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  • Journal article
    Stoddart J, Garner A, Tuncer M, Cobb J, van Arkel RJet al., 2022,

    The risk of tibial eminence avulsion fracture with bi-unicondylar knee arthroplasty - a finite element analysis

    , Bone & Joint Research, Vol: 11, ISSN: 2046-3758

    Aims: To determine the risk of tibial eminence avulsion intraoperatively for bi-unicondylar knee arthroplasty (Bi-UKA) with consideration to the effect of implant positioning, overstuffing, and sex, compared to the risk for isolated medial UKA (UKA-M) and bi-cruciate retaining total knee arthroplasty (BCR-TKA).Methods: Two experimentally validated finite element models of tibia were implanted. Intraoperative loads were applied through the condyles, ACL, MCL and LCL, and the risk of fracture (ROF) was evaluated in the spine as the ratio of the 95th percentile maximum principal elastic strains over the tensile yield strain of proximal tibial bone.Results: Peak tensile strains occurred on the anterior portion of the medial sagittal cut in all simulations. Lateral translation of the medial implant in Bi-UKA had the largest increase in ROF of any of the implant positions (43%). Overstuffing the joint by 2mm had a much larger effect, resulting in a 6-fold increase in ROF. Bi-UKA had ~10% increased ROF compared to UKA-M for both the male and female models, though the smaller, less dense female model had a 1.5 times greater ROF compared to the male model. Removal of anterior bone akin to BCR-TKA doubled ROF compared to Bi-UKA.Conclusion: Tibial eminence avulsion fracture has a similar risk associated with Bi-UKA to UKA-M. The risk is higher for a smaller and less dense tibiae. To minimise risk, it is most important to avoid overstuffing the joint, followed by correctly positioning the medial implant, taking care not to narrow the bony island anteriorly.
  • Journal article
    Edwards T, Guest B, Garner A, Logishetty K, Liddle A, Cobb Jet al., 2022,

    The metabolic equivalent of task score: a useful metric for comparing high functioning hip arthroplasty patients

    , Bone & Joint Research, Vol: 11, Pages: 1-10, ISSN: 2046-3758

    Aims: This study investigates the use of the Metabolic Equivalent of Task (MET) score in a young hip arthroplasty population and its ability to capture additional benefit beyond the ceiling effect of conventional patient reported outcomes.Patients & Method: Oxford Hip Score (OHS), EuroQol-5D index (EQ-5D), and the MET were recorded in 221 primary hip arthroplasty procedures pre-operatively and at 1-year. The distribution was examined reporting the presence of ceiling & floor effects. Validity was assessed correlating the MET with the other scores using Spearman’s rank and determining responsiveness. A subgroup of 93 patients scoring 48/48 on the OHS were analysed by age, sex, BMI and pre-operative MET using the other metrics to determine if differences could be established despite scoring identically on the OHS.Results: From our electronic database of 751 hip arthroplasty procedures, 117 primary total hip and 104 hip resurfacing arthroplasty operations were included. Mean age was 59.4 ± 11.3. Post-operatively the OHS and EQ-5D demonstrate significant negatively skewed distributions with ceiling effects of 41% and 53%, respectively. The MET was normally distributed post-operatively with no ceiling effect. Weak-moderate significant correlations were found between the MET and the other two metrics. In the 48/48 subgroup, no differences were found comparing groups with the EQ-5D, however significantly higher MET scores were demonstrated for patients aged <60 (12.7 vs 10.6, p=0.008), male patients (12.5 vs 10.8, p=0.024) and those with pre-operative MET scores >6 (12.6 vs 11.0, p=0.040). Conclusion: The MET is normally distributed in patients following hip arthroplasty, recording levels of activity which are undetectable using the OHS.
  • Journal article
    van der Straeten C, 2022,

    Hip resurfacing arthroplasty in young patients: international high-volume centres' report on the outcome of 11,382 metal-on-metal hip resurfacing arthroplasties in patients ≤50 years at surgery

    , HIP INTERNATIONAL, Vol: 32, Pages: 353-362, ISSN: 1120-7000
  • Journal article
    Davies A, Selmi H, Sabharwal S, Vella-Baldacchino M, Liddle AD, Reilly Pet al., 2022,

    Revision shoulder hemiarthroplasty and total shoulder arthroplasty a systematic review and meta-analysis.

