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  • Journal article
    Turner S, Belsi A, McGregor AH, 2022,

    Issues faced by prosthetists and physiotherapists during lower-limb prosthetic rehabilitation: a thematic analysis

    , Frontiers in Rehabilitation Sciences, Vol: 2, ISSN: 2673-6861

    Successful prosthetic rehabilitation is essential to improve the physical and mental outcomes of people with lower-limb amputation. Evaluation of prosthetic services from a prosthesis user perspective have been published and commissioned by the national bodies, however, the perspectives of clinicians working with service users during rehabilitation have not to date been sought. We sought to determine factors impacting lower-limb prosthetic rehabilitation from a clinician’s perspective to inform studies focusing on prosthetic and socket design and fitting. Six clinician (2 prosthetists, 4 physiotherapists) interviewees were self-selected from a survey exploring issues and frustrations during lower-limb prosthetic rehabilitation. Semi-structured interviews explored the impactors on and frustrations with rehabilitation and the prosthetic socket. A thematic analysis was subsequently conducted to identify themes in the responses. Five themes were identified: Service Disparity, Body Impactors, Consequences of Ill-Fit, Prosthesis Irritants, and Limitations of Practice. Each theme, though distinct, relates to the others either as a cause or consequence and should be viewed as such. Addressing the themes will have benefits beyond the issues addressed but also expand into the other themes. This study provides an insight into the clinician perspectives on lower-limb prosthetic rehabilitation, which has not been formally documented to date.
  • Journal article
    Chew E, Sharma A, Gupte C, 2022,

    Triple dislocation around the knee joint: a case report

    , JOURNAL OF MEDICAL CASE REPORTS, Vol: 16
  • Journal article
    Goss C, Culley FJ, Parthasarathy P, MacLeod K, McGregor AH, Sam AHet al., 2022,

    A paradigm shift in assessment of scientific skills in undergraduate medical education

    , Advances in Medical Education and Practice, Vol: 13, Pages: 123-127, ISSN: 1179-7258

    The General Medical Council’s publication ‘Outcomes for Graduates’ places emphasis on doctors being able to integrate biomedical science, research and scholarship with clinical practice. In response, a new paradigm of assessment was introduced for the intercalated Bachelor of Science program at Imperial College School of Medicine in 2019. This innovative approach involves authentic “active learning” assessments analogous to tasks encountered in a research environment and intends to test a wider range of applied scientific skills than traditional examinations. Written assessments include a “Letter to the Editor”, scientific abstract, and production of a lay summary. A clinical case study titled “Science in Context” presents a real or virtual patient, with evaluation of current and emerging evidence within that field. Another assessment emulates the academic publishing process: groups submit a literature review and engage in reciprocal peer review of another group’s work. A rebuttal letter accompanies the final submission, detailing how feedback was addressed. Scientific presentation skills are developed through tasks including a research proposal pitch, discussion of therapies or diagnostics, or review of a paper. A data management assignment develops skills in hypothesis generation, performing analysis, and drawing conclusions. Finally, students conduct an original research project which is assessed via a written report in the format of a research paper and an oral presentation involving critical analysis of their project. We aspire to train clinicians who apply scientific principles to critique the evidence base of medical practice and possess the skillset to conduct high-quality research underpinned by the principles of best clinical and academic practice. Assessment drives learning, and active learning has been demonstrated to enhance academic performance and reduce attainment gaps in science education.
  • Conference paper
    Paszkiewicz FP, Wilson S, Oddsson M, McGregor AH, Alexandersson A, Huo W, Vaidyanathan Ret al., 2022,

    Microphone Mechanomyography Sensors for Movement Analysis and Identification

    , 7th IEEE International Conference on Advanced Robotics and Mechatronics, Publisher: IEEE, Pages: 118-125
  • Journal article
    Newington L, Alexander C, Wells M, 2021,

    Would you like to be contacted about future research?

