Orthopaedics: Barwon Centre for Orthopaedic Research and Education (B-CORE)

• Commenced the RAPSODI study – an international multi-site RCT comparing anatomical and reverse shoulder arthroplasty. Professor Richard Page is the Australian CIA for this NHMRC funding study
• Commenced the ARC study – a national multi-site RCT comparing shoulder arthroscopy with rotator cuff repair to arthroscopy without rotator cuff repair. BCORE is a lead partner for this trial
• Dr Stephen Gill completed a three-month academic study program, representing Deakin University in Europe and collaborating with leading musculoskeletal researchers at the University of Oxford, England and Hôpitaux Universitaires Genève, Switzerland

B-CORE is conducting a range of projects investigating the pathophysiology and post-operative outcomes of people undergoing shoulder surgery for adhesive capsulitis, shoulder instability, rotator cuff tear and osteoarthritis. The projects involve assessing biomarkers in tissue and blood samples, including gene expression analysis. Postoperative outcomes are also assessed via a range of patient reported outcome measures (PROMS). The projects represent an ideal example of benchtop to bedside research.

In conjunction with the Centre for Sport Research at the School of Exercise and Nutrition Sciences, Deakin University, B-CORE is also conducting a range of biomechanics studies which explore the effects of different surgical approaches on shoulder function, ranging from improving surgery for instability to the effects of shoulder replacement surgery (see bcore.deakin.edu.au/current-research/ for details).

Joint replacement surgery is one of the most common operations conducted throughout the world. Over 120,000 joint replacements occur in Australia each year.

The Barwon Joint Registry is a powerful research tool for evaluating the effects of joint replacement surgery conducted at Barwon Health and St John of God Hospital Geelong, and is one of Australia’s longest standing joint replacement registries. B-CORE manages the Registry, which contains over 5,000 people actively following joint replacements.

B-CORE researchers recently utilised Registry data to examine and compare outcomes of bilateral knee replacement techniques. Up to two thirds of people who require knee replacement surgery actually need both knees replaced at some stage in their lives. A common concern is whether same-day bilateral knee replacement surgery, in which two surgeons replace both knees simultaneously, or two separate staged knee replacement surgeries (each knee is replaced months apart) provides the best outcomes for patients.

Our study found that simultaneous bilateral knee replacements conducted at Barwon Health were comparatively safe, cost‐effective and improved pain and function at faster rates than staged knee replacements.

B-CORE also partners with the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) to conduct registry nested clinical trials and to investigate the effects of different surgical procedures. Examples include the CRISTAL study (Aspirin vs Heparin for prevention of deep vein thrombosis post joint replacement), DISTICT assessing total hip replacement surgery after hip fractures and PROMs studies assessing the outcomes and factors influencing joint replacement surgery.

B-CORE partnered with Deakin University and the AFL to conduct Australia’s largest study investigating female Aussie Rules players and the type of injuries they sustain when compared to males. This research has been disseminated widely via publications (x4), national and international conference presentations, and media outlet (Channel 7 news, national radio, print media).

The research team is now investigating the types and mechanisms of netball injuries. The results of the study will help community members understand the relative risks involved with playing netball and Australian football.

ARC Trial

The ARC Trial is a clinical trial that will compare arthroscopic shoulder surgery with the rotator cuff tear repaired to the same surgery but without repairing the rotator cuff. The research project is testing whether surgery to repair the tear is an effective treatment to improve shoulder pain and function and quality of life in people with rotator cuff tears. People aged between 45-75 years old who have been suffering from shoulder problems for the last six months and have been diagnosed as having a reparable rotator cuff tear, which was confirmed by an MRI imaging scan, are invited to participate.

RAPSODI Trial

Currently recruiting participants at St John of God Hospital Geelong and soon expanding to University Hospital Geelong, the RAPSODI-AUS study compares two common types of shoulder replacement: the Total Shoulder (Anatomic) replacement, and the Reverse Shoulder replacement. These are the two types of shoulder replacement that surgeons use very often for patients with osteoarthritis who need a shoulder replacement. They both help to reduce pain and maintain or improve movement. However, doctors don’t know yet which one works best. The aim of the study is to find this out.

