was no data to explain if function was better if they were done at the same time.”

Other considerations are whether a patient has family support and what efficiencies could be realized for use of facilities and for the patients themselves with bilateral operations. Patient safety is always foremost, and by getting both knees done simultaneously, patients won’t struggle deciding whether to proceed with the second knee.

“When you stage the operations, you may choose not to do a second surgery,” adds Dr. Christian Righolt, director of clinical research. “We have a lot of interest because patients world-wide have the same concerns.”