    , Journal of Shoulder and Elbow Arthroplasty, Vol: 6, Pages: 1-8, ISSN: 2471-5492

    The number of shoulder replacements performed each year continues to increase, and the need for revision replacements has grown accordingly. The outcome of a revision replacement may influence which primary implant is selected and the timing of primary surgery, particularly in younger patients. The aim of this study was to establish the expected improvement in shoulder function and implant survival following revision of a hemiarthroplasty and revision of an anatomical total shoulder arthroplasty (TSA). A systematic review and meta-analysis were performed of all studies reporting shoulder scores or implant survival following revision hemiarthroplasty or revision TSA. MEDLINE, EMBASE, CENTRAL, The Cochrane Database of Systematic Reviews and National Joint Registry reports were searched. 15 studies were included, reporting on 593 revision anatomical shoulder replacements. There was large variation in the magnitude of improvement in shoulder scores following revision surgery. Over 80% of revision replacements last 5 years and over 70% last 10 years. There was no significant difference in shoulder scores or implant survival according to the type of primary implant. The belief that revision of a shoulder hemiarthroplasty may lead to improved outcomes compared to revision of a TSA is not supported by the current literature.
  • Journal article
    Greenwood J, Hurley M, McGregor A, McCourt O, Jones Fet al., 2022,

    A qualitative evaluation of participants experiences of living with back pain, lumbar fusion surgery, and post-operative rehabilitation

    , Pilot and Feasibility Studies, Vol: 8, ISSN: 2055-5784

    BackgroundThe use of lumbar fusion surgery is increasing in developed economies. High levels of patient dissatisfaction are reported post-operatively. To address this need, we developed a theoretically informed rehabilitation programme for use following lumbar fusion surgery (the REFS programme). We conducted a mixed methods randomised controlled feasibility study (REFS v ‘usual care’). The numerical and feasibility outcomes are reported separately. The current qualitative study was ‘nested’ within the main feasibility study to explore participants’ experiences before and after lumbar fusion surgery including the impact of rehabilitation content. This facilitated a deeper understanding of potential mechanisms of action, for theoretical and programme refinement.MethodsA purposive sample (n = 10 ‘usual care’, n = 10 REFS) was identified from the main feasibility study cohort. Individual semi-structured interviews were conducted post-operatively (median 8 months, range 5–11). Interview data were transcribed verbatim, coded, and analysed thematically.ResultsThree themes were constructed: the breadth and severity of impact associated with a chronic lumbar disorder was summarised in theme 1, ‘Ever-decreasing circles; living with a chronic lumbar disorder’. Theme 2, ‘What have I done? Reflections on recovery from lumbar fusion surgery’, illustrated participants post-operative helplessness, which was associated with worsening mental health, problematic use of opioids, fear related to the instillation of metalware, and the important mitigating effect of informal social support. Theme 3 ‘Rehabilitation experiences’ identified critical rehabilitation programme content including exercise, a shared rehabilitation experience, the opportunity for vicarious learning, and professional expertise.ConclusionsTo enhance patient benefit future REFS programme iterations s
  • Journal article
    Dandridge O, Garner A, Amis A, Cobb J, van Arkel RJet al., 2022,

    Variation in the patellar tendon moment arm identified with an improved measurement framework

