Healio
Healio
Issue: Issue 3 2011
May 01, 2011
5 min read
Save

Aarhus University Hospital’s orthopaedic clinic a leader in Denmark

Issue: Issue 3 2011
Pioneer clinics

For the last 30 years, the orthopaedic department at Aarhus University Hospital has maintained a tradition of academic excellence in Denmark.

“It’s often considered the leading department in Denmark,” Peter Holmberg Jørgensen, MD, DMSc, consultant orthopaedic surgeon in the tumor section, told Orthopaedics Today Europe. “Many new achievements in orthopaedic surgery start here.”

That reputation extends internationally. On a trip to the Mayo Clinic about 12 years ago, Jørgensen met a researcher in the biomechanics department. When Jørgensen told the gentleman that he was from Aarhus, the man responded “Oh, that’s the Mayo Clinic of Europe.”

Three hospitals, one leader

The clinic started as three independent orthopaedic hospitals in Aarhus. At this time, all surgeons performed many procedures: a little hip, a little spine, a little foot, etc. Eventually, the departments merged once Aarhus University Hospital was established in 1990.

In its early days under the leadership of Eivind Thomasen, MD, only the second professor of orthopaedics in Denmark, the department became known for its surgical procedures. He introduced many surgical techniques, including total hip arthroplasty and wedge osteotomy, according to Cody Bünger, MD, DMSc, professor of experimental orthopaedics, spine.

“He was a really good carpenter,” Bünger told Orthopaedics Today Europe. “But he was not a big scientist.”

Things changed when Otto Sneppen, MD, DMSc, who became a professor in 1978, took over the leadership of the department. He focused on increasing the department’s reputation for research.

“Prof. Sneppen established a very lively academic milieu here,” Jørgensen said.

The other way Sneppen improved the department’s academic profile was to introduce the concept of subspecialization in 1993. Subspecialization is what sets this department apart.

“It was actually the subspecialization that made us,” Bünger said.

Orthopaedic Research Laboratory

Prof. Sneppen launched the Orthopaedic Research Laboratory in 1979. One part of the lab, called the Orthopaedic Surgical Research Group, is led by Kjeld Søballe, MD, who is professor of clinical orthopaedics and head of the hip unit. The group focuses on the etiology, prevention and treatment of joint and muscle disorders. To date, they have published approximately 240 papers. In 2010 alone, the group published 27 papers.

One of the group’s greatest successes has been the periacetabular osteotomy, also known as Ganz osteotomy, which Søballe introduced to Denmark in 1996. He has changed the procedure to a minimally invasive approach, which he performs through a 3-inch incision.

“It was a huge operation when I started,” Søballe said in an interview. “It was like a 5-hour procedure, but now I can do it in 1 hour.” Blood loss has decreased significantly as well, dropping from several liters to 200 mL to 300 mL.

Currently, the team is studying gene therapy. Although the long-term results are still unknown, early mice studies have been promising, he said.

“We were able to transform completely dead bone to living bone in a few weeks with gene therapy,” Søballe said.

Other current research includes a study on a new bone cement and a study comparing implant designs. Some team members are studying how to treat chronic infections with a one-stage revision rather than the traditional two-stage procedure. At 1 year, the 10 hips in the study have had no problems, Søballe said.

Orthopaedic spinal research

Spine unit researchers have always had “a profound interest in basic research,” said Bünger, who is president of SICOT. This basic research has allowed them to introduce new growth instrumentation for children with scoliosis and produce new coatings from carbon fiber. A recent multidisciplinary endeavor is the NanoScience Project, which is studying applied nanoscience into musculoskeletal regeneration.

“We’re in a new era with respect to controlling metabolic process, inflammatory processes,” Bünger said. “We can control them, not with traditional gene therapy, but with gene therapy using small interfering RNA, which is a totally new concept of controlling attachment of various cells.”

In the pediatric orthopaedic department, researchers are currently involved in several cerebral palsy protocols and studies on the growth plate, said Bjarne Møller-Madsen, Professor MD, DMSci.

Furthermore, research is underway on developmental dysplasia of the hip, a randomized study comparing two methods of knee deformity correction using partial epiphysiodesis and a study on using artificial bone grafting in calcaneal lengthening for severe flat foot, according to Ivan Hvid, MD, professor of pediatric orthopaedics.

In cooperation with the Center for Rare Diseases, Hvid said the pediatric department of orthopaedics at Aarhus University Hospital Skejby has established specialized outpatient clinics for patients with cerebral palsy, spina bifida, osteogenesis imperfecta and skeletal dysplasia. Other specialized clinics for patients with rare disorders, such as arthrogryposes multiplex congenita, are planned. The teams in these clinics include pediatric orthopaedic surgeons, a pediatric nurse and physiotherapists, Møller-Madsen said.

The Danish Hip Arthroplasty Register

The orthopaedic department at Aarhus University Hospital continues to distinguish itself by pursuing projects like patient registers and clinical databases.

The Danish Hip Arthroplasty Register, started by Ulf Lucht, MD, is probably the most prominent. Since 1995, researchers have prospectively collected data on 70,000 total hip arthroplasty and 10,000 revision patients from 52 orthopaedic departments across Denmark.

The Lumbar Spinal Fusion Database, started by Bünger and Chief Surgeon Finn Bjarke Christensen, MD, PhD, DMSc, began registering patients in January 1993. To date, the database includes more than 2,200 patients, with approximately 150 new patients registered annually. The researchers collect surgeon and patient data preoperatively, intraoperatively and at 1 and 2 years postoperatively.

In addition, the Orthopaedic Research Laboratory runs the TLIF database, which has been collecting data since 2003, and the anterior/posterior project, which began in 1996.

A new national database for sarcomas was recently established, said Jørgensen, who is leading that database. All sarcomas will be registered in one database as part of the Danish Multidisciplinary Cancer Groups. Researchers are currently preparing a report for the Danish government on the first 2 years of data.

These databases are important clinical tools, Bünger said. While randomized controlled trials are useful, they only provide some answers.

“You don’t get external validity,” he said. “You don’t get how the system works in real life – that you get from the database. You need to have the long-term effects and you get this information via the registries and the database.”

Ultimately, quality improves, Bünger said.

“The orthopaedic world needs better orthopaedic surgeons, not better concepts,” he said. “There must be perfection around the procedures and the selection criteria must be proven.”– by Colleen Owens

References:

  • Orthopaedic Surgical Research Group. www.orthoresearch.dk. Accessed April 21, 2011.
  • Orthopaedic Spinal Research. www.orf-aarhus.dk. Accessed April 21, 2011.
  • Danish Hip Arthroplasty Register. www.dhr.dk. Accessed April 21, 2011.