Pragmatic Research in Orthopedics - PRIO

Hip prosthesis in titanium with bone ingrowth Thor Balkhed

PRIO focuses on biological, mechanical and pharmacological aspects of fracture healing and implant osseointegration. Our translational approach aims to understand and explain complex clinical problems to improve decision making and thereby patient care.


Hip prosthesis in titanium with bone ingrowth. Photo credit Thor BalkhedBone is a unique tissue with the capacity to regenerate itself through true tissue regeneration by reactivation of embryonal processes. Implant fixation and healing of fractures are inherently related to each other on a biological level but often separated from each other in the minds of orthopedic surgeons. We are orthopedic surgeons with an interest in joint replacement and fracture treatment, anesthesiologists, radiologists, biologists, movement scientists and others working together with national registries, the industry and academic collaborators around the world.

Hip prosthesis in titanium with bone ingrowth. Photo credit Thor BalkhedOur main focus is to improve the survival of first- time joint replacements through bone specific drugs and to improve outcome after complex joint revision surgeries with the use of morselized bonegraft, detailed pre-operative planning and evaluation of specific surgical techniques. We are interested in the pathomechanisms behind stress fractures, specifically atypical femoral fractures, the treatment and evaluation of healing and avoidance of early and late complications through implant choices guided through biomechanical understanding. Only then can we improve day-to-day practical decision making.


Latest publications in LiU DiVA


Jörg Schilcher, Alva Nilsson, Oliver Andlid, Anders Eklund (2024) Fusion of electronic health records and radiographic images for a multimodal deep learning prediction model of atypical femur fractures Computers in Biology and Medicine, Vol. 168, Article 107704 Continue to DOI


Mischa Woisetschläger, Ronald Booij, Erik Tesselaar, Edwin H. G. Oei, Jörg Schilcher (2023) Improved visualization of the bone-implant interface and osseointegration in ex vivo acetabular cup implants using photon-counting detector CT EUROPEAN RADIOLOGY EXPERIMENTAL, Vol. 7, Article 19 Continue to DOI
Mattias Rönnerfalk, Lotta Velin, Lars Palm, Andreas Meunier, Jörg Schilcher (2023) Autologous Bone Graft From the Ipsilateral Distal Femur in Tibial Condyle Fractures Journal of Orthopaedic Trauma, Vol. 37, p. E377-E381 Continue to DOI

The research group

Group members

Portrait image of Hans Peter Bögl.

Hans Peter Bögl

Studies healing aspects of atypical femoral fractures and the effect of fracture type and fracture fixation of femoral shaft fractures. Watch Hans Peter's author insight video here.

Image of Rico Perlbach.

Rico Perlbach

Rico’s research is focused on specific surgical techniques, drugs and implant designs to improve outcome after acetabular revision and primary total hip replacement.

Image of Georg Zdolsek.

Georg Zdolsek

Investigates pathomechanisms that lead to the development of atypical femoral fractures, how to optimally treat and whether artificial intelligence improves the primary diagnosis of these fractures.

Image of Håkan Ledin.

Håkan Ledin

Studies the effects of tourniquet use and bone-specific drugs on implant fixation in primary total knee- and hip replacement.

Image of Jonathan Brandt.

Jonathan Brandt

Image of Andreas Meunier.

Andreas Meunier

Image of Abraham Nilsson.

Abraham Nilsson

An acute compartment syndrome (ACS) is a condition of increased muscular tissue pressure often caused by a fracture. The increased pressure leads to impaired circulation which, if left untreated, causes devastating consequences. Unfortunately, the diagnosis is difficult since the predominant symptom of ACS is pain which can be very difficult to differentiate from pain caused by a fracture. A need for an objective tool is therefore most welcome. The aim of our research is to investigate whether biomarkers could be this aid.
There is also an exertional form of compartment syndrome. Here we investigate if there is difference in tissue composition among affected patients and if ultrasound can be used as a tool for compartment pressure measurements.

