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Book chapterMusbahi O, Logishetty K, Cobb JP, 2021,
Hip Resurfacing Arthroplasty or Total Hip Arthroplasty?
, Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 15-22Hip resurfacing arthroplasty (HRA) is an alternative to total hip arthroplasty (THA) in younger patients with good bone quality who wish to return to high levels of activity. Usage of HRA has declined due to implant-specific complications—metal debris and periarticular soft tissue damage, implant loosening, and femoral neck fracture. These were most common with implants which have now been withdrawn, but fears remain. HRA is more technically challenging than THA, but revision rates for patients operated at specialist centres are equivalent. Gait and biomechanical studies suggest that HRA better restores normal function compared to THA, and registry-based studies suggest a lower mortality. However, randomised clinical trials have not shown superiority using conventional patient-reported outcome measures. As the clinical indications are dependent on patient demands, and more active patients are more likely to wear out artificial joints, it is difficult to robustly compare HRA and THA. Today, safe HRA implants inserted by experienced surgeons in active, male patients seem to deliver the most predictable outcomes, high performance and longevity.
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Book chapterConnon F, Logishetty K, 2021,
Approaches for Total Hip Arthroplasty
, Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 41-52Total hip arthroplasty, via any surgical approach, can offer reliable, substantial, and clinically relevant improvements in patient pain, mobility, and quality of life that makes it one of the most effective and reliable operations in modern medicine. The debate as to which surgical approach to utilise to perform total hip arthroplasty is as old as arthroplasty itself. At the time of writing, there is an increasing rate of utilisation of the Anterior Approach (AA), but the Posterior Approach (PA) is still the most employed worldwide, followed by the Lateral Approach (LA). The purported benefits and risks of the AA relative to the PA and LA are discussed here in greater detail, focusing on functional recovery, pain, implant longevity, infection, nerve palsy, and the learning curve. Training surgeons would be well advised to consider achieving proficiency in both the AA and PA. Surgeons already well-trained in any of the approaches described for this reliable procedure should consider the complications entailed with altering techniques as there is an associated learning curve, and should organise appropriate training if wishing to employ a different method.
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Journal articleClunie G, Roe J, Alexander C, et al., 2021,
Voice and swallowing outcomes following airway reconstruction in adults: a systematic review
, The Laryngoscope, Vol: 131, Pages: 146-157, ISSN: 0023-852XObjectives: Laryngotracheal stenosis is a rare condition characterized by upper airway narrowing. Reconstructive surgical treatment aims to manage the area of stenosis to improve dyspnea and can impact on voice and swallowing function. This article critically evaluates the literature about voice and swallowing outcomes in adults with laryngotracheal stenosis who undergo reconstructive surgery.Study Design: Systematic review.Methods: Six databases were searched for articles referring to voice and swallowing outcome measures following reconstruction procedures in adults with laryngotracheal stenosis. Screening was completed using predefined inclusion/exclusion criteria. Results: A total of 143 abstracts were reviewed, with 67 articles selected for full text review. 20 studies met the inclusion criteria. Data extraction was completed with The Strengthening Reporting of Observational Studies in Epidemiology checklist with Oxford Centre for Evidence-Based Medicine Level of Evidence used to indicate quality. Risk of bias was assessed using the Risk of Bias Assessment Tool for Non-Randomized Studies. All studies scored a high risk of bias in at least one of the domains. Selection and timing of outcome measures was heterogenous and there was limited information provided about rationale or reliability.Conclusion: The literature acknowledges the importance of voice and swallowing outcomes following airway reconstruction. Studies show correlation between reconstructive surgery and deterioration in vocal function; there is no consistent data about swallowing outcomes. The lack of a core outcome measures set for adults with laryngotracheal stenosis limits the findings of this review. Further research is needed to establish clear criteria for robust and clinically relevant outcome measurement.
