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  • Journal article
    Jaggard MKJ, Boulange CL, Graca G, Akhbari P, Vaghela U, Bhattacharya R, Williams HRT, Lindon JC, Gupte CMet al., 2021,

    The influence of sample collection, handling and low temperature storage upon NMR metabolic profiling analysis in human synovial fluid

    , JOURNAL OF PHARMACEUTICAL AND BIOMEDICAL ANALYSIS, Vol: 197, ISSN: 0731-7085
  • Journal article
    Clunie GM, Belsi A, Roe JWG, Alexander CM, Sandhu G, McGregor Aet al., 2021,

    Not just dyspnoea: swallowing as a concern for adults with laryngotracheal stenosis undergoing airway reconstruction

    , Dysphagia, Vol: 37, Pages: 365-374, ISSN: 0179-051X

    Acquired laryngotracheal stenosis (LTS) is a rare condition causing dyspnea and stridor. Patients often require multiple surgical procedures with no guarantee of a definitive outcome. Difficulty swallowing is a recognised problem associated with LTS and the reconstructive surgeries required to manage the condition. The breathlessness patient’s experience impacts on swallowing, and the vulnerable structures of the larynx are implicated during complex surgeries. This leads to dysphagia post-surgery, with some patients experiencing more chronic symptoms depending on the biomechanical impact of the surgery, or a pre-existing dysphagia. Despite this there is limited observational research about the dysphagia associated with LTS, with no exploration of the patient experience. Our aim was to investigate patient experience of living with LTS focussing on dysphagia in order to guide clinical practice. A qualitative study was completed using focus groups and semi-structured interviews with 24 patients who have had reconstructive surgery for LTS. Thematic analysis was used to identify three over-arching themes: The Physical Journey, The Emotional Journey and The Medical Journey. Key sub-themes included the importance of self-management and control, presence of symptoms, benefits of therapy, living with a life-long condition, fear and anxiety, autonomy, medicalisation of normal processes and the dichotomy between staff expertise and complacency. Swallowing was connected to all themes. The results are reviewed with consideration of the wider literature of lived experience particularly in relation to other chronic conditions and those that carry a high symptom burden such as head and neck cancer. Future clinical and research recommendations have been made. Akin to other clinical groups, adults with LTS are keen that management of their swallowing is person-centred and holistic.
  • Journal article
    Abel R, Behforootan S, Boughton O, Hansen U, Cobb J, Huthwaite Pet al.,

    Ultrasound and Bone Disease: A Systematic Review

    , World Journal of Surgery and Surgical Research
  • Journal article
    Zakieh O, Park C, Hornby K, Gupte C, Sarraf KMet al., 2021,

    Paediatric anterior cruciate ligament injury.

    , Br J Hosp Med (Lond), Vol: 82, Pages: 1-9, ISSN: 1750-8460

    The number of paediatric anterior cruciate ligament injuries is rising at a greater rate than in the adult population, as a result of the increased participation of children and adolescents in sports. This review explores the key presentations, diagnostic and management plans, and prevention methods associated with paediatric anterior cruciate ligament injuries. This injury presents as an acute pop and effusion, with limitations in gait, and can be extremely debilitating. Clinical examination and magnetic resonance imaging are used to diagnose the injury. The pivot shift and Lachman test remain the most valid exams when suspecting an anterior cruciate ligament tear. Management of the injury can be surgical or non-surgical depending on the severity of the tear and associated injuries. The surgical approach chosen is determined by the patient's Tanner classification, considering potential damage to the physes of the bone. Management plans should include rehabilitation consisting of strength, proprioception and neuromuscular training, to maximise the patient's recovery. Injury prevention programmes, consisting of strength training and neuromuscular training, should be followed by young athletes to reduce anterior cruciate ligament injuries. Compliance and earlier implementation coupled with an understanding of the biomechanics of anterior cruciate ligament injuries and verbal feedback maximise the benefit of neuromuscular training.
  • Journal article
    Deane JA, Lim AKP, McGregor AH, Strutton PHet al., 2021,

