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Journal articlePatel A, Edwards T, Jones G, et al., 2023,
Metabolic equivalent of task (MET) scores avoid the ceiling effect observed with conventional patient reported outcome scores following knee arthroplasty
, Bone & Joint Open, Vol: 4, Pages: 129-137, ISSN: 2633-1462Aims : The metabolic equivalent of task (MET) score examines patient performance in relation toenergy expenditure before and after knee arthroplasty. This study assesses it’s use in a kneearthroplasty population in comparison with the widely used Oxford Knee Score (OKS) and EuroQol5d Index (EQ-5D) which are reported to be limited by ceiling effects.Method: One-hundred and sixteen patients with OKS, EQ-5D and MET scores before, and at least sixmonths following unilateral primary knee arthroplasty were identified from a database. Procedureswere performed by a single surgeon between 2014 & 2019 consecutively. Scores were analysed fornormality, skewness, kurtosis and the presence of ceiling/floor effects. Concurrent validity betweenthe MET score, OKS and EQ-5D was assessed using Spearman’s rank.Results: Post-operatively the OKS and EQ-5D demonstrated negative skews in distribution, with highkurtosis at six months and one year. The OKS demonstrated a ceiling effect at one year (15.7%) postoperatively. The EQ-5D demonstrated a ceiling effect at six months (30.2%) and one year (39.8%)post-operatively. The MET score did not demonstrate a skewed distribution or ceiling effect either atsix months or one year post-operatively. Weak-moderate correlations were noted between the METscore and conventional scores at six-months and one-year post-operatively.Conclusion: In contrast to the OKS and EQ-5D, the MET score was normally distributed postoperatively with no ceiling effect. It is worth consideration as an arthroplasty outcome measure,particularly for patients with high expectations.
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Journal articleGarner AJ, Dandridge OW, van Arkel RJ, et al., 2023,
The compartmental approach to revision of partial knee arthroplasty results in nearer-normal gait and improved patient reported outcomes compared to total knee arthroplasty
, Knee Surgery Sports Traumatology Arthroscopy, Vol: 31, Pages: 1143-1152, ISSN: 0942-2056PURPOSE: This study investigated the gait and patient reported outcome measures of subjects converted from a partial knee arthroplasty to combined partial knee arthroplasty, using a compartmental approach. Healthy subjects and primary total knee arthroplasty patients were used as control groups. METHODS: Twenty-three patients converted from partial to combined partial knee arthroplasty were measured on the instrumented treadmill at top walking speeds, using standard gait metrics. Data were compared to healthy controls (n = 22) and primary posterior cruciate-retaining total knee arthroplasty subjects (n = 23) where surgery were performed for one or two-compartment osteoarthritis. Groups were matched for age, sex and body mass index. At the time of gait analysis, combined partial knee arthroplasty subjects were median 17 months post-revision surgery (range 4-81 months) while the total knee arthroplasty group was median 16 months post-surgery (range 6-150 months). Oxford Knee Scores and EuroQol-5D 5L scores were recorded at the time of treadmill assessment, and results analysed by question and domain. RESULTS: Subjects revised from partial to combined partial knee arthroplasty walked 16% faster than total knee arthroplasty (mean top walking speed 6.4 ± 0.8 km/h, vs. 5.5 ± 0.7 km/h p = 0.003), demonstrating nearer-normal weight-acceptance rate (p < 0.001), maximum weight-acceptance force (p < 0.006), mid-stance force (p < 0.03), contact time (p < 0.02), double support time (p < 0.009), step length (p = 0.003) and stride length (p = 0.051) compared to primary total knee arthroplasty. Combined partial knee arthroplasty subjects had a median Oxford Knee Score of 43 (interquartile range 39-47) vs. 38 (interquartile range 32-41, p < 0.