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Journal articleGarner A, Dandridge O, Amis A, et al., 2021,
The extensor efficiency of unicompartmental, bicompartmental and total knee arthroplasty
, Bone and Joint Research, Vol: 10, Pages: 1-9, ISSN: 2046-3758Aims: Unicompartmental (UKA) and bicompartmental (BCA) knee arthroplasty have been associated with improved functional outcomes compared to Total Knee Arthroplasty (TKA) in suitable patients, although the reason is poorly understood. The aim of this study was to measure how the different arthroplasties affect knee extensor function. Methods: Extensor function was measured for sixteen cadaveric knees and then re-tested following the different arthroplasties. Eight knees underwent medial UKA then BCA, then posterior-cruciate retaining TKA, and eight underwent the lateral equivalents then TKA. Extensorefficiency was calculated for ranges of knee flexion associated with common 46activities of daily living. Data were analyzed with repeated measures analysis of variance (=0.05). Results: Compared to native, there were no reductions in either extension moment or efficiency following UKA. Conversion to BCA resulted in a small decrease in extension moment between 70-90° flexion(p<0.05), but when examined in the context of daily activity ranges of flexion, extensor efficiency was largely unaffected. Following TKA, large decreases in extension moment were measured at low knee flexion angles(p<0.05), resulting in 12-43% reductions in extensor efficiency for the daily activity ranges. Conclusion: This cadaveric study found that TKA resulted in inferior extensor function compared to UKA and BCA. This may, in part, help explain the reported differences in 58function and satisfaction differences between partial and total knee arthroplasty.
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Journal articleRodríguez-Merchán EC, Liddle AD, 2021,
Preface
, Controversies in Orthopaedic Surgery of the Lower Limb -
Book chapterRodríguez-Merchán EC, Liddle AD, 2021,
Total Knee Arthroplasty in Patients with a History of Metal Allergy: Conventional Implant or Hypoallergenic Implant?
, Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 151-15920–25% of patients experiencing TKA acquire hypersensitivity to metals, but solely less than 1% present symptoms (dermatitis, continuous painful synovitis of the knee or aseptic loosening of the implant). Currently, skin patch test (SPT), leukocyte migration inhibition test (LMIT) and lymphocyte transformation tests (LTT) are being habitually utilized to evaluate metal hypersensitivity. However, these tests are not fully dependable and most patients are diagnosed on the basis of self-reported reactions. Most patients with metal allergy patients tolerate the conventional implants without complications. Given the current controversy over whether or not to use a conventional primary implant in patients who report having a metal allergy, the logical decision is to use a “hypoallergenic” primary prosthesis. There are two “hypoallergenic” options: (1) equivalent design but with different materials (oxidized zirconium, ceramic or titanium-based alloys); (2) equivalent designs but with coatings, normally titanium niobium or titanium nitride.
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Book chapterPopat R, Liddle AD, 2021,
Unicompartmental Knee Arthroplasty vs Total Knee Arthroplasty
, Controversies in Orthopaedic Surgery of the Lower Limb, Pages: 121-126Unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA) are established treatment options for end-stage osteoarthritis of the knee. A vast amount of evidence is available on the relative risks and benefits of UKA and TKA. Proponents of TKA argue that the revision rate of UKA is much higher than that of TKA. Supporters of UKA point to data suggesting that the threshold for revision of a UKA is lower than that applied to TKA, potentially because revising a UKA is an easier operation. Additionally, UKA is associated with numerous other benefits over TKA, including better functional outcomes, shorter hospital stays and lower morbidity/mortality. In this chapter, a clear summary of the relevant evidence regarding UKA and TKA is presented to enable informed decision-making.
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Journal articleMullington CJ, Malhotra S, 2021,
Hyperthermia after epidural analgesia in obstetrics
, BJA Education, Vol: 21, Pages: 26-31, ISSN: 2058-5349 -
Journal articleCastro-Sanchez E, Alexander CM, Atchison C, et al., 2020,
Evaluation of a personal protective equipment (PPE) support programme ('PPE Helpers') for staff during the COVID-19 pandemic in London
, Journal of Hospital Infection, Vol: 109, Pages: 68-7, ISSN: 0195-6701BackgroundThe COVID-19 pandemic has presented one of the biggest challenges to healthcare providers worldwide. The appropriate use of Personal Protective Equipment (PPE) has been essential to ensuring staff and patient safety. To counteract sub-optimal PPE practice, a PPE helper programme was developed at a large London hospital group. Based on a behaviour change model of Capability, Opportunity and Motivation (COM-B), the programme provided PPE support, advice and education to ward staff.AimEvaluation of the PPE Helper Programme.MethodsClinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, free-text responses were analysed thematically.FindingsOver a six-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than those who had not. Black and Minority Ethnic (BAME) staff were significantly more anxious in relation to the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the programme supportive and would have liked it earlier in the pandemic.ConclusionA PPE Helper programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.
