1
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Cowie RM, Macri-Pellizzeri L, McLaren J, Sanderson WJ, Felfel RM, Scotchford CA, Scammell BE, Grant DM, Sottile V, Jennings LM. Functional performance of a bi-layered chitosan-nano-hydroxyapatite osteochondral scaffold: a pre-clinical in vitro tribological study. R Soc Open Sci 2024; 11:230431. [PMID: 38204795 PMCID: PMC10776221 DOI: 10.1098/rsos.230431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
Osteochondral grafts are used for repair of focal osteochondral lesions. Autologous grafts are the gold standard treatment; however, limited graft availability and donor site morbidity restrict use. Therefore, there is a clinical need for different graft sources/materials which replicate natural cartilage function. Chitosan has been proposed for this application. The aim of this study was to assess the biomechanics and biotribology of a bioresorbable chitosan/chitosan-nano-hydroxyapatite osteochondral construct (OCC), implanted in an in vitro porcine knee experimental simulation model. The OCC implanted in different surgical positions (flush, proud and inverted) was compared to predicate grafts in current clinical use and a positive control consisting of a stainless steel graft implanted proud of the cartilage surface. After 3 h (10 800 cycles) wear simulation under a walking gait, subsidence occurred in all OCC samples irrespective of surgical positioning, but with no apparent loss of material and low meniscus wear. Half the predicate grafts exhibited delamination and scratching of the cartilage surfaces. No graft subsidence occurred in the positive controls but wear and deformation of the meniscus were apparent. Implanting a new chitosan-based OCC either optimally (flush), inverted or proud of the cartilage surface resulted in minimal wear, damage and deformation of the meniscus.
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Affiliation(s)
- Raelene M. Cowie
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Laura Macri-Pellizzeri
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jane McLaren
- Academic Unit Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Reda M. Felfel
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
- Department of Mechanical and Aerospace Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, UK
- Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Colin A. Scotchford
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Brigitte E. Scammell
- Academic Unit Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | - David M. Grant
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Virginie Sottile
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Louise M. Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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2
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Zedan Y, Knaggs R, Cooper D, Kurien T, Walsh DA, Auer DP, Scammell BE. Is there a difference in the analgesic response to intra-articular bupivacaine injection in people with knee osteoarthritis pain with or without central sensitisation? Protocol of a feasibility randomised controlled trial. BMJ Open 2023; 13:e072138. [PMID: 37433734 DOI: 10.1136/bmjopen-2023-072138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
INTRODUCTION Pain is the main symptom of osteoarthritis (OA) with approximately 50% of patients reporting moderate-to-severe pain. Total knee replacement (TKR) is the ultimate treatment option to alleviate pain in knee OA. Nevertheless, TKR does not provide complete relief for all as approximately 20% of patients experience chronic postoperative pain. Painful peripheral stimuli may alter the central nociceptive pathways leading to central sensitisation that can influence treatment response in patients with OA. Currently, there is no objective protocol for detecting whether a patient will respond to a given treatment. Therefore, there is a need for a better mechanistic understanding of individual factors affecting pain relief, consequently informing personalised treatment guidelines. The purpose of this research is to examine the feasibility of conducting a full-scale mechanistic clinical trial in painful knee OA investigating the analgesic response to intra-articular bupivacaine between those with or without evidence of central sensitisation. METHODS AND ANALYSIS The Understanding Pain mechanisms in KNEE osteoarthritis (UP-KNEE) study is a feasibility, double-blinded, placebo-controlled randomised parallel study in participants with radiographically defined knee OA and with self-reported chronic knee pain. The study involves the following assessments: (1) a suite of psychometric questionnaires; (2) quantitative sensory testing; (3) magnetic resonance imaging (MRI) scan of the knee and brain; (4) a 6-minute walk test; and (5) an intra-articular injection of bupivacaine or placebo (sodium chloride 0.9%) into the index knee. Assessments will be repeated post intra-articular injection apart from the MRI scan of the knee. Our aim is to provide proof of concept and descriptive statistics to power a future mechanistic trial. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority (HRA) (REC: 20/EM/0287). Results will be disseminated via peer-reviewed journals and scientific conferences. The results will also be shared with lay audiences through relevant channels, such as Pain Centre Versus Arthritis website and patient advocacy groups. TRIAL REGISTRATION NUMBER NCT05561010.
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Affiliation(s)
- Yasmine Zedan
- Radiological Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, School of Medicine, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Roger Knaggs
- Clinical Pharmacy Practice, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Dale Cooper
- School of Allied Health Professions, Keele University, Keele, UK
| | - Thomas Kurien
- Pain Centre Versus Arthritis, School of Medicine, University of Nottingham, Nottingham, UK
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - David Andrew Walsh
- Pain Centre Versus Arthritis, School of Medicine, University of Nottingham, Nottingham, UK
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Dorothee P Auer
- Radiological Sciences, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis, School of Medicine, University of Nottingham, Nottingham, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- Pain Centre Versus Arthritis, School of Medicine, University of Nottingham, Nottingham, UK
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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3
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Kurien T, Kerslake RW, Graven-Nielsen T, Arendt-Nielsen L, Auer DP, Edwards K, Scammell BE, Petersen KKS. Chronic Postoperative Pain after Total Knee Arthroplasty: The Potential Contributions of Synovitis, Pain Sensitization, and Pain Catastrophizing - An Explorative Study. Eur J Pain 2022; 26:1979-1989. [PMID: 35959735 PMCID: PMC9544145 DOI: 10.1002/ejp.2018] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/01/2022] [Accepted: 08/07/2022] [Indexed: 11/10/2022]
Abstract
Background A subset of osteoarthritis patients will experience chronic postoperative pain after total knee arthroplasty (TKA), but the source of pain is unclear. The aim of this exploratory study was to assess patients with and without postoperative pain after TKA using magnetic resonance imaging (MRI), quantitative sensory testing (QST), clinical assessment of pain and assessments of catastrophizing thoughts. Methods Forty‐six patients completed the 6‐month postoperative assessment. MRI findings were scored according to the MRI Osteoarthritis Knee Score recommendation for Hoffa synovitis, effusion size and bone marrow lesions. QST included assessment of pressure pain thresholds (PPTs), temporal summation of pain (TSP) and conditioned pain modulation (CPM). Pain catastrophizing was assessed using the Pain Catastrophizing Scale (PCS). Clinical pain assessment was conducted using a visual analogue scale (VAS, 0–10 cm), and groups of moderate‐to‐severe (VAS > 3) and none‐to‐mild postoperative pain (VAS ≤ 3) were identified. Results Patients with moderate‐to‐severe postoperative pain (N = 15) demonstrated higher grades of Hoffa synovitis (p < 0.001) and effusion size (p < 0.001), lower PPTs (p = 0.039), higher TSP (p = 0.001) and lower CPM (p = 0.014) when compared with patients with none‐to‐mild postoperative pain (N = 31). No significant difference was found in PCS scores between the two groups. Multiple linear regression models found synovitis (p = 0.036), effusion size (p = 0.003), TSP (p = 0.013) and PCS (p < 0.001) as independent parameters contributing to the postoperative pain intensity. Conclusion These exploratory findings could indicate that chronic postoperative pain after TKA is a combination of joint‐related synovitis and effusion, sensitization of central pain mechanisms and potentially pain catastrophizing thoughts, but larger studies are needed to confirm this. Significance The end‐stage treatment of knee osteoarthritis is total knee arthroplasty. Some patients experience chronic postoperative pain after total knee arthroplasty, but the mechanism for chronic postoperative pain is widely unknown. The current study indicates that higher levels postoperative of synovitis and effusion, higher temporal summation of pain and higher pain catastrophizing scores could be associated with higher chronic postoperative pain.