    , BMC Research Notes, Vol: 14, ISSN: 1756-0500

    Many research participants are willing to be contacted about future research opportunities, however this question is not always asked. Furthermore, if participants do consent for contact about future research, this information is not always accessible to other research teams. We discuss our experience of recruiting individuals who have previously taken part in healthcare research and suggest potential strategies to support this process and enable greater research participation.
  • Journal article
    Tukanova K, Chidambaram S, Guidozzi N, Hanna G, McGregor A, Markar Set al., 2021,

    Physiotherapy regimens in esophagectomy and gastrectomy: a systematic review and meta-analysis

    , Annals of Surgical Oncology, Vol: 29, ISSN: 1068-9265

    BackgroundEsophageal and gastric cancer surgery are associated with considerable morbidity, specifically postoperative pulmonary complications (PPCs), potentially accentuated by underlying challenges with malnutrition and cachexia affecting respiratory muscle mass. Physiotherapy regimens aim to increase the respiratory muscle strength and may prevent postoperative morbidity.ObjectiveThe aim of this study was to assess the impact of physiotherapy regimens in patients treated with esophagectomy or gastrectomy.MethodsAn electronic database search was performed in the MEDLINE, EMBASE, CENTRAL, CINAHL and Pedro databases. A meta-analysis was performed to assess the impact of physiotherapy on the functional capacity, incidence of PPCs and postoperative morbidity, in-hospital mortality rate, length of hospital stay (LOS) and health-related quality of life (HRQoL).ResultsSeven randomized controlled trials (RCTs) and seven cohort studies assessing prehabilitation totaling 960 patients, and five RCTs and five cohort studies assessing peri- or postoperative physiotherapy with 703 total patients, were included. Prehabilitation resulted in a lower incidence of postoperative pneumonia and morbidity (Clavien–Dindo score ≥ II). No difference was observed in functional exercise capacity and in-hospital mortality following prehabilitation. Meanwhile, peri- or postoperative rehabilitation resulted in a lower incidence of pneumonia, shorter LOS, and better HRQoL scores for dyspnea and physical functioning, while no differences were found for the QoL summary score, global health status, fatigue, and pain scores.ConclusionThis meta-analysis suggests that implementing an exercise intervention may be beneficial in both the preoperative and peri- or postoperative periods. Further investigation is needed to understand the mechanism through which exercise interventions improve clinical outcomes and which patient subgroup will gain the maximal benefit.
  • Journal article
    Musbahi O, Syed L, Le Feuvre P, Cobb J, Jones Get al., 2021,

    Public patient views of artificial intelligence in healthcare: A nominal group technique study

    , Digital Health, Vol: 7, Pages: 1-11, ISSN: 2055-2076

    Objectives: The beliefs of laypeople and medical professionals often diverge with regards to disease, and technology has had a positive impact on how research is conducted. Surprisingly, given the expanding worldwide funding and research into Artificial Intelligence (AI) applications in healthcare, there is a paucity of research exploring the public patient perspective on this technology. Our study sets out to address this knowledge gap, by applying the Nominal Group Technique (NGT) to explore patient public views on AI. Methods: A Nominal Group Technique (NGT) was used involving four study groups with seven participants in each group. This started with a silent generation of ideas regarding the benefits and concerns of AI in Healthcare. This was followed by a group discussion. Then a round-robin process was conducted until no new ideas were generated. Participants then ranked their top five benefits and top five concerns regarding the use of AI in healthcare. A final group consensus was reached. Results: Twenty-Eight participants were recruited with the mean age of 47 years. The top five benefits were: Faster health services, Greater accuracy in management, AI systems available 24/7, reducing workforce burden, and equality in healthcare decision making. The top five concerns were: Data cybersecurity, bias and quality of AI data, less human interaction, algorithm errors and responsibility, and limitation in technology. Conclusion: This is the first formal qualitative study exploring patient public views on the use of AI in healthcare, and highlights that there is a clear understanding of the potential benefits delivered by this technology. Greater patient public group involvement, and a strong regulatory framework is recommended.
  • Journal article
    Tukanova K, Chidambaram S, Guidozzi N, Hanna GB, McGregor AH, Markar SRet al., 2021,

    ASO author reflections: the role of physiotherapy regimens in esophagectomy and gastrectomy for cancer