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Journal articlePapi E, Chiou S-Y, McGregor A, 2020,
A feasibility and acceptability study on the use of a smartphone application to facilitate balance training in the ageing population
, BMJ Open, Vol: 10, ISSN: 2044-6055Objectives This study aims to investigate the feasibilityand acceptability of using an app-based technology totrain balance in the older population.Design Prospective feasibility study.Setting The study was conducted in a university settingand participants’ homes.Participants Thirty-five volunteers ≥55 years old wererecruited.InterventionParticipants were asked to follow a balanceexercise programme 7 days a week for 3 weeks using aphone application. Seventeen participants trained for afurther 3 weeks.Outcome measuresPostural sway measures duringquiet standing with feet at shoulder width apart andfeet together, one leg standing and tandem stancewere measured at baseline, and at the end of the 3and 6 training weeks; the International Physical ActivityQuestionnaire (IPAQ) assessed participants’ physicalactivity level before training; and app acceptability wasrecorded using a user experience questionnaire.ResultsParticipants on the 3 and 6-week programmeon average completed 20 (±5) and 38 (±11) days oftraining, respectively, and all scored moderate to high onthe IPAQ. Between baseline and the 3-week assessments,statistically significant improvements were observedfor anteroposterior sway, mediolateral sway, sway areaduring tandem stance, for anteroposterior sway duringone leg standing and for sway area during feet togetherstance. Improvements were observed at 6 week comparedwith baseline but those between 3 and 6 weeks werenot significant. Based on the questionnaire, participantsreported that the app is an appropriate tool for balancetraining (77%), they reported benefits from the training(50%) and found it easy to fit it into daily routine (88%).Conclusion The high level of adherence andimprovements observed in the analysed measuresdemonstrate the feasibility of using an app to train balancein moderately to highly physically active older participants.This demonstrates that given appropriate tools the olderpopulation is positive towards and r
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Journal articleAldera M, Alexander C, McGregor A, 2020,
Prevalence and incidence of low back pain in the Kingdom of Saudi Arabia: a systematic review
, Journal of Epidemiology and Global Health, Vol: 10, Pages: 269-275, ISSN: 2210-6006Study Design: A systematic review.Objective: To identify published studies that assess the prevalence and incidence of Low Back Pain (LBP) in the Saudi Arabian population.Methods: Six electronic databases were searched for articles published between January 1995 and December 2018. Crosssectional or cohort studies were included if they were conducted in the KSA and focused on the prevalence or incidence of LBP in adults. Case–control and retrospective studies were excluded. Studies were also excluded if they did not meet the quality criteria set out by the Joanna Briggs Institute (JBI) assessment or had a high or medium risk of bias according to the criteria proposed by Hoy et al. One independent reviewer (MAA) verified that the studies met the inclusion criteria, and three independent reviewers (MAA, AHM, CMA) assessed the quality of the studies and extracted their relevant characteristics. All the studies were assessed for quality using the JBI assessment and were assessed for risk of bias according to the Hoy et al. approach.Results: The initial search identified 158 papers; five studies met the inclusion criteria. The nature of the findings meant no meta-analysis could be performed; therefore, a narrative summary was generated to discuss the findings. The prevalence of LBP in different professional groups within a working-age group ranged between 64% and 89%.Discussion: The prevalence of LBP in the KSA has only been examined within specific professional groups, which limits the ability to generalize the finding. The review clarifies the need for further quality epidemiological studies to identify the prevalence of LBP in the general population. Many of the issues identified are problems related to occupational risk of LBP. The implication therefore is that these occupational factors need to be assessed so that risk factors for LBP among employees in KSA can be modified.
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Journal articleGoldsworthy S, Zheng CY, McNair H, et al., 2020,
The potential for haptic touch technology to supplement human empathetic touch during radiotherapy
, Journal of Medical Imaging and Radiation Sciences, Vol: 51, Pages: S39-S43, ISSN: 0820-5930Radiotherapy for cancer is an effective treatment but requires precise delivery. Patients are required to remain still in the same position during procedure which may be uncomfortable. This combined with high anxiety experienced by patients, and feelings of isolation, have indicated a need for comfort interventions. Care conveyed through empathetic touch promotes comfort, individual attention and presence and provides both psychological and physical comfort at the same time. Evidence in nursing and care literature showed that empathetic touch interventions have a significant role in promoting comfort, facilitating communication between care recipients and caregivers. However, the application of empathetic touch interventions may be challenging to administer due to the safety concern in the radiotherapy environment. The emergence of haptic technologies that enable the communication of touch remotely may have a potential to fill this gap. We take inspiration from both clinical empathetic touch in radiotherapy practice, as well as affective haptic technologies to envision the opportunities for haptic technologies as a complimentary comfort intervention to supplement human empathetic touch during radiotherapy.
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Journal articleJaggard MKJ, Boulange CL, Graca G, et al., 2020,
Can metabolic profiling provide a new description of osteoarthritis and enable a personalised medicine approach?
