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  • Journal article
    Sabharwal S, Patel NK, Griffiths D, Athanasiou T, Gupte CM, Reilly Pet al., 2016,

    Trials based on specific fracture configuration and surgical procedures likely to be more relevant for decision making in the management of fractures of the proximal humerus

    , Bone & Joint Research, Vol: 5, Pages: 470-480, ISSN: 2046-3758

    Objectives The objective of this study was to perform a meta-analysis of all randomised controlled trials (RCTs) comparing surgical and non-surgical management of fractures of the proximal humerus, and to determine whether further analyses based on complexity of fracture, or the type of surgical intervention, produced disparate findings on patient outcomes.Methods A systematic review of the literature was performed identifying all RCTs that compared surgical and non-surgical management of fractures of the proximal humerus. Meta-analysis of clinical outcomes was performed where possible. Subgroup analysis based on the type of fracture, and a sensitivity analysis based on the type of surgical intervention, were also performed.Results Seven studies including 528 patients were included. The overall meta-analysis found that there was no difference in clinical outcomes. However, subgroup and sensitivity analyses found improved patient outcomes for more complex fractures managed surgically. Four-part fractures that underwent surgery had improved long-term health utility scores (mean difference, MD 95% CI 0.04 to 0.28; p = 0.007). They were also less likely to result in osteoarthritis, osteonecrosis and non/malunion (OR 7.38, 95% CI 1.97 to 27.60; p = 0.003). Another significant subgroup finding was that secondary surgery was more common for patients that underwent internal fixation compared with conservative management within the studies with predominantly three-part fractures (OR 0.15, 95% CI 0.04 to 0.63; p = 0.009).Conclusion This meta-analysis has demonstrated that differences in the type of fracture and surgical treatment result in outcomes that are distinct from those generated from analysis of all types of fracture and surgical treatments grouped together. This has important implications for clinical decision making and should highlight the need for future trials to adopt more specific inclusion criteria.
  • Journal article
    Lord BR, El-Daou H, Sabnis BM, Gupte CM, Wilson AJ, Amis AAet al., 2016,

    Erratum to: Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction (vol 25, pg 559, 2017)

    , Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 25, Pages: 988-988, ISSN: 0942-2056

    Purpose: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery.Methods: Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus.Results: Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout.Conclusion: Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the nativ
  • Journal article
    Aqil A, Wiik A, Zanotto M, Manning V, Masjedi M, Cobb JPet al., 2016,

    The Effect of Hip Arthroplasty on Osteoarthritic Gait: A Blinded, Prospective and Controlled Gait Study at Fast Walking Speeds

    , JOURNAL OF ARTHROPLASTY, Vol: 31, Pages: 2337-2341, ISSN: 0883-5403
  • Journal article
    Fanous R, Sabharwal S, Altaie A, Gupte CM, Reilly Pet al., 2016,

    Hip fracture litigation: A 10-year review of NHS Litigation Authority data and the effect of national guidelines.

    , Annals of the Royal College of Surgeons of England, ISSN: 1478-7083

    We present a review evaluating all litigation claims relating to hip fractures made in a 10-year period between 2005 and 2015. Data was obtained from the NHS Litigation Authority through a freedom of information request. All claims relating to hip fractures were reviewed. During the period analysed, 216 claims were made, of which 148 were successful (69%). The total cost of settling these claims was in excess of £5 million. The introduction of a best-practice tariff by the Department of Health in 2010 was designed to improve the quality of care for hip fracture patients. This was followed by guidance from the National Institute for Health and Clinical Excellence in 2011 and the British Orthopaedic Association in 2012. We analysed claims submitted before and after these guidelines were introduced and no significant difference in the number of claims was noted. The most common cause for litigation was a delay in diagnosis, which accounted for 86 claims in total (40%). Despite the presence of these guidelines and targets, there has not been a significant reduction in the number of claims or an improvement in diagnostic accuracy. This may be due to an increasing level of litigation in the UK but we must also question whether we are indeed providing best-practice care to our hip fracture patients and whether these guidelines need further review.
  • Journal article
    Lord BR, El-Daou H, Sabnis BM, Gupte CM, Wilson AM, Amis AAet al., 2016,

    Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction

    , Knee Surgery Sports Traumatology Arthroscopy, Vol: 25, Pages: 559-568, ISSN: 1433-7347

    PURPOSE: Double-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery. METHODS: Nine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus. RESULTS: Significant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout. CONCLUSION: Although 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remain
  • Journal article
    Deane JA, Mcgregor A, 2016,

    Current and Future Perspectives on Lumbar Degenerative Disc Disease: a UK survey exploring specialist multidisciplinary clinical opinion.