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Affiliation(s)
- Thomas Kurien
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham.,Nottingham Elective Orthopaedic Service (NEOS), Nottingham University Hospitals NHS Trust, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK
| | - Robert W Kerslake
- Pain Centre Versus Arthritis, University of Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, UK
| | - Thomas Graven-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Faculty of Medicine, Aalborg University, Denmark
| | - Lars Arendt-Nielsen
- Center for Neuroplasticity and Pain (CNAP), Faculty of Medicine, Aalborg University, Denmark.,Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark.,Center for Mathematical Modelling of Knee Osteoarthritis, Department of Materials and Production, Aalborg University, Denmark
| | - Dorothee P Auer
- Pain Centre Versus Arthritis, University of Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK.,Sir Peter Mansfield Imaging Centre, University of Nottingham, UK
| | - Kimberley Edwards
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham.,Nottingham Elective Orthopaedic Service (NEOS), Nottingham University Hospitals NHS Trust, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, UK
| | - Kristian Kjaer-Staal Petersen
- Center for Neuroplasticity and Pain (CNAP), Faculty of Medicine, Aalborg University, Denmark.,Center for Mathematical Modelling of Knee Osteoarthritis, Department of Materials and Production, Aalborg University, Denmark
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Harrison C, Clelland AD, Davis TRC, Scammell BE, Zhang W, Russell P, Fullilove S, Chakrabarti I, Davidson D, Rodrigues J. A comparative analysis of multidimensional computerized adaptive testing for the DASH and QuickDASH scores in Dupuytren's disease. J Hand Surg Eur Vol 2022; 47:750-754. [PMID: 35225047 DOI: 10.1177/17531934221081803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The QuickDASH is a short-form version of the DASH questionnaire, the most widely used patient-reported outcome measure in hand surgery. Multidimensional computerized adaptive testing (MCAT) can produce shorter and more precise testing than static short forms, like QuickDASH. We used DASH responses from 507 patients with Dupuytren's disease to develop a MCAT. The algorithm was evaluated in a Monte Carlo simulation, where the standard error of measurement (SEm) of scores obtained from the 11-item QuickDASH was compared with scores obtained from an MCAT that could administer up to 11 items from the full 30-item DASH. The MCAT asked a mean of 8.51 items (SD 2.93) and 265/1000 simulated respondents needed to complete ≤five items. Median SEms were better for DASH MCAT: 0.299 (hand function) and 0.256 (sensory symptoms) versus 0.320 and 0.290, respectively, for QuickDASH. Our study showed that the DASH MCAT can produce more precise DASH measurement than the QuickDASH, from fewer items.
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Affiliation(s)
- Conrad Harrison
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Tim R C Davis
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Brigitte E Scammell
- Nottingham University Hospitals NHS Trust, Nottingham, UK.,Academic Unit of Injury, Inflammation and Recovery Sciences School of Medicine, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Unit of Injury, Inflammation and Recovery Sciences School of Medicine, University of Nottingham, Nottingham, UK
| | - Peter Russell
- Derby Teaching Hospitals NHS Foundation Trust, Derby, UK
| | - Sue Fullilove
- University Hospitals Plymouth NHS Trust, Plymouth, UK
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5
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Hammouche SA, Phillips J, Massoumi A, Scammell BE, Moran CG. Implant and patient survival rates using Exeter Trauma Stem hemiarthroplasty in fracture neck of femur patients: The largest study to date. Injury 2022; 53:2199-2206. [PMID: 35393097 DOI: 10.1016/j.injury.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/21/2022] [Accepted: 03/06/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Exeter Trauma Stems (ETS) femoral hemiarthroplasties are based on Exeter THR stems with a few design changes. Little has been published on ETS survival rates to justify their high cost compared to other cheaper implants. This is the largest prospective study to assess ETS implant failure-free survival rates in fracture neck of femur patients (NOF). This non-developing-centre study examined whether these design differences have altered implant survival (compared with Exeter THR's published survival data). METHODS Data were prospectively collected by independent audit officers. Dislocation, periprosthetic fracture, re-admission with severe hip pain, deep infection and revision surgery were considered events of interest in implant failure-free survival. RESULTS This study assessed 1,123 ETS stems (36 patients received bilateral ETS) in NOF patients. The mean patient age at the time of operation was 83 years (range; 49 - 102 years). The mean observation period was 2.5 years (range; 0 days - 8 years). Only 29 implants failed. All failure events were reported within the first year. Stem failure-free survival was 97.2% at eight years (CI 95.9% - 98%). Dislocation occurred in 10 patients (1%), periprosthetic femoral fracture in 4 (0.4%), and deep infection in 11 patients (1.2%). Patient survival rates were 75% and 48% at one and five years respectively. CONCLUSION ETS has high implant failure-free survival rates when used in hip fractures. ETS design changes have not altered ETS survival when used in hip fractures compared with the published literature of Exeter THR stem when used as a treatment for OA. Exeter Trauma Stems in NOF patients might last these elderly patients their entire short lifetime.
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Affiliation(s)
- Salah A Hammouche
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom.
| | - Jonathan Phillips
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - Abaris Massoumi
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - Brigitte E Scammell
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
| | - Chris G Moran
- The Orthopaedic Academic Unit, Queen's Medical Centre, Nottingham University Hospitals, Nottingham NG7 2UH, United Kingdom
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6
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Tavakol M, Scammell BE, Wetzel AP. Feedback to support examiners' understanding of the standard-setting process and the performance of students: AMEE Guide No. 145. Med Teach 2022; 44:582-595. [PMID: 34726546 DOI: 10.1080/0142159x.2021.1993164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The ratings that judges or examiners use for determining pass marks and students' performance on OSCEs serve a number of essential functions in medical education assessment, and their validity is a pivotal issue. However, some types of errors often occur in ratings that require special efforts to minimise. Rater characteristics (e.g. generosity error, severity error, central tendency error or halo error) may present a source of performance irrelevant variance. Prior literature shows the fundamental problems in student performance measurement attached to judges' or examiners' errors. It also indicates that the control of such errors supports a robust and credible pass mark and thus, accurate student marks. Therefore, for a standard-setter who identifies the pass mark and an examiner who rates student performance in OSCEs, proper, user-friendly feedback on their standard-setting and ratings is essential for reducing bias. This feedback provides useful avenues for understanding why performance ratings may be irregular and how to improve the quality of ratings. This AMEE Guide discusses various methods of feedback to support examiners' understanding of the performance of students and the standard-setting process with an effort to make inferences from assessments fair, valid and reliable.