    , Annals of Surgical Oncology, Vol: 29, Pages: 3168-3169, ISSN: 1068-9265

    PASTDespite advancements in surgical management, esophageal and gastric cancer surgery is still associated with a significant morbidity. Traditionally, esophagectomy and gastrectomy via an open surgical approach has been the treatment of choice for esophageal and gastric cancer, respectively.1,2 Enhanced recovery after surgery (ERAS) protocols commonly include physiotherapy regimens or early mobilization intervention. These programs are well-established in colorectal cancer surgery and have shown to reduce postoperative complication rates and shortened the length of hospital stay (LOS).3Only a small number of studies have assessed the role of respiratory physiotherapy in gastrointestinal cancer surgery, while this patient group commonly present with pre-existing respiratory disease and is particularly at risk for malnutrition and loss of muscle mass.4 Although there is growing evidence of the benefits of physiotherapy implementation in decreasing the risk for postoperative morbidity, there is currently insufficient strong evidence for routine implementation of standardized respiratory physiotherapy in esophageal and gastric cancer surgery.PRESENTThis is the first meta-analysis assessing the effect of prehabilitation and peri- or postoperative physiotherapy regimens on postoperative mortality and morbidity in esophageal and gastric cancer surgery.5 A lower incidence of pneumonia was observed following both prehabilitation and peri- or postoperative rehabilitation. Furthermore, a lower incidence of postoperative morbidity was seen in patients undergoing prehabilitation, while peri- or postoperative rehabilitation resulted in a shorter LOS and better health-related quality-of-life scores for dyspnea and physical functioning. These results suggest that implementation of a physiotherapy regimen in both the pre- and peri- or postoperative setting may be beneficial. This meta-analysis is however limited by the lack of a standardized physiotherapy protocol for patients unde
  • Journal article
    Dandridge O, Garner A, Jeffers JRT, Amis AA, Cobb JP, van Arkel RJet al., 2021,

    Validity of repeated-measures analyses of in vitro arthroplasty kinematics and kinetics

    , Journal of Biomechanics, Vol: 129, Pages: 1-5, ISSN: 0021-9290

    In vitro models of arthroplasty enable pre-clinical testing and inform clinical decision making. Repeated-measures comparisons maximise resource efficiency, but their validity without testing order randomisation is not known. This study aimed to identify if there were any large testing order effects for cadaveric models of knee and hip arthroplasty. First, the effect of testing order on total knee arthroplasty (TKA) biomechanics was assessed. Extension moments for TKAs (N=3) implanted into the native knee (TKA-only) were compared to a dataset of TKAs (N=24) tested after different combinations of partial knee arthroplasty (TKA-last). The effect of repeatedly testing the same knee five times over 36 hours on patellofemoral and tibiofemoral kinematics was also quantified. Second, the effect of testing order on capsular ligament function after total hip arthroplasty (THA) was assessed. Randomisation was removed from a previously published dataset to create increasing and decreasing head size groups, which were compared with t-tests.All three TKA-only extension moments fell within the 95% CI of the TKA-last knees across the full range of knee flexion/extension. Repeated testing resulted in root-mean-squared kinematics errors within 1 mm, 1°, or < 5 % of total range of motion. Following THA, smaller head-size resulted in greater laxity in both the increasing (p=0.01) and decreasing (p<0.001) groups. Testing order did not have large effects on either knee or hip arthroplasty biomechanics measured with in vitro cadaveric models.
  • Journal article
    Bates A, McGregor A, Alexander C, 2021,

    Prolonged standing behaviour in people with Joint Hypermobility Syndrome

    , BMC Musculoskeletal Disorders, Vol: 22, ISSN: 1471-2474

    Background: Joint Hypermobility Syndrome (JHS) is a rare Heritable Disorder of Connective tissue characterised by generalised joint laxity and chronic widespread pain. Joint Hypermobility Syndrome has a large impact on patients’ day to day activities, and many complain of symptoms when standing for prolonged periods. This study investigates whether people with JHS exhibit the same behaviours to deal with the effects of prolonged standing as people with equal hypermobility and no pain, and people with normal flexibility and no pain.Methods: 23 people with JHS, 22 people with Generalised Joint Hypermobility (GJH), and 22 people with normal flexibility (NF) were asked to stand for a maximum of 15 minutes across two force-plates. Fidgets were counted and quantified using a cumulative sum algorithm and sway parameters of the quiet standing periods between fidgets were calculated. Results: Average standing time for participants with JHS was 7.35 minutes and none stood for the full 15 minutes. All participants with GJH and NF completed 15 minutes of standing. There were no differences in fidgeting behaviour between any groups. There was a difference in anteroposterior sway (p=.029) during the quiet standing periods.Conclusion: There is no evidence to suggest people with JHS exhibit different fidgeting behaviour. Increased anteroposterior-sway may suggest a muscle weakness and strengthening muscles around the ankle may reduce postural sway and potentially improve the ability to stand for prolonged periods.
  • Journal article
    Arnold M, Zhao S, Doyle R, Jeffers J, Boughton Oet al., 2021,

