Musculoskeletal Research

Transcription

1 Musculoskeletal Research Kuopio Musculoskeletal Research Unit (KMRU), University of Eastern Finland & Department of Orthopaedics, Traumatology and Hand Surgery, Kuopio University Hospital Prof. Heikki Kröger

2 Kuopio Musculoskeletal Research Research Continuum Bone and Cartilage Basic Research Applied Research Instrumentation Clinical Research Clinical Medicine Surgery /Orthopaedics/ KMRU Profs. H. Kröger, A.Joukainen and docent J.Sirola Clinical research, imaging, epidemiology, histomorphometry Osteoporosis/Osteoarthritis (OA) Physical Medicine and Rehabilitation Docent J. Arokoski Physical function and rehabil. in knee and hip OA Medical Physics Profs R. Korhonen, J. Töyräs and J.Jurvelin Biophysics of bone and cartilage Imaging Biomechanics Prof. P. Karjalainen Gait analysis Epidemiology UEF Spearhead project consortium covering two faculties Musculoskeletal Research is one of the UEF strong research areas

3 Kuopio Musculoskeletal Research Unit (KMRU) Mediteknia Epidemiological studies (OSTPRE study) Bone histomorphometry laboratory Bone Densitometry laboratory (DXA, pqct, QUS) Randomised controlled trials RCT (KFPS, Phase II-III drug trials)

4 Department of Orthopaedics, Traumatology and Handsurgery Clinical RCTs Recruitment and follow-up of clinical patient materials Testing of novel instruments, implants Bone/cartilage samples Excellent radiological facilities in the hospital

5 Kuopio Musculoskeletal Research Unit (KMRU)- Main Research Lines I OSTPRE study - population based 25 yr follow up OP study (n=14 400) with sarcopenia, national registers and bone-brain-atherosclerosis substudies II Bone Quality characterization of bone specimens using sophisticated techniques III Improved Diagnostics development of new techniques for diagnostics of OP and OA, eg. intra-artic. ultrasound, cone-beam CT, spin-off companies IV Physical function, gait and rehabilitation in OA RCTs in knee and hip OA, bariatric surgery-induced weight loss V RCTs in clinical orthopaedics national multicenter RCT trials

6 optical density absorption unit orientation angle [ ] Biophysics of Bone and Cartilage Group (BBC) Main Research Lines I Development of novel diagnostic methods (US, MRI, CT, optical, mechanical) for osteoarthritis and osteoporosis II Development of microscopic and spectroscopic techniques for evaluation of cartilage and bone Proteoglycan content Collagen content surface 90 Collagen orientation surface 10 5 III Biomechanics of soft tissues, hard tissues and cells Imaging (MRI, CT) (joint geometry, tissue properties) 0 DD Computational Fig. 4. Huttu models et al. FTIR 0 PLM IV Computational modeling, functional imaging Motion analysis (kinetic/kinematic parameters) Intact menisci joint Meniscectomy Analysis of stress, strain, tissue adaptation

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8 Simple, clinical functional tests predict fracture risk and mortality Rikkonen et al. ASBMR2014

9 Can falls be prevented? Strength and balance exercises, including Taiji, have proved to be effective in the prevention of falls in small/medium sized trials Knowledge on the effect and cost-effectiveness of community based fall prevention with exercise is missing! Kuopio Fall Prevention Study (KFPS) was launched to estimate the effect of exercise in prevention of falls and promotion of wellbeing in elderly women (74-83 years, n=1078) in co-operation with the municipality of Kuopio The city provides free facilities, including weights room and a gymnastic hall for Taiji sessions.

10 Kuopio Fall Prevention Study KFPS is a 2-year randomized controlled trial, started in March 2016, to study the effect of excercise (gym + taji) on falls, fractures and subjective wellbeing Target population: women aged yrs living in Kuopio City (n = 1078, exercise group control group 539). Supervised exercise twice a week for 6 months (1 h Gym + 1 h Taji) + 6 months unsupervised Control group will get similar fall prevention information, but no supervised exercise Study visits: baseline, 12 months, 24 months Falls will be recorded by SMS messages and fall/exercise diary

11 Kuopio Fall Prevention Study Work packages and outcomes

12 The OSTPRE study has contributed in many ways to clinical practice in Finland and internationally >130 full papers, 12 PhD theses Validation and development of FRAX Finland Osteoporosis Guidelines in Finland (2014) Meta-analyses, textbook chapters

13 Bone Quality -project Bone strength depend not only on bone mass but also: Microarchitecture Mineralization Bone material properties Collagen, mineral Bone turnover Microcracks Human bone samples (hip, calcaneus, patella, tibia, iliac crest ) n = 100 (18-80+yr) Bone material characteristics are assessed by histomorphometry, micro-ct, acoustic microscope, nanointendation and IR/Raman spectroscopy

14 Quantitative Bone Histomorphometry Osteoclast Osteoblast Tetracycline double label Kröger

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16 Bindex Measures cortical bone thickness at the tibial and radius shaft and gives an estimate from proximal femur BMD (Density Index, DI) When used with FRAX, only 30 % of subjects will need axial DXA measurement, compared with the standard protocol (69 vs. 244 /448) Karjalainen et al. Osteoporos Int 2012 Karjalainen et al. Osteoporosis Int (submitted)

17 Intra-articular ultrasound for cartilage diagnostics Quantitative cartilage and subchondral bone assessment Cartilage thickness, roughness, material quality

18 Clinical Research projects (2016) Department of Orthopaedics, Traumatology and Hand Surgery Hip fracture study (clinical and registers) PERIPROT-project (bone loss after TJA) Spine projects (LSS, USS) PAH study (early knee OA) Obesity and TKA -study Shoulder projects (RC-RCT studies) Degenerative menisci study (FIDELITY) Bioactive glass in hand surgery Hallux valgus study (RCT) TWINHIP study Achilles rupture study Knee osteotomy study (OHTO) Epidemiology of periprosthetic fractures Diagnostics of TJA infection Life quality after TJA Randomized national hip and knee arthroplasty studies

19 Musculoskeletal Research Translational research area (basic research, clinical research, epidemiology and register studies) Research focuses on age-related public health problems Strengths: Large, long-term prospective population-base cohort and National register data Innovative physics research group Academic orthopaedic department (KUH)