    , Journal of Orthopaedic Research, Vol: 40, Pages: 799-807, ISSN: 0736-0266

    The mechanical advantage of the knee extensor mechanism depends heavily on the patellar tendon moment arm (PTMA). Understanding which factors contribute to its variation may help improve functional outcomes following arthroplasty. This study optimized PTMA measurement, allowing us to quantify the contribution of different variables. The PTMA was calculated about the instantaneous helical axis of tibiofemoral rotation from optical tracked kinematics. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of motion (root-mean-squared error 0.2 mm, max error 0.4 mm), whereas large errors were measured for raw, filtered-only and interpolated-only techniques at terminal flexion/extension. Before scaling, the mean PTMA was 46 mm; PTMA magnitude was consistently larger in males (mean differences: 5 to 10 mm, p < .05) and was strongly related to knee size: larger knees have a larger PTMA. However, while scaling eliminated sex differences in PTMA magnitude, the peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p = .01). Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle where peak PTMA occurred. This substantial variation in angle of peak PTMA has implications for the design of musculoskeletal models and morphotype-specific arthroplasty. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement.
  • Journal article
    McGregor A, Clunie G, Hall H, Dhuga Yet al., 2022,

    Patient and practitioner perspectives on the design of a simulated affective touch device to reduce procedural anxiety associated with radiotherapy: a qualitative study

    , BMJ Open, Vol: 12, ISSN: 2044-6055

    Objective The aim of this study was to elicit the views of relevant stakeholders on the design of a device using simulated affective touch to reduce procedural anxiety surrounding radiotherapy and imaging. Design This qualitative study collected data from focus groups which were then analysed using inductive thematic analysis in line with Braun and Clarke’s methods. Participants and setting Twenty patients and carers were recruited, as well as ten healthcare practitioners involved in either delivering radiotherapy or imaging procedures. Results Patients, carers and healthcare practitioners agreed on some aspects of the device design, such as ensuring the device is warm and flexible in where it can be used on the body. However, patient and healthcare practitioner cohorts had at times differing viewpoints. For example, healthcare practitioners provided professional perspectives and required easy cleaning of the device. Meanwhile patients focused on anxiety relieving factors, such as the tactile sensation of the device being either a vibration or pulsation. There was no consensus on who should control the device. Conclusions The desired features of a simulated affective touch device have been investigated. Different priorities of patients and their carers and healthcare practitioners were evident. Any design must incorporate such features as to appease both groups. Areas where no consensus was reached could be further explored, alongside including further patient and public involvement in the form of a project advisory group.
  • Journal article
    Olsen J, Turner S, Chadwell A, Dickinson A, Ostler C, Armitage L, McGregor AH, Dupan S, Day Set al., 2022,

    The Impact of Limited Prosthetic Socket Documentation: A Researcher Perspective

    , FRONTIERS IN REHABILITATION SCIENCES, Vol: 3
  • Journal article
    Davies DJ, McLean PF, Kemp PR, Liddle AD, Morrell MJ, Halse O, Martin NM, Sam AHet al., 2022,

    Assessment of factual recall and higher-order cognitive domains in an open-book medical school examination

    , Advances in Health Sciences Education, Vol: 27, Pages: 147-165, ISSN: 1382-4996

    Open-book examinations (OBEs) will likely become increasingly important assessment tools. We investigated how access to open-book resources affected questions testing factual recall, which might be easy to look-up, versus questions testing higher-order cognitive domains. Few studies have investigated OBEs using modern Internet resources or as summative assessments. We compared performance on an examination conducted as a traditional closed-book exam (CBE) in 2019 (N = 320) and a remote OBE with free access to Internet resources in 2020 (N = 337) due to COVID-19. This summative, end-of-year assessment focused on basic science for second-year medical students. We categorized questions by Bloom’s taxonomy (‘Remember’, versus ‘Understand/Apply’). We predicted higher performance on the OBE, driven by higher performance on ‘Remember’ questions. We used an item-centric analysis by using performance per item over all examinees as the outcome variable in logistic regression, with terms ‘Open-Book, ‘Bloom Category’ and their interaction. Performance was higher on OBE questions than CBE questions (OR 2.2, 95% CI: 2.14–2.39), and higher on ‘Remember’ than ‘Understand/Apply’ questions (OR 1.13, 95% CI: 1.09–1.19). The difference in performance between ‘Remember’ and ‘Understand/Apply’ questions was greater in the OBE than the CBE (‘Open-Book’ * ‘Bloom Category’ interaction: OR 1.2, 95% CI: 1.19–1.37). Access to open-book resources had a greater effect on performance on factual recall questions than higher-order questions, though performance was higher in the OBE overall. OBE design must consider how searching for information affects performance, particularly on questions measuring different domains of knowledge.
  • Journal article
    Gimson E, Greca Dottori M, Clunie G, Yan Zheng C, Wiseman T, Joyce E, McGregor A, McNair Het al., 2022,