    Power tool use in orthopaedic surgery: iatrogenic injury, its detection and technological advances

    , JBJS Open Access, Vol: 6, Pages: 1-16, ISSN: 2472-7245

    Background: Power tools are an integral part to orthopaedic surgery but have the capacity to cause iatrogenic injury. This systematic review aimed to investigate the prevalence of iatrogenic injury due to power tools in orthopaedic surgery and discuss the current methods 9that can be used to reduce this. Methods: A systematic review of all English language articles using a keyword search was undertaken in Medline, Embase, PubMed and Scopus databases. Exclusion criteria included injuries related to cast saw, temperature induced damage and complications not clearly related to power tool use. Results: 3694 abstracts were retrieved, and 88studies were included in the final analysis. Only a few studies and individual case reports directly looked at prevalence of injury due to power tools. This included 2 studies looking at frequency of vascular injury during femoral fracture fixation (0.49% and 0.2%),2 studies investigating frequency of vertebral artery injury during spinal surgery (0.5% and 0.08%)and 3 studies investigating vascular injury during total joint arthroplasty (124 vascular injuries involving 138 blood vessels,0.13% and 0.1% incidence)in addition to 1 questionnaire sent electronically to surgeons. There are multiple methods to prevent damage during the use of power tools. These include robotics, Revised Manuscript (Maximum 3000 Words)simulation, specific drill settings and real-time feedback techniques such as spectroscopy and electromyography. Conclusion: Power tools have the potential to cause iatrogenic injury to surrounding structures during orthopaedic surgery. Fortunately, the published literature suggests the frequency of iatrogenic injury using orthopaedic power tools is low. There are multiple technologies available to reduce damage using power tools. In high-risk operations the use of advanced technologies to reduce the chance of iatrogenic injury should be considered. Clinical Relevance: Power tools used during orthopaedic surgery have the potentia
  • Journal article
    Kennedy DL, Vollert J, Ridout D, Alexander CM, Rice ASet al., 2021,

    The responsiveness of quantitative sensory testing-derived sensory phenotype to disease-modifying intervention in patients with entrapment neuropathy: a longitudinal study

    , Pain, Vol: 162, Pages: 2881-2893, ISSN: 0304-3959

    ABSTRACT: The German Research Network on Neuropathic Pain (DFNS) quantitative sensory testing (QST) method for sensory phenotyping is used to stratify patients by mechanism associated sensory phenotype, theorised to be predictive of intervention efficacy. We hypothesised that change in pain and sensory dysfunction would relate to change in sensory phenotype. We investigated the responsiveness of sensory phenotype to surgery in patients with an entrapment neuropathy.With ethical approval and consent, this observational study recruited patients with neurophysiologically confirmed carpal tunnel syndrome. Symptom and pain severity parameters and DFNS QST were evaluated prior to and after carpal tunnel surgery. Surgical outcome was evaluated by patient-rated change. Symptom severity score of the Boston Carpal Tunnel Questionnaire and associated pain and paraesthesia subgroups were comparators for clinically relevant change.QST results (n=76) were compared to healthy controls (n=54). At 6 months post-surgery 92% participants reported a good surgical outcome and large decrease in pain and symptom severity (p<.001). Change in QST parameters occurred for thermal detection, thermal pain and mechanical detection thresholds with a moderate to large effect size. Change in mechanical pain measures were not statistically significant. Change occurred in sensory phenotype post-surgery (p<.001); sensory phenotype was associated with symptom subgroup (p=.03) and patient-rated surgical outcome (p =.02).QST derived sensory phenotype is sensitive to clinically important change. In an entrapment neuropathy model, sensory phenotype was associated with patient-reported symptoms and demonstrated statistically significant, clinically relevant change after disease modifying intervention. Sensory phenotype was independent of disease severity and may reflect underlying neuropathophysiology.
  • Journal article
    Urbanczyk CA, Bonfiglio A, McGregor AH, Bull AMJet al., 2021,

    Comparing optical and electromagnetic tracking systems to facilitate compatibility in sports kinematics data.