Read more about frozen shoulder here: https://www.smh.com.au/lifestyle/health-and-wellness/that-sounds-a-bit-made-up-why-frozen-shoulder-is-real-and-painful-20230505-p5d5y0.html

Adhesive capsulitis (AC), also called frozen shoulder, causes pain and stiffness in the shoulder. Over time, the shoulder becomes very hard to move. AC affects up to 5% of the population, most commonly between the ages of 30 and 70, and occurs in women more often than men. It creates a high burden on individuals and the community, affecting employment, lifestyle, and care-giving.

While studies suggest that inflammation (the body’s natural response to infection, disease and tissue damage) is a major driver of AC, the cause of the disease is not well understood. As part of a program of work investigating gene expression in a range of shoulder and painful musculoskeletal conditions, B-CORE researchers at Barwon Health sought to learn more about the cause of adhesive capsulitis, to enable the development of better diagnostic tests and treatment strategies.

Our researchers analysed samples of shoulder capsule tissue collected from patients who underwent shoulder surgery to relieve AC, and compared them to the same type of tissue collected from patients who did not suffer from AC who underwent shoulder surgery.

The B-CORE team are extending their research into other conditions, with analysis of a cohort of patients with rotator cuff tears who have undergone surgery, and recruitment of patients with osteoarthritis of the shoulder who require shoulder replacement surgery currently underway.

Click here to read the full article.

Read more about shoulder pain here: https://researchoutreach.org/articles/new-approach-shoulder-pain/

B-CORE were proud to present at the 2019 Conference of the European Federation of National Associations of Orthopaedics and Traumatology. Our analysis of the outcomes of over 5000 patients who had received arthroplasty (replacement surgery) for shoulder fractures identified a significant difference in the need for revision surgery. Males experienced an 8% revision risk in the first month vs. 2% for females. To find out more, visit https://wordpress-ms.deakin.edu.au/bcore/wp-content/uploads/sites/133/2019/11/Arthroplasty-may-not-be-best-option-for-young-men-with-proximal-humeral-fractures.pdf