    Understanding the impact of lumbar disc degeneration and chronic low back pain: a cross-sectional electromyographic analysis of postural strategy during predicted and unpredicted postural perturbations

    , PLoS One, Vol: 16, ISSN: 1932-6203

    People with chronic low back pain (LBP) exhibit changes in postural control. Stereotypical muscle activations resulting from external perturbations include anticipatory (APAs) and compensatory (CPAs) postural adjustments. The aim and objective of this study was to determine differences in postural control strategies (peak amplitude, APAs and CPAs) between symptomatic and asymptomatic adults with and without Lumbar Disc Degeneration (LDD) using surface electromyography during forward postural perturbation. Ninety-seven subjects participated in the study (mean age 50 years (SD 12)). 3T MRI was used to acquire T2 weighted images (L1-S1). LDD was determined using Pfirrmann grading. A bespoke translational platform was designed to deliver horizontal perturbations in sagittal and frontal planes. Electromyographic activity was analysed bilaterally from 8 trunk and lower limb muscles during four established APA and CPA epochs. A Kruskal-Wallis H test with Bonferroni correction for multiple comparisons was conducted. Four groups were identified: no LDD no pain (n = 19), LDD no pain (n = 38), LDD pain (n = 35) and no LDD pain (n = 5). There were no significant differences in age or gender between groups. The most significant difference between groups was observed during forward perturbation. In the APA and CPA phases of predictable forward perturbation there were significant differences ankle strategy between groups (p = 0.007–0.008); lateral gastrocnemius and tibialis anterior activity was higher in the LDD pain than the LDD no pain group. There were no significant differences in the unpredictable condition (p>0.05). These findings were different from the remaining groups, where significant differences in hip strategy were observed during both perturbation conditions (p = 0.004–0.006). Symptomatic LDD patients exhibit different electromyographic strategies to asymptomatic LDD controls. Future LBP electromyographic research should benefit from considering asses
  • Journal article
    Wiik AV, Aqil A, Al-Obaidi B, Brevadt M, Cobb JPet al., 2021,

    The impact of reducing the femoral stem length in total hip arthroplasty during gait

    , Archives of Orthopaedic and Trauma Surgery, Vol: 141, Pages: 1993-2000, ISSN: 0344-8444

    AimThe length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics.MethodsPatients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare.ResultsWith the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem.ConclusionBy testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.
  • Journal article
    Grigoras M, Boughton O, Cleary M, McKenna P, Rowan FEet al., 2021,

    Short-term outcomes of total knee arthroplasty performed with and without a tourniquet

    , SICOT-J, Vol: 7, ISSN: 2426-8887
  • Journal article
    Bogomolova K, Sam AH, Misky AT, Gupte CM, Strutton PH, Hurkxkens TJ, Hierck BPet al., 2021,

    Development of a virtual three-dimensional assessment scenario for anatomical education

    , Anatomical Sciences Education, Vol: 14, Pages: 385-393, ISSN: 1935-9772

    In anatomical education three-dimensional (3D) visualization technology allows for active and stereoscopic exploration of anatomy and can easily be adopted into medical curricula along with traditional 3D teaching methods. However, most often knowledge is still assessed with two-dimensional (2D) paper-and-pencil tests. To address the growing misalignment between learning and assessment, this viewpoint commentary highlights the development of a virtual 3D assessment scenario and perspectives from students and teachers on the use of this assessment tool: a 10-minute session of anatomical knowledge assessment with real-time interaction between assessor and examinee, both wearing a HoloLens and sharing the same stereoscopic 3D augmented reality model. Additionally, recommendations for future directions, including implementation, validation, logistic challenges, and cost-effectiveness, are provided. Continued collaboration between developers, researchers, teachers, and students is critical to advancing these processes.
  • Journal article
    Mullington CJ, Shetty P, Dalton J, 2021,

    Intubation of COVID patients: always a risky business?

