Orthopaedics, Trauma Surgery and Rehabilitation

The research within our LUMC departments is conducted within departmental research programmes. The research programme below is embedded within the department of Orthopaedic Surgery.

Aim and focus

In society, impairments and limitations of mobility have a major and increasing impact on the independency and quality of life of many persons and pose a large economic burden to society as well. As for more common conditions, in The Netherlands about 60,000 patients have a knee or hip arthroplasty, 55,000 persons suffer from hip, ankle or wrist fractures, and more than 25,000 from stroke annually, all with varying clinical outcome after intervention. The latter resulted in the overarching research theme of "Mobility", encompassing Musculoskeletal (MSK) pathology and Brain and nerve injuries. Unsatisfactory outcomes and complications are common in all designated subgroups of patients, leading to significant health care usage and loss of productivity. In order to address this issues, the research program focusses on two research themes: "Prognostic Clinical Modelling" and "Optimising Clinical Outcome". The related conditions are common pathology (with huge societal impact), therefor this research is performed within regional clinical networks. Next to these more common clinical conditions, specific top-referral (TRF) clinical cases (i.e. specialised low volume cases with multidisciplinary diagnostics and treatment options), like bone and soft tissue tumours, pelvic fractures, neuromuscular conditions, are treated and evaluated within research subprogrammes of the departments of Orthopaedics, Trauma Surgery and Rehabilitation Medicine.
The research program is built on the extensive experience of clinical network building as well as methodological expertise on the development, evaluation and implementation of complex care and technology.  By aiming at the better selection of patients for specific management strategies (prognostic clinical modelling) and optimising care delivery by improving transparency, monitoring and vigilance of effectiveness and safety by means of national and regional registries and clinical networks (Optimising clinical outcome) the program significantly contributes to the concept of Value Based Health Care.

The two common research themes with their subsequent subprograms are:
I. Prognostic Clinical Modelling

  • Prospective population networks: Arthroplasty Patients:  C Tilbury, C Leichtenberg, J Meessen (collaboration Molec Epidemiology, Prof E Slagboom); W Verra; K Hamersveld, J Meinardi, C Smeekes Supervised by Prof R Nelissen, Prof T Vliet Vlieland , M Gademan B Kaptein, P Marang -van de Mheen (Statistics), Bone and soft tissue tumors Mastboom, M Fiocco (Statistics). Bosma, supervised by Prof Dijkstra, M van de Sande, M Fiocco (Statistics), M Gademan. 
  • Optimising efficacy and implementation: Patient Blood management Arthroplasties: V. Voorn, supervised by Prof R Nelissen, Dr. L. van Bodegom-Vos; Thromboprofylaxis: R Adrichem, B Nemeth, supervised by Prof R Nelissen, prof S Cannegieter, Prof Schipper. Common Fracture Care. A. de Zwart,  S. Woltz, S Verhage, S. Voeten, P. van Gerven M. Van der Sijp, supervised by prof. Schipper and P.Krijnen. Brain Injury (BI) Supervised by Prof Vliet Vlieland, Dr Goossens, Dr Schiemanck, Dr Meesters, Dr de Kloet, Dr van Bodegom-Vos (Statistics), Dr van den Hout (Statistics). Bone and soft tissue tumors van Praag, Mastboom, Bosma, supervised by Prof Dijkstra, M van de Sande, Prof Nelissen, M Fiocco, M Gademan.
  • Complex trauma care: Injury patterns: L.A. Leijdesdorff supervised by prof. Schipper , Pediatric fractures: A Dekker, supervised by prof. Schipper Trauma systems and polytrauma care S. Dijkink supervised by prof. Schipper, N. Appelman, P. Krijnen; Bone Healing: E Gorter; supervised by prof. Schipper, N. Appelman, P. Krijnen;  Burn injuries: Z.Rashaan, K Kwa, supervised Prof Breederveld, P.Krijnen.  
II. Optimising Clinical Outcome 
  • Biomaterials and 3-D printing of implants, supervised by Prof S Dijkstra, B Kaptein, PhD, Prof Nelissen, Prof Zadpoor (TUDelft)
  • Technological innovation diagnostics and treatment: implant fixation: M Schoeman; J Mattheijer, G. Kraaij supervised by Prof R Nelissen, Prof Dankelman (TUDelft). 3D printed implants Prof Dijkstra, Prof Zadpoor (TUDelft) Kinematic analysis and muscle activation JF Henseler, A.Kolk and C.L. Overbeek supervised by Prof Nelissen,  J Nagels, Dr de Groot. Mobility clinic (Technology-in-Motion). Collaboration with Neurology. Supervised by Dr Ir de Groot, Dr Schiemanck, Dr Stijntjes. Prosthetic Joint Infection, Induction heating (ZonMW Off Road grant, dr B Pijls), collaboration Microbiology (prof E Kuijper) 
  • E-rehabilitation: Development, evaluation and implementation of e-technology in rehabilitation supervised by Dr Meesters, Dr de Kloet , Prof Vliet Vlieland. 