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Affiliation(s)
- Mohsen Tavakol
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Angela P Wetzel
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
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7
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Pitrolino KA, Felfel RM, Pellizzeri LM, McLaren J, Popov AA, Sottile V, Scotchford CA, Scammell BE, Roberts GAF, Grant DM. Development and in vitro assessment of a bi-layered chitosan-nano-hydroxyapatite osteochondral scaffold. Carbohydr Polym 2022; 282:119126. [PMID: 35123750 DOI: 10.1016/j.carbpol.2022.119126] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/04/2022] [Accepted: 01/07/2022] [Indexed: 11/15/2022]
Abstract
An innovative approach was developed to engineer a multi-layered chitosan scaffold for osteochondral defect repair. A combination of freeze drying and porogen-leaching out methods produced a porous, bioresorbable scaffold with a distinct gradient of pore size (mean = 160-275 μm). Incorporation of 70 wt% nano-hydroxyapatite (nHA) provided additional strength to the bone-like layer. The scaffold showed instantaneous mechanical recovery under compressive loading and did not delaminate under tensile loading. The scaffold supported the attachment and proliferation of human mesenchymal stem cells (MSCs), with typical adherent cell morphology found on the bone layer compared to a rounded cell morphology on the chondrogenic layer. Osteogenic and chondrogenic differentiation of MSCs preferentially occurred in selected layers of the scaffold in vitro, driven by the distinct pore gradient and material composition. This scaffold is a suitable candidate for minimally invasive arthroscopic delivery in the clinic with potential to regenerate damaged cartilage and bone.
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Affiliation(s)
- Katherine A Pitrolino
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, UK.
| | - Reda M Felfel
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, UK; Physics Department, Faculty of Science, Mansoura University, Mansoura 35516, Egypt
| | - Laura Macri Pellizzeri
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, UK
| | - Jane McLaren
- Academic Unit Inflammation, Injury and Recovery Sciences, School of Medicine, University of Nottingham, UK
| | - Alexander A Popov
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, UK; Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, UK
| | - Virginie Sottile
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, UK; Department of Molecular Medicine, University of Pavia, Italy.
| | - Colin A Scotchford
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, UK
| | - Brigitte E Scammell
- Academic Unit Inflammation, Injury and Recovery Sciences, School of Medicine, University of Nottingham, UK
| | - George A F Roberts
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, UK
| | - David M Grant
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, UK
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8
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Tavakol M, Scammell BE, Wetzel AP. Reply to Christopher Harrison. Med Teach 2022; 44:453-454. [PMID: 35037563 DOI: 10.1080/0142159x.2022.2027697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mohsen Tavakol
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- Medical Education Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Angela P Wetzel
- School of Education, Virginia Commonwealth University, Richmond, VA, USA
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9
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Nightingale J, Shu'an KL, Scammell BE, Leighton P, Ollivere BJ. What Is Important to Patients Who Are Recovering From an Open Tibial Fracture? A Qualitative Study. Clin Orthop Relat Res 2022; 480:263-272. [PMID: 34779791 PMCID: PMC8747585 DOI: 10.1097/corr.0000000000002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 10/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Open tibial fracture research has traditionally focused on surgical techniques; however, despite technological advances, outcomes from these injuries remain poor, with patients facing a sustained reduced quality of life. Research has rarely asked patients what is important to them after an open tibial fracture, and this question could potentially offer great insight into how to support patients. A qualitative study may assist in our understanding of this subject. QUESTIONS/PURPOSES We asked: (1) What common themes did patients who have experienced open tibial fractures share? (2) What stresses and coping strategies did those patients articulate? (3) What sources for acquiring coping strategies did patients say they benefited from? METHODS Semistructured interviews were conducted with patients who had sustained an open tibial fracture between January 1, 2016 and January 1, 2019. All participants were recruited from a Level 1 trauma center in England, and 26 participants were included. The mean age was 44 ± 17 years, and 77% (20 of 26) were men. The patients' injuries ranged in severity, and they had a range of treatments and complications. Transcripts were analyzed using framework analysis, with codes subsequently organized into themes and subthemes. RESULTS Four themes were identified, which included recouping physical mobility, values around treatment, fears about poor recovery, and coping strategies to reduce psychological burden. Coping strategies were important in mitigating the psychological burden of injury. Task-focused coping strategies were preferred by patients and perceived as taking a proactive approach to recovery. Healthcare practitioners, and others with lived experience were able to educate patients on coping, but such resources were scant and therefore probably less accessible to those with the greatest need. CONCLUSION Most individuals fail to return to previous activities, and it is unlikely that improvements in surgical techniques will make major improvements in patient outcomes in the near future. Investment in psychosocial support could potentially improve patient experience and outcomes. Digital information platforms and group rehabilitation clinics were identified as potential avenues for development that could offer individuals better psychosocial support with minimal additional burden for surgeons. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Jessica Nightingale
- Department of Trauma & Orthopaedics, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Kyle Lin Shu'an
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Brigitte E. Scammell
- Department of Trauma & Orthopaedics, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Paul Leighton
- Population and Lifespan Sciences, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK
| | - Ben J. Ollivere
- Department of Trauma & Orthopaedics, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Queens Medical Centre, Nottingham, UK
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10
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Markides H, Foster NC, McLaren JS, Hopkins T, Black C, Oreffo ROC, Scammell BE, Echevarria I, White LJ, El Haj AJ. Short-Term Evaluation of Cellular Fate in an Ovine Bone Formation Model. Cells 2021; 10:1776. [PMID: 34359945 PMCID: PMC8305225 DOI: 10.3390/cells10071776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 02/07/2023] Open
Abstract
The ovine critical-sized defect model provides a robust preclinical model for testing tissue-engineered constructs for use in the treatment of non-union bone fractures and severe trauma. A critical question in cell-based therapies is understanding the optimal therapeutic cell dose. Key to defining the dose and ensuring successful outcomes is understanding the fate of implanted cells, e.g., viability, bio-distribution and exogenous infiltration post-implantation. This study evaluates such parameters in an ovine critical-sized defect model 2 and 7 days post-implantation. The fate of cell dose and behaviour post-implantation when combined with nanomedicine approaches for multi-model tracking and remote control using external magnetic fields is also addressed. Autologous STRO-4 selected mesenchymal stromal cells (MSCs) were labelled with a fluorescent lipophilic dye (CM-Dil), functionalised magnetic nanoparticles (MNPs) and delivered to the site within a naturally derived bone extracellular matrix (ECM) gel. Encapsulated cells were implanted within a critical-sized defect in an ovine medial femoral condyle and exposed to dynamic gradients of external magnetic fields for 1 h per day. Sheep were sacrificed at 2 and 7 days post-initial surgery where ECM was harvested. STRO-4-positive (STRO-4+) stromal cells expressed osteocalcin and survived within the harvested gels at day 2 and day 7 with a 50% loss at day 2 and a further 45% loss at 7 days. CD45-positive leucocytes were also observed in addition to endogenous stromal cells. No elevation in serum C-reactive protein (CRP) or non-haem iron levels was observed following implantation in groups containing MNPs with or without magnetic field gradients. The current study demonstrates how numbers of therapeutic cells reduce substantially after implantation in the repair site. Cell death is accompanied by enhanced leucocyte invasion, but not by inflammatory blood marker levels. Crucially, a proportion of implanted STRO-4+ stromal cells expressed osteocalcin, which is indicative of osteogenic differentiation. Furthermore, MNP labelling did not alter cell number or result in a further deleterious impact on stromal cells following implantation.
