Research Capacity

Tomorrow's Treatment Begins with Today's Research

The Trauma and Orthopaedic Research Unit (TORU) is located within the Canberra Hospital. TORU was established by Associate Professor Paul Smith and Dr Damian McMahon with the mission to undertake innovative trauma, orthopaedic and related research in clinical and basic sciences in order to advance the body of knowledge and improve clinical outcomes of musculoskeletal diseases.
 

About TORU

TORU has a clinical arm and a laboratory arm. The clinical arm is based at TCH and involves clinicians, research staff and graduate and post-graduate students in a range of projects. The laboratory arm has research facilities at the John Curtin School of Medical Research at the Australian National University and at TCH. These two laboratories are able to provide the nexus between clinical and laboratory research work that is so critical to translational research.

TORU is also founded within the ANU Medical School. TORU accommodates several PhD and M.Phil students as well as medical students completing research projects. The leadership team of TORU are staff, clinical associates and adjunct staff of the ANU.

Recruitment of Volunteers for Studies and Clinical Trials

Staff and students of TORU are clinically skilled for recruiting and managing volunteers for clinical studies. High level communication skills, clinical experience and a strong human rights and compassion values are essential factors in the staff selection process.

Click on the links below to see information about our two research arms

TORU Laboratory Research

TORU Clinical Research

Laboratory Research

TORU Laboratory team bridges basic and clinical sciences and facilitates communication among TORU’s collaborative institutes, universities and orthopaedic industries.

TORU team presently investigates chronic and complex bone diseases, some of which cause life-long pain and disability. These chronic conditions can be rare, such as revision joint replacement and osteolysis or can be remarkably common, such as arthritis, trauma and osteoporotic fractures. Combined, they afflict millions of Australians and cause tremendous human suffering, and cost million dollars in health care.

The team utilizes a mix of conventional molecular biology approaches as well as global methods such as next generation sequencing to study mRNA expression and its regulation by non-coding RNA e.g. microRNAs with an ultimate goal of identifying novel molecules that regulate bone resorption, formation, fracture repair and bone homeostasis.

Key Research Areas

Osteoimmunology, microRNAs’ (miRNA) regulation and genetic risk factors in biomaterial related osteolysis in total joint replacement.

  • This research has in part supported by AOA Research Foundation. Building on the foundation laid by the dendritic cells involvement in osteolysis, the group is using off-cut tissues from the cohorts of healthy, primary and revision subjects of TJR for characterization of wear particles and identification of molecular and genetic risk factors that contribute to the osteolysis. The ultimate goals are to contribute to the development of better predictive markers, treatments, and prevention strategies.

The third generation of magnesium (Mg)-based biomaterial development

  • This area addresses a need for translational research to enhance treatment and improve management of bone diseases and disorders. To advance the understanding of interaction at the interface of biomaterials and biological systems, the team is studying biocompatibility, biodegradability and bioactivity on a series of magnesium (Mg)-based biomaterials either on controlling biodegradation or osteointegration.

Silico model of interplay and mechanism of human bone remodelling

  • Integrated molecular, genetic and mathematic approaches help to identify genes that play a key role in bone homeostasis and disease process. The team is developing a multi-scale, quantitative and predictive model, which will significantly contribute to a better understanding of the intersystem crosstalk in bone remodelling including cell-cell, pathway-pathway, molecule-molecule, and gene-gene. The silico model of osteo network will hopefully facilitate recognizing biomarkers for diagnosis of rheumatoid arthritis and osteoporosis.

Molecular pharmacological research for wound and fracture healing.

  • We are screening anabolic drug candidates for bone biological therapeutics that promote wound and fracture healing by directing the progenitor cells growth and differentiation. We are also exploring the use of natural extracellular matrix components as biomaterials that provide appropriate structural and stimulating properties for generating functional osteoblast and bone cells.

TORU Laboratory Facilities

TORU Laboratory is located at the John Curtin School of Medical Research in the Australian National University and has established collaborations with Professor Chris Parish at the Department of Immunology and Genetics. TORU Lab has access to all the necessary high-end equipment.