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Journal articleGarner AJ, Dandridge OW, van Arkel RJ, et al., 2023,
Medial bicompartmental arthroplasty patients display more normal gait and improved satisfaction, compared to matched total knee arthroplasty patients
, Knee Surgery, Sports Traumatology, Arthroscopy, Vol: 31, Pages: 830-838, ISSN: 0942-2056PurposeMedial bicompartmental arthroplasty, the combination of ipsilateral medial unicompartmental and patellofemoral arthroplasty, is an alternative to total knee arthroplasty for patients with medial tibiofemoral and severe patellofemoral arthritis, when the lateral tibiofemoral compartment and anterior cruciate ligament are intact. This study reports the gait and subjective outcomes following medial bicompartmental arthroplasty.MethodsFifty-five subjects were measured on the instrumented treadmill at top walking speeds, using standard metrics of gait. Modular, single-stage, medial bicompartmental arthroplasty subjects (n = 16) were compared to age, body mass index, height- and sex-matched healthy (n = 19) and total knee arthroplasty (n = 20) subjects. Total knee arthroplasty subjects with pre-operative evidence of tricompartmental osteoarthritis or anterior cruciate ligament dysfunction were excluded. The vertical component of ground reaction force and temporospatial measurements were compared using Kruskal–Wallis, then Mann–Whitney test with Bonferroni correction (α = 0.05). Oxford Knee and EuroQoL EQ-5D scores were compared.ResultsObjectively, the medial bicompartmental arthroplasty top walking speed of 6.7 ± 0.8 km/h was 0.5 km/h (7%) slower than that of healthy controls (p = 0.2), but 1.3 km/h (24%) faster than that of total knee arthroplasty subjects (5.4 ± 0.6 km/h, p < 0.001). Medial bicompartmental arthroplasty recorded more normal maximum weight acceptance (p < 0.001) and mid-stance forces (p = 0.03) than total knee arthroplasty subjects, with 11 cm (15%) longer steps (p < 0.001) and 21 cm (14%) longer strides (p = 0.006). Subjectively, medial bicompartmental arthroplasty subjects reported Oxford Knee Scores of median 41 (interquartile range 38.8&nd
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Journal articleHohenschurz-Schmidt D, Draper-Rodi DJ, Vase PL, et al., 2023,
Blinding and sham control methods in trials of physical, psychological, and self-management interventions for pain (article II): a meta-analysis relating methods to trial results
, Pain, Vol: 164, Pages: 509-533, ISSN: 0304-3959Sham interventions in randomised clinical trials (RCTs) of physical, psychological, and self-management (PPS) therapies for pain are highly variable in design and thought to contribute to poor internal validity. It has, however, not been formally tested whether the extent to which sham controls resemble the treatment under investigation consistently affects trial outcomes, such as effect sizes, differential attrition, participant expectancy, and blinding effectiveness.Placebo or sham-controlled RCTs of PPS interventions of clinical pain populations were searched in twelve databases. The similarity of control interventions to the experimental treatment was rated across 25 features. Meta-regression analyses assessed putative links between employed control interventions, observed effect sizes in pain-related outcomes, attrition, and blinding success.The sample included 198 unique control interventions, dominated by manual therapy and chronic musculoskeletal pain research. Meta-analyses indicated small to moderate benefit of active treatments over control interventions, across subgroups of manual therapies, exercise, and rehabilitation, and psychological intervention trials. Multiple meta-regression modelling demonstrated that similarity between sham control and tested interventions predicted variability in pain-related outcomes, attrition, and blinding effectiveness. Influential were differences relating to the extent of intervention exposure, participant experience, and treatment environments.The results support the supposed link between blinding methods and effect sizes, based on a large and systematically sourced overview of methods. Challenges to effective blinding are, however, complex, and often difficult to discern from trial reports. Nonetheless, these insights have the potential to change trial design, conduct, and reporting and will inform guideline development.