Image of Lars Palm.

Lars Palm

Image of Daphne Wezenberg

Daphne Wezenberg

Cornelia Klasson and Terez Zara Hanqvist are also part of the research group.

Our large research projects

Logo for the research project abograft with a hip prosthesis as an illustration.


The ABOGRAFT study is a multi-center international study into the effects of providing local antibiotics to prevent joint infection in patients who undergo hip replacement surgery using bone graft.


The BioFACTS study is a prospective multinational, multi-centre study involving patients with tibial fractures.

The project was designed by Ass. Prof. Jörg Shilcher at the Linköping University hospital and started recruiting in 2019. After expanding to several hospitals in Sweden, it arrived at the rough shores of Finland in the early 2020 with the first patient being recruited in January 2021.

Why is this study needed?
Acute compartment syndrome (ACS) is a serious complication in trauma. The cardinal clinical symptom of ACS is pain, which can be very difficult to differentiate from the pain caused by the fracture. In the absence of objective measures, the decision to perform fasciotomy is often based solely on clinical findings. As a missed ACS is assumed to have a detrimental effect on lower extremity function, fasciotomy is often performed at a low level of suspicion. However, fasciotomy involves a large incision of the skin and compromises the soft tissue envelope around the fractured bone, resulting in profound fracture treatment complications causing impaired lower extremity function on its own. Therefore, correct and timely diagnosis of ACS is of the outmost importance for these patients.

What are the objectives of the BioFACTS study?
BioFACTS-1: Can biomarkers (P-myoglobin and P-CK) be used to predict acute compartment syndrome in patients with traumatic tibial fractures?

BioFACTS-2: What is the functional outcome after
a) a tibial fracture?
b) a tibial fracture and fasciotomy?
c) a missed ACS?

BioFACTS-3: Can the implementation of biomarkers into the diagnostic pathway reduce the number of unnecessary fasciotomies?

BioFACTS logotype - a research project within the research group PRIO.

Where are we now?
The protocol of BioFACTS-1 has been published in BMJ Open in 2022 and so far we have recruited more than 200 tibial fracture patients. At the current pace, recruitment of BioFACTS-1 should be completed by 2023 and one-year follow-up in 2024. We are currently recruiting more centres for the BioFACTS-2 study and drafting the protocol for BioFACTS-3.

Project team
Jörg Schilcher (Sponsor and PI Sweden), Thomas Ibounig (PI Finland), Abraham Nilsson, Lasse Rämö, Andrew Schmidt, Johan Lyth, Björn Alkner, Ferdinand von Walden, Lotta Fornander, Leena Caravitis, Andreas Meunier

Research projects of our collaborators

The TrAFFiC Study

The TrAFFiC Study is investigating risk factors and identifying causes of atypical femoral fractures to find ways to prevent it.

To the website


The purpose of the DUALITY study is to find out whether double cups reduce the risk of dislocation after a collum fracture.

To the website


HipSTHeR – Hip Screws or (Total) Hip Replacement. The HipSTHeR study is the first randomized study in orthopedics in the world.

To the website


Fragility Fracture Trial. Zoledronate in patients with fracture - a randomized double-blind study.

To the website

Collaborative partners

Map of the world where the countries Sweden, Denmark, USA, Australia and Germany are marked. In these countries, the research group PRIO has partners.

Map of collaboration

The marked countries on the world map illustrate the research group's partners (past and future projects).

CMIV (Center for Medical Image Science and Visualization (CMIV) - Linköping University

Experimental Orthopedics, Linköping University


The Wallenberg Center of Molecular and Translational Medicine, University of Gothenburg

The TrAFFiC Study group




Jörg Schilcher

Lower extremity reconstruction unit
Department of orthopedic surgery and department of biomedical and clinical sciences
University Hospital Linköping and Linköping University
58185 Linköping
Phone: 0046101034291