Molecular and genetics

TORU Lab has access to

  • Thermocyclers (PCR and RT-PCR machine)
  • Film processor/developer,
  • Bio-rad gel doc system,
  • Complete Affymetrix GeneChip DNA array system,
  • Sequence analysis pipeline such as SOLiDTM Small RNA Pipeline and HiSeq2500.

Immunology, Immunohistochemistry and Biochemistry

TORU Lab has access to

  • UV-VIS spectrophotometer
  • Infinite 200Pro (Luminescence, fluorescent and isotope spectrometer)
  • Beckman ultracentrifuge
  • Packard liquid scintillation counter
  • Victor X3 Flow cytometer (BD’s FACSCalibur with 9 colors, FACScan)
  • Fluorescent, Confocal, and Electron microscopy.

Cell Culturing

TORU Lab has a dedicated tissue culture room equipped with

  • Class II biosafety hoods
  • CO2 incubators
  • Phase contrast inverted microscope with digital photography capabilities
  • Water baths
  • Temperature controlled centrifuge
  • Bench-top microcentrifuge
  • Freezers and fridges.

TORU Laboratory team bridges basic and clinical sciences and facilitates communication among TORU’s collaborative institutes, universities and orthopaedic industries.

TORU team presently investigates chronic and complex bone diseases, some of which cause life-long pain and disability. These chronic conditions can be rare, such as revision joint replacement and osteolysis or can be remarkably common, such as arthritis, trauma and osteoporotic fractures. Combined, they afflict millions of Australians and cause tremendous human suffering, and cost million dollars in health care.

Animal Facilities

Facilities at JCSMR include the small animal facility (mice, rats, rabbits) and a dedicated operating theatre, operating equipment and anaesthetic machine. We have a well-developed surgical model in sheep. Currently, we are testing a possible candidate for reversing ischemia using a pig model.

Clinical Research

The Canberra Hospital is home to the clinical research arm of TORU. The research unit has capacity to undertake broad based clinical studies concerning surgical and medical treatment of musculoskeletal disease. In addition to this, specific targeted studies are welcomed and supported.

The Canberra Hospital is home to the clinical research arm of TORU. The research unit has capacity to undertake broad based clinical studies concerning surgical and medical treatment of musculoskeletal disease. In addition to this, specific targeted studies are welcomed and supported.

Clinical Research Facilities

Accommodation

  • TORU is located in Building 6, level 1 of TCH, with the Division of Surgery. Accommodation comprises eight offices, totalling 130 m2 and a teaching room seating 20. Each of these offices is equipped with furnishings and computer terminals and PC’s for 1 – 4 people. Currently four full time staff, 3 PhD students, and a variety of medical students and M. Phil students are housed here.

Information Technology:

Systems

  • Two parallel systems operate within TORU. The hospital system (Intact) is sustained by the ACT Government and provides access to patients’ clinical records, pathology, and hospital communication networks. The Intact network’s advantages are its security and confidentiality for maintaining patient’s records, and the system of back up and file safety provided. Running parallel is the ANU network. This provides the communication network for the students completing research here. The ANU network provides advantages in flexibility in terms of housing a range of different hardware and software capacities. TORU uses both networks and also stand alone IT facilities for various project requirements.

Hardware

  • TORU houses a server within the ANU Medical School. Located in TORU are 12 PC’s each connected to one of three printers. TORU also has easy access to a shared colour printer. There are 3 document scanners. There is a medical imaging film scanner. TORU has access to multimedia services at the hospital giving the capacity to develop, print and laminate posters, patient information brochures and other materials.

Software

  • TORU PC’s are equipped with Microsoft office suite. In addition TORU uses SPSS version 16, or STATA for statistical analysis. Auto CAD is used for drawing and design, measurement and curve fitting. Adobe Photoshop and JASIC Paint shop pro are used for imaging and development of figures. MATLAB is also used for mathematical analysis of imaging and drawings. TORU has easy access to the medical imaging software used in PACS (medical imaging).

