Research Projects
Oral Cannabis Trial
Approximately 20% of patients develop persistent post-surgical pain after undergoing total knee arthroplasty (TKA), and higher pre-surgery and acute postoperative pain are associated with this outcome. Medicinal cannabis has anti-inflammatory and analgesic properties and may reduce perioperative pain and the rate of PPSP following TKA. We will recruit patients undergoing TKA and randomize them to receive oral cannabidiol (CBD; derived from cannabis) to assess whether oral CBD helps decrease persistent post-surgical pain. We are partnering with the Centre for Medicinal Cannabis Research and the Institute for Pain Research and Care at McMaster to complete this trial.
TOPIKS trial
Physicians and the public have become concerned about the amount of opioids being used in healthcare because of the risks of serious adverse effects including overdose, addiction, and death. We hypothesize that topical cannabidiol (CBD) in addition to standard pain management will result in better pain control and a reduction in opioid use compared to standard care alone and will have a preferable safety profile compared to other commonly used pain medications (e.g. opioids and oral NSAIDs). We also hypothesize that topical CBD and topical diclofenac together will have improved effects on pain relief over topical CBD or topical diclofenac alone. The TOPIKS Trial is a pilot randomized factorial trial of patients undergoing knee replacement surgery. We are assessing topical CBD, topical diclofenac, topical CBD+diclofenac, and placebo. We are partnering with the Centre for Medicinal Cannabis Research and the Institute for Pain Research and Care at McMaster to complete this trial.
SPOC Study
Knee arthroplasty is a common surgical procedure to replace weight-bearing surfaces of the knee joint in order to relieve pain and improve functioning; however, many patients report persistent pain and poor functional outcome after surgery. The SPOC Study aims to capture the incidence of persistent post-surgical pain and poor satisfaction at 12 months after knee arthroplasty, and also look at physical and psychological determinants of long term outcomes. We will conduct this prospective cohort study of 388 patients in collaboration with the Department of Anesthesia.
RoboKnees Trial
St. Joseph’s Healthcare Hamilton is the first institution in Canada to obtain an orthopaedic surgical robot to assist with joint replacements. The RoboKnees Trial is a pilot randomized controlled trial of patients to give us preliminary evidence of whether we can use the robotic technology to perform better partial knee replacements to improve functional outcomes, return to activities, implant survival, and patient satisfaction in a cost-effective manner.
OREOS Trial
Opioid overuse is a major public health concern that can result in inadequate pain control, adverse events, addiction, overdose, and death. We are conducting a randomized cluster-crossover trial that will randomly assign total joint replacement patients to receive standard care or a novel pain management pathway that aims to minimize opioids used before, during, and after surgery. The goal of this study is to determine whether this pathway can improve patients’ satisfaction with pain management while improving safety and minimizing opioids.
Clinical Program
Bilateral Knee Replacement Trial
The Bilateral TKA trial aims to determine whether patients with bilateral end-stage knee osteoarthritis benefit from replacing both knees at the same time (simultaneous) or replacing one at a time (sequential). Local Principal Investigator: Dr. Vickas Khanna
FitJoints Trial
The FitJoints Trial is investigating whether a multimodal fitness and nutrition program before joint replacement surgery helps frail elderly patients have better outcomes after surgery.
Local Principal Investigators (HHS Juravinski Site): Dr. Justin de Beer, Dr. Mitch Winemaker, Danielle Petruccelli
Local Principal Investigator (St. Joseph’s Site): Dr. Anthony Adili