Maiken Stilling

Title

Clinical Professor, MD, PhD

Primary affiliation

Department of Clinical Medicine Orthopaedic surgery

Email address: Send email maiken.stilling@clin.au.dk

Research

SCIENTIFIC INTEREST

Hand Surgery

Relating to my clinical sub specialty in hand surgery, I have research focus on reconstruction and replacement in general.

JOINTS/BONES/LIGAMENTS: I have established local clinical databases for trapeiometacarpal joint total joint arthroplasty (N>1000) and wrist arthroplasty (N>50) joint replacement for assessment of implant fixation, function, survival and patient related outcomes. I have implemented new minimally invasive arthroscopic guided procedures for partiel wrist fusion and follow cases for safety assessment as well as research purpose. I have appled functional wrist kinematic assessment (dynamic RSA) as well as malunion visualization/grading (model mirroring) of radius and ulna maluion to be able to calculate precisely the needed reconstruction to recover normalized function. Patients are follow cases for safety assessment and research. Years of research in kinematics of the distal radioulnar joint and triangular-fibrocartilage (TFCC) lesions is the basis of this clinical-scientific research expansion.

Furthermore, I have helped initiate a national study to clarify the results of different surgical methods to treat scapholunate-ligament lesion.

AMPUTATIONS/NERVES: New products and new clinical recommendations in repair, reconstruction and rescue after nerve injury stress the importance of systematic patient follow-up and scientific sharing of results, which I have facilitated with establishment of local clinical databases. Following international visits, I have applied to both upper and lower extremities new clinical treatments for muscle reeinnervations and/or neuropathic pain for amputees and after iatrogenic or traumatic nerve lesions in terms of targeted muscle reinnervation (TMR) and regenerative peripheral nerve interface (RPNI). Likewise, results after arm prosthesis – osseointegrated and socket prostheses - are followed closely and data ensured in a database.

Musculoskeletal Imaging

My research expertise in muscoluskeletal imaging is broad and interdisciplinary and include experimental and clinical research targeting improvements in tribology, survival and function of joint prostheses including investigations of implant design, implant coatings, bone cements, polyethylene wear, pseudotumors, bone quality, and rehabilitation. Quantitative imaging modalities is the fulcrum of my applied methodologies and take in radiostereometry (RSA), dual-energy x-ray absorptiometry (DXA), computed tomography (CT), microCT (μCT), finite element analysis (FE), and motion capture. I use measures of periprosthetic bone density, bone histology, and bone metabolism (blood samples) including bone turnover markers to investigate bone quality in relation to implant migration and survival, and to evaluate treatment effects of bone anti-resorptive pharmaceuticals. Artificial Intelligence become more and more important in the analyses of the big data sets generated.

Activity, function and health economics

Patient function before/after conservative treatment and surgical intervention is assessed by activity (accelerometry) and gait/motion analysis (inertia measurement unit, motion capture) and patient reported outcome measures. I have worked with establishment of clinical patient pathways and and health economic evaluations in relation to change of treatment regimes.

Microdialysis, pharmakokinetics, population pharmacokinetic modelleing

Microdialysis is the instrument used for evaluation of pharmacokinetic concetration profiles as well as ischaemia and inflammation in different tissue compartments. In several experimental (laboratory and animal models) and clinical studies my research group have evaluated antibiotics and chemotherapeutics in relation to differet administration routes and drug dose.

We have established the optimal time for administration and re-administration of cefuroxime in relation to infection prophylaxis in hand surgery, foot surgery and spine surgery. In cooperation with KU we also work with an infected pig model.

Through international collaborators we establish population pharmacokinetic models, which can simulate changes in treatment regimes e.g. effect on tissue concentration with increasing pharmaceutical dose.

RESEARCH QUALITY

I conduct research at international level and have published several level 1 state-of-the-art randomized clinical studies. I have published >160 papers in an 15-year publication carreer with 28 publications in 2022 and currently 15 publications in 2020. The publication list is mainly first and last authorships, which reflects a high degree of involvement in all studies. I expect my publication commitment to stay constant in the next 5 years based on my research plan.