TORU has existing developed research capacity in:

Medical Imaging

The Canberra Hospital has a well equipped Medical Imaging Department, including

  • 2 Seimens Avanto MRI machines
  • Toshiba Aquillon 16 CT
  • Axiom Artis MP fluoroscopy
  • Lunar DEXA
  • Well-equipped facilities for ultrasound, nuclear medicine and whole body bone scanning.

Kinematic Analysis

Past clinical studies have examined the effects of injury, surgical reconstruction and degenerative disease on knee joint kinematics.

  • In collaboration with the department of Medical Imaging at TCH the technique of analysis of knee kinematics using standard MRI has been refined.
  • Currently work in image registration between static 3D imaging such as MRI and CT and dynamic imaging such as fluoroscopy is enabling 3D modelling of in vivo knee kinematics.
  • Kinematic analysis is also performed using Electrogoniometry (Biometrics, UK) for knee, hip and spine kinematics analysis.

The addition of the IDEEA system (Min Sun Singapore) permits more extensive analysis and characterisation of physical activities.

The addition of the IDEEA system (Min Sun Singapore) permits more extensive analysis and characterisation of physical activities.

Physical Assessment

TORU has orthopaedic surgical staff and registrars, physiotherapy, and human movement sciences staff that are trained and competent to conduct the following physical assessment

  • Orthopaedic assessment of injuries, including ligament, muscular and other injuries
  • Measurement of knee laxity using the KT1000
  • Assessment of strength using dynamometry
  • Assessment of range of motion
  • Anthropomorphic assessment

Clinical and Functional Outcomes

TORU staff are trained and competent in the following outcomes measures

  • Functional Tests: Timed up and Go, 10 meter walk test
  • General Health Self Reported Outcomes Measures: AQoL (quality of life), Functional comorbidity index, Australian Physical Activity Score (or pedometer if preferred), Visual Analogue Scale
  • Disease specific outcome measures: Harris Hip score, Oxford Hip score, GTPS Assessment tool, IKDC, KSS, Oxford knee, WOMAC, Disease severity index, Oswestry Disability Index
  • Development of clinical tests
  • A new clinical test for assessment of the severity of Greater Trochanter Pain Syndrome has been developed and tested here for reliability and validity in healthy and GTPS populations.

Database collection and analysis

TORU maintains databases in several areas, for analysis of interventions, trends and characterisation of clinical issues

  • Fractured neck of femur: Database operational since 2002, increasing by 400 patients each year.
  • Pelvis fractures database: collecting all surgically managed pelvic fracture cases since 1998.
  • Total joint replacement retrievals: Collecting retrieved prosthesis for analysis of wear
  • Trauma data gathering and analysis:
  • The Shock Trauma Database collects data on each aero medical retrieval case, and every case that has a Trauma Code called. This database has been operating since 1999.

Materials and construction testing:

TORU is collaborating with the Engineering department at ANU in biomechanical applications using the Instron Materials Testing Station. This Instron MTS is capable of testing constructs of orthopaedic interventions such as tibial fracture fixation, loss of bone integrity due to drilling, reaming or other interventions, or characteristics of ACL or acromioclavicular joint reconstruction.

The ARAMIS Optical 3D Deformation & Strain Analysis system (Trillion, USA) is capable of characterising stress and deformity of materials for materials characterization of metals, composites, ceramics; - FEM confirmation & boundary condition checking; fracture mechanics and estimating stability; dimensioning components; examining non-linear deformation behaviour; characterizing creep and aging processes; high-speed deformation & strain measurements. In biomechanics it is able to assess fatigue failure and stress loading of tissues.

Testing of wear mechanisms in knee simulation:

TORU has developed a prototype knee actuator for characterisation of polyethylene wear debris. TORU has a ProSim knee simulator (Simulation Solutions UK) to be commissioned in October 2008.