Flinders Medical Centre Foundation
Flinders Medical Centre Foundation


Bone & Joint


World First Robot Makes No Bones About Orthopaedic Research

Seeking Solutions for Scleroderma


High Tech help For Joint Replacement

New Research To Soothe Sore Joints

Improving Longer Term Outcomes For Joint Replacement Patients

Better Outcomes for Joint Replacement Surgery

Researchers Revolutionise the Treatment of Rheumathoid Arthritis

Digital Images Give Vital Insights Into Bone Implants 

Scleroderma - Unlocking The Mystery


World First Robot Makes No Bones About Orthopaedic Research
First Published: ENews - February 2011

Flinders research into bone and joint problems has been boosted by the development of a new robot, which is the most advanced of its type in the world.

Developed by a team including researchers from the Flinders Medical Devices and Technologies - Biomechanics and Implants group, based at Flinders University, and The University of Adelaide, the new hexapod robot can simulate people walking, bending, twisting and lifting and undertaking repetitive motions.

Two years in the making, the hexapod robot uses technology similar to three-dimensional 'virtual' rides at theme parks and in flight simulators (although more advanced) to subject the spines and joints of individuals who have donated their bodies to science to repetitive forces.

'By simulating the motion of a joint we are able to understand how that joint might fail, and therefore provide information that will allow the design and manufacture of better joint replacements, and more accurate information for computer simulation models of joint function and implant performance,' Flinders Biomechanical Engineer and project leader Dr John Costi, said.

It will also help researchers test the manufactured joint's ability to withstand wear and tear.

'We will be able to test materials in a very advanced way, twisting, pulling and pushing with up to two tonnes of force, with a very high precision of less than one tenth the width of a human hair,' Dr Costi said.

Dr Costi will use the robot to continue research into strains in spinal discs that may be a cause of 'slipped discs' and lower back pain.

Lower back pain affects approximately 70 percent of the adult population at some stage during their lives and in Australia, back problems are the most frequently seen musculoskeletal condition in general practice, and the third most common long-term health condition.

Dr Costi plans to subject spinal discs to thousands of stress cycles in different movement combinations. He will analyse the way in which they fail in the hope of providing improved manual handling guidelines in the workplace, and strategies to reduce the risk of damaging our discs during everyday activities.


Seeking Solutions for Scleroderma
First Published: ENews - February 2010


February is national Scleroderma month, and as home to Australia’s only population-based register of scleroderma sufferers Flinders is at the forefront of research which is helping patients with this rare disease live longer.


About 25 South Australians are diagnosed each year with scleroderma, a disorder which causes damage to and loss of the capillaries which deliver oxygen to the skin. This leads to hardening skin, ulcerations over joints and impaired mobility.


Scleroderma’s most serious form can also severely shorten the sufferer’s life by causing fibrosis (thickening of the tissue) of the internal organs.


Established in 1993 by Professor Peter Roberts-Thomson and his team in the Department of Immunology, Allergy and Arthritis, the South Australian Scleroderma Register tracks the prevalence and incidence of the disease in South Australia.


Recently, the database has been expanded to include autoantibodies (specific blood markers) for scleroderma and survival data. Clinicians can now use this information to determine the type of scleroderma the patient has, prognosis, and how best to proceed with treatment.


“Patients are now living longer because of better management,” Prof Roberts-Thomson said.


Prof Roberts-Thomson and his team hope to determine the cause of the disease and whether its progress can be halted by looking at the capillaries which are damaged in its early stages.


Honours student Karen Patterson is using video imaging of the blood vessels at the base of the fingernail (one of the first places to show signs of damage) to track the changes that occur over time.

It is hoped the project will lead to a better understanding of the pathological processes that cause the loss of capillaries.

“If we could understand why the blood vessels are being damaged we could hopefully interfere with that process and block it,” Prof Roberts-Thomson said.


First Published: Southern Adelaide Health Service News - June 2009


Scleroderma literally means ‘hard skin’ and is a disease of the body’s connective tissue. It is thought to be an example of an auto-immune disorder where the body’s immune system starts to attack the body.


Professor Peter Roberts-Thomson, Clinical Director of Immunology for SA Pathology and Bachelor of Science Honours student Karen Patterson discuss the disease and their latest research.


What is scleroderma?

Scleroderma (also called Systemic Sclerosis) is a disease of the body’s connective tissue. The human body is held together by meshes of connective tissue. These ‘nets’ consist of a strong, fibrous collagen, stretchy elastin and a substance called proteoglycan. People who develop scleroderma overproduce collagen, which can result in the connective tissue and skin becoming hard and tight. Scleroderma can affect just the skin, or more seriously, internal organs including the heart, lungs and kidneys.


How common is it?

