Professor Donald W Howie, MBBS, FRACS, PhD
Centre Clinical Director
Professor Donald Howie is the Co-Clinical Director of the Centre for Orthopaedic and Trauma Research, University of Adelaide, established 2012. He has been the Clinical Director of the Orthopaedic and Trauma Service, Royal Adelaide Hospital since 1992. He has been a Professor since 1988 and Head of Discipline of Orthopaedics and Trauma, University of Adelaide since 1993. Professor Howie obtained his PhD on the role of wear particles in prosthesis loosening. His clinical specialty is in complex hip and knee joint replacement and reconstruction, with his research expertise in joint replacement, surgical complications, bone loss and prosthesis wear.
Professor Howie has an international reputation as both a practicing surgeon and scientist, with regular invitations as a guest lecturer at international meetings. He has been a previous Chairman, Hip Section, Asia Pacific Orthopaedic Association, and is an invited member of the 60-member International Hip Society (the first of only two Australians). He is also a recently invited member of the American Hip Society. Professor Howie is a reviewer for JBJS(Br) and CORR, highly ranked journals in the discipline, and is on the editorial board of/or reviewer for 5 other orthopaedic journals. He has had continuous funding by the NHMRC over 20 years. He has to date 105 publications (periprosthetic bone loss, implant wear, clinical management, RCTs). His work has been cited 2521 times and his H-index is 28 (Thomson ISI).
Contributions to knowledge and expertise
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 as one of Australia's 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, the causes and management of pathological, implant, and fracture related bone loss around total joint replacement. For example, my animal model was the first to confirm periprosthetic bone loss from wear particle induced inflammation. Our bone biology research has found a direct link between metal and polyethylene particles and key mediators of 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 near orthopaedic implants.
From the clinical perspective, 25 years ago I recognised the need for a consistent and long-term approach to clinical outcomes research in the field of joint replacement and therefore established a prospective patient outcomes and implant retrieval program to ensure an evidence-based approach to joint replacement. Our strong interest in outcomes led to our team developing the early stages of the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), which is now an internationally recognised Registry. Our local program produces important long-term outcomes to inform evidence based practice and will continue to remain an important source of clinical, patient-important pain and functional data and implant wear and failure data to supplement the implant survival data provided by the AOANJRR. My PhD and extensive experience as a revision surgeon focussed my interest in complications of joint replacement surgery. I also appreciated the need for epidemiological expertise in undertaking clinical research, culminating in our large international multi-centre randomised controlled trial on efficacy of a large articulation to reduce dislocation. This study has shown unequivocally for the first time that a 36 mm articulation in total hip replacement resulted in a fourfold decrease in dislocation compared to a 28 mm articulation. 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. My research team has also developed computed tomography protocols to quantify peri-prosthetic osteolysis. The current application stems from my appreciation and support for the stepwise introduction of prostheses and the critical importance of appropriate evaluation of new technologies and management techniques.
Selected Recent Publications
1. Howie DW, Neale SD, Haynes DR, Holubowycz OT, McGee MA, Solomon LB, Callary SA, Atkins GJ, Findlay DM. Periprosthetic osteolysis after total hip replacement: molecular pathology and clinical management. Inflammopharmacology. 2013 Dec;21(6):389-96.
2. Howie DW, Neale SD, Martin W, Costi K, Kane T, Stamenkov R, Findlay DM. Progression of periacetabular osteolytic lesions. J Bone Joint Surg Am. 2012 Aug 15;94(16):e1171-6.
3. Howie DW, Holubowycz OT, Middleton R; Large Articulation Study Group. Large femoral heads decrease the incidence of dislocation after total hip arthroplasty in a randomized controlled trial. J Bone Joint Surg Am. 2012 Jun 20;94(12):1095-102.
4. Howie DW, Costi K, McGee MA, Standen A, Solomon LB. Femoral bone is preserved using cemented polished stems in young patients. Clin Orthop Relat Res. 2012 Nov;470(11):3024-31.
