Current Research

2003 2004
JR Giffin, Guyatt G, Walter S; Jackowski D.

Prospective Randomized Trial of the Effect of Surgical Intervention on Patient's Ability to Recall Preoperative Quality of Life. Funded by The Lawson Research Institute

For the purposes of conducting clinical trials, physicians often assess pre-treatment health status to illustrate similarity between groups before treatment begins, to adjust for differences between groups before treatment began, and to increase the power of the analysis. However, often times, physicians are not able to fully assess a patient's eligibility for study participation before surgical evaluation and preoperative data is collected for patients who have the potential to be disqualified following surgical evaluation. This trial will address two primary objectives. The first is to evaluate a patient's ability to recall their pre-operative quality of life. If patients are able to recall their pre-surgical quality of life reliably, then this data can be collected retrospectively following surgical determination of patient eligibility thus improving the use of research resources and reducing patient burden. Second, this trial will determine whether using a pre-operative assessment to calculate a change score will increase or decrease the power of the analysis evaluating the difference between treatment groups.

2003 2008
TB Birmingham. P.J. Fowler, B Litchfield, JR Giffin, B Chesworth, TR Jenkyn, D Jackowski

Medial Opening Wedge High Tibial Osteotomy for the Treatment of Knee Osteoarthritis: Evaluation of Dynamic Joint Loads and Health-Related Quality of Life. Funded by Canadian Institutes of Health Research Industry Partnership Programme in Partnership with Arthrex Inc.

Knee joint osteoarthritis (OA) is now recognized as an extremely common, disabling, and costly disease. Increased awareness of the impact of knee OA has provided strong impetus for the advancement of treatments that prevent the progression of the disease. This is a prospective cohort study evaluating the effect of a new orthopaedic surgical procedure that is designed to decrease the load on the medial compartment of the knee, delay disease progression and improve quality of life. One hundred and twenty patients will receive a medial opening wedge High Tibial Osteotomy, and will be evaluated before and periodically for two years after surgery. Assessments will include self-reported health-related quality of life, radiographs and sophisticated applied biomechanical assessments of gait.

2003 2006
Johnson JA, Chess DG, Dunning CE, Giffin JR, King GJW

Development of Computer Assisted Methods for Shoulder, Elbow and Knee Reconstruction. An NSERC Collaborative Health Research Project

2003 2006
Jenkyn T, Giffin JR

Abnormal Weight-bearing Arthrokinematics and Osteoarthritis. Funded by the Canada Foundation for Innovation and The Ontario Innovation Trust

The new Fluoroscopic Biomechanics lab combines three state-of-the-art technologies of 1) real-time motion analysis (which measures external joint motion) and 2) x-ray fluoroscopic radio-stereometric analysis (which measures internal bone motion) with 3) a novel treadmill capable of measuring biomechanical forces. This facility enables the most accurate measurement, to date, of the 3D articular joint motion that occurs during weight-bearing activities such as walking and running. This will greatly advance the understanding of the forces at work within human joints during ?real-life' conditions and how such forces are altered by osteoarthritis, traumatic injury, surgery and rehabilitation. The long-term goal is improved surgical and rehabilitation techniques for treatment of arthritis and sport injuries.

2001 2004
P.J. Fowler, B. Feagin, M. Eliaziw, A. Amendola, R. Litchfield, J. Pope, J. Kramer

Surgical vs Non- Surgical Treatment for Osteoarthritis of the Knee. Funded By the Medical Research Council of Canada

Osteoarthritis of the knee is a painful, progressive disease. Treatment is directed at the control of pain and improvement of function. Many patients are controlled with analgesics, non-steroidal anti-inflammatory drugs, and physiotherapy. Arthroscopic surgery of the knee has been utilized since the 1930's although the effectiveness has not been rigorously evaluated in patients with this disease. To determine if the surgery provides any additional benefit above and beyond that of the best, feasible, non-surgical treatment, we have designed a clinical trial. In this study 160 patients with osteoarthritis of the knee will be randomized to receive either arthroscopic surgery or non-surgical treatment. The surgical group will also participate in the non-surgical treatment which will include health education, physiotherapy and medication for pain. Patients entered into this study will be followed for 2 years. They will be assessed on function, pain and quality of life. As well, the economic implications of the diagnosis and treatment of knee osteoarthritis will be addressed by performing a cost effectiveness analysis.

2001 2004
R. Litchfield

Cemented versus uncemented fixation of humeral components in total shoulder arthroplasty for the treatment of osteoarthritis of the shoulder. Multi ? centre study funded by the Canadian Institutes of Health Research Industry Partnership Programme in Partnership with Zimmer Canada

A prospective, randomized double blinded clinical trial comparing cemented versus uncemented/tissue-ingrowth fixation of the humeral componet in total shoulder arthroplasty . Our outcome measures include: disease specific quality of life assessment, global health status, shoulder function, radiographic evaluation of the component fixation, operative time, complications and revision surgery. The target population is men and women, of all ages with a diagnosis of primary osteoarthritis of the shoulder who present to an orthopaedic surgeon and have failed medical management.

2003 2005
R. Litchfield, D. Drosdewech, K. Faber

A randomized clinical trial comparing the effectiveness of subacromial decompression to subacromial bursectomy for rotator cuff tendinosis.
Funded by The Lawson Research Institute

The most commonly performed surgical procedure to treat rotator cuff tendinosis, when no full-thickness tear exists, is a subacromial decompression (acromioplasty). This procedure is based on the theory that primary acromial morphology is the initiating factor leading to the dysfunction and eventual tearing of the rotator cuff. Several studies have indicated that the vast majority of partial-thickness tears are found on the articular surface of the rotator cuff which is not in keeping with the theory that rotator cuff impingement is primarily a result of acromion morphology. Arthroscopic bursectomy with debridement of rotator cuff tears alone, without acromioplasty, addresses the primary anatomical pathology and may offer similar success rates to subacromial decompression, without the risk of future instability caused by resection of the acromion and release of the coracoacromial ligament.

Our hypothesis is that an arthroscopic subacromial decompression provides no clinically significant benefit as evaluated with disease specific quality of life measures over an arthroscopic subacromial bursectomy for patients with rotator cuff tendinosis. This is a double-blind randomized clinical trial of a 114 patients, with rotator cuff tendinosis, who will be randomized to undergo either arthroscopic subacromial decompression (acromioplasty) or arthroscopic subacromial bursectomy (no acromioplasty). The Western Ontario Rotator Cuff Index (WORC) is the primary outcome measure. Follow-up evaluations will take place at 6 weeks, 3, 6, 12, 18 and 24 months post-surgery.

2003 2005
R. Litchfield, D. Whelan, D. Sackett, J. Koval

A Randomized Evaluation of Immobilization in External Rotation for the Management of Acute Anterior Dislocations of the Shoulder. Funded by Physician Services Incorporated Foundation

Traditionally, the conservative management of traumatic anterior shoulder dislocations involves joint immobilization using a traditional shoulder sling (adduction and internal rotation). Although methods of surgical stabilization exist, conservative methods eliminate the complications and cost associated with surgical procedures. In light of recent scientific data, it has proposed that immobilizing the arm in a position of external rotation (and adduction), rather then internal rotation, will expedite and facilitate the healing of intra-capsular structures. This study evaluates both shoulder function and the incidence of recurrent shoulder dislocations in ?first time dislocators.? Participants are randomly assigned to 4 weeks of immobilization treatment using an external rotation brace or a traditional sling.