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Affiliation(s)
- Hareklea Markides
- Guy Hilton Research Centre, Institute of Science and Technology in Medicine, Keele University, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK; (H.M.); (T.H.); (I.E.)
- Healthcare Technologies Institute, Institute of Translational Medicine, School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK;
| | - Nicola C. Foster
- Healthcare Technologies Institute, Institute of Translational Medicine, School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK;
| | - Jane S. McLaren
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham NG7 2RD, UK; (J.S.M.); (L.J.W.)
| | - Timothy Hopkins
- Guy Hilton Research Centre, Institute of Science and Technology in Medicine, Keele University, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK; (H.M.); (T.H.); (I.E.)
| | - Cameron Black
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (R.O.C.O.)
| | - Richard O. C. Oreffo
- Bone and Joint Research Group, Centre for Human Development, Stem Cells and Regeneration, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK; (C.B.); (R.O.C.O.)
| | - Brigitte E. Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Queen’s Medical Centre, University of Nottingham, Nottingham NG7 2UH, UK;
| | - Iria Echevarria
- Guy Hilton Research Centre, Institute of Science and Technology in Medicine, Keele University, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK; (H.M.); (T.H.); (I.E.)
| | - Lisa J. White
- Centre for Biomolecular Sciences, University of Nottingham, Nottingham NG7 2RD, UK; (J.S.M.); (L.J.W.)
| | - Alicia J. El Haj
- Guy Hilton Research Centre, Institute of Science and Technology in Medicine, Keele University, Thornburrow Drive, Stoke-on-Trent ST4 7QB, UK; (H.M.); (T.H.); (I.E.)
- Healthcare Technologies Institute, Institute of Translational Medicine, School of Chemical Engineering, University of Birmingham, Birmingham B15 2TT, UK;
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11
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Coughlin T, Norrish AR, Scammell BE, Matthews PA, Nightingale J, Ollivere BJ. Infographic: Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures: a randomized controlled trial of effectiveness. Bone Joint J 2021; 103-B:1031-1032. [PMID: 34058884 DOI: 10.1302/0301-620x.103b6.bjj-2021-0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | - Alan R Norrish
- Queen Elizabeth Hospital, King's Lynn, UK.,Academic Orthopaedics, Trauma and Sports Medicine
| | | | | | - Jessica Nightingale
- Nottingham University Hospitals, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine.,University of Nottingham, Nottingham, UK
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12
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Parekh SM, Fernandes GS, Moses JP, Fuller CW, Scammell BE, Batt ME, Zhang W, Doherty M. Risk Factors for Knee Osteoarthritis in Retired Professional Footballers: A Cross-Sectional Study. Clin J Sport Med 2021; 31:281-288. [PMID: 31157625 PMCID: PMC8061337 DOI: 10.1097/jsm.0000000000000742] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/22/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers. DESIGN This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders. SETTINGS AND PARTICIPANTS Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs. ASSESSMENT OF RISK FACTORS Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire. MAIN OUTCOME MEASURES Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs). RESULTS Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes. CONCLUSION This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement.
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Affiliation(s)
- Sanjay M. Parekh
- Division of Rheumatology, Orthopaedics and Dermatology, Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
| | - Gwen S. Fernandes
- Division of Rheumatology, Orthopaedics and Dermatology, Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, United Kingdom
| | - Jonathan P. Moses
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom; and
| | - Colin W. Fuller
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Colin Fuller Consultancy Ltd, East Leake, United Kingdom
| | - Brigitte E. Scammell
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, United Kingdom
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom; and
| | - Mark E. Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, United Kingdom; and
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, United Kingdom
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, United Kingdom
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, United Kingdom
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13
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Coughlin T, Norrish AR, Scammell BE, Matthews PA, Nightingale J, Ollivere BJ. Comparison of rehabilitation interventions in nonoperatively treated distal radius fractures: a randomized controlled trial of effectiveness. Bone Joint J 2021; 103-B:1033-1039. [PMID: 33926211 DOI: 10.1302/0301-620x.103b.bjj-2020-2026.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. METHODS Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year. RESULTS A total of 116 (97%) of 120 enrolled participants commenced treatment. Of those, 21 were lost to follow-up, resulting in 30 participants in the advice leaflet, 32 in the advice video, and 33 face-to-face therapy arms, respectively at six weeks of follow-up. There was no significant difference between the treatment groups in the DASH at six weeks (advice leaflet vs face-to-face therapy, p = 0.69; advice video vs face-to-face therapy, p = 0.56; advice leaflet vs advice video, p = 0.37; advice leaflet vs advice video vs face-to-face therapy, p = 0.63). At six weeks, there were no differences in any secondary outcome measures except for the DASH work subscale, where face-to-face therapy conferred benefit over advice leaflet (p = 0.01). CONCLUSION Following cast removal for nonoperatively treated distal radius fractures, offering an advice leaflet or advice video for rehabilitation gives equivalent patient-reported outcomes to a course of face-to-face therapy. Cite this article: Bone Joint J 2021;103-B(6):1033-1039.