Position in international context

Orthopaedics

  • Leading role in the international radiostereometry (RSA) communities (RSA, radiostereometry, is an early quality tool predicting performance of new implants). An international RSA research network is established in 2017. During a four year government funded research, AutoRSA project (Aarhus, Denmark), the department was advisor. An international collaboration on meta-regression of 10 year available RSA data was started with Hässleholm and Umea, Sweden. 
  • The Dutch Arthroplasty (LROI, >600.000 implants), is the third largest registry in the world with high level data (co-founded Prof Rob Nelissen and Prof Brand). Prof Nelissen is also chairman of NORE (network Orthopaedic registries of Europe, section of EFORT) and Board member of the International society of registries (ISAR); He is member of the global steering committee of ICHOM on osteoarthritis.
  • Since 2014 Prof Sander Dijkstra is EMSOS board member and since 2016 ISOLS aspirant board member. MIchiel vd Sande, MD, PhD is EPOS boardmember in subcommittee paediatric oncology. Every year more than 20 presentations on orthopaedic oncology topics are given at the leading European (EMSOS, EFORT) Asian (ASM) and American (ISOLS, CTOS) congresses.
  • the department is an ERN (European Reference Network) for orthopaedic oncology.

Trauma Surgery
Prof Inger Schipper is board member of the American College of Surgery – Committee on Trauma and involved in many international trauma initiatives for research and education. She established a scientific  student exchange program for LUMC and Boston Massachusetts General Hospital. The multicentre and (inter)national research projects such as the completed Sleutel trial on treatment for clavicular fractures, the WARRIOR trial, and DHFA have lead to publications in high-impact journals. She co-initiated a national registry on hipfracture outcome (DHFA, dutch hipfracture assessment). Every year multiple presentations are given at leading European (ECTES) and American (OTA) conferences. 

Rehabilitation
Prof Vliet Vlieland is honorary member of EULAR and leading the health professionals' classroom of the EULAR School of Rheumatology. Every year, she gives multiple presentations at international conferences on the topic of rehabilitation in rheumatic and musculoskeletal diseases and is involved in various international research projects, including local project leader of a European EIT project and task force leader of multiple EULAR projects on the development of evidence based recommendations.  

Content / highlights / achievements

Orthopaedics
Funding: Over the past 6 years the PI’s were main applicant in 12 grant applications and 3 Co-PI for funding (Reumafonds, STW, ZonMW, KWF, Alpe D’Huez, Industry, Bontius Stichting: about 5,6 milj€). The main theme optimisation of joint reconstruction (i.e. prognostic modelling, optimising outcome) both from a technological perspective (TU Delft) as well as from a patient perspective in both osteoarthritic as well as orthopaedic oncology patient groups within clinical networks.  
Completion of PhD trajectories 2012 - 2017: 29.
Scientific output: annually about 70-80 papers are published. 34 PhD trajectories (all externally funded) are in progress.