    , International Biomechanics, Vol: 8, Pages: 75-84, ISSN: 2333-5432

    Electromagnetic (EM) tracking has been used to quantify biomechanical parameters of the lower limb and lumbar spine during ergometer rowing to improve performance and reduce injury. Optical motion capture (OMC) is potentially better suited to measure comprehensive whole-body dynamics in rowing. This study compared accuracy and precision of EM and OMC displacements by simultaneously recording kinematics during rowing trials at low, middle, and high rates on an instrumented ergometer (n=12). Trajectories calculated from OMC and EM sensors attached to the pelvis, lumbar spine, and right leg were highly correlated, but EM tracking lagged behind ergometer and OMC tracking by approximately 6%, yielding large RMS errors. When this phase-lag was corrected by least squares minimization, agreement between systems improved. Both systems demonstrated an ability to adequately track large dynamic compound movements in the sagittal plane but struggled at times to precisely track small displacements and narrow angular ranges in medial/lateral and superior/inferior directions. An OMC based tracking methodology can obtain equivalence with a previously validated EM system, for spine and lower limb metrics. Improvements in speed and consistency of data acquisition with OMC are beneficial for dynamic motion studies. Compatibility ensures continuity by maintaining the ability to compare to prior work.
  • Journal article
    Federer SJ, Jones GG, 2021,

    Artificial intelligence in orthopaedics: A scoping review

    , PLOS ONE, Vol: 16, ISSN: 1932-6203
  • Journal article
    Turner S, Jain S, Patel A, Hopkins M, McGregor Aet al., 2021,

    Visual biofeedback tool for quantitative pressure monitoring in lower-limb prosthetic sockets

    , Prosthesis, Vol: 3, Pages: 394-405, ISSN: 2673-1592

    Obtaining a good socket fit is an iterative process dependent on the skill and experience of the prosthetist creating it and requires individualisation based on the size and shape. There is no standard measurement system used to aid prosthetic socket creation despite the severe impacts on physical health and quality of life if one is ill fitting. Pressure sensors embedded in a prosthetic socket were used to collect data at the socket–residuum interface. To choose an interpolation method, the sensor array was simplified to a 2D grid with a border for extrapolation and tested using previously collected walking test pressure data. Four multivariable interpolation methods were evaluated to create a colour map of the pressure data. Radial basis function interpolation was chosen, as it produced a clear image with a graduated interpolation between data points, and was used to create a colour map across the surface of a 3D prosthetic socket model. For the model to be accessible to clinical audiences, a desktop application was created using PyQt to view the model. The application allowed for connection to the sensors via Bluetooth, with the pressure data updating on the 3D model in real time. Clinician feedback on the application showed the potential for a clinical product; however, further development informed by feedback from rehabilitation clinicians and prosthesis users is required.
  • Journal article
    Kennedy DL, Ridout D, Lysakova L, Vollert J, Alexander CM, Rice ASCet al., 2021,

    The association of sensory phenotype and concomitant mood, sleep and functional impairment with the outcome of carpal tunnel surgery