5. Howie DW, Callary SA, McGee MA, Russell NC, Solomon LB. Reduced femoral component subsidence with improved impaction grafting at revision hip arthroplasty. Clin Orthop Relat Res. 2010 Dec;468(12):3314-21.
Professor Brian J C Freeman, BCh, BAO, DM (Nottm), FRCS (Tr & Orth), FRACS (Ortho)
Centre Clinical Director
Professor Freeman is Head of Spinal Services at the Royal Adelaide Hospital and Professor of Spinal Surgery in the Discipline of Orthopaedics and Trauma at the University of Adelaide. He was appointed Research Director at the Adelaide Centre for Spinal Research in 2012 and Clinical Co-Director of the Centre for Orthopaedic and Trauma Research, University of Adelaide in 2012. Professor Freeman enjoys a busy clinical practice as an adult and paediatric spinal surgeon. He has a strong interest in both basic science and clinical research of the spine.
In the last 5 years, Professor Freeman has been supported by $2.3 million from peer review funding bodies and attracted an additional $2.75 million from industry to support his research. Professor Freeman has published 76 peer-reviewed publications, 19 book chapters, 143 published abstracts from 212 podium presentations and 94 poster presentations to national and international meetings.
He has been awarded 29 national and international prizes for his research including: 2007 ISSLS Prize in Clinical Studies, 2009 Spine Society of Australia Spinal Research Award, 2009 ISSLS Prize in Basic Science/Biomechanics, The Spine Journal 2012 Outstanding Paper Award in Surgical Science (Runner Up) and 2013 Spine Society of Australia Spinal Research Award.
Selected recent publications
1. Arun R, Freeman BJC, Scammell BE, McNally D, Gowland P, Cox E. 2009 ISSLS Prize Winner: What influence does sustained mechanical load have on diffusion in the human intervertebral disc: An in-vivo study using serial post-contrast magnetic resonance imaging. Spine 2009 Oct 1; 34 (21) 2324-2337.
2. Meir AR, Freeman BJC, Fraser RD, Fowler SM. 2012 Outstanding Paper Surgical Science: Runner Up. Ten-year survival and clinical outcome of the AcroFlex lumbar disc replacement for the treatment of symptomatic disc degeneration. The Spine Journal. 2013 Jan; 13 (1): 13-21.
3. Alexander WM, Smith M, Freeman BJC, Sutherland LM, Kennedy JD, Cundy PJ. The effect of posterior spinal fusion on respiratory function in Duchenne Muscular Dystrophy. European Spine Journal. 2013 Feb; 22 (2): 411-6.
4. Cundy TP, Antoniou G, Sutherland LM, Freeman BJC, Cundy PJ. Serum titanium, niobium, and aluminium levels after instrumented spinal arthrodesis in children. Spine (Phila Pa 1976) 2013; 38: 7: 564-570.
5. Freeman BJC, Ludbrook G, Hall S, Cousins M, Mitchell B, Jaros M, Wyand M, Gorman J. A randomized, double-blind, placebo-controlled trial of transforaminal epidural etanercept for the treatment of symptomatic lumbar disc herniation. Spine 2013; 38: 23: 1986-1994.
Professor David M Findlay, M.Sc., PhD
Centre Scientific Director
Professor Findlay obtained his BSc and MSc from The University of Melbourne, the latter studying the physiology of glucagon. He obtained his PhD, also from The University of Melbourne, in 1982, investigating calcitonin-receptor interactions and cell signalling. He subsequently undertook Post-doctoral training at the National Institutes of Health in Maryland, USA, working on the, then newly discovered, osteonectin molecule. He moved to Adelaide in 1996, taking the position of Professor of Orthopaedic Research. His research career has focused primarily on bone and joint physiology and pathology, including cancers of bone, with particular expertise in the cell and molecular biology of bone physiology and pathology. His research interests also encompass pre-clinical and clinical approaches to investigate the mechanisms of pathological bone loss and its treatment. His work has been supported by continuous peer-reviewed funding from the Australian NHMRC, as well as from the Cancer Councils, other granting bodies and industry. He has published over 200 peer-reviewed papers, book chapters and reviews, covering a broad range of topics within the bone field. This research has given him a comprehensive understanding of the physiological processes and pathological mechanisms that lead to skeletal disease, and to pathological bone loss in particular. He has supervised numerous higher degree students and mentored a number of visiting fellows.
