Save the Date!

Advances in Motion McCaig Institute for Bone and Joint Health

The Wood Forum on Juvenile Arthritis

Arthritis is a condition most commonly associated with people in their senior years. Most people don’t realize that arthritis affects people of all ages – even children. In fact, nearly 20,000 Canadian children are suffering from juvenile arthritis right now, and this condition is diagnosed in children as young as 12 months old. This year, the McCaig Institute plans to raise awareness about the fact that arthritis affects kids too. Continued on page 2…

Expressions of Arthritis

Saturday, September 20, 2014 TELUS Spark

A creative workshop for children

with arthritis. To register go to mccaiginstitute.com

Meet an Innovator

Saturday, September 27, 2014 TELUS Spark

Meet scientists from the McCaig

Institute to learn how to keep your bones and joints healthy!

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Check out our revamped website!

The McCaig Institute for Bone and Joint Health’s website

underwent a complete makeover! Useful features include research

updates, patient resources for care and education, and public event information. Send us your

feedback so we can make it even more useful:

www.mccaiginstitute.com.

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McCaig Institute for Bone and Joint Health

Saturday, October 4, 2014 Libin Theatre, HSC

Learn about: innovations in the clinic, lab, and pain management. To register go to mccaiginstitute.com

The Wood Forum on JIA

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Nigel’s Nook Congratulations to all trainees who convocated in the past year. It is a pleasure to see our MSc and PhD students complete their programmes and achieve their academic goals. There are currently over 60 trainees and 15 postdocs contributing to bone and joint research here at the McCaig Institute.

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The works of art will be put on display at TELUS Spark. Our special guest for this event is Bev Kelly, a Calgary-based artist. Bev will be speaking to the children at the workshop about her experiences as an artist who is thriving in spite of living with chronic joint pain. Have you ever wondered how McCaig Institute scientists study bones and joints? Now is your chance to get an up-close look at the research we do. On September 27th, TELUS Spark has invited the McCaig Institute to their Meet an Innovator day. With tons of exciting, hands-on activities (including gloves that simulate what it feels like to have arthritis) you will get a chance to look at bones and joints from our perspective. Through the generous support of the Wood Family, the McCaig Institute hosts an annual public forum that features presentations and open discussions with leaders from a specific area of bone and joint health. This is a great opportunity for the public to engage directly with researchers and clinicians. This year, we are pleased to announce the Wood Forum on Innovations in Juvenile Arthritis. We have three paediatric rheumatologists: Dr. Susanne Benseler, Dr. Nadia Luca, and Dr. Heinrike Schmeling, who will be addressing Innovations in the Clinic, in Disease Management and in Research. This is a wonderful opportunity to learn about the latest advances in the field of JIA, and to take home some practical information and valuable resources. The McCaig Institute will also hold a Wood Forum on Innovations in JIA in Edmonton. For details please visit www.mccaiginstitute.com.

Continued from page 1… We want to share their story, give them a voice and let our community know what the McCaig Institute is doing to make a difference. We are thrilled to announce three exciting events we have planned for the fall! On September 20th, we are inviting all children affected by juvenile idiopathic arthritis (JIA) to attend Expressions of Arthritis: a creative workshop designed specifically for kids with juvenile arthritis to tell us in their own way what it feels like to live with this condition.

Left to right: S. Abubacker, K. Barton, T. Ludwig

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Featured Trainee: Emily Bishop Emily Bishop is a PhD candidate at the McCaig Institute under the supervision of Dr. Janet Ronsky. She is also a member of the Alberta Osteoarthritis Team, and the NSERC CREATE Training Programme for Biomedical Engineers for the 21st Century. Emily is interested in understanding changes and adaptations that happen in the knee joint after injury. The anterior cruciate ligament (ACL) is the most commonly injured ligament of the knee, and the risk of developing osteoarthritis (OA) greatly increases following an ACL tear. Osteoarthritis is a disease where the cartilage in joints breaks down, resulting in bones rubbing together causing pain, swelling, and stiffness.