, CLINICAL RHEUMATOLOGY, Vol: 39, Pages: 3875-3882, ISSN: 0770-3198- Cite
- Citations: 8
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Journal articleYork T, Jenney H, Jones G, 2020,
Clinician and computer: a study on patient perceptions of artificial intelligence in skeletal radiography
, BMJ Health & Care Informatics, Vol: 27, ISSN: 2632-1009Background Up to half of all musculoskeletal injuries are investigated with plain radiographs. However, high rates of image interpretation error mean that novel solutions such as artificial intelligence (AI) are being explored.Objectives To determine patient confidence in clinician-led radiograph interpretation, the perception of AI-assisted interpretation and management, and to identify factors which might influence these views.Methods A novel questionnaire was distributed to patients attending fracture clinic in a large inner-city teaching hospital. Categorical and Likert scale questions were used to assess participant demographics, daily electronics use, pain score and perceptions towards AI used to assist in interpretation of their radiographs, and guide management.Results 216 questionnaires were included (M=126, F=90). Significantly higher confidence in clinician rather than AI-assisted interpretation was observed (clinician=9.20, SD=1.27 vs AI=7.06, SD=2.13), 95.4% reported favouring clinician over AI-performed interpretation in the event of disagreement.Small positive correlations were observed between younger age/educational achievement and confidence in AI-assistance. Students demonstrated similarly increased confidence (8.43, SD 1.80), and were over-represented in the minority who indicated a preference for AI-assessment over their clinicians (50%).Conclusions Participant’s held the clinician’s assessment in the highest regard and expressed a clear preference for it over the hypothetical AI assessment. However, robust confidence scores for the role of AI-assistance in interpreting skeletal imaging suggest patients view the technology favourably.Findings indicate that younger, more educated patients are potentially more comfortable with a role for AI-assistance however further research is needed to overcome the small number of responses on which these observations are based.
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Journal articleAhmad K, Bhattacharyya R, Gupte C, 2020,
Using Cognitive Task Analysis to train Orthopaedic Surgeons - Is it time to think differently? A systematic review.
, Ann Med Surg (Lond), Vol: 59, Pages: 131-137, ISSN: 2049-0801BACKGROUND: Working time restraints; senior led care; and a reduction in 'out of hours' operating has resulted in less operating time for orthopaedic trainees in the United Kingdom. Therefore, there has been an attempt to overcome these challenges by implementing novel techniques. Cognitive Task Analysis (CTA) focuses on the mental steps required to complete complex procedures. It has been used in training athletes and in general surgery but is new to orthopaedic training. AIM: To undertake a systematic review to analyse if CTA is beneficial to train novice surgeons in common orthopaedic and trauma procedures. MATERIALS AND METHODS: A systematic review was performed evaluating CTA in trauma and orthopaedic surgery on MEDLINE and EMBASE. Search terms used were: 'Cognitive task', 'mental rehearsal' and 'Orthop*'']. 33 studies were originally identified. Duplicate studies were excluded (11). Articles not relating to Orthopaedic surgery were excluded (15). The CTA research ranking scale was used to evaluate the impact of the studies included. RESULTS: 7 studies were identified as appropriate for inclusion. 264 participants. 178 M, 86F. All studies showed objective or subjective benefits from CTA in orthopaedic training when compared to traditional methods. The majority of the participants highlighted high subjective satisfaction with the use of the CTA tools and reported that they proved to be excellent adjuncts to the traditional apprenticeship model. CONCLUSION: CTA learning tools have demonstrated significant objective and subjective benefits in trauma and orthopaedic training. It is cost effective, easily accessible and allows repeated practice which is key in simulation training.
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Journal articleDeane JA, Papi E, Phillips A, et al., 2020,
Reliability and minimal detectable change of the ‘Imperial Spine’ marker set for the evaluation of spinal and lower limb kinematics in adults
, BMC Research Notes, Vol: 13, ISSN: 1756-0500ObjectivesAs a step towards the comprehensive evaluation of movement in patients with low back pain, the aim of this study is to design a marker set (three rigid segment spine, pelvic and lower limb model) and evaluate the reliability and minimal detectable change (MDC) of this marker set in healthy adults during gait and sit to stand (STS) tasks using three dimensional motion capture.ResultsThe ‘Imperial Spine’ marker set was used to assess relative peak angles during gait and STS tasks using the minimum recommended sample size (n = 10) for reliability studies with minimum Intraclass Correlation Coefficient (ICC) of 0.70, optimum ICC 0.90 and 9 trials replicated per subject per task. Intra- and inter-tester reliability between an experienced and inexperienced user was examined. ICC, mean, standard error (SEM), Bland Altman 95% limits of agreement (LOA) and MDC were computed.ICC values demonstrated excellent intra- and inter-tester reliability in both tasks, particularly in the sagittal plane (majority ICCs > 0.80). SEM measurements were lower in gait (0.8–5.5°) than STS tasks (1°-12.6°) as were MDC values. LOA demonstrated good agreement. The ‘Imperial Spine’ marker set is reliable for use in healthy adults during functional tasks. Future evaluation in patients is required.