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Journal articleClarke SG, Logishetty K, Halewood C, et al., 2023,
Low dose CT-based spatial analysis (CTSA) to measure implant migration after ceramic hip resurfacing arthroplasty (HRA): a phantom study
, Proceedings of the Institution of Mechanical Engineers Part H: Journal of Engineering in Medicine, Vol: 237, Pages: 359-367, ISSN: 0954-4119Implant migration is a predictor of arthroplasty survivorship. It is crucial to monitor the migration of novel hip prostheses within premarket clinical investigations. RSA is the gold standard method, but requires calibrated radiographs using specialised equipment. A commercial computed tomography micromotion analysis solution is a promising alternative but is not yet available for use with monobloc ceramic implants. This study aimed to develop and validate a CT-based spatial analysis (CTSA) method for use with ceramic implants. A phantom study was undertaken to assess accuracy and precision. A ceramic hip resurfacing arthroplasty (HRA) and 20 tantalum beads were implanted into a synthetic hip model and mounted onto a 6-degree of freedom motion stage. The hip was repeatedly scanned with a low dose CT protocol, with imposed micromovements. Data were interrogated using a semiautomated technique. The effective radiation dose for each scan was estimated to be 0.25 mSv. For the head implant, precision ranged between 0.11 and 0.28 mm for translations and 0.34°-0.42° for rotations. For the cup implant, precision ranged between 0.08 and 0.11 mm and 0.19° and 0.42°. For the head, accuracy ranged between 0.04 and 0.18 mm for translations and 0.28°-0.46° for rotations. For the cup, accuracy ranged between 0.04 and 0.08 mm and 0.17° and 0.43°. This in vitro study demonstrates that low dose CTSA of a ceramic HRA is similar in accuracy to RSA. CT is ubiquitous, and this method may be an alternative to RSA to measure prosthesis migration.
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Journal articleClunie G, Belsi A, Roe J, et al., 2023,
“Is there something wrong with your voice?” A qualitative study of the voice concerns of people with laryngotracheal stenosis
, International Journal of Language and Communication Disorders, Vol: 58, Pages: 376-389, ISSN: 1368-2822BackgroundAcquired laryngotracheal stenosis (LTS) is a rare condition that causes breathlessness and dyspnoea. Patients have reconstructive airway surgery to improve their breathing difficulties, but both LTS and the surgery can cause voice difficulties. The existing evidence base for management of the voice difficulties for adults with LTS focuses on symptoms. There is limited information to provide clinical guidance for speech and language therapists (SLTs), and limited understanding of the impact of voice changes on adults with LTS. AimTo investigate the lived experience of adults with laryngotracheal stenosis (LTS), who have had reconstructive surgery; here focussing on voice concerns with the aim of guiding clinical care for SLTs.Methods & ProceduresA phenomenological, qualitative study design was used. Focus groups and semi-structured interviews were completed with adults living with LTS who had had reconstructive surgery. Audio-recordings were transcribed and inductive thematic analysis was used by the research team to identify themes and sub-themes. Outcomes & ResultsA total of 24 participants (5 focus groups and 2 interviews) took part in the study before thematic saturation was identified in analysis. Three main themes were identified specific to the experience of living with LTS: the Medical, Physical and Emotional journey. All participants referenced voice difficulties as they related to each of these overall themes. Sub-themes directly related to voice included: experience of surgery, information provision, staff expertise/complacency, symptoms, symptom management, identity, support networks, impact on life and living with a chronic condition. Conclusions & ImplicationsIn this qualitative study participants have described the integral part voice difficulties play in their lived experience of LTS and reconstructive surgery. This is considered in the context of their clinical care and the need for individualised management and information prov