• A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan.  Andrew Lawson, Justine Naylor, Rachelle Buchbinder, Rebecca Ivers, Zsolt Balogh, Paul Smith, Rajat Mittal, Wei Xuan, Kirsten Howard, Arezoo Vafa, Piers Yates, Bertram Rieger, Geoff Smith, Ilia Elkinson, Woosung Kim, Jai Sungaran, Kim Latendresse, James Wong, Sameer Viswanathan, Keith Landale, Herwig Drobetz, Phong Tran, Richard Page, Raphael Hau, Jonathan Mulford, Ian Incoll, Michael Kale, Bernard Schick, Andrew Higgs, Andrew Oppy, Diana Perriman, Ian Harris. Trials 21 (1), 1-132020
• One-surgeon vs two-surgeon single-anesthetic bilateral total knee Arthroplasty: revision and mortality rates from the Australian Orthopaedic Association National Joint Replacement Registry. SD Gill, A Hatton, RN de Steiger, RS Page. The Journal of arthroplasty 35 (7), 1852-185612020
• Lifetime risk of primary shoulder arthroplasty from 2008‐2017: A population‐level analysis using national registry data. D Miura, L Busija, RS Page, R de Steiger, M Lorimer, IN Ackerman. Arthritis care & research2020
• Reverse total shoulder arthroplasty compared to stemmed hemiarthroplasty for proximal humeral fractures: a registry analysis of 5,946 patients. Owain Critchley, Andrew McLean, Richard Page, Fraser J Taylor, Stephen Graves, Michelle Lorimer, Yi Peng, Alesha Hatton, Gregory Bain. Journal of Shoulder and Elbow Surgery 2020
• The epidemiology of emergency presentations for falls from height across Western Victoria, Australia. KL Holloway-Kew, TR Baker, MA Sajjad, MA Kotowicz, PM Livingston, …Australasian emergency care 23 (2), 119-1252020
• Diaphyseal Screw Prominence in Distal Radius Volar Plating. K Eng, S Gil, R Page Journal of Wrist Surgery 9 (03), 214-218 2020
• Volar Scaphoid Plating for Nonunion: A Multicenter Case Series Study. K Eng, S Gill, S Hoy, V Shridar, N Van Zyl, R Page Journal of Wrist Surgery 9 (03), 225-229 2020
• Functional Dart-Throwing Motion: A Clinical Comparison of Four-Corner Fusion to Radioscapholunate Fusion Using Inertial Motion Capture. Sina Babazadeh, Ferraby Ling, Nhan B Nguyen, Trieu H Pham, Pubudu N Pathirana, Kevin Eng, Richard Page Journal of Wrist Surgery2020
• A New Method for Measuring Glenoid Version on Standard Magnetic Resonance Imaging. NJ Maister, A Hely, LG Twycross, SD Gill, RS Page. Journal of Shoulder and Elbow Arthroplasty 4, 24715492209268262020
• Simultaneous (two‐surgeon) versus staged bilateral knee arthroplasty: an observational study of intraoperative and post‐operative outcomes. Stephen D Gill, Leaha‐Marie Hill‐Buxton, Stella May Gwini, Stewart Morrison, Brett Moreira, Sally Beattie, Andrew Thomson, Richard S Page. ANZ Journal of Surgery 90 (5), 826-832 2020
• Transcriptomic analysis of adhesive capsulitis of the shoulder. N Kamal, SL McGee, K Eng, G Brown, S Beattie, F Collier, S Gill, RS Page Journal of Orthopaedic Research®2020
• Lifetime risk of primary shoulder arthroplasty over a decade: a population-level analysis. D Miura, L Busija, RS Page, R de Steiger, M Lorimer, IN Ackerman Osteoarthritis and Cartilage 28, S445 2020
• Discharge destination and patient‐reported outcomes after inpatient treatment for isolated lower limb fractures. Lara A Kimmel, Pamela M Simpson, Anne E Holland, Elton R Edwards, Peter A Cameron, Richard S de Steiger, Richard S Page, Raphael Hau, Andrew Bucknill, Jessica Kasza, Belinda J Gabbe Medical Journal of Australia 212 (6), 263-27012020
• Lower operating volume in shoulder arthroplasty is associated with increased revision rates in the early postoperative period: long-term analysis from the Australian Orthopaedic Association National Joint Replacement Registry. JS Brown, RJ Gordon, Y Peng, A Hatton, RS Page, KA Macgroarty. Journal of Shoulder and Elbow Surgery, 2020
• Simulating the impact of glenohumeral capsulorrhaphy on movement kinematics and muscle function in activities of daily living. AS Fox, SD Gill, J Bonacci, RS Page. bioRxiv, 2020

• Assessment of shoulder range of motion using a wireless inertial motion capture device – a validation study. Michael Rigoni, Stephen Gill, Sina Babazadeh, Osama Elsewaisy, Hugh Gillies, Nhan Nguyen, Pubudu Pathirana, Richard Page.(2019), Vol. 19, Sensors, Basel, Switzerland, C1
• Arthroscopic repair of HAGL lesions yields good clinical results, but may not allow return to former level of sport. U Schmiddem, A Watson, D Perriman, E Liodakis, R Page. Knee Surgery, Sports Traumatology, Arthroscopy, 1-8, 2019
• The Stiff Shoulder.RS Page, G Mitreski. Textbook of Shoulder Surgery, 173-193
• Adhesive capsulitis of the shoulder: protocol for the adhesive capsulitis biomarker (AdCaB) study. RS Page, SL McGee, K Eng, G Brown, S Beattie, F Collier, SD Gill. BMC Musculoskeletal Disorders 20 (1), 1452019
• Early revision in anatomic total shoulder arthroplasty in osteoarthritis: a cross-registry comparison. MT Dillon, RS Page, SE Graves, MF Lorimer, HA Prentice, JE Harris. Shoulder & Elbow, 17585732198421682019
• Patient‐centred care through a broader lens: Supporting patient autonomy alongside moral deliberation. SD Gill, G Fuscaldo, RS Page
• Using Patient-Reported Outcomes to Predict Revision Arthroplasty Following Femoral Neck Fracture: Enhancing the Value of Clinical Registries through Data Linkage. CLEkegren, R de Steiger, ER Edwards, RS Page, R Hau, S Liew, A Oppy. International Journal of Environmental Research and Public Health 16 (8), 1325