Donald Howie

A major aim of my professional career has been to foster interdisciplinary collaboration in research between those involved in clinical management, basic science, bioengineering, pathology and epidemiology. This has been successful to the extent that our Department, with its collaborators, is recognised internationally as one of the leading academic centres in orthopaedics.

Major scientific achievements have been in the field of joint replacement and prosthesis loosening, the subject of my doctoral thesis, and, more particularly, research into the tissue response to prosthesis-derived wear particles and the causes and management of pathological bone loss around total joint replacement. For example, my animal model was the first to confirm periprosthetic bone loss from wear particle induced inflammation. An important focus of our research has been the collection of human tissue at the time of revision surgery and implant retrieval which has been underway for over two decades. This has allowed us to focus on studies of human cells. More recently our bone biology research has found a direct link between metal and polyethylene particles and key mediators of human osteoclast formation and bone resorption in periprosthetic tissues and that particles directly induce a change in the phenotype of mature osteoblasts and osteocytes, consistent with a net loss of bone adjacent to orthopaedic implants.

From the clinical perspective, 25 years ago I recognised the need for a consistent and long-term approach to clinical outcomes research and established a prospective patient outcomes database that, to this day, remains an important source of clinical and patient-derived data and has facilitated a number of important publications on outcomes of joint replacement. My appreciation of the need for epidemiological expertise in undertaking clinical research led to collaboration with an epidemiologist and to us successfully undertaking one of the largest international multi-centre randomised controlled trials in orthopaedic surgery. This RCT established that large articulations in THR significantly reduced the incidence of dislocation, leading to major changes in clinical practice. Other RCTs in THR are currently underway.

Close collaboration with international centres of expertise led to the establishment of one of the first radiostereometric analysis (RSA) facilities in Australia, enabling accurate assessment of implant migration and polyethylene wear and novel investigations into the use of RSA to monitor fracture and soft tissue healing. The current application is based on our approach to joint replacement research, which is to combine in one research team the capability to use the internationally recognised best surrogate measures that predict the success or failure of joint replacement, in this study, the use of RSA for to measure prosthesis wear.