    , BMJ Open, Vol: 6, ISSN: 2044-6055

    Objectives: Despite lumbar degenerative disc disease (LDDD) being significantly associatedwith non-specific low back pain and effective treatment remaining elusive, specialistmultidisciplinary clinical stakeholder opinion remains unexplored. The present studyexamines the views of such experts.Design: A reliable and valid electronic survey was designed to establish trends usingtheoretical constructs relating to current assessment and management practices. Cliniciansfrom the Society of Back Pain Research (SBPR) U.K. were invited to take part. Quantitativedata was collated and coded using Bristol On-line Surveys (BOS) software, and contentanalysis used to systematically code and categorise qualitative data.Setting: Specialist multidisciplinary spinal interest group in the U.K.Participants: 38/141 clinically active, multidisciplinary SBPR members with specialistspinal interest participated. 84% had greater than 9 years postgraduate clinical experience.Interventions: NoneOutcome Measures: Frequency distributions were used to establish general trends inquantitative data. Qualitative responses were coded and categorised in relation to each themeand percentage responses calculated.Results: LDDD symptom recurrence, in the absence of psychosocial influence, wasassociated with physical signs of joint stiffness (26%), weakness (17%), joint hypermobility(6%), while physical factors (21%) and the ability to adapt (11%) were postulated as reasonswhy some experience pain and others do not. No one management strategy was supportedexclusively or with consensus. Regarding effective modalities, there was no significantdifference between AHP and Medic responses (p= 0.1-0.9). The future of LDDD care wasexpressed in terms of improvements in patient communication (35%), patient education(38%) and treatment stratification (24%).
  • Journal article
    Ma S, Boughton O, Karunaratne A, Jin A, Cobb JP, Hansen U, Abel RLet al., 2016,

    Synchrotron imaging assessment of bone quality

    , Clinical Reviews in Bone and Mineral Metabolism, Vol: 14, Pages: 150-160, ISSN: 1559-0119

    Bone is a complex hierarchical structure and its principal function is to resist mechanical forces and fracture. Bone strength depends not only on the quantity of bone tissue but also on the shape and hierarchical structure. The hierarchical levels are interrelated, especially the micro-architecture, collagen and mineral components; hence analysis of their specific roles in bone strength and stiffness is difficult. Synchrotron imaging technologies including micro-CT and small/wide angle X-Ray scattering/diffraction are becoming increasingly popular for studying bone because the images can resolve deformations in the micro-architecture and collagen-mineral matrix under in situ mechanical loading. Synchrotron cannot be directly applied in-vivo due to the high radiation dose but will allow researchers to carry out systematic multifaceted studies of bone ex-vivo. Identifying characteristics of aging and disease will underpin future efforts to generate novel devices and interventional therapies for assessing and promoting healthy aging. With our own research work as examples, this paper introduces how synchrotron imaging technology can be used with in-situ testing in bone research.
  • Book chapter
    McGregor AH, 2016,

    Sports innovation in the journey towards rowing gold: Enhancement of performance and well being

    , Sports Innovation Technology and Research, Pages: 31-38
  • Journal article
    Nahas S, Ieong E, Logishetty K, Mahapatra P, Nathwani Det al., 2016,

    The Use of Personalized Video Training for Orthopaedic Surgeons

    , MUSCULOSKELETAL CARE, Vol: 14, Pages: 180-184, ISSN: 1478-2189
  • Journal article
    Grice JE, Willmott H, Halewood C, MBiomedE M, Dunning M, Amis Aet al., 2016,

    A Biomechanical Comparison of First Metatarsophalangeal Arthrodesis Using Crossed Screws and Shape-Memory Staples in Various Configurations

    , Foot & Ankle Orthopaedics, Vol: 1, ISSN: 2473-0114

    <jats:sec><jats:title>Category:</jats:title><jats:p> Midfoot/Forefoot </jats:p></jats:sec><jats:sec><jats:title>Introduction/Purpose:</jats:title><jats:p> Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a commonly performed procedure for the treatment of hallux rigidus. A range of fixation methods have been used. Most recently, the shape-memory staple has been described. Made from an equiatomic alloy, the staple changes its shape when heated to body temperature so as to provide compression across the arthrodesis. We aimed to determine load to failure, cyclic loading and failure characteristics of different staple configurations compared to crossed screws. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> A cadaveric porcine model was used to simulate first MTPJ arthrodesis. Five forms of fixation were tested: single vertical staple; single horizontal staple; paired staples in orthogonal superior-inferior and medial-lateral configuration (0-90° to sagittal plane); paired staples in an oblique orthogonal configuration (45-135° to sagittal plane); two crossed screws. Using a materials-testing machine, specimens were loaded in dorsiflexion to simulate weight bearing. Cyclical loading was performed from 5-40N at a rate of 0.5 Hz for 1000 cycles. Plantar gapping, shear and creep were measured. Specimens were then loaded to failure in order to generate a load-displacement curve. The mechanism of failure was noted for each group. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Single staple configurations failed at very low loads. Single vertical staples failed at a mean load 15N±5N and single horizontal staples at 19N±3N. Mean failure load for paired 0-90° staples was 43N±9N which was significantly lower than the paired 45-135° staples which failed
  • Conference paper
    Bates AV, Mcgregor AH, Alexander C, 2016,

