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ABJHI STUDY EXAMINES SAFETY AND EFFECTIVENESS OF HIP RESURFACING

Alberta Bone and Joint Health Institute (ABJHI) is managing a long-term study comparing the safety and effectiveness of metal-on-metal (MOM) hip resurfacing with that of primary total hip replacement in young and middle-age adults who are active.

Despite growing worldwide use, there is little reliable evidence on the risks and benefits of MOM resurfacing. The study being managed by ABJHI, called Alberta Hip Improvement Project (Alberta HIP), is examining rates of implant failure and the effects of metal particles released as the MOM implant surfaces wear from contact.

Alberta HIP began in 2004 and more than 1,200 patients are participating. They are being followed for 10 years after their surgery.

Click here to read the report on Alberta HIP, based on data from 2004 to 2009.

Click here to read the abridged version of the report on Alberta HIP on Alberta HIP.

Click here to read the summary report for patients participating in Alberta HIP.

In Brief

ABJHI conducting one of the world’s largest studies of metal-on-metal hip resurfacing.

      • Evaluating patient safety and device effectiveness.
      • Examining rates of device failure, metal particles in the blood, pain reduction, return of normal function.
      • Cost-effectiveness model being developed.
      • More than 1,000 Albertans being followed for 10 years after surgery.
      • Interim results released in scientific reports and research paper.

RESEARCHERS DEVELOPING TOOL TO SIMULATE, OBSERVE IMPACT OF CHANGES ON HEALTH CARE FOR OSTEOARTHRITIS

ABJHI is working with a research team at the McCaig Institute that is developing the world’s first automated tool for predicting how the health care system would be affected as resources or practices are altered.

The tool will enable service planners, care providers and policy makers to simulate changes and immediately observe their impact on the effectiveness and efficiency of health care service.

This automated capability is unavailable anywhere else. It will help planners select highly effective and appropriate approaches for resolving or managing challenges in the health system, such as lengthy waiting times, bed shortages, staffing constraints and reduced operating room availability.

Using the tool, changes could be made to a wide range of variables, including services and resources. For example, users could input a change in the number of surgical facilities or operating room hours and immediately see the impact on patient outcomes, cost, waiting times and other important aspects of health system performance.

This capability can be used to guide decisions on how to deploy resources to achieve performance targets and relieve service bottlenecks. It can also be used to predict the impact on services when resources are diverted to other areas of health care because of sudden health threats such as a pandemic.

Click to view presentation – Decision Support Tool for Delivery of Health Services to Hip and Knee Osteoarthritis Patients.

In Brief

The world’s first automated tool for predicting health care performance in response to changes in resources or practices.

      • Simulate changes and observe their impact on health care service.
      • Used to select best approaches for managing challenges – long waits, bed shortages, staff constraints, etc.
      • Will guide decisions on how to deploy resources to achieve performance targets and relieve service bottlenecks.
      • Also a tool for measuring and evaluating health system performance.
      • Prototype could be built should funding be available.

RESEARCH TEAM DESIGNING OPTIMAL CENTRALIZED INTAKE FOR ALBERTANS WITH ARTHRITIS

A research team is designing the optimal centralized intake system for arthritis sufferers in Alberta. The intake system is being designed to refer and triage Albertans with osteoarthritis and rheumatoid arthritis. The researchers’ goal is to increase rates of early diagnosis by reducing the waiting time for consultation, and to improve disease control by getting patients into treatment more quickly.

ABJHI is managing the data for the research, which is funded by a grant from the Partnership for Research and Innovation in the Health System. The work involves nearly 40 researchers led by Dr. Deborah Marshall, ABJHI’s Director of Health Technology Assessment and the Canada Research Chair of Health Services and Systems Research, and by Dr. Linda Woodhouse, who holds the David Magee Endowed Chair in Musculoskeletal Health and is the President of the Canadian Physiotherapy Association.

The project will be completed in three phases ending in December 2016. In the first phase, researchers will set out performance objectives for better access to care and patient outcomes, and will develop a framework for measuring the new system’s performance. In the second phase, researchers will examine different centralized intake systems to identify the features that best support the objectives they set. The final phase will involve implementing and evaluating the new system.