    , ANAESTHESIA, Vol: 76, Pages: 3-4, ISSN: 0003-2409
  • Journal article
    Lex JR, Edwards TC, Packer TW, Jones GG, Ravi Bet al., 2021,

    Perioperative Systemic Dexamethasone Reduces Length of Stay in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    , JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 1168-1186, ISSN: 0883-5403
  • Journal article
    Favier C, Finnegan M, Quest R, Honeyfield L, McGregor A, Phillips Aet al., 2021,

    An open-source musculoskeletal model of the lumbar spine and lower limbs: a validation for movements of the lumbar spine

    , Computer Methods in Biomechanics and Biomedical Engineering, Vol: 24, Pages: 1310-1325, ISSN: 1025-5842

    Musculoskeletal models of the lumbar spine have been developed with varying level of detail for a wide range of clinical applications. Providing consistency is ensured throughout the modelling approach, these models can be combined with other computational models and be used in predictive modelling studies to investigate bone health deterioration and the associated fracture risk. To provide precise physiological loading conditions for such predictive modelling studies, a new full-body musculoskeletal model including a detailed and consistent representation of the lower limbs and the lumbar spine was developed. The model was assessed against in-vivo measurements from the literature for a range of spine movements representative of daily living activities. Comparison between model estimations and electromyography recordings was also made for a range of lifting tasks. This new musculoskeletal model will provide a comprehensive physiological mechanical environment for future predictive finite element modelling studies on bone structural adaptation. It will be made freely available on https://simtk.org/projects/llsm/.
  • Journal article
    Logishetty K, Edwards TC, Subbiah Ponniah H, Ahmed M, Liddle AD, Cobb J, Clark Cet al., 2021,

    How to prioritize patients and redesign care to safely resume planned surgery during the COVID-19 pandemic.

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

    AIMS: 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. METHODS: A multidisciplinary surgical prioritization committee developed the SPAG, incorporating procedural urgency, shared decision-making, patient safety, and biopsychosocial factors; and applied it to 1,142 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: A total of 1,142 patients were included, 47 declined surgery, and 110 were deemed high-risk or requiring specialist resources. In the ten-week study period, 28 high-risk patients underwent surgery, during which 68% (13/19) of Priority 2 (P2, surgery within one month) patients underwent surgery, and 15% (3/20) of P3 (< three months) and 16% (11/71) of P4 (> three months) groups. Of the 1,032 low-risk patients, 322 patients underwent surgery. Overall, 21 P3 and P4 patients were expedited to 'Urgent' based on biopsychosocial factors identified by the SPAG. During the study period, 91% (19/21) of the Urgent group, 52% (49/95) of P2, 36% (70/196) of P3, and 26% (184/720) of P4 underwent surgery. No patients died or were admitted to HDU/ICU, or contracted COVID-19. CONCLUSION: Our widely generalizable model enabled the restart of planned surgery during the COVID-19 pandemic, without compromising patient safety or excluding high-risk or complex cases. Patients classified as Urgent or P2 w
  • Journal article
    Boughton O, Cobb J, owyang D, Bakhsh A, brewer Det al., 2021,

    Patient and Public Involvement Within Orthopaedic Research: A Systematic Review

    , Journal of Bone and Joint Surgery: American Volume, ISSN: 0021-9355
  • Journal article
    Morton S, Kua J, Mullington CJ, 2021,

    Epidural analgesia, intrapartum hyperthermia, and neonatal brain injury: a systematic review and meta-analysis

