Orthopaedics  

Overview

Orthopaedics research at London Health Sciences Centre Research Institute (LHSCRI) aims to ensure that patients will receive the best possible care for musculoskeletal health disorders. We are an active group of surgeons, scientists and engineers that collaborate broadly, working closely with the Western Bone and Joint Institute

Research Groups

Our major areas of research interest include:

A successful orthopaedic intervention restores function and alleviates pain for the patient. We are actively evaluating the latest interventions, surgical procedures and implants to ensure patients with orthopaedic diseases have an optimal outcome. 

At LHSC’s University Hospital, a clinical database tracking all orthopaedic procedures provides an opportunity to evaluate the effectiveness and long-term success of various implant systems. 

An example of work in this area is a randomized controlled trial by investigators at the Fowler-Kennedy Sports Medicine Clinic that showed arthroscopic surgery for osteoarthritis of the knee had no additional benefit to optimized physical and medical therapy. The study, published in the New England Journal of Medicine, has changed clinical practice and was reported by news outlets around the world. 

Joints are made to move. Providing appropriate medical and surgical intervention requires an understanding of how joints function in normal and diseased conditions. Biomechanical testing involves both computational and laboratory testing of participants, devices and specimens to understand the mechanics and kinematics of joints. 

Surgeons and engineers at LHSC’s Victoria Hospital have utilized the tools at the Jack McBain Biomechanical Testing Lab to evaluate loading in the spine and the effects of trauma to the upper extremities. The Wolf Orthopaedic Biomechanics Laboratory (WOBL) at Fowler-Kennedy houses a state-of-the-art gait laboratory to evaluate the effects of physical therapy and surgery on the treatment of osteoarthritis, including high tibial osteotomy. WOBL houses both a traditional gait lab and a Motek GRAIL system, incorporating an instrumented dual-belt treadmill, 3D gait analysis system and virtual reality projection screen, enabling the next generation of gait evaluation.  

Millions of patients worldwide have benefitted from the development of artificial joints and fracture fixation devices. LHSCRI researchers are actively involved in the development of the next generation of these devices and surgical procedures. 

Many surgeon-scientists have collaborated with industry to develop new devices for replacement of the hip, knee, elbow and shoulder; arthroscopy; trauma; ACL repair; and more. 

The first 3D metal printer located within a North American medical school is located at the Facility for Biomedical Device Design and Fabrication at our partners at Robarts Research Institute at Western University, enabling our researchers to turn an idea into a physical reality in a short period of time. This includes patient-specific implants designed from a patient’s CT or MRI, and the design of new kinds of devices with complex internally porous structures that cannot be fabricated in any other manner. 

Ever since Roentgen discovered x-rays in 1895 and took the first ever radiograph (of his wife’s hand), medical imaging has been used to examine the musculoskeletal system. Our researchers not only use imaging to provide better diagnoses, evaluate different treatments, and understand bone and joint function, but they also develop future imaging technologies. 

Working in collaboration with the Biomedical Imaging Research Centre (BIRC), investigators have access to the latest 3T MRI, PET/MRI, and CT scanners. A single-plane x-ray fluoroscopy system and weight-bearing extremity CT scanner integrate with the gait analysis lab at WOBL. Canada’s first radiostereometric analysis (RSA) x-ray lab is used to study the fixation and wear of hip, knee and shoulder implants. LHSCRI researchers are also members of the Canadian RSA Network, formed to enable multi-centre clinical trials of new implants evaluated using RSA. Now researchers are performing CT-RSA with CT and weight-bearing CT scanners at the Centre for Translational Radiographic Imaging (CenTRI) at Robarts Research Institute at Western University. 

Our group has also developed a method to use micro-CT imaging to quantify wear and damage in orthopaedic implants. This technique has been used to study some of the over 5,000 failed hip, knee, and shoulder implants removed from patients and stored at the Implant Retrieval Laboratory at LHSC’s University Hospital. Surgeons and scientists from all over the world have sent implant specimens to be studied using micro-CT, such as implants undergoing mechanical wear testing from researchers and industry developing the next generation of implant materials.