An overview of ongoing research projects in orthopedics

Sarcomas are tumors that originate from connective tissues, which include bones, cartilage, fat, muscle, blood vessels, and other soft tissues. Our research group focuses, in particular, on Ewing sarcoma, an aggressive bone sarcoma affecting children, adolescents, and young adults.

In recent years, artificial intelligence (AI) and machine learning (ML) methods have gained importance in clinical research. The data-driven approach of AI-based prediction tools enables analysis of patient features in an “unbiased” manner while also having the capacity to take into consideration the changing impact of variables over time, and potential variable interactions. By combining data from different European sarcoma centers, we strive to improve risk prediction in patients diagnosed with STS.

Leading-edge research is revolutionizing our understanding of how tendons respond to exercise. The group is gaining transformative insight into exercisebased treatments for tendinopathy, offering hope to patients suffering from this painful condition.

Charcot arthropathy is a limb-threatening condition leading to foot collapse and subsequently to below the knee amputation in around 7 % of patients. The long-term complications of both conservative and surgical treatment have not been systematically investigated. We suspect that foot collapse can be predicted by radiologic variables during radiologic workup upon admission.

In 2021, tendon allgraft was used at Balgrist University Hospital for the treatment of dropped head syndrome to avoid metal-based cervical fusion surgery by reinforcing the posterior ligaments. The implanted tendons kept their mechanical properties
over time which suggested that a similar approach could also be successfully used for semi-rigid stabilization in the lumbar spine region.

Endoscopic spine surgery is the most emerging technique of minimally invasive spine surgery. However, it is hypothesized that pressure elevation through fl uid irrigation may contribute to adverse events. Our team of researchers set itself the goal of shedding light on the dark area of fluid dynamics in spinal endoscopy.

The Spine Planner enables surgeons to conduct biomechanical simulations of spinal fusion to identify the most suitable surgical strategy.

The severity of fat build-up (fatty infiltration) in a rotator cuff muscle in the shoulder predicts the treatment outcome if one of these muscles/tendons is torn. Our study explores how fat buildup in the supraspinatus muscle (part of the rotator cuff) develops over time during nonsurgical treatment.

The traditional training approach of medical professionals, following the principle of ”see one, do one, and teach one“, is no longer aligned with contemporary requirements and the technological possibilities available for the education of surgical residents.

Total knee arthroplasty (TKA) is a well-established procedure for endstage knee osteoarthritis patients when previous conservative treatments have failed. Preoperative physical and mental preparation, known as “prehabilitation” (prehab) is emerging as a potential strategy for influencing risk factors positively associated with prolonged recovery time.

Surgical planning and intraoperative monitoring for the correction of rotational deformities of the lower extremities are needed in order to ensure the optimization of the overall outcome, and to reduce the occurence of insufficient or adverse correction. Currently available techniques for controlling rotation do not allow for real-time rotation tracking, or for minimally invasive surgery. These challenges are addressed by an electromagnetic field (EMT) guided tracking system.

The overarching aim of our project is to advance understanding of prediction modeling and health communication concerning patientreported outcomes and revision surgery after THA and TKA, using population-based SIRIS data and qualitative approaches.

The SALuBRITY Trial aims to investigate two common treatments for back-related leg pain - spinal manual therapy and cortisone injections - to understand the extent to which they improve pain, function, and quality of life in patients with sciatica.

Corrective osteotomies around the knee allow for the treatment of different deformities of the lower extremities. At Balgrist University Hospital, patients treated with such osteotomies are prospectively registered for assessment of clinical and radiological outcomes with the aim of continuous improvement of orthopedic surgery.

Minimally invasive surgical techniques have dramatically advanced patient care. Despite these advancements, the challenge of suturing soft tissues with precision and without tissue damage remains. In our research we develop a novel approach through feedback-controlled, fl uorescent nanothermometry-guided laser tissue soldering, tailored for use in arthroscopic and robotic surgery.

At the Balgrist Ingenuity Lab we are transforming patient care by developing advanced materials and devices that enhance therapeutic outcomes, improve diagnostic precision, and expedite recovery. By harnessing the unique properties of materials, this research centered on musculoskeletal soft tissue aims to create integrated solutions that not only treat but also monitor health conditions in real-time.

The unit of Infectious Diseases and Infection Control targets the streamlining of the management, a reasonable use of antibiotic agents, and their prevention of orthopedic infections, including those associated with diabetic foot complications. The unit runs several prospective databases and fi ve parallel randomized-controlled trials.

A randomized double-blinded placebo-controlled trial revealed that perioperative intravenous dexamethasone significantly reduces postoperative opioid requirement and nausea after unilateral elective hip arthroscopy.

The distal radioulnar joint (DRUJ) is crucial for the rotational movement of the forearm, as well as for power and load transfer. Little was known about the importance and relative contribution of musculoskeletal units to the stabilization of this joint. We quantified the influence of the flexor carpi ulnaris (FCU) and the extensor carpi ulnaris (ECU) muscles on DRUJ stability. Our results indicate that intentional ulnar forearm muscle activation results in 70 % less anteroposterior ulnar head translation and greater DRUJ stability.

The external torque device, which was developed at Balgrist University Hospital, is able to evaluate the syndesmotic ligaments as precisely as an intraoperative lateral hook test.

The novel technology for suture-free surgery of rotator cuff repair has become reality. After four years of research and development in collaboration with the Balgrist Shoulder Team and start-up ZuriMED, this unique concept method has demonstrated its potential in an initial clinical indication.

FAROS introduces a novel approach to surgical robotics, integrating multisensory technologies and artifi cial intelligence to advance autonomy and precision in operative procedures.

The Digital Medicine Unit is developing a sustainable digital framework that pursues two main objectives: firstly, to increase the efficiency of research projects by supporting data management, and secondly, to develop and validate trustworthy artificial intelligence models and digital tools to support clinical processes.

The Laboratory for Orthopedic Biomechanics is driving advances in patient healing through innovative biomaterial design. Our dedicated team has developed a state-of-the-art research platform that features biomaterials with adjustable biomechanical characteristics, which clo- sely mimic the physical and chemical properties of soft musculoskeletal tissues. These innovative materials are revealing how materials can be engineered to interact with human tissue in powerful ways to promote healing and regeneration.