    , British Journal of Anaesthesia, Vol: 126, Pages: 500-515, ISSN: 0007-0912

    BackgroundEpidural analgesia is associated with intrapartum hyperthermia, and chorioamnionitis is associated with neonatal brain injury. However, it is not known if epidural hyperthermia is associated with neonatal brain injury. This systematic review and meta-analysis investigated three questions: (1) does epidural analgesia cause intrapartum hyperthermia, (2) is intrapartum hyperthermia associated with neonatal brain injury, and (3) is epidural-induced hyperthermia associated with neonatal brain injury?MethodsPubMed, ISI Web of Knowledge, The Cochrane Library, and Embase were searched from inception to January 2020 using Medical Subject Headings (MeSH) terms relating to epidural analgesia, hyperthermia, labour, and neonatal brain injury. Studies were reviewed independently for inclusion and quality by two authors (Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach). Two meta-analyses were performed using the Mantel–Haenszel fixed effect method to generate odds ratios (ORs) and 95% confidence intervals (CIs).ResultsForty-one studies were included for Question 1 (646 296 participants), 36 for Question 2 (11 866 021 participants), and two studies for Question 3 (297 113 participants). When the mode of analgesia was randomised, epidural analgesia was associated with intrapartum hyperthermia (OR: 4.21; 95% CI: 3.48–5.09). There was an association between intrapartum hyperthermia and neonatal brain injury (OR: 2.79; 95% CI: 2.54–2.3.06). It was not possible to quantify the association between epidural-induced hyperthermia and neonatal brain injury.ConclusionsEpidural analgesia is a cause of intrapartum hyperthermia, and intrapartum hyperthermia of any cause is associated with neonatal brain injury. Further work is required to establish if epidural-induced hyperthermia is a cause of neonatal brain injury.
  • Journal article
    Raymond AC, Liddle AD, Alvand A, Donaldson JR, Carrington RWJ, Miles Jet al., 2021,

    Clinical Outcome of Free Latissimus Dorsi Flaps for Coverage of Soft Tissue Defects in Multiply Revised Total Knee Arthroplasties

    , JOURNAL OF ARTHROPLASTY, Vol: 36, Pages: 664-669, ISSN: 0883-5403
  • Journal article
    Bates A, McGregor A, Alexander C, 2021,

    Adaptation of balance reactions following anterior perturbations in people with Joint Hypermobility Syndrome

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

    BackgroundJoint Hypermobility Syndrome (JHS) is a Heritable Disorder of Connective tissue characterised by joint laxity and chronic widespread arthralgia. People with JHS exhibit a range of other symptoms including balance problems. To explore balance further, the objective of this study is to compare responses to forward perturbations between three groups; people who are hypermobile with (JHS) and without symptoms and people with normal flexibility.MethodsTwenty-one participants with JHS, 23 participants with Generalised Joint Hypermobility (GJH) and 22 participants who have normal flexibility (NF) stood on a platform that performed 6 sequential, sudden forward perturbations (the platform moved to the anterior to the participant). Electromyographic outcomes (EMG) and kinematics for the lower limbs were recorded using a Vicon motion capture system. Within and between group comparisons were made using Kruskal Wallis tests.ResultsThere were no significant differences between groups in muscle onset latency. At the 1st perturbation the group with JHS had significantly longer time-to-peak amplitude than the NF group in tibialis anterior, vastus medialis, rectus femoris, vastus lateralis, and than the GJH group in the gluteus medius. The JHS group showed significantly higher cumulative joint angle (CA) than the NF group in the hip and knee at the 1st and 2nd and 6th perturbation, and in the ankle at the 2nd perturbation. Participants with JHS had significantly higher CA than the GJH group at the in the hip and knee in the 1st and 2nd perturbation. There were no significant differences in TTR.ConclusionsThe JHS group were able to normalise the timing of their muscular response in relation to control groups. They were less able to normalise joint CA, which may be indicative of impaired balance control and strength, resulting in reduced stability.
  • Journal article
    Akhbari P, Jaggard MK, Boulange CL, Vaghela U, Graca G, Bhattacharya R, Lindon JC, Williams HRT, Gupte CMet al., 2021,

