Clinical Outcomes

A successful orthopaedic intervention restores function and alleviates pain for the patient. All of our subspecialties within Lawson Orthopaedics are actively evaluating the latest interventions, surgical procedures and implants to ensure patients with have an optimal outcome.

The Clinical Research Laboratory at the Roth|McFarlane Hand and Upper Limb Centre (HULC), located at St. Joseph’s Hospital, produces high quality research on measuring, predicting and reducing upper extremity disability with a focus on surgery and rehabilitation. At University Hospital’s Joint Replacement Institute, 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 on by news outlets around the world.

Joint Biomechanics

Joints are made to move, and being able to provide 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 subjects, 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.

The Bioengineering Laboratory at the HULC is focused on a wide range of studies, such as joint kinematics, fracture and implant fixation, implant development, and tendon biomechanics. Investigators have made many significant contributions to the study of the shoulder, elbow and wrist, including the development of novel mechanical simulators that enable realistic laboratory evaluations of joint kinematics and the effects of various interventions.

Implant Development

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

Many Lawson 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 Surgical Mechatronics Laboratory is a new facility at HULC with specialization in computer-navigation and robotics for surgical applications, and biomechanical transducer design for orthopaedic surgery.

The first 3D metal printer located within a North American medical school is located at the Facility for Biomedical Device Design and Fabrication at the Robarts Research Institute, 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.

Imaging

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 are also involved with developing 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. Lawson researchers are members of the Canadian RSA Network, formed to enable multi-centre clinical trials of new implants evaluated using RSA. The Preclinical Imaging Research Centre at Robarts houses North America’s largest collection of micro-CT scanners, providing high-resolution imaging for animal studies and biomechanical testing.

Our group has 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 3,000 failed hip, knee, and shoulder implants explanted 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.

Training and Education

Research opportunities in these areas for undergraduate, graduate, and postdoctoral trainees are through the Collaborative Training Program in Musculoskeletal Health Research, and for clinical residents and fellows through the MSc in Surgery program.