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Journal articleDing Z, Henson D, Sivapuratharasu B, et al., 2023,
The effect of muscle atrophy in people with unilateral transtibial amputation for three activities: gait alone does not tell the whole story
, Journal of Biomechanics, Vol: 149, Pages: 1-10, ISSN: 0021-9290Amputation imposes significant challenges in locomotion to millions of people with limb loss worldwide. The decline in the use of the residual limb results in muscle atrophy that affects musculoskeletal dynamics in daily activities. The aim of this study was to quantify the lower limb muscle volume discrepancy based on magnetic resonance (MR) imaging and to combine this with motion analysis and musculoskeletal modelling to quantify the effects in the dynamics of key activities of daily living. Eight male participants with traumatic unilateral transtibial amputation were recruited who were at least six months after receiving their definitive prostheses. The muscle volume discrepancies were found to be largest at the knee extensors (35 %, p = 0.008), followed by the hip abductors (17 %, p = 0.008). Daily activities (level walking, standing up from a chair and ascending one step) were measured in a motion analysis laboratory and muscle and joint forces quantified using a detailed musculoskeletal model for people with unilateral transtibial amputation which was calibrated in terms of the muscle volume discrepancies post-amputation at a subject-specific level. Knee extensor muscle forces were lower at the residual limb than the intact limb for all activities (p ≤ 0.008); residual limb muscle forces of the hip abductors (p ≤ 0.031) and adductors (p ≤ 0.031) were lower for standing-up and ascending one step. While the reduced knee extensor force has been reported by other studies, our results suggest a new biomechanically-based mitigation strategy to improve functional mobility, which could be achieved through strengthening of the hip abd/adductor muscles.
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Journal articleMahmoud K, Alagha MA, Nowinka Z, et al., 2023,
Predicting total knee replacement at 2 and 5 years in osteoarthritis patients using machine learning
, BMJ Surgery, Interventions, & Health Technologies, Vol: 5, Pages: 1-9, ISSN: 2631-4940Objectives Knee osteoarthritis is a major cause of physical disability and reduced quality of life, with end-stage disease often treated by total knee replacement (TKR). We set out to develop and externally validate a machine learning model capable of predicting the need for a TKR in 2 and 5 years time using routinely collected health data.Design A prospective study using datasets Osteoarthritis Initiative (OAI) and the Multicentre Osteoarthritis Study (MOST). OAI data were used to train the models while MOST data formed the external test set. The data were preprocessed using feature selection to curate 45 candidate features including demographics, medical history, imaging assessments, history of intervention and outcome.Setting The study was conducted using two multicentre USA-based datasets of participants with or at high risk of knee OA.Participants The study excluded participants with at least one existing TKR. OAI dataset included participants aged 45–79 years of which 3234 were used for training and 809 for internal testing, while MOST involved participants aged 50–79 and 2248 were used for external testing.Main outcome measures The primary outcome of this study was prediction of TKR onset at 2 and 5 years. Performance was evaluated using area under the curve (AUC) and F1-score and key predictors identified.Results For the best performing model (gradient boosting machine), the AUC at 2 years was 0.913 (95% CI 0.876 to 0.951), and at 5 years 0.873 (95% CI 0.839 to 0.907). Radiographic-derived features, questionnaire-based assessments alongside the patient’s educational attainment were key predictors for these models.Conclusions Our approach suggests that routinely collected patient data are sufficient to drive a predictive model with a clinically acceptable level of accuracy (AUC>0.7) and is the first such tool to be externally validated. This level of accuracy is higher than previously published models utilising MRI data, whi