RESEARCH GROUPS

I am the head of two productive, well-established research groups that are well-known internationally for high-quality research and we have multiple international collaborators at top research intsitutions. Furthermore, I am responsible for continuing and reshaping a resilient orthopaedic research laboratory at Aarhus University Hospital towards new research areas aod focus.

The AutoRSA Research Group https://autorsa.au.dk is an interdisciplinary research group formed and directed by me since 2014 with impetus in a big scale technology research project based at Aarhus Universit Hospital. I was chairman of the project steerings committee and project leader for development of dynamic RSA. I followed the Harvard Business School and Innovation Foundation Pasteur Program in a 1 year project leader education. The research group successfully developed an image-diagnostic platform for biomechanical evaluation of fixation and function of orthopaedic joint replacements based on dynamic RSA.

Furthermore the largest database in the world with clinical radiostereometry of hip and knee arthroplasty was established and continue to form the basis of new studies including predictions of implant survival and patient reported outcomes in relation to hip and knee arthroplasty surgery.

TEAM

The research group currently consist of 1 professor (me), 6 clinical physicians in different sub-specialties (hip, knee, shoulder/elbow, hand, paediatrics, reconstruction), 3 post.docs., 3 phd students, 3 research year student (2 post research year/1 application), 1 medical students and 1 project coordinator.

AMBITION

The activity in the group is high and focus is on software development, validation research and clinical research. Artificial intelligence is applied for for analyses of the big data.

The Microdialysis Research Group https://microdialysis.au.dk is an interdisciplinary research group formed in 2014. I have directed the group since 2017. The research group use microdialysis for assessment of drug pharmacokinematics with a specific focus on contentrations of antimicrobials in bone such as for surgical infection prophylaxis and treatment of bone infection. We have studied many diffent antimicrobial drugs as well as the effect of dose and way of administration in experimental pig models as well as clinical studies. The group also work on optimization of antineoplastic treatment with measurement of chemotherapeutics in target sites and healthy tissues such as for bone cancers (sarcoma) and peritoneal carconomatosis (gynecholocal cancers). We have a current focus for evaluation of local treatment application and on establishing pharmacokinetic models to simulate changes in treatment regimes.

TEAM

The research group currently consist of 1 professor (me), 1 associate professor, 1 assistant professor, 10+ clinical physicians in different orthopaedic subspecialties (hand, hip, knee, shoulder/elbow, spine, tumor) and other specialties (infection, plastic surgery, microbiology, oncology, veterinary), 4 phd students (and 1 in application), 5 active research year students (2 official/3 post research year), and 1 laboratory technician.

AMBITION

The activity in the group is great with a strong drive for high-quality experimental and clinical studies and publications.