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Journal articleRudran B, Little C, Wiik A, et al., 2020,
Tibial plateau fracture: anatomy, diagnosis and management
, BRITISH JOURNAL OF HOSPITAL MEDICINE, Vol: 81, ISSN: 1750-8460- Author Web Link
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- Citations: 16
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Journal articleWiik AV, Nathwani D, Akhtar A, et al., 2020,
The unicompartmental knee is the preferred side in individuals with both a unicompartmental and total knee arthroplasty
, Knee Surgery Sports Traumatology Arthroscopy, Vol: 28, Pages: 3193-3199, ISSN: 0942-2056PurposeTo determine the preferred knee in patients with both one total and one unicompartmental knee arthroplasty.MethodPatients simply with a unicompartmental (UKA) and total knee arthroplasty (TKA) on contralateral sides were retrospectively screened from three senior knee surgeon’s logs over a 15 year period. Patients safe and free from other diseases to affect gait were approached. A total of 16 patients (mean age 70 ± 8) agreed to ground reaction force testing on an instrumented treadmill at a fair pace and incline. A gender-ratio identical group of 16 healthy control subjects (mean age 67 ± 10) and 16 patients with ipsilateral medial knee OA (mean age 66 ± 7) were analysed to compare.ResultsRadiographically the mode preoperative Kellgren–Lawrence knee grade for each side was 3. Postoperatively, the TKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 89° with a mean posterior slope of 5° in the sagittal plane. The UKA side had a mean coronal femoral component alignment of 7° and a mean tibial coronal alignment of 86° with a mean posterior slope of 4° in the sagittal plane. In 7 patients, the TKA was the first procedure, while 6 for the UKA and 3 done simultaneously. Gait analysis demonstrated in both walking conditions the UKA limb was the preferred side through all phases of loading (p < 0.05) and nearer to normal than the TKA limb when compared to healthy controls and patients with knee OA. The greatest difference was observed between the transition of weight acceptance and midstance (p = 0.008), when 22% more load was taken by the UKA side.ConclusionBy using a dynamic metric of an everyday activity, a distinct gait difference between differing arthroplasty types were established. A more natural loading pattern can be achieved with unicompartmentals as compared to total knees.Level o
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Journal articleLiddle AD, 2020,
<i>CORR</i> Insights®: What Is the Survivorship After Hip Arthroscopy for Femoroacetabular Impingement? A Large-database Study
, CLINICAL ORTHOPAEDICS AND RELATED RESEARCH, Vol: 478, Pages: 2274-2276, ISSN: 0009-921X -
Journal articleTurner S, McGregor A, 2020,
Perceived impact of socket fit on major lower limb prosthetic rehabilitation: a clinician and amputee perspective
, Archives of Rehabilitation Research and Clinical Translation, Vol: 2, Pages: 1-8, ISSN: 2590-1095ObjectiveTo determine amputees’ and rehabilitation clinicians’ perspectives on the impact of socket fit and issues caused by ill-fitting sockets throughout lower limb prosthetic rehabilitation.DesignA survey was developed to identify rehabilitation factors and issues for prosthesis wearers and rehabilitation clinicians. Participants opted to participate in a further telephone interview.SettingOnline and across the United Kingdom.ParticipantsLower limb prosthetic wearers and clinicians that are part of a lower limb prosthetic rehabilitation team.InterventionsNot applicable.Main Outcome Measure(s)A survey and an interview to measure the perceived impact of socket fit on lower limb rehabilitation.Results48.0% of amputees and 65.7% of clinicians identified socket fit related issues as the biggest factor impacting rehabilitation. Amputee interviewees focused on the impact of fit on quality of life and the ability to complete daily tasks, whilst clinicians focused on the lack of widespread ability to adjust the socket and gait re-education.ConclusionsSocket fit has a large impact on and is a large source of frustration to amputees and their clinical teams throughout rehabilitation. From the interviews, it became clear that the interpretation of socket fit is different for each person; thus “socket fit” does not mean the same for all.
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