Trauma Surgery
Funding: To improve the effectiveness and efficiency of trauma care, all aspects of trauma systems including prehospital and in-hospital care, education and training of medical personnel and quality assurance, need to be analysed individually and benchmarked in an international perspective, in order to be optimized (3 PhDs, one of which is rewarded with an MD-PhD position). Other promising studies are the’ Evaluation of need for radiographic control after ankle and wrist fractures’ (ZonMw), ‘VBHC: The optimalisation of care for hip fracture patients’ (DICA) and Acute treatment of Burn victims and their injuries’ (Brandwonden Stichting). Over the past 5 years several other grants have been obtained by the PhD candidates from the Van Walree fund, the LUF, the Michaël Fund and the Bontius Stichting.
Completion of PhD trajectories 2012-2017: 8.
Scientific output: annually about 30 papers are published; on average 2 PhD projects completed per year. Currently, 10 PhD students are in progress.

Rehabilitation Medicine
Funding: Over the past 6 years the program leaders were main applicant, PI, or thesis supervisor in > 20 successful applications for funding (national and international projects). An illustration for achievements regarding clinical networks concerned the funding of a project on the development and evaluation of a digital rehabilitation platform, submitted by a consortium of partners from the rehabilitation centers, LUMC, TUDelft and commercial parties (RAAK-PRO application). Grants from:  ZonMw, Hersenstichting, Revalidatiefonds, Reumafonds, SKMS, KNGF, Stichting Innovatie Alliantie, NWO-TTW.
Completion of PhD trajectories 2012-2017: 13  (Leiden, VU, Nijmegen as co-supervisor).
Scientific output: annually about 30-45 papers are published. The most important publications include publications on international guidelines or recommendations (e.g. EULAR hip and knee osteoarthritis.

Future themes

  • Health care evaluation and prognostic modelling research within clinical networks (in collaboration with dept Clinical Epidemiology and dept Biomedical Data Sciences). The target will be on extending the health care evaluation research by combining PROMS data with MRI data, accelerometer data and molecular predictors in prognostic outcome modelling. Thus population health research and implementation research (Implant surgery, bone/soft-tissue tumors, common fracture care, brain injuries) are important. Regarding the Optimising Clinical Outcome theme, the strong and overarching interest of all is Value Based Health care. Although the latter is also in need for an evidence based evaluation. 
  • The rehabilitation research focusses more on the process of care, by evaluating current care, developing and evaluating innovative interventions and care processes and implementation strategies.
  • A technology platform on mobility (i.e. activities and participation within society) will be developed; 
  • Technological innovation (TUDelft) projects on non-pharmacological treatment of implant infections; 3D printed implants for large bony defects; intraoperative imaging of bone- and soft-tissue tumors. 
  • Biobanking by the surgical departments will be extended in line with the research lines.

Cohesion within LUMC

The research themes Prognostic Modelling and Optimising Clinical Outcome contribute to the generic research profiles Ageing and Innovation in Health Strategy and Quality of Care (IHCQ). Furthermore, the LUMC has been appointed by the Ministry of Health as level-1 Regional  Trauma Center. As such, it is charged with the provision of complex trauma care (TRF) and the organisation of trauma care within the trauma region West Netherlands that comprises around 2.5 million inhabitants and 9 hospitals. Clinical outcome related scientific research is a prerequisite for the LUMC Trauma Center to act in its role as a regional center of expertise. The expertise of the rehabilitation research programme regarding the methodology for research on quality of care and recovery in the context of Value Based Health Care contributes to the orthopaedic and trauma surgery research lines as well as the abovementioned generic LUMC research profiles.
The Biomedical research theme Cancer Pathogenesis and Therapy focuses mainly on basic research, nevertheless clinical evaluation of these patients adds to this research profile for two reasons. First, the (inter)national clinical networks being built on tumor patients enables health care evaluation and prognostic modeling on outcome of these specific patient groups. Secondly molecular biological, research on surgical retrieved material is done in collaboration with dept Oncology and Pathology.