Collaborations

RESEARCH COLLABORATIONS AND PARTNERS

Imaging, activity and big data / artificial intelligence
2006-	Biomechanics and Imaging Group (BIG), Department of Orthopaedic Surgery, Leiden University MedicalCenter (LUMC), Leiden, The Netherlands Bart L. Kaptein, Senior Researcher, Dr. Ir., PhD Rob G.H.H. Nelissen, Chair & Professor Orthopaedics, MD, PhD Bart Pijls, Senior Researcher, Epidemiologist, MD, PhD * Collaboration on: RSA research and development in the AutoRSA project, co-supervision of researchprojects, PhD courses in RSA, The International RSA Society, Updated RSA guideline paper
2019-	Department of Mechanical and Aerospace Engineering, University of Florida, USA Scott Arthur Banks, Professor and Department Chair, MSc, PhD * Collaboration on: RSA research and software development
2013-	Erasmus MC - University Medical Center, Rotterdam, The NetherlandsDanish Technical University (DTU), Division of Medical Image Science, University of Copenhagen, Denmark Marleen de Bruijne, Professor of medical image analysis, MSc, PhD * Collaboration on: Imaging research and method development within hip dysplasia, co-supervision ofresearch projects
2016-	Technical Faculty, Institute for Mechanics, Production and Biomechanics (M-TECH), Aalborg, Denmark & The AnyBody Group, Center for Mathematical Modelling of Knee Osteoarthritis, Department of Materials and Production, Aalborg University, DK Michael Skipper Andersen, Professor of Biomechanics and head of research center, MSC, PhD * Collaboration on: biomechanical modelling for kinematic assessment of loaded joint functions, MRImodels and segmentation.
2014-	Physics Laboratory, Johns Hopkins University, Baltimore, Maryland, USA Armand Mehran, Mechanical Engineer, Professor of The Applied Physics Laboratory * Collaboration on: surgical navigation tools, artificial intelligence for imaging and big data
2021-	ARC Training Centre for Medical Implant Technologies, Department of Biomedical Engineering, TheUniversity of Melbourne David Ackland, Professor and Deputy Director * Collaboration on: artificial intelligence for imaging and big data
2009-	Center for Implant and Radiostereometry Research Oslo (CIRRO), Oslo University Hospital, Norway Stephan Röhrl, Associate Professor, Director of CIRRO, MD, PhD * Collaboration on: RSA research and development, Board Colleague of the International RSA Society,Updated RSA guideline paper
2021-	Bone and Joint Institute, Western University, London, Ontario, Canada Matthew Teeter, Associate professor and head of research program, MSc, PhD Daniel Langoir, Senior Researcher * Collaboration on: computational medicine and wearable sensor monitoring for activity measurement ofthe upper extremity
2015-	Department of Orthopaedics, Salgrenska Academy, Gothenburg University, Gothenburg, Sweden Johan Karrholm, Professor of Orthopaedics, MD, PhD Peter Axelsson, Associate Professor, Hand Surgeon with expertise in arthroplasty, MD, PhD * Collaboration on: RSA research and development in hand arthroplasty surgery, The International RSASociety, Updated RSA guideline paper
2017-	Department of Orthopaedics, Dalhousie University, Halifax, Nova Scotia, Canada Michael Dunbar, Professor of Orthopaedics and Director of Research, MD, PhD * Collaboration on: The International RSA Society, Updated RSA guideline paper
2018-	Human mobility Research Laboratory, Faculty of Engineering & Applied Science, Queens University, Kingston, Ontario, Canada Elise Laende, Post.doc. Fellow, MSc, PhD * Collaboration on: RSA of knee arthroplasty, big data, artificial intelligence, combining database results,The International RSA Society, Updated RSA guideline paper
2015-	Dept of Orthopaedics and Trauma, Royal Adelaide Hospital, Australia Bogdan Solomon, Professor of Adelaide University,- Stuart Callary, Senior Medical Scientist, Board of International RSA Society * Collaboration on: The International RSA Society, Updated RSA guideline paper
2015-	Institute of Medical Sciences, Dept. of Radiology and Orthopedics, Aberdeen University Hospital, United Kingdom Martin Downing, MSc Medical Physics and IT * Collaboration on: RSA research and development in the AutoRSA project, The International RSA Society
2015-	Department of Dentistry and Oral Health, Dept of Orthodontics, Aarhus University, Aarhus, Denmark Ruben Spin Neto, Professor, MSs, PhD, DMSc * Collaboration on: mechanical testing and biomechanics, RSA research and development in the AutoRSAproject, reverse engineering of bone models
2011-	Department of Procurement and Clinical Engineering, Aarhus University Hospital, Aarhus, Denmark Jesper Thygesen, MSc, PhD * Collaboration on: RSA imaging, dose estimations, CT scan optimization and model delveopment