    Not as simple as “fear of the unknown”: a qualitative study exploring anxiety in the radiotherapy department

    , European Journal of Cancer Care, Vol: 31, ISSN: 0961-5423

    Objective:Little is understood about the anxiety experienced by cancer patients undergoing radiotherapy or investigative imaging. Our aim was to identify sources of anxiety, the points along the cancer journey where anxiety occurred and methods to alleviate it.Methods:Six focus groups were conducted with cancer patients (n = 17), caregivers (n = 3) and healthcare practitioners (HCPs; n = 10) in the radiotherapy department. Patients described specific elements in the care pathway which induced anxiety, while HCPs focused on their perception of the patient experience. Thematic analysis was used to analyse data.Results:Three broad themes emerged: The Environment, The Individual and The Unknown. The physical environment of the hospital, inside the scanner for example, emerged as a key source of anxiety. The impact of cancer on patients' individual lives was significant, with many feeling isolated. The majority of participants described anxiety associated with the unknown. HCPs reported difficulty in identifying the anxious patient.Conclusions:Anxiety is experienced throughout the cancer pathway. Common sources include the physical environment and the uncertainty associated with having cancer. Identifying both anxiety-inducing factors, and the anxious patients themselves, is crucial to enable targeted interventions to alleviate anxiety.
  • Journal article
    Riviere C, Sivaloganathan S, Villet L, Cartier P, Lustig S, Vendittoli P-A, Cobb Jet al., 2022,

    Kinematic alignment of medial UKA is safe: a systematic review

    , KNEE SURGERY SPORTS TRAUMATOLOGY ARTHROSCOPY, Vol: 30, Pages: 1082-1094, ISSN: 0942-2056
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    • Citations: 10
  • Journal article
    Carlos Rodriguez-Merchan E, Encinas-Ullan CA, Liddle AD, 2022,

    Osteochondral Allografts for Large Osteochondral Lesions of the Knee Joint: Indications, Surgical Techniques and Results

    , ARCHIVES OF BONE AND JOINT SURGERY-ABJS, Vol: 10, Pages: 245-251, ISSN: 2345-4644
  • Journal article
    Munford M, Liddle A, Stoddart J, Cobb J, Jeffers Jet al., 2022,

    Total and partial knee replacement implants that maintain native load transfer in the Tibia

    , Bone and Joint Research, Vol: 11, Pages: 1-3, ISSN: 2046-3758

    Aims:Unicompartmental and total knee arthroplasty (UKA and TKA) are successful treatments for osteoarthritis, but the solid metal implants disrupt the natural distribution of stress and strain which can lead to bone loss over time. This generates problems if the implant needs to be revised. This study investigates whether titanium lattice UKA and TKA implants can maintain natural load transfer in the proximal tibia. Methods:In a cadaveric model, UKA and TKA procedures were performed on 8 fresh-frozen knee specimens, using conventional (solid) and titanium lattice tibial implants. Stress at the bone-implant interfaces were measured and compared to the native knee.Results:Titanium lattice implants were able to restore the mechanical environment of the native tibia for both UKA and TKA designs. Maximum stress at the bone-implant interface ranged from 1.2-3.3 MPa compared to 1.3-2.7 MPa for the native tibia. The conventional solid UKA and TKA implants reduced the maximum stress in the bone by a factor of 10 and caused >70% of bone surface area to be underloaded compared to the native tibia. Conclusions:Titanium lattice implants maintained the natural mechanical loading in the proximal tibia after UKA and TKA, but conventional solid implants did not. This is an exciting first step towards implants that maintain bone health, but such implants also have to meet fatigue and micromotion criteria to be clinically viable.
  • Journal article
    Clunie G, Bolton L, Lovell L, Bradley E, Bond C, Bennington S, Roe Jet al., 2022,