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Affiliation(s)
| | - Alan R Norrish
- Queen Elizabeth Hospital, King's Lynn, UK.,Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | | | - Jessica Nightingale
- Nottingham University Hospitals, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
| | - Ben J Ollivere
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Nottingham, UK
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14
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Bestwick-Stevenson T, Wyatt LA, Palmer D, Ching A, Kerslake R, Coffey F, Batt ME, Scammell BE. Incidence and risk factors for poor ankle functional recovery, and the development and progression of posttraumatic ankle osteoarthritis after significant ankle ligament injury (SALI): the SALI cohort study protocol. BMC Musculoskelet Disord 2021; 22:362. [PMID: 33865351 PMCID: PMC8052737 DOI: 10.1186/s12891-021-04230-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/07/2021] [Indexed: 12/13/2022] Open
Abstract
Background Ankle sprains are one of the most common musculoskeletal injuries, accounting for up to 5% of all Emergency Department visits in the United Kingdom. Ankle injury may be associated with future ankle osteoarthritis. Up to 70% of ankle osteoarthritis cases may be associated with previous ankle injury. There is limited research regarding the association between ankle sprain and ankle osteoarthritis development. The current study aims to phenotype those who suffer significant ankle ligament injuries, identify potential risk factors for ankle injuries and subsequent poor recovery, examine why individuals may develop osteoarthritis, and what factors influence this chance. Methods In this multicentre cohort study participants were recruited from nine Emergency Departments and two Urgent Care Centres in the United Kingdom. Participants (aged 18–70 years old) were defined as those who had suffered an isolated acute ankle sprain, which was Ottawa Ankle Rules positive, but negative for a significant ankle fracture on x-ray. Age and sex matched controls were also recruited. The controls were individuals who had not suffered a significant ankle injury, including ankle pain, function affected for more than 7 days, or the ankle caused them to report to an Emergency Department. Data is collected through a series of seven questionnaires (at baseline, 3 months, 1 year, 3 years, 5 years, 10 years, and 15 years later). The questionnaires include four sections (demographic questions; index injury, and injury history questions; functional assessment questions; and quality of life questions) and are designed to collect detailed information about the individual, their injury, potential risk factors for ankle sprains and ankle osteoarthritis, plus their medical history and any medication consumed. Discussion The Significant Ankle Ligament Injury (SALI) study aims to add to the limited knowledge regarding which factors can predict ankle sprains, complaints, and osteoarthritis. This is important because despite ankle sprains being regarded as a benign injury that resolves quickly, residual symptoms are not uncommon months and years after the injury. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04230-8.
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Affiliation(s)
- Thomas Bestwick-Stevenson
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK. .,The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK.
| | - Laura A Wyatt
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK
| | - Debbie Palmer
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,Institute of Sport, PE and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Angela Ching
- The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK.,Centre for Health Sciences Research, School of Health and Society, University of Salford, Salford, Greater Manchester, UK
| | - Robert Kerslake
- The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK.,Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Frank Coffey
- Nottingham University Hospital NHS Trust, Nottingham, UK
| | - Mark E Batt
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK.,Institute of Sport, PE and Health Sciences, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK.,The Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Queen's Medical Centre, Nottingham, UK.,Nottingham University Hospital NHS Trust, Nottingham, UK
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15
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Fernandes GS, Parekh SM, Moses JP, Fuller CW, Scammell BE, Batt ME, Zhang W, Doherty M. Intra-articular Injection Administration in UK Ex-professional Footballers During Their Playing Careers and the Association with Post-career Knee Osteoarthritis. Sports Med 2021; 50:1039-1046. [PMID: 31925768 PMCID: PMC7142039 DOI: 10.1007/s40279-019-01255-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background The long-term risk from knee intra-articular (KIA) injections in professional athletes such as ex-footballers remains unknown. The use of KIA injections is controversial and remains anecdotally prolific as it is perceived as being safe/beneficial. The aim of this study was to determine the number, type and frequency KIA injections administered to retired professional footballers during their playing careers and the associations with post-career knee osteoarthritis (KOA). Methods This is a cross-sectional study involving a postal questionnaire (n = 1207) and subsequent knee radiographs in a random sample of questionnaire responders (n = 470). Footballers self-reported in the questionnaire whether they had received KIA injections and the estimated total number over the course of their playing career. Participant characteristics and football career-related details were also recorded. KOA was measured as self-reported knee pain (KP), total knee replacement (TKR) and radiographic KOA (RKOA). Results 44.5% of footballers had received at least one KIA injection (mean: 7.5; SD ± 11.2) during their professional career. 71% of knee injections were cortisone/corticosteroid based. Multivariate logistic regression, adjusting for age, body mass index (BMI) and significant knee injury identified that footballers with injections were two times more likely to have KP (OR 1.81, 95% CI 1.40–2.34) and TKR (OR 2.21, 95% CI 1.43–3.42) than those without injections. However, there was no association with RKOA (OR 1.30, 95% CI 0.85–2.01). Given, the association with KP and TKR, we found a significant dose–response relationship as the more injections a player received (by dose–response groups), the greater the risk of KP and TKR outcomes after adjustment for knee injury and other confounders (p for trend < 0.01). Conclusion On average, 8 KIA injections were given to the ex-footballers during their professional career. The most commonly administered injections were cortisone based. These injections associated with KP and TKR after they retired. The associations are independent of knee injuries and are dose dependent. The study suggests that there may have been excessive use of KIA injections to expedite return to play and this contributed to detrimental long-term outcomes such as KP and TKR post-retirement from professional football.
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Affiliation(s)
- Gwen S Fernandes
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK
| | - Sanjay M Parekh
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Jonathan P Moses
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Colin W Fuller
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Colin Fuller Consultancy Ltd, Sutton Bonington, LE12 5PE, UK
| | - Brigitte E Scammell
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Mark E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Weiya Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK.
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK.
| | - Michael Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queens Medical Centre, Nottingham, NG7 2UH, UK
- Arthritis Research UK Pain Centre, Nottingham City Hospital, Nottingham, NG5 1PB, UK
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16
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Abstract
AIMS To determine mortality risk after first revision total hip arthroplasty (THA) for periprosthetic femoral fracture (PFF), and to compare this to mortality risk after primary and first revision THA for other common indications. METHODS The study cohort consisted of THAs recorded in the National Joint Registry between 2003 and 2015, linked to national mortality data. First revision THAs for PFF, infection, dislocation, and aseptic loosening were identified. We used a flexible parametric model to estimate the cumulative incidence function of death at 90 days, one year, and five years following first revision THA and primary THA, in the presence of further revision as a competing risk. Analysis covariates were age, sex, and American Society of Anesthesiologists (ASA) grade. RESULTS A total of 675,078 primary and 74,223 first revision THAs were included (of which 6,131 were performed for PFF). Following revision for PFF, mortality ranged from 9% at 90 days, 21% at one year, and 60% at five years in the highest risk group (males, ≥ 75 years, ASA ≥ 3) to 0.6%, 1.4%, and 5.5%, respectively, for the lowest risk group (females, < 75 years, ASA ≤ 2). Mortality was greater in all groups following first revision THA for PFF than for primary THA. Compared to mortality risk after first revision THA for infection, dislocation, or aseptic loosening, revision for PFF was associated with higher five-year mortality in all groups except males < 75 years with an ASA ≤ 2. CONCLUSION Mortality risk after revision THA for PFF is high, reaching 60% at five years in the highest risk patient group. In comparison to other common indications for revision, PFF demonstrated the highest overall risk of mortality at five years. These estimates can be used in the surgical decision-making process and when counselling patients and carers regarding surgical risk. Cite this article: Bone Joint J 2020;102-B(12):1670-1674.