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Several have recently published in prestigious journals and presented in international platforms. For example, the McCaig Institute was well represented at the recent Osteoarthritis Research Society International (OARSI) meeting in Paris. Mentoring is fundamental in developing a culture of collaboration, trust and excellence in our research. Supervisors at the McCaig Institute are determined to equip and support their students so that they produce high quality research and are prepared for the work force or an academic career.

The fall will be here in no time and that means a new batch of eager students will be arriving with fresh minds. We look forward to meeting them and supporting them in their endeavours. In addition, four new orthopaedic surgeons will be starting in Calgary

in the coming months. I am excited to help them connect with the rest of the McCaig team to elevate bone and joint research here in Alberta. The fall also means that the Wood Forum will be taking place. This year the focus is juvenile idiopathic arthritis. There is more information about this year’s forum on the front page. Members of the Institute are of course, thrilled by the $4.4 million matching of the Canada Foundation for Innovation monies announced by the province for the development of the clinical research space. This puts us closer to the $17.9 million goal for completing the construction and start-up of the Mobility and Joint Health Facility. We are working diligently to raise the remaining $4.7 million so that facility can be fully operational at the beginning of next year. Have a safe rest of the summer everyone! Nigel

Left to right: S. Abubaker, T. Ludwig, K. Barton, J. Beveridge, B. Heard, and A. Fickadiya

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Bob and Nola Rintoul are very active members in the community at large and champions for better bone and joint health. Both have benefited from the expertise of orthopaedic surgeons and have been very mobile since treatment. When they found out that a quarter of all general practice patient care involves musculoskeletal (bone and joint) treatment they felt compelled to

contribute in some way. Continued on page 5…

Community Champions: Bob and Nola Rintoul

Many people suffering from OA have difficulty performing everyday tasks such as opening a jar or walking up stairs. OA affects more than 50% of adults over the age of 60, and has the highest indirect costs of any disease in Canada. Even with ACL repair, the risk for developing OA remains high. One approach to studying changes in the knee following injury is to look at the joint mechanics. Emily’s research combines the use of magnetic resonance imaging (MRI) and motion analysis to track changes in joint structure and function following an ACL tear. A novel, custom built device is used in the MRI to measure movement, or 'laxity', in the knee joint. Motion analysis is a tool that can track human movement using high-speed cameras and reflective skin markers. Using these techniques, she can quantify changes in knee laxity and movement stability over time in patients with a torn ACL. The goal of Emily’s research is to understand what is happening to the joint structure over time after ACL injury, and how this affects the way the knee moves. This will allow for better prediction of patient outcomes following an ACL tear and may play a role in screening strong candidates for joint replacement. Additionally, this knowledge could enhance our ability to design effective diagnoses and treatments for joint health, providing new approaches to reduce the risk of long term joint degeneration and improved options for ACL replacement and treatments. Emily finds this area of research very stimulating because she is able to apply the engineering principles learned in her mechanical engineering degree to the human body to study injury and disease development. After defending her thesis, she plans to work in the Biomedical Engineering industry in Calgary. She hopes to contribute to the growth of this industry in Calgary and encourage collaboration between researchers at the University of Calgary and the biomedical industry. When asked what advice she would give to incoming trainees she suggested getting involved! There are so many opportunities to get involved as a graduate student, from graduate student associations to event planning committees. She says that she learned so much about team work and leadership by joining various committees, and has been able to transfer those skills to her everyday life. Not the mention the many friends she has gained along the way!