He has served as a Council member (Honorary Secretary) of the Australian and New Zealand Bone and Mineral Society and as both President and Secretary of the Australian and New Zealand Orthopaedic Research Society. He is currently Scientific Director of the University of Adelaide Centre for Orthopaedic and Trauma Research and Chair of the School of Medicine Research Committee in the Faculty of Health Sciences at Adelaide University. He is a member of the Australian NHMRC Research Translation Steering Committee for Arthritis and Musculoskeletal Conditions. He has received numerous invitations to speak at national and international venues, and has served as program organiser, abstract reviewer and session chair of the major national and international bone society meetings (ANZBMS, ANZORS, ASBMR, IBMS, ORS, OARSI, CORS and ICORS). He serves on the Editorial Board of the Journal of Bone and Mineral Research.
Selected Recent Publications
1. Zinonos I, Labrinidis A, Lee M, Liapis V, Hay H, Ponomarev V, Diamond P, Zannettino ACW, Findlay DM and Evdokiou A. APOMAB, a fully human agonistic antibody to DR5 exhibits potent antitumor activity against primary and metastatic breast cancer. Mol Cancer Ther 8:2969-2980, 2009.
2. Atkins GJ, Rowe PS, Lim HP, Welldon KJ, Ormsby R, Wijenayaka R, Zelenchuk L, Evdokiou A, Findlay DM. Sclerostin is a locally acting regulator of late-osteoblast/pre-osteocyte differentiation and regulates mineralization through a MEPE-ASARM dependent mechanism. J Bone Min Res, 26:1425-36, 2011.
3. Howie DW, Neale SD, Martin W, Costi K, Kane T, Stamenkov R, Findlay DM. Progression of periacetabular osteolytic lesions. J Bone Joint Surgery Am. 94:e1171-6, 2012.
4. Wijenayaka AR, Kogawa M, Lim HP, Bonewald LF, Findlay DM, Atkins GJ. Sclerostin Stimulates Osteocyte Support of Osteoclast Activity by a RANKL-Dependent Pathway. PLoS One. 6:e25900, 2011.
5. Kogawa M, Wijenayaka AR, Ormsby RT, Thomas GP, Anderson PH, Bonewald LF, Findlay DM, Atkins GJ. (2013) Sclerostin regulates release of bone mineral by osteocytes by induction of carbonic anhydrase 2. Journal of Bone and Mineral Research 28(12):2436-48.
Associate Professor Gerald J Atkins, PhD
Centre Scientific Director
Associate Professor Gerald Atkins is the Head of the Bone Cell Biology Group and Scientific Director (Co) of the Centre for Orthopaedic and Trauma Research (COTR), University of Adelaide. Since completing his PhD in 1998 he has conducted research into the pathophysiology of bone remodelling. He has established an internationally recognised research programme within COTR. He has published 95 related peer-reviewed research articles and book chapters. His work has been cited 2,420 times and his H-index is 30 (Thomson ISI). Seven of his papers have been cited more than 100 times and 17 more than 50 times. He has been continuously funded by the NHMRC Project Grant Scheme as well as an NHMRC RD Wright Biomedical CDA Fellowship (2007-2011). His research has attracted more than $8.1M in competitive and private industry funding. He currently serves as Honorary Secretary to the Australian New Zealand Bone and Mineral Society (ANZBMS) and he is also an invited member of the Editorial Boards of the J Bone Miner Res, the World J Orthopaedics and Frontiers in Bone Biology. He is Post-Graduate Coordinator for the Discipline of Orthopaedics & Trauma, School of Medicine, at the University of Adelaide.