Up to one in 5,000 Australians may have one of the different forms of scleroderma. It is more common in people aged between 20 and 50 and affects women more than men.


What causes scleroderma?

The cause of scleroderma is unknown. However, the strongest risk factor is a family history of scleroderma but other risk factors are believed to include occupational exposure to silica dust (which is commonly seen with miners) and chemicals like polyvinyl chloride (PVC).


How do you know if you have it?

One of the most common symptoms of scleroderma is thickening and hardening of the skin, often on the hands and face. Other symptoms can include:


  • fingers and toes going white, blue and then red in response to cold and heat (a condition called Raynaud's phenomenon)
  • pain, stiffness, and swelling of fingers and joints
  • tight mask-like skin on the face, and shiny skin on the arms
  • ulcers on fingertips or toes
  • heartburn
  • shortness of breath
  • fatigue

Are there different types of Scleroderma?

Yes. Scleroderma is broadly classified according to the amount of skin and internal organs affected by the condition – limited scleroderma and diffuse scleroderma. The latter is a more serious form of the disorder as there is more extensive skin involvement and the internal organs are more severely affected.


How can it be treated?

There is currently no cure for scleroderma but it is possible to successfully manage many of the symptoms of the disease. A number of clinical trials are currently underway involving exciting new drugs but it will 1-2 years before the results are made public (as scleroderma is an uncommon disease and it takes time to recruit sufficient patients for these trials).


How is scleroderma diagnosed?

Scleroderma is diagnosed using a range of medical tests including history and physical examinations, blood tests including a test for autoantibodies (antinuclear antibodies or ANA) and tissue biopsies.


How is scleroderma managed?

Managing the disease depends on its severity, but may include medications such as immunosupressives, lifestyle changes, gentle exercise, stress management and various aids and equipment.


Is there any new research in the area?

Flinders is at the forefront of research into scleroderma. Over the last 15 years Prof Roberts-Thomson and his team have established the South Australian Scleroderma Register which attempts to identify every new patient in SA with this condition. From analysing data common to each patient it has been found that the important risk factors for this disease in SA include a positive family history, being female and being born in Europe (as compared with being born in Australia).

Investigations have also focussed on the specific auto-antibodies in the blood characterising this condition and their help in making an early diagnosis and their prediction for future disease outcome.

Damage to small blood vessels is an early and prominent feature in scleroderma. For her BSc (Hons) Karen Patterson is investigating this vascular damage at the base of the finger nail (nail fold capillaroscopy) using video-microscopy (combining a microscope with a computer) and investigating factors which may accelerate or inhibit this damage.

Such studies are increasing our understanding of the basic pathology of this disease and may help us develop specific tests for early diagnosis and for medication which may inhibit this vascular damage.


High Tech Help For Joint Replacements
First Published: Investigator - September 2008
Updated: World First Robot Makes No Bones About Orthopaedic Research

A high-tech hexapod robot will be built at Repatriation General Hospital to support research into orthopaedic conditions.


The robot is the first of its type in Australia and is believed to be the most advanced of its type in the world.


The robot will be used to study complex joint motions in three dimensions. It will simulate people walking, bending, twisting and lifting to help researchers design and manufacture improved joint replacements.


Biomechanical Engineer Dr John Costi will use the robot to continue his research into strains in vertebral discs that may be a cause of ‘slipped discs’ and lower back pain.


Lower back pain affects approximately 70 percent of the adult population at some stage during their life.


The robot will measure the complex biomechanical properties of biological tissues, bones, artificial joints and other medical and surgical devices.


Initially, the robot will test the impact of repetitive motion on the spine and vertebral discs, followed by research on hips, knees, shoulders and wrists.


John plans to test vertebral discs on thousands of stress cycles in different movement combinations. He will analyse the way in which they fail in the hope of providing improved manual handling guidelines in the workplace.


"We will be able to test materials in a very advanced way, twisting, pulling and pushing with up to two tonnes of force," he said.

"By simulating the motion of a joint we are able to understand how that joint might fail, and therefore provide information that will allow the design and manufacture of better joint replacements."

Construction of the robot is underway and will be completed within the next 12 months with Richard Stanley from RGH Orthopaedics, in collaboration with Associate Professor Ben Cazzolato from the School of Mechanical Engineering, The University of Adelaide. The technology being used is similar to that used in three-dimensional virtual rides at theme parks and in flight simulators, although it is more advanced.

The $100,000 construction is being funded by a $30,000 grant from Foundation Daw Park, the State Government and orthopaedic research funds.


New Research To Soothe Sore Joints
First Published: Investigator - August 2008

Despite osteoarthritis being the leading cause of joint replacement and the most common form of arthritis world-wide, very little is known about the mechanisms which lead to this degenerative condition.