    Comparison of prolonged unconstrained standing behaviour in people with Joint Hypermobility Syndrome and people who have normal flexibility

    , ESMAC, Publisher: Elsevier, ISSN: 1879-2219
  • Journal article
    Buckeridge EM, Weinert-Aplin RA, Bull AM, McGregor AHet al., 2016,

    Influence of foot-stretcher height on rowing technique and performance

    , Sports Biomechanics, Vol: 15, ISSN: 1752-6116

    Strength, technique, and coordination are crucial to rowing performance, but external interventions such as foot-stretcher set-up can fine-tune technique and optimise power output. For the same resultant force, raising the height of foot-stretchers on a rowing ergometer theoretically alters the orientation of the resultant force vector in favour of the horizontal component. This study modified foot-stretcher heights and examined their instantaneous effect on foot forces and rowing technique. Ten male participants rowed at four foot-stretcher heights on an ergometer that measured handle force, stroke length, and vertical and horizontal foot forces. Rowers were instrumented with motion sensors to measure ankle, knee, hip, and lumbar–pelvic kinematics. Key resultant effects of increased foot-stretcher heights included progressive reductions in horizontal foot force, stroke length, and pelvis range of motion. Raising foot-stretcher height did not increase the horizontal component of foot force as previously speculated. The reduced ability to anteriorly rotate the pelvis at the front of the stroke may be a key obstacle in gaining benefits from raised foot-stretcher heights. This study shows that small changes in athlete set-up can influence ergometer rowing technique, and rowers must individually fine-tune their foot-stretcher height to optimise power transfer through the rowing stroke on an ergometer.
  • Conference paper
    Jin A, Cobb JP, Hansen U, Reinhard C, Vo N, Atwood R, Bhattacharya R, Li J, Abel Ret al., 2016,

    ARE THE CRACKS STARTING TO APPEAR IN BISPHOSPHONATE TREATMENT FOR OSTEOPOROSIS?

    , WCO-IOF-ESCEO World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases, Publisher: Springer Verlag (Germany), Pages: S490-S490, ISSN: 1433-2965
  • Conference paper
    Geraldes D, Hansen U, Jeffers J, Amis Aet al., 2016,

    Interference fit optimisation for small press-fitted pegs

    , International Society for Technology in Arthroplasty 2015, Publisher: BRITISH EDITORIAL SOCIETY OF BONE & JOINT SURGERY, Pages: 150-150, ISSN: 2049-4416
  • Journal article
    Coudrillier B, Campbell IC, Read AT, Geraldes DM, Vo NT, Feola A, Mulvihill J, Albon J, Abel RL, Ethier CRet al., 2016,

    Effects of Peripapillary Scleral Stiffening on the Deformation of the Lamina Cribrosa

    , INVESTIGATIVE OPHTHALMOLOGY & VISUAL SCIENCE, Vol: 57, Pages: 2666-2677, ISSN: 0146-0404
  • Journal article
    Gulati V, Simpson AI, Uzoigwe C, Jaggard M, Gibbons C, Gupte C, Williams Aet al., 2016,

    Surgical care practitioners in orthopaedics: a current concepts review.

    , Journal of the Royal Society of Medicine, ISSN: 1758-1095
  • Journal article
    Kittl C, El-Daou H, Athwal KK, Gupte CM, Weiler A, Williams A, Amis AAet al., 2016,

    The Role of the Anterolateral Structures and the ACL in Controlling Laxity of the Intact and ACL-Deficient Knee: Response.

    , American Journal of Sports Medicine, Vol: 44, Pages: NP15-NP18, ISSN: 1552-3365
  • Book chapter
    Halewood C, Amis AA, 2016,

    Physiology: Biomechanics

    , Surgery of the Meniscus, Pages: 35-45
  • Journal article
    Davda K, Smyth N, Cobb JP, Hart AJet al., 2016,

    2D measurements of cup orientation are less reliable than 3D measurements

    , ACTA ORTHOPAEDICA, Vol: 87, Pages: 314-317, ISSN: 1745-3674
  • Conference paper
    Symes DR, Najmudin Z, Cole JM, Wood JC, Lopes NC, Poder K, Abel P, Abel RL, Alatabi S, Kneip S, Mecseki K, Winkler M, Foster PS, Norris DP, Teboul L, Johnson S, Szoke-Kovacs Z, Sandholzer M, Botchway S, Gratton S, Hill MA, De Lazzari M, Thomson Jet al., 2016,

    High-resolution tomographic imaging using coherent hard x-rays from compact laser driven accelerators

    , Compact EUV & X-ray Light Sources 2016, Publisher: OSA Publishing

    Extremely bright coherent femtosecond x-ray pulses are generated in compact laserdriven electron accelerators. Micro-tomography obtained with the Gemini laser indicates the usefulness of these sources in research and clinical applications.

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