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Affiliation(s)
- Tanvir Khan
- Division of Orthopaedics, Rheumatology and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals, Nottingham, UK
| | - Rob Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK.,Nuffield Orthopaedic Centre, Oxford, UK
| | | | - Brigitte E Scammell
- Division of Orthopaedics, Rheumatology and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Queens Medical Centre, Nottingham, UK
| | - Benjamin J Ollivere
- Division of Orthopaedics, Rheumatology and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK.,Nottingham University Hospitals, Nottingham, UK.,Nottingham NIHR Biomedical Research Centre, Queens Medical Centre, Nottingham, UK
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17
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Palmer D, Cooper DJ, Emery C, Batt ME, Engebretsen L, Scammell BE, Schamasch P, Shroff M, Soligard T, Steffen K, Whittaker JL, Budgett R. Self-reported sports injuries and later-life health status in 3357 retired Olympians from 131 countries: a cross-sectional survey among those competing in the games between London 1948 and PyeongChang 2018. Br J Sports Med 2020; 55:46-53. [DOI: 10.1136/bjsports-2019-101772] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/03/2022]
Abstract
ObjectiveDescribe the self-reported prevalence and nature of Olympic-career injury and general health and current residual symptoms in a self-selected sample of retired Olympians.Methods3357 retired Olympians from 131 countries completed a cross-sectional online survey, distributed by direct email through World Olympians Association and National Olympian Associations databases. The survey captured Olympic sport exposure, significant training and competition injury history (lasting >1 month), general health (eg, depression) during the athlete’s career, and current musculoskeletal pain and functional limitations.Results55% were men (44% women, 1% unknown), representing 57 sports (42 Summer, 15 Winter), aged 44.7 years (range 16–97). A total of 3746 injuries were self-reported by 2116 Olympians. This equated, 63.0% (women 68.1%, men 59.2%) reporting at least one significant injury during their Olympic career. Injury prevalence was highest in handball (82.2%) and lowest in shooting (40.0%) for Summer Olympians; and highest in alpine skiing (82.4%) and lowest in biathlon (40.0%) for Winter Olympians. The knee was the most frequently injured anatomical region (20.6%, 120 median days severity), followed by the lumbar spine (13.1%, 100 days) and shoulder/clavicle (12.9%, 92 days). 6.6% of Olympians said they had experienced depression during their career. One-third of retired Olympians reported current pain (32.4%) and functional limitations (35.9%).ConclusionsAlmost two-thirds of Olympians who completed the survey reported at least one Olympic-career significant injury. The knee, lumbar spine and shoulder/clavicle were the most commonly injured anatomical locations. One-third of this sample of Olympians attributed current pain and functional limitations to Olympic-career injury.
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18
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Matamoros-Veloza A, Hossain KMZ, Scammell BE, Ahmed I, Hall R, Kapur N. Formulating injectable pastes of porous calcium phosphate glass microspheres for bone regeneration applications. J Mech Behav Biomed Mater 2019; 102:103489. [PMID: 31622859 DOI: 10.1016/j.jmbbm.2019.103489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Abstract
Current trends in regenerative medicine treatments for bone repair applications focus on cell-based therapies. These aim to deliver the treatment via a minimally invasive injection to reduce patient trauma and to improve efficacy. This paper describes the injectability of porous calcium phosphate glass microspheres to be used for bone repair based on their formulation, rheology and flow behavior. The use of excipients (xanthan gum, methyl cellulose and carboxyl methyl cellulose) were investigated to improve flow performance. Based on our results, the flow characteristics of the glass microsphere pastes vary according to particle size, surface area, and solid to liquid ratio, as well as the concentration of viscosity modifiers used. The optimal flow characteristics of calcium phosphate glass microsphere pastes was found to contain 40 mg/mL of xanthan gum which increased viscosity whilst providing elastic properties (∼29,000 Pa) at shear rates that mirror the injection process and the resting period post injection, preventing the glass microspheres from both damage and dispersion. It was established that a base formulation must contain 1 g of glass microspheres (60-125 μm in size) per 1 mL of cell culture media, or 0.48 g of glass microspheres of sizes between 125 and 200 μm. Furthermore, the glass microsphere formulations with xanthan gum were readily injectable via a syringe-needle system (3-20 mL, 18G and 14G needles), and have the potential to be utilized as a cell (or other biologics) delivery vehicle for bone regeneration applications.
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Affiliation(s)
| | - Kazi M Zakir Hossain
- Faculty of Engineering, Advanced Materials Research Group, University of Nottingham, NG7 2RD, UK; Department of Chemistry, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Brigitte E Scammell
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, UK
| | - Ifty Ahmed
- Faculty of Engineering, Advanced Materials Research Group, University of Nottingham, NG7 2RD, UK
| | - Richard Hall
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK
| | - Nikil Kapur
- School of Mechanical Engineering, University of Leeds, LS2 9JT, UK.