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Journal articleBonicelli A, Tay T, Cobb JP, et al., 2023,
Association between nanoscale strains and tissue level nanoindentation properties in age-related hip-fractures
, Journal of the Mechanical Behavior of Biomedical Materials, Vol: 138, ISSN: 1751-6161Measurement of the properties of bone as a material can happen in various length scales in its hierarchical and composite structure. The aim of this study was to test the tissue level properties of clinically-relevant human bone samples which were collected from donors belonging to three groups: ageing donors who suffered no fractures (Control); untreated fracture patients (Fx-Untreated) and patient who experienced hip fracture despite being treated with bisphosphonates (Fx-BisTreated). Tissue level properties were assessed by (a) nanoindentation and (b) synchrotron tensile tests (STT) where strains were measured at the ‘tissue’, ‘fibril’ and ‘mineral’ levels by using simultaneous Wide-angle - (WAXD) and Small angle- X-ray diffraction (SAXD). The composition was analysed by thermogravimetric analysis and material level endo- and exo-thermic reactions by differential scanning calorimetry (TGA/DSC3+). Irrespective of treatment fracture donors exhibited significantly lower tissue, fibril and mineral strain at the micro and nanoscale respectively and had a higher mineral content than controls. In nanoindentation only nanohardness was significantly greater for Controls and Fx-BisTreated versus Fx-Untreated. The other nanoindentation parameters did not vary significantly across the three groups. There was a highly significant positive correlation (p < 0.001) between organic content and tissue level strain behaviour. Overall hip-fractures were associated with lower STT nanostrains and it was behaviour measured by STT which proved to be a more effective approach for predicting fracture risk because evidently it was able to demonstrate the mechanical deficit for the bone tissue of the donors who had experienced fractures.
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Journal articleStanley A, Edwards T, Jaere M, et al., 2023,
An automated, web-based triage tool may optimise referral pathways in elective orthopaedic surgery: a proof-of-concept study
, Digital Health, Vol: 9, Pages: 1-9, ISSN: 2055-2076IntroductionKnee pain is caused by various pathologies, making evaluation in primary-care challenging. Subsequently, an over-reliance on imaging, such as radiographs and MRI exists. Electronic-triage tools represent an innovative solution to this problem. The aims of this study were to establish the magnitude of unnecessary knee imaging prior to orthopaedic surgeon referral, and ascertain whether an e-triage tool outperforms existing clinical pathways to recommend correct imaging.MethodsPatients ≥18 years presenting with knee pain treated with arthroscopy or arthroplasty at a single academic hospital between 2015 and 2020 were retrospectively identified. The timing and appropriateness of imaging were assessed according to national guidelines, and classified as ‘necessary’, ‘unnecessary’ or ‘required MRI’. Based on an eDelphi consensus study, a symptom-based e-triage tool was developed and piloted to preliminarily diagnose five common knee pathologies and suggest appropriate imaging.Results1462 patients were identified. 17.2% (n = 132) of arthroplasty patients received an ‘unnecessary MRI’, 27.6% (n = 192) of arthroscopy patients did not have a ‘necessary MRI’, requiring follow-up. Forty-one patients trialled the e-triage pilot (mean age: 58.4 years, 58.5% female). Preliminary diagnoses were available for 33 patients. The e-triage tool correctly identified three of the four knee pathologies (one pathology did not present). 79.2% (n = 19) of participants would use the tool again.ConclusionA substantial number of knee pain patients receive incorrect imaging, incurring delays and unnecessary costs. A symptom-based e-triage tool was developed, with promising performance and user feedback. With refinement using larger datasets, this tool has the potential to improve wait-times, referral quality and reduce cost.
