By: 16 October 2023
Researcher in Focus Q&A with Thomas Turgeon

Dr Turgeon is associate professor at the University of Manitoba’s Max Rady College of Medicine, Department of Surgery, in the section of orthopaedic surgery

Dr Turgeon’s research is aimed at improving the lives of people who have undergone hip and knee replacements. He uses innovative research methods, such as radiostereometric analysis, to gain a deeper understanding of how implant design, stability, and biomaterials affect clinical outcomes. Dr Turgeon is particularly interested in developing new methods to prevent implant failure and improve the longevity of the replacement.

He is Associate Professor at the University of Manitoba’s Max Rady College of Medicine, Department of Surgery, in the Section of Orthopaedic Surgery. He is a surgeon-scientist with the Orthopaedic Innovation Centre, where he collaborates with other experts in the field, and is a member of the Canadian RSA Network and the Concordia Joint Replacement Group. His specialties include implant design and stability, clinical outcome studies, implant failure, and additive manufacturing in orthopaedics. His research has been recognised by several awards and honours and his findings have been published in numerous high-impact journals.


OPN: What drove you to choose a career in orthopaedics and medical devices?

TT: Orthopaedics, and specifically hip and knee replacement surgery, are amongst the most impactful medical procedures ever developed. The dramatic improvement in pain and quality of life that we can achieve with hip and knee replacement is tremendously rewarding on a personal level. That said, not all patients have positive or optimal outcomes and I believe that improvements in implant design and surgical technique with continue to provide addition benefits to patients.


OPN: You recently published results from a new study regarding the emerging reverse hip replacement system technology, could you tell us more about what the research involved and what outcomes you discovered?

TT: We conducted a study of the novel Reverse Hip Replacement System (Reverse HRS). This innovative reverse total hip has been developed with a femoral cup and acetabular ball, creating enhanced mechanical stability. Our study was designed to assess the implant fixation using radiostereometric analysis (RSA), and the clinical safety and efficacy of this novel design.

This study enrolled 22 patients (11 male/11 female; median age 70.6 years) and evaluated implant fixation using radiostereometric analysis (RSA). RSA is a well validated technique used to predict long-term implant stability by studying the implants early behaviour. RSA markers were viewed via radiologic imaging at six weeks (baseline) and 6, 12, and 24 months. Mean acetabular subsidence from baseline to 24 months was 0.087 mm (SD 0.152), below the critical threshold of 0.2 mm (p = 0.005). Mean femoral subsidence from baseline to 24 months was -0.002 mm (SD 0.194), below the published reference of 0.5 mm (p < 0.001).

The study outcomes with the Reverse HRS demonstrate excellent fixation with a predicted low risk of revision at ten years, mean migration below the level of radiostereometric analysis (RSA) detection for both the femoral and acetabular components, and high rates of patient satisfaction including no patients reporting symptoms consistent with soft-tissue impingement within the articulation and no symptoms consistent with adverse reaction to metal debris.


OPN: What could your findings mean to the orthopaedic industry and the patient experience?

TT: These data demonstrate that this Reverse Hip Replacement System delivers excellent fixation with a predicted low risk of revision for loosening at ten years post-surgery.


OPN: Could you tell us more about the Reverse Hip Replacement System?

TT: The Reverse HRS is a Metal-on-Polyethylene reverse geometry hip prosthesis designed to improve stability at extended ranges of motion and reduce the risk of dislocation. Like most conventional systems, the Reverse HRS consists of a femoral stem, an acetabular cup and a cobalt-chrome ball that articulates within a polyethylene liner.

Unlike existing total hip replacement systems, the ball is placed on a trunnion within the acetabular cup instead of the femoral stem, and the polyethylene liner is attached to a femoral cup, which then attaches to the femoral stem, as opposed to the polyethylene liner being attached to the acetabular cup. This technological difference does not change the center of rotation of the Reverse HRS and it remains similar to a normal physiological hip, or a well-positioned traditional Total Hip Arthroplasty. The advanced Reverse HRS implant is designed to provide greater range of motion in all planes, enhanced hip stability, and to reduce the risk of dislocation.

Importantly, the Reverse HRS also provides variability of component placement including higher abduction angles and anteversion of the acetabular cup. The femoral cup articulates around the acetabular ball and overlaps with the acetabular cup as the hip undergoes flexion-extension, abduction-adduction and internal-external rotation. This forgiving design may compensate for suboptimal component positioning which may provide benefits such as extended range of motion, hip stability and reduced likelihood of impingement.

The Reverse HRS is designed to uncouple the relationship between component placement, wear and stability. This unique implant design of the Reverse HRS provides optimal surface area contact between the acetabular ball and femoral cup, which may eliminate edge loading. Elimination of edge loading may provide benefits that include reduced high-contact stresses, decreased implant wear and uniform wear, which minimizes generation of wear debris and associated concerns related to osteolysis.


OPN: What’s the best part of your job?

TT: The best part is seeing my patients back after surgery and hearing about what activities and quality of life that they have returned to pursuing. It is what drives me every day to do my best work for each patient.


OPN: … and the worst?

TT: There are some patients where medical technology has not made the same strides and I cannot offer them the same likelihood of a great surgical outcome. This is what drives me to pursue research to expand the care options for patients.


OPN: What has been the highlight of your career so far?

TT: I get to work everyday in a tight-knit group of surgeons, nurses and allied health staff that are second to none in the care that they deliver. I get to pursue both my clinical endeavors and research and teach residents and fellows, shaping the future of arthroplasty care. It is hard to think of anything better.


OPN: Are you planning to attend any orthopaedic events over the next year?

TT: I will be attending the AAOS as well as the Canadian Arthroplasty Society and Canadian Orthopaedics Association annual meetings.


OPN: If you didn’t work in the medical industry, what would you be?

TT: I’m not sure that there is any place else for me.


OPN: What would you tell your 21-year-old self?

TT: I started medical school at 21, so I would say to follow your heart as you experience the different areas of medicine. It led me to joint replacement once and I am sure that it would do it again.


OPN: If you were Health Minister for the day, what changes would you implement?

TT: It is a difficult job with many competing interests. I would probably have a look at the levels and costs of bureaucracy within the healthcare system and make sure that the funding being spent at those levels have real benefit to patients.


OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for 2024 and the next decade?

TT: I know that, locally, we will continue to see expansion of hip and knee replacement procedures. With the greying of the baby boom generation, there will be no shortage of need for joint replacement and, unfortunately, fracture management in the next decade. It is going to require all of us to look differently at how we optimise and deliver care and step up to the challenge of offering our very best in all aspects.