Selected Recent Publications
1. Vincent C, Findlay DM, Welldon KJ, Wijenayaka AR, Zheng TS, Haynes DR, Fazzalari NL, Evdokiou A, Atkins GJ. Proinflammatory Cytokines TWEAK and TNF Induce the Mitogen Activated Protein Kinase (MAPK)-Dependent Expression of Sclerostin in Human Osteoblasts. J Bone Miner Res 24:1434-49, 2009.
2. Kogawa M, Findlay DM, Anderson PH, Ormsby R, Vincent C, Morris HA, Atkins GJ. Osteoclastic metabolism of 25(OH)-vitamin D3: a potential mechanism for optimization of bone resorption. Endocrinology 151:4613-25, 2010.
3. Atkins GJ, Rowe PS, Lim HP, Welldon KJ, Ormsby R, Wijenayaka AR, Zelenchuk L, Evdokiou A, Findlay DM. Sclerostin is a locally acting regulator of late-osteoblast/pre-osteocyte differentiation and regulates mineralization through a MEPE-ASARM dependent mechanism. J Bone Miner Res 26:1425-36, 2011.
4. Wijenayaka AW, Kogawa M, Lim HP, Bonewald LF, Findlay DM, Atkins GJ. Sclerostin promotes osteocyte support of osteoclast activity by a RANKL-dependent pathway. PLoS ONE 6: e25900, 2011.
5. Kogawa M, Wijenayaka AR, Ormsby RT, Thomas GP, Anderson PH, Bonewald LF, Findlay DM, Atkins GJ. Sclerostin regulates release of bone mineral by osteocytes by induction of carbonic anhydrase 2. J Bone Miner Res 28:2436-48, 2013.
Senior Clinical Members
- Associate Professor Bogdan Solomon - Fracture repair, anatomy, clinical orthopaedic research
- Associate Professor Mellick Chehade - Fragility fracture, education
- Associate Professor Anthony Pohl - Trauma, clinical trials, trauma complications
- Professor Andreas Evdokiou - Bone cancer, bone biology
- Dr Matt Prideaux - Bone biology
- Dr Masakazu Kogawa - Orthopaedic Surgeon/ Cell Biologist
- Dr Oksana Holubowycz - Epidemiology
- Mr Stuart Callary - Musculoskeletal imaging
- Dr Claire Jones - BioEngineer
- Dr Julia Kuliwaba - Bone structure/ pathology
- Associate Professor Michael Sandow - Surgeon, RAH and Wakefield Orthopaedic Clinic - upper limb
- Associate Professor Greg Bain - Surgeon, Mobury Hospital, RAH - upper limb, biomechanics
- Associate Professor Bruce Foster - Surgeon, WCH - paediatric orthopaedics
- Mr David Campbell - Surgeon, Wakefield Orthopaedic Clinic - joint reconstruction, bone banking
- Dr Peter Lewis - Surgeon, QEH - knee replacement
- Associate Professor Mark Clayer - Surgeon - orthopaedic oncology
- Associate Professor Ruth Marshall - Surgeon, Hampstead - spinal cord injury and orthopaedic rehabilitation medicine
- Dr Jillian Clark - Hampstead - spinal cord injury and orthopaedic rehabilitation
- Sarah Marchioro - Discipline Secretary
- Kamarul Khalid - PhD
- Asiri Wijenayaka - PhD
- Yu Chao Lee - MPhil-Surg
- Daniel Reinke - PhD
- Ioane Vakaci - PhD
- Stuart Callary - PhD
- Mario Zotti - MPhil-Surg
- Diane Howski - MPhil-Surg
- Christine Schutz - MClin-Sci
- Dzenita Muratovic - PhD
- Caroline Moran - PhD
- Thomas Fisher - MPhil-Surg