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Journal articleYork T, Raj S, Ashdown T, et al., 2023,
Clinician and computer: a study on doctors’ perceptions of artificial intelligence in skeletal radiography
, BMC Medical Education, Vol: 23, Pages: 1-10, ISSN: 1472-6920BackgroundTraumatic musculoskeletal injuries are a common presentation to emergency care, the first-line investigation often being plain radiography. The interpretation of this imaging frequently falls to less experienced clinicians despite well-established challenges in reporting. This study presents novel data of clinicians’ confidence in interpreting trauma radiographs, their perception of AI in healthcare, and their support for the development of systems applied to skeletal radiography.MethodsA novel questionnaire was distributed through a network of collaborators to clinicians across the Southeast of England. Over a three-month period, responses were compiled into a database before undergoing statistical review.ResultsThe responses of 297 participants were included. The mean self-assessed knowledge of AI in healthcare was 3.68 out of ten, with significantly higher knowledge reported by the most senior doctors (Specialty Trainee/Specialty Registrar or above = 4.88). 13.8% of participants reported an awareness of AI in their clinical practice.Overall, participants indicated substantial favourability towards AI in healthcare (7.87) and in AI applied to skeletal radiography (7.75). There was a preference for a hypothetical system indicating positive findings rather than ruling as negative (7.26 vs 6.20).ConclusionsThis study identifies clear support, amongst a cross section of student and qualified doctors, for both the general use of AI technology in healthcare and in its application to skeletal radiography for trauma. The development of systems to address this demand appear well founded and popular. The engagement of a small but reticent minority should be sought, along with improving the wider education of doctors on AI.
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Book chapterHopkins M, McMenemy L, Turner S, et al., 2023,
Sockets and Residuum Health
, Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 447-478Major limb amputation affects millions of people worldwide and became a common procedure in the latter years of the conflicts in Afghanistan and Iraq. Prosthetic devices are commonly introduced to lower-limb amputees to assist with mobility and functionality. Despite vast leaps in the technology of lower-limb prostheses, acceptance of a prosthesis is limited by the quality of interfacing between the residuum and the device. No single design fits all, and production of a socket is a complex task, requiring significant skill and expertise from the prosthetist. The fit and pressure distribution of the socket can significantly impact the health of the soft tissue, leading to conditions such as pressure sores if not properly managed. The residuum-socket interface is further complicated by natural volume fluctuations of the limb, issues with thermoregulation, infections and musculoskeletal pathologies. Researchers, clinicians and industry have attempted to better understand and inform optimal socket fit through computational and hardware methods, and surgical techniques such as direct skeletal fixation have been proposed to bypass the socket altogether. This chapter explores the nature of the prosthetic socket, common issues users present and methods to improve the interface between the residual limb and the prosthesis.
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Book chapterMcGregor AH, 2023,
Section Overview
, Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second EditionThis section builds on the journey of blast injury and the success of work to prevent and mitigate injury and the success of our clinical management of blast injuries. This short overview describes some of the factors that are discussed in the following chapters relating to long-term quality of life for survivors of blast injuries.
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Book chapterAnderson KM, McGregor AH, Masouros SD, et al., 2023,
Orthotics
, Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 437-446Continued advances are required to address mobility limitations caused by lower extremity blast injury. Individuals who experience persistent deficits following trauma may benefit from external support and/or offloading provided by ankle foot orthoses (AFOs). Currently available AFOs vary widely in their design and potential benefit. Carbon fibre custom dynamic ankle foot orthoses (CDOs) have been increasingly used to improve mobility after traumatic injury. CDOs are made predominantly from carbon fibre and are intended to restore function across a range of daily and high-energy activities. Patient-reported outcomes, physical performance measures, and biomechanics data from studies focusing on CDO use have demonstrated positive outcomes. CDOs consist of a proximal cuff, posterior carbon fibre strut, and footplate, which can be tuned to meet the needs of the patient. Available literature provides guidance related to key design considerations during the fitting process. Further, intensive training when combined with the CDO has been found to enhance clinical outcomes and facilitate successful return to high-energy activity. A majority of available data related to CDO use following limb trauma is focused on a subset of military personnel, and available civilian data is limited.