Flinders researchers are hoping to change this with a study into the effects of treating the inflammation of osteoarthritis at the very early stages of the disease.

Professor Malcolm Smith, Senior Consultant at the Rheumatology Unit at the Repatriation General Hospital, and Professor Peter Roberts-Thomson, Head of Immunology at Flinders Medical Centre, are looking at whether corticosteroid injections can help the inflammatory changes which take place in the joint in the early stages of osteoarthritis, and whether this can lead to clinical improvement.

Osteoarthritis is a progressive disorder of the joints caused by gradual deterioration of cartilage that results in the painful development of bony spurs and cysts, particularly in weight-bearing joints such as the knees and hips.

Rather than focusing on the cause of osteoarthritis, current treatments concentrate on the symptoms, namely the pain, which is managed with pain relievers or anti-inflammatory treatments or, in later stages of the disease, joint replacement.

“At the moment treatment is limited, and patients are basically waiting for their joint to fail and have it replaced,” Professor Smith said.

Professors Smith and Roberts-Thomson hope that if they can prove that the chronic inflammation in the early stages of osteoarthritis can be reduced, progression to late stage disease requiring joint replacement surgery can be prevented.

“If we can demonstrate that the inflammation that is low grade, but known to occur in osteoarthritis, is relevant to the disease progression we can change the treatment to target inflammation rather than just treating the symptoms, which would prevent the gradual damage which is occurring to the joint,” Professor Smith said.


Improving Longer Term Outcomes For Joint Replacement Patients
First Published: Investigator - August 2006


Each year between 400 and 450 people face the prospect of joint replacement surgery largely due to the damage caused by arthritis. While many of this group are over 70 years old, around 30-40% are younger.


It is people in this younger group who face a higher risk of needing further joint replacement surgery due to the first replacement joint wearing out. Current statistics indicate that between 95-98% of hip and knee replacements last in excess of 15 years in people 65 and above, however for those in the 50-65 year age group the replacements only last around 10 years.


For Professor Jegan Krishnan and his team of researchers at Flinders Medical Centre the focus is on introducing new materials that will help to reduce wear and subsequent need for further surgery.


“The problem we have is that each time a person needs to replace the worn out artificial joint, the procedure is more complex and the loss of bone stock generally means that the joint will not last that long again – only half the time,” says Professor Krishnan.


Currently most common joints are made out of plastic and metal. However, the plastic tends to wear and the debri from this can lead to an inflammatory response in the joint causing it to become loose.


Professor Krishnan and the team are trialling a number of surfaces including metal on metal, ceramic on plastic and a new surface called oxonium with the aim of reducing wear and helping to ensure that the implants will last longer.


To aid their research they are using a technique called Radio Stereometric Analysis (RSA). This involves placing radiographic markers in and around the implant and by measuring the relative movement between these markers they can predict how long these implants are going to last. The benefit of this technique is that it can show within 18 months to two years whether the new surfaces are going to be significantly beneficial to the patient.


“Rather than wait 15 years to introduce a new material with this technique we can work out if it is safe or as safe as previously used devices and whether it is going to be a better long term outcome for patients,” says Professor Krishnan.


Better Outcomes for Joint Replacement Surgery
First Published: Investigator - August 2004

The effect on the brain following joint replacement surgery will be the focus of a research study at Flinders in the coming months.


Previous studies from the USA have shown that patients who have undergone knee and hip replacements can experience micro-embolic material (numerous tiny particles of fat) lodging in the brain following surgery. This can cause marginal changes in a patient's brain function therefore effecting their recovery time.


What researchers want to know is who is at risk of this embolic phenomenon and how their outcome, following surgery, can be improved.


Working alongside Neuropsychologist Dr Anthony Kneebone, Professor Jegan Krishnan from the Department of Orthopaedic Surgery will look at 60 patients over a six-month period.


Patients will be examined the day before surgery and then three days after while still in hospital. If there are changes, this is the time they will be most marked. Patients will then be examined again six months later.


"We want to be able to measure and record changes that will allow us to identify the characteristics of those who would suffer this problem," said Professor Krishnan.


"We will look at pharmacological drugs to see if we can firstly, alter the risk, and secondly maybe vary treatment for those patients who develop this embolic occurrence."


Once assessment tools have been developed, doctors are hoping to be able to use these procedures on patients who are on the waiting list and possibly improve their outcome.


This study has been made possible through a research grant from the FMC Foundation and Professor Krishnan hopes the study will be completed by the end of the year.


Researchers Revolutionise The Treatment Of Rheumathoid Arthritis
First Published: Investigator - August 2003


After ten years of international collaboration, Flinders researchers have helped to develop a new therapy for the treatment for rheumatoid arthritis - a debilitating disease that effects 2% of the population.