2022-	Departments of Orthopaedics, Odense University Hospital, Odense, Denmark Bjarke Viberg, Professor, Head of Research in Traumatology, MD, PhD * Collaboration on: RSA research studies
2009-	Departments of Radiology and Orthopaedics, Gødstrup Hospital, Holstebro, Denmark Torben Bæk Hansen, Professor, Head of Department and Research, MD, Phd Janni Kjærgaard Thillemann, Associate Professor, MD, PhD * Collaboration on: RSA research studies
2013-	Department of Radiology, Aarhus University Hospital, Aarhus, Denmark Anna Zejden, MD, Radiology Consultant in musculoskeletal imaging Rikke Jellesen Aaberg, MD, Radiology Consultant in musculoskeletal imaging Lars Lindgren, MSc, Radiographer with specialty in RSA imaging * Collaboration on: RSA research and image measurements in a variety of projects
Infection, pharmacokinetics, population PK/PD modelleing
2020-	Centre of Research Excellence - Personalising antimicrobial dosing to reduce resistance Jason Roberts, Director and Phamacist Consultant * Collaboration on: pharmacokinetic modelleing: exchange of a PhD student to work in with modelleing of microdialysis data (cefuroxime) generated in experimental and clinical studies within the ADMIRE research group
2021-	Faculty of Pharmacy at Uppsala University, Sweden Lena Friberg, Professor and Phamacist Consultant * Collaboration on: pharmacokinetic modelleing of microdialysis data on antibiotics; dicloxacillin
2017-	Bone and Infection Unit, Nuffield Orthopaedic Centre, University of Oxford, UK Martin McNally, Professor and Consultant in Limb Reconstruction Alex Ramsden, Consultant Plastic Surgeon * Collaboration on: experimental and clinical studies, helps develop an infected porchine flap model for microdialysis
2021-	Infectious Diseases Department, University of Barcelona, Barcelona, Spain Alex Soriano, Assistant Professor and Head of Department * Collaboration on: microdialysis research on new types of antibiotics e.g., dalbavancin, exchange of PhD student planned
2020-	Harris Orthopaedic Laboratory, Harvard Medical School / Massachusetts General Hospital, Boston, MA, USA Orhun Moratoglu, Professor and Head of Department Ebru Oral, Associate Professor * Collaboration on: establishing microdialysis in a rat model, and for measurement of inflammatory markers in relation to an impant, international visit by of 2 PhD students in 2022
2021-	Section for Cell and Drug Technologies, Department of Health Technology, Danish Technical University (DTU), Copenhagen, Denmark Anders Elias Hansen, Senior Researcher and veterinarian Jonas Rosager Henriksen, Head of Section, Associate Professor * Collaboration on: testing of new drug loaded gel products with antobiotics or chemotherapy in the ADMIRE porchine animal model using microdialysis. Furthermore, application of microdialysis in a tumour rat model at DTU by a PhD student
2017-	Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark Eva Geribe, Chemist, MSc, PhD * Collaboration on: analysis of antibiotics concentrations from microdialysis studies
2019-	Department of Clinical Biochemistry, Vejle Regional Hospital, Vejle, Denmark Anne Vibeke Schmedes, Chemist, MSc, PhD * Collaboration on: analysis of antibiotics and chemotherapy concentrations from microdialysis studies
2018-	Department of Forensic Medicine, Aarhus University, Aarhus, Denmark Jakob Hansen, Molecular biologist, MSc, PhD * Collaboration on: analysis of antibiotics and chemotherapy concentrations from microdialysis
2017-	Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark Kristina Margareta Öbrink-Hansen, MD, PhD Nis Pedersen Jørgensen, MD, PhD Christian Moberg Wejse, Professor, MD, PhD * Collaboration on: research in antibiotics concentrations from microdialysis
2018-	Department of Veterinary Disease Biology, Copenhagen University, Copenhagen, Denmark Louise Kruse Jensen, Professor, PhD * Collaboration on: osteomyelitis models in pigs for evaluation of antibiotics concentrations by microdialysis * Collaboration on: research bone infection and antibiotics concentrations measured with microdialysis
Other research collaborators
2013-	Department of Biomedicine, Health, Aarhus University, Aarhus, Denmark Anne Marie Brüel, Professor MSO, MD, PhD, DMSc Jesper Skovhus Thomsen, Professor, MSc, PhD * Collaboration on: biomechanical and kinematic RSA studies involving human donor specimens, and on microCT/bone microstructure studies as well as histology
2013-	Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark Bente Lomholt Langdahl, MD, PhD, DMSc, Professor Torben Harsløf, MD, PhD, Associate Professor * Collaboration on: bone research in relation to osteoarthritis and joint implants
2018-	Danish Center of Health Economics (DacHE), Odense Universitet, Odense, Denmark Jes Søgaard, Professor of Health Economics * Collaboration on: Health economic assessment, co-supervision of research projects