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Book chapterSilverman AK, Hendershot BD, McGregor AH, 2023,
Musculoskeletal Health After Blast Injury
, Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 489-497Rehabilitation after blast injury is critical for regaining mobility and functional independence. In addition to immediate rehabilitation goals to facilitate activities of daily living, rehabilitation should address movement patterns and prosthetic interventions that mitigate long-term secondary (musculoskeletal) conditions. For example, after limb loss, which is a common result of blast trauma, people experience disproportionately high rates of osteoarthritis and low back pain relative to the general population. These conditions often develop and/or deteriorate over time and can have detrimental effects on mobility and quality of life. In this chapter, we describe and summarise existing knowledge of these musculoskeletal conditions secondary to blast injuries that include limb loss. Relationships between movement strategies and biomechanical outcomes are also discussed. While many musculoskeletal health conditions are multifactorial in onset and progression, these conditions are strongly related to movement biomechanics, and thus can be mitigated through rehabilitation approaches. Specifically, rehabilitation strategies that balance immediate goals of clinical outcomes and community engagement with long-term goals of healthy joint mechanics are critical for this population. In addition, rehabilitation and prosthetic interventions should be continually monitored and delivered so that they appropriately account for movement adaptations and changing mobility needs of the individual.
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Book chapterKaufmann JJ, McMenemy L, Phillips ATM, et al., 2023,
Bone Health in Lower-Limb Amputees
, Blast Injury Science and Engineering A Guide for Clinicians and Researchers Second Edition, Pages: 479-488Bone mineral density (BMD) loss in lower-limb amputees has in the past been referred to as either osteopenia or osteoporosis. However, evidence and hypotheses in emerging literature are beginning to challenge this, suggesting that the use of these terms could be inappropriate due to key differences in the aetiology and mechanisms underpinning the bone loss in the younger amputee population. Computational and clinical analysis carried out within the Centre for Blast Injury Studies at Imperial College London and the ADVANCE Study has provided strong evidence to support this stance. Investigating BMD discordance in the spine and femur of 153 lower-limb amputees and a frequency-matched control population has shown that bone loss in amputees is localised to the amputated limb rather than systemic (as it manifests in age-related osteoporosis). Combined musculoskeletal and finite element modelling goes some way to explaining the cause of this. Weight bearing through a prosthetic socket offloads the distal femur, and consequently large areas of the femoral shaft and neck experience significantly reduced levels of stimulation when compared to weight bearing on a healthy limb. The long-term result of this is a phenomenon that we refer to as unloading osteopenia.
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Journal articleBarrie A, Kent B, Supra Man Collaborative, 2023,
Supracondylar elbow fracture management (Supra Man) : a national trainee collaborative evaluation of practice.
, Bone Joint J, Vol: 105-B, Pages: 82-87AIMS: Management of displaced paediatric supracondylar elbow fractures remains widely debated and actual practice is unclear. This national trainee collaboration aimed to evaluate surgical and postoperative management of these injuries across the UK. METHODS: This study was led by the South West Orthopaedic Research Division (SWORD) and performed by the Supra Man Collaborative. Displaced paediatric supracondylar elbow fractures undergoing surgery between 1 January 2019 and 31 December 2019 were retrospectively identified and their anonymized data were collected via Research Electronic Data Capture (REDCap). RESULTS: A total of 972 patients were identified across 41 hospitals. Mean age at injury was 6.3 years (1 to 15), 504 were male (52%), 583 involved the left side (60%), and 538 were Gartland type 3 fractures (55%). Median time from injury to theatre was 16 hours (interquartile range (IQR) 6.6 to 22), 300 patients (31%) underwent surgery on the day of injury, and 91 (9%) underwent surgery between 10:00 pm and 8:00 am. Overall, 910 patients (94%) had Kirschner (K)-wire) fixation and these were left percutaneous in 869 (95%), while 62 patients (6%) had manipulation under anaesthetic (MUA) and casting. Crossed K-wire configuration was used as fixation in 544 cases (59.5%). Overall, 208 of the fixation cases (61%) performed or supervised by a paediatric orthopaedic consultant underwent lateral-only fixation, whereas 153 (27%) of the fixation cases performed or supervised by a non-paediatric orthopaedic consultant used lateral-only fixation. In total, 129 percutaneous wires (16%) were removed in theatre. Of the 341 percutaneous wire fixations performed or supervised by a paediatric orthopaedic consultant, 11 (3%) underwent wire removal in theatre, whereas 118 (22%) of the 528 percutaneous wire fixation cases performed or supervised by a non-paediatric orthopaedic consultant underwent wire removal in theatre. Four MUA patients (6%) and seven K-wire fixation patients (0.