    , BMC Musculoskeletal Disorders, Vol: 22, Pages: 1-19, ISSN: 1471-2474

    BackgroundUp to 25% of people who have had carpal tunnel release surgery (CTR) fail to report improvement; however, evidence for prognostic indicators in this surgical cohort is limited. To identify candidate prognostic factors, this study investigated the association of quantitative sensory testing (QST) derived sensory phenotype and attendant impairment with patient-reported surgical outcome.MethodsWith ethical approval and informed consent, this prospective observational longitudinal study recruited patients from two London hospitals. Multimodal phenotyping measures including quantitative sensory testing (QST), pain parameters, insomnia, pain-related worry, mood and function, were evaluated prior to; and at 3- and 6-months post-surgery. Pain in median nerve distribution with electrophysiologically confirmed conduction delay and DN4 score ≥ 4 was defined as neuropathic. Primary outcome was patient-rated change at 6 months, dichotomised as poor outcome; “worse” or “no change” and good outcome; “slightly better”, “much better” or “completely cured”.ResultsSeventy-six patients participated. Prior to surgery, substantial heterogeneity in established categories of somatosensory function was observed with 21% of participants categorised as having a healthy sensory phenotype; 29% with thermal hyperalgesia; 32% mechanical hyperalgesia and 18% sensory loss. Seventy six percent of participants were classified as having neuropathic pain, 33% with high levels of pain related worry and 64% with clinical insomnia. Observed differences in pain, sleep impairment, psychological factors and function, between sensory phenotypic groups, was not significant. At 3- and 6-months post-surgery there was significant improvement in all phenotyping measures with a moderate to large effect size. Thermal and mechanical measures of somatosensation improved (p < 0.001), as did functional ability
  • Journal article
    Garner A, Dandridge O, Amis A, Cobb J, van Arkel RJet al., 2021,

    Bi-unicondylar arthroplasty: a biomechanics and clinical outcomes study

    , Bone & Joint Research, Vol: 10, Pages: 723-733, ISSN: 2046-3758

    Aims Bi-Unicondylar Arthroplasty (Bi-UKA) is a bone and anterior cruciate ligament (ACL) preserving alternative to Total Knee Arthroplasty (TKA) when the patellofemoral joint is preserved. The aim of this study is to investigate the clinical outcomes and biomechanics of Bi-UKA. Methods Bi-UKA subjects (N = 22) were measured on an instrumented treadmill, using standard gait metrics, at top walking speeds. Age, sex and BMI-matched healthy (N = 24) and primary TKA (N = 22) subjects formed control groups. TKA subjects with pre-operative patellofemoral or tricompartmental arthritis or ACL dysfunction were excluded. The Oxford Knee Score (OKS) and EuroQol-5D (EQ-5D) were compared. Bi-UKA then TKA were performed on eight fresh frozen cadaveric knees, to investigate knee extensor efficiency under controlled laboratory conditions, using a repeated measures study design. Results Bi-UKA walked 20% faster than TKA (Bi-UKA 6.70.9km/h, TKA 5.60.7km/h p<0.001), exhibiting nearer-normal vertical Ground Reaction Forces in maximum weight-acceptance and mid-stance, with longer step and stride lengths compared to TKA (p<0.05). Bi-UKAsubjects reported higher OKS (p=0.004) and EQ-5D (p<0.001). In vitro, Bi-UKA generated the same extensor moment as native knees at low flexion angles, whilst reduced extensor moment was measured following TKA (p<0.003). Conversely, at higher flexion angles, the extensor moment of TKA was normal. Over the full range, the extensor mechanism was more efficient following Bi-UKA than TKA (p<0.05). Conclusion Bi-UKA had more normal gait characteristics and improved patient reported outcomes, compared to matched TKA subjects. This can, in part, be explained by differences in extensor efficiency.
  • Journal article
    Edwards TC, Coombs AW, Szyszka B, Logishetty K, Cobb JPet al., 2021,

    Cognitive task analysis-based training in surgery: a meta-analysis

    , BJS OPEN, Vol: 5, ISSN: 2474-9842
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  • Journal article
    Wedatilake T, Palmer A, Fernquest S, Redgrave A, Arnold L, Kluzek S, McGregor A, Teh J, Newton J, Glyn-Jones Set al., 2021,

    Association between hip joint impingement and lumbar disc disease in elite rowers