Bob and Nola Rintoul

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As part of the McCaig Institute for Bone and Joint Health, the Joint Transplantation Program provides biological treatments to young patients with isolated bone and cartilage defects. The objective is to treat the bone and cartilage injuries in young patients early on so they don’t develop into a larger problem and involve more surfaces of the joint (knee or shoulder). The advantage to using real bone and cartilage from a young cadaveric donor is that it replaces usage of artificial materials, including metal hardware that may later need to be removed. Continued on page 6…

Young Patients Benefit from the Joint Transplant Program

Research Updates

Orthopaedic surgeon Cy Frank directed them to the McCaig Institute for Bone and Joint Health where they made a significant contribution to support research. Their support resulted in an endowment fund, which evolved into the Rintoul Chair position. The chair position is mandated to carry out research of bone and joints to improve diagnosis, treatment and recovery. Steve Boyd, PhD was awarded the chair position and is working to construct the Mobility and Joint Health Facility. This facility will bring together experts from various fields to study the early detection and management of bone and joint disorders. In addition, Research Associate Sarah Manske, PhD was given a position to contribute to research and engage in education. For their donation to bone and joint research Bob and Nola were presented with a silver hockey stick by Ken King, the Calgary Flames president and then co-chair of Reach!, a fundraising campaign by the University of Calgary. Silver hockey sticks are customarily awarded to NHL players achieving one thousand games. Ken convinced the NHL to make an exception and award a silver hockey stick outside of the league. Both Bob and Nola were blown away by this gesture. However, instead of keeping the hockey stick for themselves they donated it to the McCaig Institute along with additional support. The hockey stick serves as a reminder to the researchers that exceptional goals can be achieved and that they have the backing of the community. Bob’s motivation in giving stems from his realization that he has been incredibly blessed. His autobiography No Regrets, No Apologies describes Bob and Nola’s adventures over the years (Bob proposed to Nola three days after meeting her!) and his reflections looking back. He sternly believes that if you have honesty, discipline and team-work you will succeed in life. When asked what advise he would give future generations he responds with conviction, “it is far better to give than to receive!”.

From left to right: B. Rintoul, S. Manske, S. Boyd, C. Frank, B. Rintoul, N. Rintoul, N. Shrive, J. Meddings and B. Saluk.

Left to right: S. Andrews, G. Rockl, R. Krawetz, N. Schachar, C. Hutchison, M. Heard, and S Miller. Missing from photo: S. Timmermann, I. Lo, J. Matyas, D. Cinats, and Z. Abusara

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The research team believes these biological transplants will last longer than artificial joints in patients under the age of 60 to prevent or at least delay the development of osteoarthritis (OA). The program translates validated basic science into clinical practice and identifies clinical problems that require further research. The program started in 2006 through an anonymous donation that was matched through the Calgary Health Trust. The first transplant was a quarter

of a knee joint performed in November 2006 by Dr. Carol Hutchison, Orthopaedic Surgeon, Faculty of Medicine,University of Calgary. In 2010, the first fresh shoulder transplant was performed by Dr. Mark Heard. This was the first procedure of its kind in Western Canada. The program has also expanded to be able to maximize more tissue from one donor – so that tissue from a single donor can be used in three or four transplants. In addition, the program is now able to transfer donor tissue from Calgary to hospitals in Edmonton for transplants there. In 2013, Orthopaedic Surgeon Dr. Nadr Jomha at the University of Alberta performed the first fresh bone/cartilage shin bone transplant in Edmonton involving the transport of tissue from Calgary that was preserved using the Transplant Program’s novel technique. The program impacts patients under 60 who are typically in their teens, 20’s and 30’s who are too young to receive an artificial joint replacement. Patients under 60 years of age are not suitable for artificial joint replacements because the implants only last 10-15 years and typically, people can only have 1, possibly 2 artificial replacements on the same joint in a lifetime due to complications involved. Young patients are also more active and would wear out an artificial joint at a faster rate. Traditional treatments have failed in these patients, leaving them with no other option but to live with chronic pain and limited joint function. Some patients had previously feared dislocating their joint when engaging in common movements such as coughing or raising their hand to answer a question in class. “Unfortunately, there are very few, if any options for young patients with bone and cartilage defects. Traditional treatment involves microfracture (poking holes in the underlying bone to stimulate bleeding and formation of fibrocartilage – which is not the same as healthy articular cartilage), or synthetic options such as a hemi-cap (metal plug). These treatments often fail after a couple of years and implants are not ideal for patients under 60”, explained Dr. Schachar, Director of the Joint Transplantation Program. After receiving a biological transplant these young patients have been able to return to work, engage in leisure activities and sports and sleep better knowing that their joints are stable.

