Wetenschapsstages Orthopedie

1. Analysis of hip stems with roentgen stereophotogrammetry

 

Achtergrond

Stability of an implant is achieved during surgery (primary stability) and will increase afterwards (secondary stability). Aseptic mechanical loosening is the major factor for prosthesis failure. This loosening starts with progressive migration of 0.2 - 1.0 mm of the prosthesis. Early migration can be detected accurately with RSA making evaluation of new prosthesis design or different fixation techniques is possible in small patient groups. Publications have shown that the 2-year migration results have a predictive value for early prosthesis failure. Tantalum markers inserted in the bone during surgery form a rigid body that serves as the reference to which the migration of the prosthesis is calculated. Two roentgen images are made simultaneously while the patient is positioned over a calibration box. The calibration box defines the 3D position of the roentgen sources and it calibrates the entire setup.

Model-based RSA software detects marker projections and prosthesis contours automatically. When several follow-up moments are analyzed, the migration of the prosthesis with respect to the bone can be calculated with sub-millimeter accuracy.

 

Doel

Ad 1. Is the Taperloc BoneMaster coated prosthesis comparable with the standard porous coated Taperloc in terms of migration and rotation measured with RSA (roentgen stereophotogrammetry analysis) in a population with an age below 65 years.

Ad 2. Is the Taperloc BoneMaster coated prosthesis comparable with the standard porous coated Taperloc in terms of migration and rotation measured with RSA (roentgen stereophotogrammetry analysis) in a population of 66-75 years.

Ad 3. Is the Taperloc BoneMaster coated prosthesis comparable with a cemented Taperloc stem in terms of migration and rotation measured with RSA (roentgen stereophotogrammetry analysis) in a population of 66-75 years.

Ad 4. Is the GTS prosthesis comparable with the Taperloc prosthesis in terms of migration and rotation measured with RSA (roentgen stereophotogrammetry analysis).

 

Methode

Two prospective studies with a follow-up of at least 5 years. Follow-up moments are preoperative, direct postoperative, 6 weeks, 3 months, 6 months, 1 year, 2 year and 5 years. During these FU moments the following information is collected: Harris Hip Score, HOOS, SF-12, VAS pain and disability questionnaires and RSA radiographs are taken. RSA radiographs have to be analysed with RSA software. Data analysis regarding mirgration have to be performed and correlated with the subjective and clinician based outcomes collected during the study period. Multivariate analysis will be performed.

 

Plaats

Afdeling Orthopedie, HMC locatie Westeinde

 

Duur

vanaf 14 weken, onderzoek wordt opgesplitst in delen om haalbaarheid te bewaken. Maximaal 3 FU momenten per student worden uitgewerkt.

 

Begeleider

S.B. Keizer, orthopedisch chirurg, B.J.W. Thomassen, onderzoekscoordinator/ epidemioloog

 

 
2. Treatment of early arthrosis in the knee joint because of meniscal problems

 

Achtergrond

The knee menisci have numerous critical functions within the knee, including equalizing incongruence of the articular surfaces of the femur and tibia, distributing load over a larger area of the tibia, shock absorbing, joint stabilization and distributing lubrication fluid between the femur and tibial articulating surfaces. Several different options have been evaluated as potential meniscus replacements. The use of prosthetic replacement is limited due to the unique and extremely complex biomechanical and biochemical properties of normal meniscus tissue; no artificial material with meniscus like properties is currently available.

 

Doel

Ad 1. What is the survival rate of open meniscal transplantation in our cohort with a mean follow-up of 15-20 years?

Ad 2. What is the clinical follow-up of meniscal transplantations in terms of bone density and radiological activity?

 

Methode

Ad 1. Cohort (observational research) of open meniscal transplantations. The event failure is defined as re-operation of meniscal injury and/or other surgical interventions of the affected knee. These failure rates will be compared with earlier failure rates (publication 2007 Am J Sports Med) and clinical outcomes measured with KOOS, Tegner, Lysholm questionnaires.

Ad 2. Prospective cohort with a follow-up of at least 2 years. At the different follow-up moments additional diagnostics were performed (DEXA, skeletscintigraphy) which have to be analysed. The DEXA has to be evaluated on the regions of interest (ROI). Comparison of the clinical outcome with the results of additional diagnostics.

 

Plaats

HMC locatie Westeinde

 

Duur

Divers

 

Begeleider

Dr. E.R.A. van Arkel, Orthopedisch Chirurg / B.J.W. Thomassen, onderzoekscoordinator

 

 

3. Betrouwbaarheid incidentiecijfers van PREZIES infectie data en de complicatieregistratie

 

Achtergrond

Het RIVM volgt via het PREZIES-netwerk de surveillance uit over zorginfecties. Voor de orthopedie zitten hier de postoperatieve wondinfecties in van prothesiologiepatiënten. Binnen de afdeling Orthopedie wordt er gewerkt met een algemene complicatieregistratie bij orthopedische patiënten. De PREZIES-data worden aangeleverd vanuit de ingediende kweken op de afdeling Microbiologie. Samenvoeging van  de verschillende databases en aanvullen met andere variabelen die landelijk vanuit de wetenschappelijke vereniging vereist zijn om te komen tot een landelijke database en informatie over de prothesiologiepatiënten.

 

Doel

Ad 1. Het verzamelen van gegevens en het aanvullen van eerder verzamelde gegevens m.b.t. prothesiologische infecties. Wat is de incidentie van postoperatieve wondinfecties aan de hand van de twee verschillende databases?

Ad 2. Wat zegt de huidige literatuur over behandeling van infecties bij prothesiologie en wat heeft de voorkeur en moet daarop het huidige protocol aangepast worden?

 

Methode

Ad 1. Retrospectief onderzoek naar de complicaties geregistreerd vanaf 2011 in het complicatiesysteem van de orthopedie en deze vergelijken met de data die aangeleverd zijn aan PREZIES (landelijke postoperatieve wondinfectieregistratie). Combineren van deze data in een nieuw landelijk opgezette database naar infecties bij prothesiologie.

Ad 2. Review van de literatuur en eventueel opstellen c.q. aanpassen van het protocol

 

Plaats

Afdeling Orthopedie, MCH Westeinde

 

Duur

Vanaf 14 weken

 

Begeleider

S.B. Keizer, orthopedisch chirurg, B.J.W. Thomassen, onderzoekscoördinator/epidemioloog

 

 

4. Evaluation of blood transfusion percentages in total joint arthroplasty

 

Achtergrond

In 2013 as a result of a PhD traject our hospital changed their blood management practice according to the results of the studies. We would like to compare the last two years of our cohort joint arthroplasties with the two years before de-implementation of some blood saving techniques. Has our policy change led to a better (superior) quality of care in terms of blood transfusion figures, complications and length of hospital stay

Doel: Are the transfusion figures of our population joint arthroplasty patients comparable over the period 2010-2012 and 2013-2014

Are the complication rates of our population joint arthroplasty patients comparable over the period 2010-2012 and 2013-2014

Is the length of hospital stay of our population joint arthroplasty patients comparable over the period 2010-2012 and 2013-2014

 

Methode

All blood transfusion figures and complications will be collected in this retrospective cohort of joint arthroplasty patients. Students will retrospectively collect all data and perform analysis.

Better / Superior is defined as lower or equal transfusion percentages, less complications and lower length of hospital stay.

 

Plaats

Afdeling Orthopedie, HMC locatie Westeinde

 

Duur

vanaf 14 weken

 

Begeleider

S.B. Keizer, orthopedisch chirurg, B.J.W. Thomassen, onderzoekscoordinator/ epidemioloog

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