    Differences between infected and noninfected synovial fluid

    , Bone & Joint Research, Vol: 10, Pages: 85-95, ISSN: 2046-3758

    AimsThe diagnosis of joint infections is an inexact science using combinations of blood inflammatory markers and microscopy, culture, and sensitivity of synovial fluid (SF). There is potential for small molecule metabolites in infected SF to act as infection markers that could improve accuracy and speed of detection. The objective of this study was to use nuclear magnetic resonance (NMR) spectroscopy to identify small molecule differences between infected and noninfected human SF.MethodsIn all, 16 SF samples (eight infected native and prosthetic joints plus eight noninfected joints requiring arthroplasty for end-stage osteoarthritis) were collected from patients. NMR spectroscopy was used to analyze the metabolites present in each sample. Principal component analysis and univariate statistical analysis were undertaken to investigate metabolic differences between the two groups.ResultsA total of 16 metabolites were found in significantly different concentrations between the groups. Three were in higher relative concentrations (lipids, cholesterol, and N-acetylated molecules) and 13 in lower relative concentrations in the infected group (citrate, glycine, glycosaminoglycans, creatinine, histidine, lysine, formate, glucose, proline, valine, dimethylsulfone, mannose, and glutamine).ConclusionMetabolites found in significantly greater concentrations in the infected cohort are markers of inflammation and infection. They play a role in lipid metabolism and the inflammatory response. Those found in significantly reduced concentrations were involved in carbohydrate metabolism, nucleoside metabolism, the glutamate metabolic pathway, increased oxidative stress in the diseased state, and reduced articular cartilage breakdown. This is the first study to demonstrate differences in the metabolic profile of infected and noninfected human SF, using a noninfected matched cohort, and may represent putative biomarkers that form the basis of new diagnostic tests for infected SF.
  • Journal article
    Salman D, Vishnubala D, Le Feuvre P, Beaney T, Korgaonkar J, Majeed A, McGregor AHet al., 2021,

    Returning to physical activity after covid-19

    , BMJ: British Medical Journal, Vol: 372, Pages: 372-m4721, ISSN: 0959-535X
  • Journal article
    Nugent FJ, Vinther A, McGregor A, Thornton JS, Wilkie K, Wilson Fet al., 2021,

    The relationship between rowing-related low back pain and rowing biomechanics: a systematic review

    , British Journal of Sports Medicine, Vol: 55, Pages: 616-630, ISSN: 0306-3674

    BACKGROUND: Low back pain (LBP) is common in rowers. Understanding rowing biomechanics may help facilitate prevention and improve rehabilitation. OBJECTIVES: To define the kinematics and muscle activity of rowers and to compare with rowers with current or LBP history. DESIGN: Systematic review. DATA SOURCES: EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus from inception to December 2019. Grey literature was searched. STUDY ELIGIBILITY CRITERIA: Experimental and non-experimental designs. METHODS: Primary outcomes were kinematics and muscle activity. Modified Quality Index (QI) checklist was used. RESULTS: 22 studies were included (429 participants). Modified QI score had a mean of 16.7/28 points (range: 15-21). Thirteen studies investigated kinematics and nine investigated muscle activity. Rowers without LBP ('healthy') have distinct kinematics (neutral or anterior pelvic rotation at the catch, greater hip range of motion, flatter low back spinal position at the finish) and muscle activity (trunk extensor dominant with less flexor activity). Rowers with LBP had relatively greater posterior pelvic rotation at the catch, greater hip extension at the finish and less efficient trunk muscle activity. In both groups fatigue results in increased lumbar spine flexion at the catch, which is greater on the ergometer. There is insufficient evidence to recommend one ergometer type (fixed vs dynamic) over the other to avoid LBP. Trunk asymmetries are not associated with LBP in rowers. CONCLUSION: Improving clinicians' and coaches' understanding of safe and effective rowing biomechanics, particularly of the spine, pelvis and hips may be an important strategy in reducing incidence and burden of LBP.
  • Book chapter
    Matthews E, Sinha I, Liddle AD, 2021,

    Management of Distal Femoral Periprosthetic Fractures: Plate, Intramedullary Nail or Arthroplasty?

    , Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 143-150

    Whilst fractures around a knee replacement are uncommon, their incidence can be expected to increase in line with the increase in primary knee arthroplasty procedures being performed. These patients are often elderly and these injuries represent fragility fractures. The challenges of treating this patient and injury are significant. There is no consensus on which modality of treatment is best for treating the periprosthetic distal femoral fracture. Most fractures present with displacement but without loosening or compromise of the implant, these are amenable to fixation. Modalities of fixation have improved with an increase in understanding of fracture biology and improvements in technology, and locking plates, intramedullary nails, and combinations of both are being used. Fractures with poor or inadequate bone stock or a loose prosthesis may necessitate treatment with an endoprosthetic replacement.

This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.

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