Orthopaedics

Why do revision knees replacements fail?

Supervisor

Simon Young
Mark Zhu

Discipline

Orthopaedics

Project code: MHS033

Revision knee arthroplasty is a challenging procedure, and risk factors for failure have not been clarified. This study aims to identify patient and surgical factors that affect subsequent re-revision rates and functional outcome scores following revision total knee arthroplasty (TKA).

Using identifiers from the New Zealand Joint Registry, this study will involve gathering data from patient electronic notes to determine the failure mechanisms of revisions TKAs. The student will need to liaise with statisticians and must have basic Excel skills.

Important skills - academic writing, data extraction and analysis.
Skills taught - clinical orthopaedic knowledge, opportunities to attend theatre lists and clinics.

The goal of this studentship is to prepare and finalize an article for a high quality, peer reviewed international journal. A highly motivated student is required.

Anterior cruciate ligament reconstruction in New Zealand - what factors are associated with treatment success?

Supervisor

Simon Young
Mark Zhu

Discipline

Orthopaedics

Project code: MHS034

Anterior cruciate ligament (ACL) rupture is a common injury, with a reported incidence of 1/3000 – 1/3500 people per year. Functional instability following ACL rupture commonly requires ligament reconstruction.
In October 2013 at the annual meeting of the Knee and Sports Society, the Knee Society made a decision to establish an ACL registry in New Zealand.

The ACL registry has now been collecting data for five years. The registry prospectively collects data on each patient treated. This includes preoperative demographic and outcome scores, with follow-up scores being measured at 6 months, 1, 2 and 5 years postoperatively. Intraoperative data regarding the cartilage condition in the joint and any meniscal injuries and how they were treated is recorded. Graft size and type, together with the surgical technique of tunnel drilling and the fixation implants is obtained.

The purpose of this studentship is to analyze NZ Registry data, with the goal of publishing 3-4 peer-reviewed journal articles during the year. This will enable careful analysis of each of the underlying variables and their contribution to the success or failure of ACL reconstruction surgery.

Projects will include

1) Practice patterns in graft choice in New Zealand
2) Impact of patient and surgical factors on patient reported outcomes
3) Impact of patient and surgical factors of revision and re-injury rates in New Zealand

The successful applicant will learn research methods including protocol development, literature review, ethical application, data analysis and statistical methods, and manuscript preparation and submission. The position will be based in Auckland, at north shore hospital. This project has the possibility of continuing on to a BMedSci honours project.

Revision arthroplasty for prosthetic joint infection - is one stage better than two stages?

Supervisor

Jacob Munro
Mark Zhu

Discipline

Orthopaedics and Surgery

Project code: MHS184

Prosthetic joint infection is a devastating complication following joint replacement. A two stage revision procedure involves the total removal of all implants, followed by an insertion of a spacer and reimplantation of metalware after 6-12 weeks. This process causes significant patient morbidity.

One stage revisions have been proposed in recent times in an effort to improve patient mobility and outcomes. This study will compare the success rate of one stage vs two stage revisions performed at ADHB over the last 10 years. We will identify factors associated with treatment success and will establish guidelines on when one stage revision should be performed.

Skills required - strong academic writing skills, competency with Excel, basic statistical knowledge.

The student will work closely with clinicians to improve their understanding of a difficult orthopaedic problem, they will be expected to drive and deliver a finished article for publication in a international journal. Data analysis and research design will be taught by the supervisors.

Clarifying the histopathological features of hip abductor tendon tears.

Supervisor

Mark Zhu
Jacob Munro
David Musson

Discipline

Orthopaedics and Surgery

Project code: MHS186

The gluteus medius and minimus muscles are often referred to as the hip abductors. They are crucial in maintaining pelvic stability and are essential for normal gait. Tears of these two tendons have been increasingly recognised as a cause for chronic hip dysfunction and pain, particularly in older adults. However, the predominant pattern of disease and the histological basis underlying the tears have not been clarified. This study aims to describe the macroscopic and histological changes in hip abductor tendon tears.

Using obtained samples from 36 cadavers, this project will be perform histological analysis of both the distal tendon and the bone/tendon junction using transmitted and polarized light. We aim identify key morphological differences between the anterior, middle and posterior sections of the gluteus medius and minimus insertions. Through this, we hope to identify the underlying mechanism of disease.

An interest in histology is required, the successful student will drive the project to completion, with the goal of publishing in a high quality international journal.