    Considerations for speech and language therapy management of dysphagia in patients who are critically ill with COVID-19: a single centre case series

    , International Journal of Therapy and Rehabilitation, Vol: 29, ISSN: 1354-8581

    Background/AimsPatients treated with intubation and tracheostomy for COVID-19 infection are at risk of increased incidence of laryngeal injury, dysphagia and dysphonia. Because of the novelty of the SARS-CoV-2 virus, little is known about the type of dysphagia patients experience as a result of infection and critical illness. The aim of this case series report was to progress understanding of COVID-19 and dysphagia following admission to an intensive care unit and to guide speech and language therapy clinical practice in the ongoing pandemic.MethodsA retrospective case review was conducted of all patients at Imperial College Healthcare NHS Trust, London who underwent a tracheostomy because of COVID-19 and received an instrumental assessment of swallowing in the early stages of the pandemic.ResultsA total of 11 patients were identified, and descriptive statistics were used to present demographic data, with a narrative account of their dysphagia profile used to describe presentation. Causes and presentation of dysphagia were heterogenous, with each patient requiring individualised clinical management to maximise outcome. A positive trend was seen in terms of recovery trajectory and progressing to oral intake.ConclusionsThis study reports on early experience of the presentation of dysphagia in patients with COVID-19 and demonstrates the value of instrumental assessment. It indicates the need for further research to consolidate knowledge and guide clinical practice.
  • Conference paper
    Gupta A, Maslen C, Vindlacheruvu M, Abel R, Bhattacharya P, Bromiley P, Clark E, Compston J, Crabtree N, Gregory J, Kairki E, Harvey N, McCloskey E, Ward K, Poole Ket al., 2022,

    LB VPP - 840: Digital Health Interventions for Osteoporosis and Post-Fragility Fracture Care

    , Annual Meeting of the American-Society-for-Bone-and-Mineral-Research (ASBMR), Publisher: Wiley, Pages: 184-184, ISSN: 0884-0431
  • Conference paper
    Tukanova K, Banger M, Hanna G, McGregor A, Markar Set al., 2022,

    Assessment of changes in chest wall mechanics in esophageal cancer survivors using a 3D-motion capture system

    , ASCO Gastrointestinal Cancers Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0732-183X
  • Journal article
    Logishetty K, Edwards T, Ponniah HS, Ahmed M, Liddle AD, Cobb J, Clark Cet al., 2022,

    How to prioritise patients and redesign care to safely resume planned surgery during the COVID-19 pandemic. A clinical validation study

    , Bone & Joint Open, Vol: 2, Pages: 134-140, ISSN: 2633-1462

    Background and Purpose: Restarting planned surgery during the COVID-19 pandemic is a clinical and societal priority, but it is unknown whether it can be done safely and include high-risk or complex cases. We developed a Surgical Prioritization and Allocation Guide (SPAG). Here, we validate its effectiveness and safety in COVID-free sites. Patients and Methods: A multidisciplinary Surgical Prioritisation Committee developed the SPAG, incorporating procedural urgency, shared decision making, patient safety and biopsychosocial factors; and applied it to 1142 adult patients awaiting orthopaedic surgery. Patients were stratified into four priority groups and underwent surgery at three COVID-free sites – including one with access to a High Dependency Unit (HDU) or Intensive Care Unit (ICU) and specialist resources. Safety was assessed by the number of patients requiring inpatient postoperative HDU/ICU admission, contracting COVID-19 within 14 days postoperatively, and mortality within 30 days postoperatively. Results: 1142 patients were included, 47 declined surgery. 110 were deemed high-risk or requiring specialist resources. In the 10-week study period, 28 high-risk patients underwent surgery, during which 68% of Priority 2 (P2, surgery within 1 month) patients underwent surgery, and 15% of P3 (<3 months) and 16% of P4 (>3 months) groups. Of the 1032 low-risk patients, 322 patients underwent surgery. Twenty-one P3 and P4 patients were expedited to ‘Urgent’ based on biopsychosocial factors identified by the SPAG. During the study period, 91% of the Urgent group, 52% of P2, 36% of P3, and 26% of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. Interpretation: Our widely generalisable model enabled the restart of planned surgery during the CO
  • Journal article
    Turner S, Belsi A, McGregor AH, 2022,