RESEARCH ‘DREAM TEAM’ TAKES FOUR-PILLAR APPROACH TO OSTEOARTHRITIS PREVENTION AND TREATMENT

ABJHI is acquiring and managing data for an Alberta team conducting world-leading research into osteoarthritis (OA), one of the fastest growing chronic diseases in developed countries.

The Alberta Osteoarthritis Team is using an integrated, four-pillar research plan aimed at pinpointing the risks and causes of OA, preventing OA in at-risk populations, and developing novel therapies and better health services for OA patients. ABJHI is acquiring and storing data for the research and providing it to team members in a ready-to-apply format.

The Alberta Osteoarthritis Team, known as the “dream team” in osteoarthritis research, comprises about three dozen researchers who have been brought together to form an interdisciplinary team. They include scientists, orthopaedic surgeons, rehabilitation specialists and health care design experts from the University of Calgary’s McCaig Institute for Bone and Joint Health and from the University of Alberta.

The work is funded by a grant from Alberta Innovates – Health Solutions.

Leading the research in each of the four pillars are:

      • Improving health services: Tom Noseworthy and Deborah Marshall.
      • Developing novel therapies: Walter Maksymowych.
      • Identifying risks and causes: David Hart, Marvin Fritzler, Walter Herzog and Jeff Dunn.
      • Prevention in at-risk population: Lauren Beaupré and Carol Emery.

RESEARCHERS DEVELOP WORLD’S FIRST EARLY DETECTION TEST FOR OSTEOARTHRITIS

A McCaig Institute research team has developed the world’s first test to detect osteoarthritis (OA) before the onset of pain and impaired mobility in the joints – the usual but late triggers for diagnosis.

The researchers have developed a way to identify early markers for OA through a blood test or by examining a small sample of the synovial fluid from a person’s joint. It is the first method of its kind in the world and was developed by a team led by Marvin Fritzler, Roman Krawetz and Bryan Heard. Their research is part of the working being done by the Alberta Osteoarthritis Team to identify risks and causes of OA.

There is no cure for OA but the ability to detect the disease early offers opportunity to impede its progress. An article on the research has been published in the Journal of Rheumatology.

COST-EFFECTIVENESS AND SAFETY OF BEARING SURFACES FOR RESURFACING AND CONVENTIONAL TOTAL HIP REPLACEMENT

Principal Investigator: Dr. Jason Werle

Funding: Alberta Arthroplasty Research Group

The bearing surfaces study examines the long-term safety and compares the cost-effectiveness of metal-on-metal hip resurfacing and conventional hip bearing surfaces.

Resurfacing involves reshaping the damaged head of the femur, or thighbone, and capping it with metal while also removing damaged areas of the socket and relining it with a metal cup, creating metal-on-metal contact.

Conventional hip replacement devices require removing the femur head and part of the neck and resurfacing the socket with a liner. Different ball and socket surface combinations are used, such as metal-on-polyethylene, ceramic-on-ceramic and ceramic-on-polyethylene are used.

As part of the study, researchers are developing a decision analytic model that synthesizes information and compares the effectiveness and cost-effectiveness of the different devices evaluated.

HIP AND KNEE REPLACEMENT PILOT ONE OF NORTH AMERICA’S LARGEST HEALTH SERVICE STUDIES

The Alberta Hip and Knee Replacement Pilot was one of the biggest health service delivery studies ever undertaken in North America. Managed by ABJHI, it tested the performance of an integrated care path featuring multidisciplinary team care, case managers and specialized hip and knee clinics for patients.

The pilot was conducted as a randomized, controlled study over a 12-month period ending in April 2006. It involved 1,125 patients streamed randomly into a study group that received care under the new care path, and 513 streamed randomly into a control group that received conventional care.

Results proved the new care path superior to conventional care. It is now the standard of care for hip and knee replacement patients in Alberta and has helped shape care in other parts of Canada.

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