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Reality check: the cost-effectiveness of removing body checking from youth ice hockey.

Sarah Lacny has researched the effects of body checking in hockey with principal investigators Deborah Marshall, PhD and Carolyn Emery, PhD. Hockey Canada has recently raised the age at which body checking is allowed from the Pee Wee level (ages 11-12 years) to Bantam (ages 13-14 years). This decision was made after studies demonstrated that injury rates in Pee Wee leagues in which body checking was allowed were 3 times greater than leagues that did not allow body checking. In addition to physical consequences, injuries placed an economic burden on both the healthcare system and families who bear the costs that are not covered by the healthcare system. To better understand the economic implications associated with body checking, Sarah examined the cost–effectiveness of disallowing body checking in Pee Wee hockey in Alberta.

She compared injury rates and costs incurred by injured players during the 2007-2008 Pee Wee hockey season in Alberta, where body checking was allowed, and Quebec, where body checking was not allowed. Sarah and her team of researchers found that, in addition to significantly higher injury rates, resulting healthcare costs were 2.5 times greater in Alberta than Quebec. They demonstrated that implementing a policy that does not allow body checking in Pee Wee hockey is cost-saving (associated with fewer injuries and lower costs) compared to policies that allows body checking. These findings may better inform Hockey Canada and other organizations responsible for developing body checking policies in youth hockey.

The Joint Transplantation Program offers biological treatment options to young patients that were not previously available in the province. Alberta has one of the largest communities of bone and joint health researchers in the world. Led by the McCaig Institute for Bone and Joint Health, this province is a leader in research and innovation in this field. Goals of the program include performing enough transplants (10 of each type of transplant in each different joint) to show evidence that this procedure, using the novel storage protocol, should be adopted as a standard practice of care throughout the province and beyond. The program is also currently conducting research to investigate how to preserve fresh menisci, another type of cartilage in the knee joint for transplantation. Frozen or dead menisci are currently used, however they result in high failure rates.

Awards and Recognitions

mccaiginstitute.com 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6

MCCAIG INSTITUTE

SUMMER 2014

Carolyn Anglin, PhD was successful in securing a 3 year CIHR-NSERC Collaborative Health Research Project Grant. The $470,000 grant will support her study in Development and Clinical Efficacies of an Innovative Quantitative Intraoperative C-arm System.

Cheryl Barnabe, MD, received the 2014 CIHR New Investigator Salary Award for her research in arthritis care in indigenous populations. Cy Frank, MD has been appointed to the Order of Canada. The AIHS President and CEO has contributed to advancing orthopaedic health care services in Alberta and has also conducted research in bone and joint health. In addition, he was appointed to a federal panel on Health Care Innovation to inform the government on how to improve the quality and cost-effectiveness of patient care in Canada. Marvin Fritzler was awarded the Order of the University of Calgary this past spring. The award goes to individuals that have made exemplary and distinguished service to the University. Tannin Schmidt was named as a Canada Research Chair in Biomaterials. Tannin’s research contributes to understanding of lubrication around the knee joint and eye and the creation of new biomaterials to address lubrication issues. Congratulations to all faculty members and trainees that have been awarded!

The McCaig Institute’s newsletter was written by Elisa Park Kim with contributions from Jaymi Taiani, Sue Miller, Emily Bishop, and Sarah Lacny. Questions and comments for any of our stories can be sent to mccaig@ucalgary.ca. For the next winter’s edition we will be combining efforts with other provincial bone and joint organizations to bring you a unified voice on bone and joint news and research updates.

Patient Engagement Research: Do you have rheumatoid arthritis? Are you interested in sharing your experience accessing and navigating the health care system? Contact Sylvia Teare at 403-242-3681 or teares@shaw.ca