    Issues faced by people with amputation(s) during lower limb prosthetic rehabilitation: a thematic analysis

    , Prosthetics and Orthotics International, Vol: 46, Pages: 61-67, ISSN: 0309-3646

    Background: Successful rehabilitation is essential to improve the physical and mental outcomes of people with lower limb amputation(s). Individuals have different goals and expectations of successful rehabilitation and experience issues that affect their quality of life.Objectives: To determine factors affecting lower limb prosthetic rehabilitation from people with amputation(s), important for studies focusing on prosthetic and socket design and fitting because they provide context of need and user issues.Study design: Thematic analysis of semistructured interviews.Methods: Ten people with amputation(s) were self-selected from a survey identifying factors affecting lower limb prosthetic rehabilitation. The telephone interviews were semistructured exploring the biggest impactors on and frustrations with rehabilitation and the socket. A thematic analysis was completed by following the undermentioned steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and reporting.Results: Five distinct but interrelated themes were identified: External to Prosthesis, Body Impactors, Consequences of Ill-Fit, Prosthesis Irritants, and Work and Social Impact. Those living with amputation(s) mentioned prosthetic-related issues affecting their work and social life, including difficulties wearing their prosthesis all day, the socket's rigidity, and the ability to participate in hobbies.Conclusions: The study provides new insights into the issues experienced during prosthetic rehabilitation, highlighting impacts beyond just physical health consequences. The study provides an evidence base for areas of the rehabilitation journey which could be improved to improve the quality of life of people with amputation(s)
  • Journal article
    Newington L, Alexander CM, Wells M, 2022,

    What is a clinical academic? Qualitative interviews with healthcare managers, research-active nurses and other research-active healthcare professionals outside medicine

    , Journal of Clinical Nursing, Vol: 31, Pages: 378-389, ISSN: 0962-1067

    AIM AND OBJECTIVES: To explore the concept of 'clinical academic' from the perspectives of healthcare managers and research-active healthcare professionals outside medicine. BACKGROUND: Clinical academics are understood to be healthcare professionals who combine clinical and research responsibilities within their role. However, there is no agreed definition for this term either within or across nursing, midwifery and the other healthcare professions outside medicine. DESIGN: Qualitative service evaluation, reported using the COREQ checklist. METHODS: Semi-structured qualitative interviews were conducted with a purposive sample of eight healthcare managers and 12 research-active clinicians within a UK hospital group. Interviews were audio recorded, transcribed verbatim, and analysed using the Framework method. RESULTS: Clinical academics were described in four themes. Two themes explored the components of the role and the contribution of these individuals to their profession: combining clinical practice, research and education; and pushing boundaries. The third theme identified the clinical academic label as: a title that doesn't fit. The final theme examined a characteristic mindset of research-active clinicians. There were no clear differences in the perceptions of managers and research-active clinicians. CONCLUSIONS: Clinical academics were perceived as valuable members of their team and were able to push the boundaries to move their profession forward. Some research-active clinicians did not identify with the term 'clinical academic' and for some managers and research-active clinicians, the term was viewed as jargonistic. A clear and accepted definition would aid development of clinical academic career pathways and identities. It would also assist in evaluating the impact of these roles. RELEVANCE TO PRACTICE: As clinical academics roles and opportunities are being developed across the professions outside medicine, it is important to have a shared common understa
  • Journal article
    Mohammad HR, Liddle AD, Judge A, Murray DWet al., 2022,

    A Matched Comparison of Long-Term Outcomes of Total and Unicompartmental Knee Replacements in Different Ages Based on National Databases: Analysis of Data From the National Joint Registry for England, Wales, Northern Ireland, and the Isle of Man

    , JOURNAL OF ARTHROPLASTY, Vol: 37, Pages: 243-251, ISSN: 0883-5403
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    • Citations: 11

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