Designed for chronic sufferers, this new therapy is hoped to revolutionise the treatment of rheumatoid arthritis by inhibiting the production of the chemical substances in the body which cause this disease.


Enbrel, has been released onto the PBS Scheme but due to the high cost ($25,000) will only be administered by rheumatologists to patients who meet the very strict criteria and there are long term side effects.


Unfortunately it isn't the cure but is a major improvement of what is currently available to chronic sufferers of rheumatoid arthritis.


Further to this breakthrough, Flinders investigators continue to work on early diagnosis and pain management of rheumatoid arthritis to help slow the progression of the disease. The FMC Arthritis Tissue Bank, established in 1996 by Dr Malcolm Smith, provides a rich resource for researchers wanting to understand the impact of existing and new drug therapies.


"If we can identify early that a treatment is not working and therefore change the treatment, it will spare the patient great discomfort," said Dr Smith.


"At present our research efforts are establishing whether taking a biopsy before someone starts treatment will direct what their outcome will be or, alternatively, by taking the biopsy during treatment we can determine whether the treatment is working or not, and if so change the therapy. Ultimately, we want to avoid treating people unnecessarily," he said.


Rheumatoid arthritis is the commonest form of inflammatory arthritis in the western world effecting most small joints in the body. There is no cure, but the work of Dr Malcolm Smith is a positive step toward the pain management and slowing the progression of this devastating disease.


Digital Images Give Vital Insights Into Bone Implants
First Published: Investigator - May 2003


A new revolutionary technique known as Radiostereometric Analysis (RSA), that enables better assessment of orthopaedic implants, has been introduced to Flinders Medical Centre.


Flinders Associate Professor of Orthopaedic Research, Dr John Field brought the program to Adelaide after attending an extensive training course in Sweden, where the technique was founded, making Adelaide a leader in this type of research within Australia.


RSA is a computer imaging program that enables scientists to obtain accurate position information in three-dimensions of orthopaedic implants which enable them to track any changes, (for example; wear and tear or movement) that may occur to the implant.


During surgery tiny radio-opaque markers are placed into the bone at several different points as well as markers already placed onto the implant. Directly after surgery, a digital image is obtained of the implant accurately pin-pointing the positions of the markers on the implant and in the bone. Images are subsequently taken at 3 months, 6 months and a year after surgery so that a comparison can be made to see the progress of the implant. This invaluable imaging technique provides insights into the strengths and weaknesses of orthopaedic implants and will enable better construction and implanting techniques for the future.


Dr Field said that this technique is a remarkable break-through for the orthopaedic world and will allow scientists to discover problems with implants before they appear obvious within the patient.


The RSA program has been in Adelaide only 6 months, but is already proving beneficial. The RSA program has been so successful that an upgraded version has recently been released in Sweden and Dr Field is hoping to see this program become part of everyday life for orthopaedic practice throughout Australia.


For further inquiries or information please contact Dr John Field at the Repatriation General Hospital on 8275 1042 or lantbruks@bigpond.com


Scleroderma - Unlocking The Mystery
First Published: Investigator - January 2003
Updated: Seeking Solutions for Scleroderma

Scleroderma is an uncommon immune disorder where the skin becomes hard and thickened and the patient literally becomes entrapped in their own skin. The sufferer's life is frequently shortened due to the thickening or fibrotic process also impairing internal organs.


South Australia has one of the highest scleroderma prevalence figures in the world with around 350 sufferers registered. The usual age of onset is between 40 and 60 years.


Unfortunately the cause of scleroderma is unknown and there is no specific treatment.


At Flinders Medical Centre, Professor Peter Roberts-Thomson and his team in the Department of Immunology, Allergy and Arthritis are investigating the reasons behind why the body turns against itself and produces hardened skin with distressing joint contractures.


They have recently completed an epidemiological study into the genetic component of the disease to ascertain whether sclerodema can be inherited. The study showed that the disease is more common in immigrants born in Europe (particularly Greece and Italy) as well as people that may have been exposed to silica dust. However there is not enough evidence to show that any particular job is more likely to cause the disease.


However the study has been unable to explain why the disease is also more prevalent in women than men with a ratio of 4:1.


In addition to using the epidemiological study, the team is also researching the disease on a micro-vascular level. A microscopic examination of the skin's blood vessels, will then be carefully examined to hopefully determine how they are being damaged.


Professor Roberts-Thomson said that the establishment of a South Australian register for scleroderma sufferers has had many benefits for the advancement of knowledge about the disease.


"Having a register allows continuous in-depth research work as well as the trial of new therapies in controlled studies. Because of this, we have been able to recently study a new treatment called anti-endothelin which neutralises one of the substances released from the small blood vessels. In time we hope to be able to unlock the mystery surrounding this disease and offer some form of life-saving treatment for its sufferers."

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