    , BMJ Open Sport and Exercise Medicine, Vol: 7, Pages: 1-7, ISSN: 2055-7647

    Objectives Lumbar disc disease is a known cause of back pain. Increasingly it is thought that cam morphology of the hip may have a causal role in development of lumbar disc disease. The aim of this study was to describe the morphology of the hip and investigate the association of cam morphology with lumbar disc disease observed on MRI in elite rowers.Methods Cross-sectional observational study of 20 elite rowers (12 male, 8 female, mean age 24.45, SD 2.1). Assessment included clinical examination, questionnaires, 3T MRI scans of the hips and lumbar spine. Alpha angle of the hips and Pfirrmann score of lumbar discs were measured.Results 85% of rowers had a cam morphology in at least one hip. Alpha angle was greatest at the 1 o’clock position ((bone 70.9 (SD 16.9), cartilage 71.4 (16.3)). 95% of the group were noted to have labral tears, but only 50% of the group had history of groin pain. 85% of rowers had at least one disc with a Pfirrmann score of 3 or more and 95% had a history of back pain. A positive correlation was observed between the alpha angle and radiological degenerative disc disease (correlation coefficient=3.13, p=0.012). A negative correlation was observed between hip joint internal rotation and radiological degenerative disc disease (correlation coefficient=−2.60, p=0.018).Conclusions Rowers have a high prevalence of labral tears, cam morphology and lumbar disc disease. There is a possible association between cam morphology and radiological lumbar degenerative disc disease, however, further investigation is required.
  • Journal article
    Khatri C, Ward AE, Nepogodiev D, Ahmed I, Chaudhry D, Dhaif F, Bankhad-Kendall B, Kaafarani H, Bretherton C, Mahmood A, Marais L, Parsons N, Bhangu A, Metcalfe A, Parsons N, Khatri C, Siaw-Acheampong K, Chaudhry D, Dawson BE, Evans JP, Glasbey JC, Gujjuri RR, Heritage E, Jones CS, Kamarajah SK, Khatri C, Keatley JM, Lawday S, Li E, Mckay SC, Nepogodiev D, Pellino G, Tiwari A, Simoes JFF, Trout IM, Venn ML, Wilkin RJW, Bhangu A, Ademuyiwa AO, Agarwal A, Al Ameer E, Alderson D, Alser O, Arnaud AP, Augestad KM, Bankhead-Kendall B, Benson RA, Chakrabortee S, Blanco-Colino R, Brar A, Bravo AM, Breen KA, Buarque IL, Caruana E, Cunha MF, Davidson GH, Desai A, Di Saverio S, Edwards J, Elhadi M, Farik S, Fiore M, Fitzgerald JE, Ford S, Gallo G, Ghosh D, Gomes GMA, Griffiths E, Halkias C, Harrison EM, Hutchinson P, Isik A, Kaafarani H, Kolias A, Lawani I, Lederhuber H, Leventoglu S, Loffler MW, Martin J, Mashbari H, Mazingi D, Mohan H, Moore R, Moszkowicz D, Ng-Kamstra JS, Metallidis S, Moug S, Niquen M, Ntirenganya F, Outani O, Pata F, Pinkney TD, Pockney P, Radenkovic D, Ramos-De la Medina A, Roberts K, Santos I, Schache A, Schnitzbauer A, Stewart GD, Shaw R, Shu S, Soreide K, Spinelli A, Sundar S, Tabiri S, Townend P, Tsoulfas G, van Ramshorst G, Vidya R, Vimalachandran D, Wright N, Simoes JFF, Mak JKC, Kulkarni R, Sharma N, Nankivell P, Tirotta F, Parente A, Breik O, Kisiel A, Cato LD, Saeed S, Bhangu A, Griffiths E, Pathanki AM, Ford S, Desai A, Almond M, Kamal M, Chebaro A, Lecolle K, Truant S, El Amrani M, Zerbib P, Pruvot FR, Mathieu D, Surmei E, Mattei L, Marin H, Dudek J, Singhal T, El-Hasani S, Nehra D, Walters A, Cuschieri J, Davidson GH, Ho M, Wade RG, Johnstone J, Bourke G, Brunelli A, Elkadi H, Otify M, Pompili C, Burke JR, Bagouri E, Chowdhury M, Abual-Rub Z, Kaufmann A, Munot S, Lo T, Young A, Kowal M, Wall J, Peckham-Cooper A, Winter SC, Belcher E, Stavroulias D, Di Chiara F, Wallwork K, Qureishi A, Lami M, Sravanam S, Mastoridis S, Shah K, Chidambaram S, Smet al., 2021,

    Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

    , BMJ Open, Vol: 11, Pages: 1-10, ISSN: 2044-6055

    Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p<0.001), age >80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before t

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