RESEARCH COLLABORATIONS WITH COMPANIES

Imaging, activity and big data / artificial intelligence
2015-	ZimmerBiomet: company producing bone cements and joint implants * Collaboration on investigator initiated studies
2015-	Stryker: company producing bone cements and joint implants * Collaboration on investigator initiated studies
2015-	Fischer Medical: company producing bone cements and joint implants * Collaboration on investigator initiated studies
	DePuy: company producing bone cements and joint implants * Collaboration on investigator initiated studies
	Nordic Xray Technique (NRT), Aarhus, Denmark: company developing state-of-the-art radiostereometryequipment * Collaboration in the “AutoRSA” technological research and development project
	Zebicon A/S, Billund, Denmark * Collaboration on optical and blue-light scanning of orthopaedic implants for computer models
	Eurocon CNC Process, Holstebro, Denmark * Collaboration on development of motorized fixtures for kinematic studies of joint implants
	Swetest Instrument AB, Saltsjö-boo, Sweden * Collaboration on Mark-10 test instrument for implant push-out testing in combination with RSA
	BioXpedia Laboratory Service, Aarhus, Denmark * Collaboration on chemical analyses of antibiotic concentrations and inflammatiory proteins in microdialysis samples
2020-	DoMore Diagnostics, Oslo, Norway Sepp de Raedt, Chief Technology Officer, MSc, PhD * Collaboration on: AutoRSA software maintenance and development, artificial intelligence for imaging diagnostics

Job responsibilities

IMPLEMENTATION of CLINICAL NEW HIGH SPECIALTY TREATMENTS IN HAND SURGERY AT AUH

Based on clinical interests and inspiration from international trips I have implemented new treatment options within hand surgery / reconstruction.

Joint surgery / bone reconstruction
- Minimally invasive arthroscopic assisted partial wrist arthrodesis (RSL, RL, two-collum fusion).
- Patient specific planning and reconstruction of radius and ulna malunions using bone CT models and RSA kinematics for asssment of joint pathomechanics.
- Optimized surgery of scaphoid pseudoarthrosis by invention of a radiolucent graft measurement device and bone graft harvest guide for intra-operative use.

Nerve surgery
- Targeted muscle reinnervation (TMR) in the treatment of painful neuromas or for functional reinnervation of muscles following trauma or to aid signals in bionic limbs for amputees.
- Regenerative peripheral nerve interface (RPNI) in the treatment of painful neuromas.
- Hyper selective neurotomy as a permanent function-restoring treatment of local spasticity.
- Optimized nervereconstruction concerning intra-operative electrical nerve stimulation, instrumented nerve autograft harvest and state-of-the-art nerve coaptation by fibrin glue.
- Local nerve-transfers to restore shoulder, elbow and hand function after proximal nerve injury.
- First use in the world of 4K and 3D surgical imaging into microsurgery on the hand (30 x optical magnification). Read more in the 2 links below:

https://region-midtjylland.23video.com

https://www.linkedin.com/posts/healthau_healthau-surgery-imaging-activity