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Journal articleNewington L, Alexander C, Kirby P, et al., 2022,
Reflections on contributing to health research: A qualitative interview study with research participants and patient advisors
, PLoS One, Vol: 17, ISSN: 1932-6203Objectives:The aims of this study were to explore individuals’ experiences of contributing to health research and to identify the types of impact that are perceived as important by participants or patient and public advisors. Specifically, research led by NMAHPP clinicians (Nursing, Midwifery, Allied health professions, Healthcare science, Psychology and Pharmacy).Methods:Semi-structured one-to-one interviews were conducted with health research participants and patient or public advisors. Interviewees were recruited from five UK sites and via social media. Interview transcripts were analysed using Thematic Analysis to identify key themes and areas of disagreement.Results:Twenty-one interviews were completed, and four main themes were identified. The first, optimising research experiences, included personal reflections and broader recommendations to improve participant experiences. The second, connecting health research with healthcare, described research as key for the continued development of healthcare, but illustrated that communication between research teams, participants, and clinicians could be improved. The third theme explored the personal impacts of contributing to research, with interviewees recalling common positive experiences. The final theme discussed capturing research impacts. Interviewees highlighted potential priorities for different stakeholders, but emphasised that financial impacts should not be the sole factor.Conclusion:Individuals who were involved in NMAHPP health research recalled positive experiences and reported good relationships with their research teams. They felt that their contributions were valued. Suggested strategies to optimise the research experience focused on simplifying documentation, clear signposting of the research activities involved, and feedback on the research findings. Routine sharing of relevant research data with clinicians was also recommended. Personal impacts included a deeper understanding of their health
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Journal articleBottle A, Liddle A, 2022,
Hip fracture in the COVID-19 era: what can we say about care and patient outcomes?
, BMJ Quality & Safety, Vol: 32, Pages: 244-246, ISSN: 2044-5423 -
Journal articleBehforootan S, Thorniley M, Minonzio J-G, et al., 2022,
Can guided wave ultrasound predict bone mechanical properties at the femoral neck in patients undergoing hip arthroplasty?
, Journal of the Mechanical Behavior of Biomedical Materials, Vol: 136, ISSN: 1751-6161The bone quality of patients undergoing hip replacement surgery is poorly predicted by radiographs alone. With better bone quality information available to a surgeon, the operation can be performed more safely. The aim of this study was to investigate whether ultrasound signals of cortical bone at peripheral sites such as the tibia and radius can be used to predict the compressive mechanical properties of cortical bone at the femoral neck.We recruited 19 patients undergoing elective hip arthroplasty and assessed the radius and tibia of these patients with the Azalée guided wave ultrasound to estimate the porosity and thickness of the cortex. Excess bone tissues were collected from the femoral neck and the compressive mechanical properties of the cortex were characterised under a mechanical loading rig to determine stiffness, ultimate strength, and density. The correlations between the ultrasound measurements and mechanical properties were analysed using linear regression, Pearson correlation statistics, and multiple regression analysis.Cortical mechanical properties were weakly to moderately correlated with the ultrasound measurements at various sites (R2 = 0.00–0.36). The significant correlations found were not consistent across all 4 peripheral measurement sites. Additionally, weak to moderate ability of the ultrasound to predict mechanical properties at the neck of femur with multiple regression analysis was found (R2 = 0.00–0.48). Again, this was inconsistent across the different anatomical sites. Overall, the results demonstrate the need for ultrasound scans to be collected directly from clinically relevant sites such as the femoral neck due to the inconsistency of mechanical properties across various sites.
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