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Matthews PA, Scammell BE, Ollivere BJ. Re: Measuring Recovery After Ankle Fractures: A Systematic Review of the Psychometric Properties of Scoring Systems. J Foot Ankle Surg 2019; 57:854. [PMID: 29703459 DOI: 10.1053/j.jfas.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Indexed: 02/03/2023]
Affiliation(s)
- Paul A Matthews
- Department of Academic Orthopaedics, Trauma, and Sports Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals, Nottingham, UK
| | - Brigitte E Scammell
- Department of Academic Orthopaedics, Trauma, and Sports Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals, Nottingham, UK
| | - Ben J Ollivere
- Department of Academic Orthopaedics, Trauma, and Sports Medicine, University of Nottingham, Nottingham, UK; Nottingham University Hospitals, Nottingham, UK
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20
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McLaren JS, Macri-Pellizzeri L, Hossain KMZ, Patel U, Grant DM, Scammell BE, Ahmed I, Sottile V. Porous Phosphate-Based Glass Microspheres Show Biocompatibility, Tissue Infiltration, and Osteogenic Onset in an Ovine Bone Defect Model. ACS Appl Mater Interfaces 2019; 11:15436-15446. [PMID: 30990301 DOI: 10.1021/acsami.9b04603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phosphate-based glasses (PBGs) are bioactive and fully degradable materials with tailorable degradation rates. PBGs can be produced as porous microspheres through a single-step process, using changes in their formulation and geometry to produce varying pore sizes and interconnectivity for use in a range of applications, including biomedical use. Calcium phosphate PBGs have recently been proposed as orthobiologics, based on their in vitro cytocompatibility and ion release profile. In this study, porous microspheres made of two PBG formulations either containing TiO2 (P40Ti) or without (P40) were implanted in vivo in a large animal model of bone defect. The biocompatibility and osteogenic potential of these porous materials were assessed 13 weeks postimplantation in sheep and compared to empty defects and autologous bone grafts used as negative and positive controls. Histological analysis showed marked differences between the two formulations, as lower trabeculae-like interconnection and higher fatty bone marrow content were observed in the faster degrading P40-implanted defects, while the slower degrading P40Ti material promoted dense interconnected tissue. Autologous bone marrow concentrate (BMC) was also incorporated within the P40 and P40Ti microspheres in some defects; however, no significant differences were observed in comparison to microspheres implanted alone. Both formulations induced the formation of a collagen-enriched matrix, from 20 to 40% for P40 and P40Ti2.5 groups, suggesting commitment toward the bone lineage. With the faster degrading P40 formulation, mineralization of the tissue matrix was observed both with and without BMC. Some lymphocyte-like cells and foreign body multinucleated giant cells were observed with P40Ti2.5, suggesting that this more durable formulation might be linked to an inflammatory response. In conclusion, these first in vivo results indicate that PBG microspheres could be useful candidates for bone repair and regenerative medicine strategies and highlight the role of material degradation in the process of tissue formation and maturation.
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Wyatt LA, Nwosu LN, Wilson D, Hill R, Spendlove I, Bennett AJ, Scammell BE, Walsh DA. Molecular expression patterns in the synovium and their association with advanced symptomatic knee osteoarthritis. Osteoarthritis Cartilage 2019; 27:667-675. [PMID: 30597276 DOI: 10.1016/j.joca.2018.12.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a major source of knee pain. Mechanisms of OA knee pain are incompletely understood but include synovial pathology. We aimed to identify molecular expression patterns in the synovium associated with symptomatic knee OA. DESIGN Snap frozen synovia were from people undergoing total knee replacement (TKR) for advanced OA, or from post-mortem (PM) cases who had not sought help for knee pain. Associations with OA symptoms were determined using discovery and validation samples, each comprising TKR and post mortem (PM) cases matched for chondropathy (Symptomatic or Asymptomatic Chondropathy). Associations with OA were determined by comparing age matched TKR and PM control cases. Real-time quantitative PCR for 96 genes involved in inflammation and nerve sensitisation used TaqMan® Array Cards in discovery and validation samples, and protein expression for replicated genes was quantified using Luminex bead assay. RESULTS Eight genes were differentially expressed between asymptomatic and symptomatic chondropathy cases and replicated between discovery and validation samples (P<0.05 or >3-fold change). Of these, matrix metalloprotease (MMP)-1 was also increased whereas interleukin-1 receptor 1 (IL1R1) and vascular endothelial growth factor (VEGF) were decreased at the protein level in the synovium of symptomatic compared to asymptomatic chondropathy cases. MMP1 protein expression was also increased in OA compared to PM controls. CONCLUSION Associations of symptomatic OA may suggest roles of MMP1 expression and IL1R1 and VEGF pathways in OA pain. Better understanding of which inflammation-associated molecules mediate OA pain should inform refinement of existing therapies and development of new treatments.
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Affiliation(s)
- L A Wyatt
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK.
| | - L N Nwosu
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D Wilson
- Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - R Hill
- Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - I Spendlove
- Divison of Cancer and Stem Cells, University of Nottingham, UK
| | - A J Bennett
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; School of Life Sciences, University of Nottingham, Nottingham, NG5 1PB, UK
| | - B E Scammell
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, UK; NIHR Nottingham, Biomedical Research Centre, University of Nottingham, UK
| | - D A Walsh
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK; NIHR Nottingham, Biomedical Research Centre, University of Nottingham, UK
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22
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Patel U, Macri‐Pellizzeri L, Zakir Hossain KM, Scammell BE, Grant DM, Scotchford CA, Hannon AC, Kennedy AR, Barney ER, Ahmed I, Sottile V. In vitro cellular testing of strontium/calcium substituted phosphate glass discs and microspheres shows potential for bone regeneration. J Tissue Eng Regen Med 2019; 13:396-405. [PMID: 30666804 PMCID: PMC6492078 DOI: 10.1002/term.2796] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/02/2018] [Accepted: 01/09/2019] [Indexed: 01/26/2023]
Abstract
Phosphate-based glasses (PBGs) are ideal materials for regenerative medicine strategies because their composition, degradation rates, and ion release profiles can easily be controlled. Strontium has previously been found to simultaneously affect bone resorption and deposition. Therefore, by combining the inherent properties of resorbable PBG and therapeutic activity of strontium, these glasses could be used as a delivery device of therapeutic factors for the treatment of orthopaedic diseases such as osteoporosis. This study shows the cytocompatibility and osteogenic potential of PBGs where CaO is gradually replaced by SrO in the near invert glass system 40P2 O5 ·(16-x)CaO·20Na2 O·24MgO·xSrO (x = 0, 4, 8, 12, and 16 mol%). Direct seeding of MG63 cells onto glass discs showed no significant difference in cell metabolic activity and DNA amount measurement across the different formulations studied. Cell attachment and spreading was confirmed via scanning electron microscopy (SEM) imaging at Days 3 and 14. Alkaline phosphatase (ALP) activity was similarly maintained across the glass compositions. Follow-on studies explored the effect of each glass composition in microsphere conformation (size: 63-125 μm) on human mesenchymal stem cells (hMSCs) in 3D cultures, and analysis of cell metabolic activity and ALP activity showed no significant differences at Day 14 over the compositional range investigated, in line with the observations from MG63 cell culture studies. Environmental SEM and live cell imaging at Day 14 of hMSCs seeded on the microspheres showed cell attachment and colonisation of the microsphere surfaces, confirming these formulations as promising candidates for regenerative medicine strategies addressing compromised musculoskeletal/orthopaedic diseases.
