Tackling a clinical research challenge in Cambridge amid the pandemic
Covid-19 has placed a huge strain on clinical research but the pandemic has also educated us on the value of global “collaboration, communication and harnessing the power of technology”.
Addenbrooke’s consultant orthopaedic surgeon and clinical research lead, Vikas Khanduja, told the Cambridge Independent that “there is no doubt” the past 18 months have “taught us to communicate on a global scale very quickly”.
“I’m sure this will only be for the benefit of our patients in the future,” he explained.
But for the next 18 months, said Mr Khanduja, staff are acutely overloaded and this, coupled with the current climate and funding challenges, could mean research opportunities may be difficult for some time to come.
Mr Khanduja has been working on pioneering research into young adults with hip pain that is transforming people’s lives here and in Africa.
Mr Khanduja’s research group is focussed on improving outcomes of hip preservation in young people from age 13 to adults of about 45 years old who are suffering hip impingement, also known as femoroacetabular impingement.
The condition was first described in 1999, and research continues into whether genetic makeup or an adaptive response to load is responsible for it.
Mr Khanduja with the help of his colleagues developed the young adult hip service in Cambridge which is now the tertiary referral centre for young adult hip surgery in the east of England.
“The aim is to try and save as many hips as possible from requiring a hip replacement at a younger age,” he explained. Mr Khanduja, who has been at Addenbrooke’s since 2007, continued: “Most of the research I do is on a condition called cam hip impingement which you find in young adult males and this can potentially lead to the development of hip arthritis. The research looks at understanding the disease process, correcting this morphological abnormality and improving outcomes.”
Cambridge Global Health Partnerships (CGHP), part of the Addenbrooke’s Charitable Trust, works with hospitals, governments and health organisations in countries across Africa, Asia and Latin America to improve healthcare outcomes across the globe, through healthcare training, shared skills and knowledge.
Mr Khanduja, who is passionate about the benefits of global working, has developed a long-standing relationship and collaboration with Botswana and Gaborone-based orthopaedic surgeon, Dr Laughter Lisenda, that is benefitting patients in both countries.
It began when Dr Lisenda travelled to Cambridge to work as a trainee in the orthopaedic department under Mr Khanduja.
And it has continued with general mentorship, sharing knowledge and ideas, research projects, advice on complex cases virtually, all of which have continued during the pandemic.
With the support of CGHP, the hope is to establish a health partnership between Botswana and Cambridge with opportunities for more healthcare professionals on both sides of the globe to get involved in sharing knowledge, expertise, skills.
Mr Khanduja said the benefits of the partnership had been substantial: “The last 18 months have clearly shown us the value of global partnerships. I’ve always been a big proponent of that because there are some diseases, which are quite endemic in one area, and you learn more if you are collaborating with people there.”
He highlighted avascular necrosis of the hip, which is very prevalent in Botswana because of sickle cell disease in Africa.
“We learn a lot more about that and find that treating patients here who’ve got that which you would encounter irregularly, you become much more proficient at managing that because you’ve actually discussed it with your colleague in Africa, and vice versa,” said Mr Khanduja.
“We are blessed here to be managing conditions with the best equipment, the best theatres, and the best staff. But when you go to places like Africa, you may not have all these systems in place or the best equipment or the theatre staff – and to learn how these surgeons manage with minimal equipment and to see their expertise is again phenomenal both on the clinical side and the surgical side.”
He said the joint replacement practice in Botswana had directly benefitted patients because of the work that Dr Lisenda did at Addenbrooke’s.
Mr Khanduja added: “If you train one surgeon well then potentially you may be affecting many more lives because in their lifetime a surgeon will come across that many people and train people as well.”
And there are further benefits for patients in the UK, with many patients in Africa presenting with conditions at a much more advanced stage due to a lack of access to treatment and financial issues.
“The disease that they are managing is probably quite advanced, and seeing those advanced cases, or discussing those advanced cases, definitely helps us because we seem to be seeing these earlier on because access to health care is good,” Mr Khanduja said, adding: “The other thing is, we have an extra pair of hands in the department of a senior fellow or a registrar, which comes with very little resources that the hospital has to spend on.”
Mr Khanduja will be giving a virtual talk on Tuesday, July 6 for people to hear more about the work he has been doing with the partnership and his research, at which a patient with hip impingement will share their story.
He will be highlighting how crucial the funding from ACT has been in supporting his work and his plans for the future.
“We want to be able to stratify disease, and find out which patients will benefit from surgical intervention and which patients do not need surgery,” Mr Khanduja explained.
“We would want to use the platform that ACT has provided for running future clinical trials, and expanding the international research collaborative network.”
He continued: “In the current climate with reduced funding, I think that’s going to be challenging for the next 18 months to two years for research in this arena.”
But there are some positives to take from the challenges of the pandemic: “My personal belief about adversity is it brings out the best in you. There’s no doubt that the last 18 months have taught us how to communicate on a global scale, very quickly.
“They’ve also taught us the power of technology and harnessing the power of technology for education, for communication, and for clinical trials, as you’ve seen with vaccines.
“They have been done at a very rapid pace and they’ve become cheaper. I’m sure this will only be for our benefit in the future.”