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Prof Ian Harris

Professor, Orthopaedics

Major current projects include:
1. ACORN: The Arthroplasty Clinical Outcomes Registry, National. This is the first multicentre registry of patient-relevant outcomes after joint replacement surgery. Currently, there is no standardised measurement of how well hip and knee replacement surgery is performing, apart from the National Joint Replacement Registry (NJRR). The NJRR measures re-operation as the main indicator of performance, but unlike many registries internationally, it does not measure relief of pain, improvement in function, or overall satisfaction – the outcomes of interest to the patients and outcomes that measure the effectiveness of this type of surgery in achieving its goals.
2. ANZHFR: The ANZ Hip Fracture Registry. The National Hip Fracture Database in the UK has led to improvement in the processes and outcomes of care for elderly patients with hip fractures. Professor Harris co-chairs the ANZ Hip Fracture Registry which has been established to measure outcomes of care in all hospitals in Australia and New Zealand that treat hip fractures. The registry aims to improve care incrementally, and to document that improvement, by feeding back the outcomes to the institutions and the public. The registry has developed NHMRC approved guidelines for hip fracture care and is currently assisting the Australian Commission on Quality and Safety in Health Care in developing national Standards of Care. The first hospitals started entering registry data at the end of 2014 and we aim to have 25 hospitals recruiting by the end of 2015.
3. CROSSBAT: A multicentre randomised trial of operative versus non-operative treatment for ankle fractures. This is one of the largest multicentre randomised trials in orthopaedics. It compares the results of surgical treatment to non-operative treatment for common ankle fractures. Currently nearly half of these fractures are treated surgically, and there is considerable variation in recommendations across the country. The results of this study will mean that treatment can be based on high level evidence so that all future patients with these common injuries can be treated with the optimum treatment. The success of this study has spurred new, similar multicentre studies that will begin in 2015.
4. Multicentre study exploring the association between protocol adherence and clinical outcomes in total joint replacement surgery. Total hip and knee replacement surgery is common, effective and expensive. However, there exists considerable variation in the protocols and procedures around the care of these patients, for example, treatments aimed at avoiding complication such as infection and venous clots and emboli. We have performed a multicentre study across the country involving nearly 2,000 patients to determine the degree of treatment variation and to determine the effect of that variation on the outcomes of hip and knee replacement surgery. This will be the largest study of its kind and the results are expected to lead to an improvement in the care of joint replacement patients and a subsequent improvement in outcomes. In addition to exploring the relationship between the care received intended to prevent infection and clots, the study will provide numerous insights into other aspects of care of import in this area including: whether inpatient rehabilitation is associated with better outcomes after surgery; whether an anterior approach is better than a posterior approach after hip replacement; whether satisfaction with the acute care experience is higher amongst patients treated in the private sector.
5. HIHO: A multicentre randomised trial of hospital inpatient rehabilitation versus a home exercise program after total knee replacement. In Australia, and in NSW in particular, it is common to have inpatient rehabilitation after total knee replacement surgery. However, this is expensive and the evidence supporting this practice is lacking. We have conducted a multicentre randomised trial of inpatient versus a monitored home rehabilitation after knee replacement surgery. This study will provide high level evidence that will either support or refute current practice. This study adds to the program of work undertaken by the Centre in this area.
6. ANZMUSC. The Whitlam Orthopaedic Research Centre is part of the organising group that is establishing ANZMUSC: the Australian and New Zealand Musculoskeletal Clinical Trials Network. The first meeting was held in 2014 and this group aims to improve the quality and impact of randomised trials in musculoskeletal medicine. The group of senior and emerging researchers from both countries will establish priority areas to study and will review and approve trials, and support applications for funding.
7. Opioid use in orthopaedics and trauma. The research centre has undertaken several studies exploring the impact of opioid use, and the incidence of opioid dependence after injury. Using this experience, the Centre was able to secure funding to begin a randomised trial comparing major opioids to “over the counter” opioids for patients discharged after orthopaedic fracture treatment. This study has the potential to reduce costs and harms associated with the routine use of major opioids.
8. Consumer and clinician perspectives on the role of and need for inpatient rehabilitation after knee or hip replacement. In order for new or alternative models of care to be acceptable to consumers and clinicians alike, we need to understand why people regard inpatient rehabilitation as an important part of the recovery after joint replacement surgery. This study adds to the program of work undertaken by the Centre in this area.

Publications

C1 - Journal Article