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Affiliation(s)
- Uresha Patel
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
| | - Laura Macri‐Pellizzeri
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
- Wolfson STEM Centre, School of MedicineUniversity of NottinghamNottinghamUK
| | | | - Brigitte E. Scammell
- Orthopaedics and Trauma Group, Division of Rheumatology, Orthopaedics, and Dermatology, School of MedicineUniversity of NottinghamNottinghamUK
| | - David M. Grant
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
| | | | - Alex C. Hannon
- ISIS FacilityRutherford Appleton Laboratory, ChiltonDidcotUK
| | | | - Emma R. Barney
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
| | - Ifty Ahmed
- Faculty of EngineeringUniversity of NottinghamNottinghamUK
| | - Virginie Sottile
- Wolfson STEM Centre, School of MedicineUniversity of NottinghamNottinghamUK
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23
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Marson BA, Deshmukh SR, Grindlay DJC, Ollivere BJ, Scammell BE. A systematic review of local antibiotic devices used to improve wound healing following the surgical management of foot infections in diabetics. Bone Joint J 2018; 100-B:1409-1415. [PMID: 30418057 DOI: 10.1302/0301-620x.100b11.bjj-2018-0720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Local antibiotics are used in the surgical management of foot infection in diabetic patients. This systematic review analyzes the available evidence of the use of local antibiotic delivery systems as an adjunct to surgery. MATERIALS AND METHODS Databases were searched to identify eligible studies and 13 were identified for inclusion. RESULTS Overall, the quality of the studies was poor. A single trial suggested that wound healing is quicker when a gentamicin-impregnated collagen sponge was implanted at time of surgery, with no difference in length of stay or rate of amputation. Results from studies with high risk of bias indicated no change in wound healing when a gentamicin-impregnated sponge was implanted during transmetatarsal amputation, but a reduction in the incidence of wound breakdown (8% vs 25%, not statistically significant) was identified. A significant cost reduction was identified when using an antimicrobial gel to deliver antibiotics and anti-biofilm agents (quorum-sensing inhibitors) compared with routine dressings and systemic antibiotics. Analyses of case series identified 485 patients who were treated using local antibiotic delivery devices. The rates of wound healing, re-operation, and mortality were comparable to those that have been previously reported for the routine management of these infections. CONCLUSION There is a lack of good-quality evidence to support the use of local antibiotic delivery devices in the treatment of foot infections in patients with diabetes. Cite this article: Bone Joint J 2018;100-B:1409-15.
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Affiliation(s)
- B A Marson
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - S R Deshmukh
- Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J C Grindlay
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B J Ollivere
- Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK and Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
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24
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Kurien T, Arendt-Nielsen L, Petersen KK, Graven-Nielsen T, Scammell BE. Preoperative Neuropathic Pain-like Symptoms and Central Pain Mechanisms in Knee Osteoarthritis Predicts Poor Outcome 6 Months After Total Knee Replacement Surgery. The Journal of Pain 2018; 19:1329-1341. [DOI: 10.1016/j.jpain.2018.05.011] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 05/07/2018] [Accepted: 05/17/2018] [Indexed: 12/15/2022]
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25
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Marson BA, Deshmukh SR, Grindlay DJC, Scammell BE. Alpha-defensin and the Synovasure lateral flow device for the diagnosis of prosthetic joint infection: a systematic review and meta-analysis. Bone Joint J 2018; 100-B:703-711. [PMID: 29855233 DOI: 10.1302/0301-620x.100b6.bjj-2017-1563.r1] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims The aim of this review was to evaluate the available literature and to calculate the pooled sensitivity and specificity for the different alpha-defensin test systems that may be used to diagnose prosthetic joint infection (PJI). Materials and Methods Studies using alpha-defensin or Synovasure (Zimmer Biomet, Warsaw, Indiana) to diagnose PJI were identified from systematic searches of electronic databases. The quality of the studies was evaluated using the Quality Assessment of Studies of Diagnostic Accuracy (QUADAS) tool. Meta-analysis was completed using a bivariate model. Results A total of 11 eligible studies were included. The median QUADAS score was 13 (interquartile range 13 to 13) out of 14. Significant conflicts of interest were identified in five studies. The pooled sensitivity for the laboratory alpha-defensin test was 0.95 (95% confidence interval (CI) 0.91 to 0.98) and the pooled specificity was 0.97 (95% CI 0.95 to 0.98) for four studies with a threshold level of 5.2 mgl-1 The pooled sensitivity for the lateral flow cassette test was 0.85 (95% CI 0.74 to 0.92) and the pooled specificity was 0.90 (95% CI 0.91 to 0.98). There was a statistically significant difference in sensitivity (p = 0.019), but not specificity (p = 0.47). Conclusion Laboratory-based alpha-defensin testing remains a promising tool for diagnosing PJI. The lateral flow cassette has a significantly lower performance and pooled results are comparable to the leucocyte esterase test. Further studies are required before the widespread adoption of the lateral flow cassette alpha-defensin test. Cite this article: Bone Joint J 2018;100-B:703-11.
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Affiliation(s)
- B A Marson
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - S R Deshmukh
- Nottingham Elective Orthopaedic Service, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, UK
| | - D J C Grindlay
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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26
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Matthews PA, Scammell BE, Ali A, Coughlin T, Nightingale J, Khan T, Ollivere BJ. Early motion and directed exercise (EMADE) versus usual care post ankle fracture fixation: study protocol for a pragmatic randomised controlled trial. Trials 2018; 19:304. [PMID: 29855386 PMCID: PMC5984379 DOI: 10.1186/s13063-018-2691-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/16/2018] [Indexed: 12/15/2022] Open
Abstract
Background Following surgical fixation of ankle fractures, the traditional management has included immobilisation for 6 weeks in a below-knee cast. However, this can lead to disuse atrophy of the affected leg and joint stiffness. While early rehabilitation from 2 weeks post surgery is viewed as safe, controversy remains regarding its benefits. We will compare the effectiveness of early motion and directed exercise (EMADE) ankle rehabilitation, against usual care, i.e. 6 weeks’ immobilisation in a below-knee cast. Method/design We have designed a pragmatic randomised controlled trial (p-RCT) to compare the EMADE intervention against usual care. We will recruit 144 independently living adult participants, absent of tissue-healing comorbidities, who have undergone surgical stabilisation of isolated Weber B ankle fractures. The EMADE intervention consists of a non-weight-bearing progressive home exercise programme, complemented with manual therapy and education. Usual care consists of immobilisation in a non-weight-bearing below-knee cast. The intervention period is between week 2 and week 6 post surgery. The primary outcome is the Olerud and Molander Ankle Score (OMAS) patient-reported outcome measure (PROM) at 12 weeks post surgery. Secondary PROMs include the EQ-5D-5 L questionnaire, return to work and return to driving, with objective outcomes including ankle range of motion. Analysis will be on an intention-to-treat basis. An economic evaluation will be included. Discussion The EMADE intervention is a package of care designed to address the detrimental effects of disuse atrophy and joint stiffness. An advantage of the OMAS is the potential of meta-analysis with other designs. Within the economic evaluation, the cost-utility analysis, may be used by commissioners, while the use of patient-relevant outcomes, such as return to work and driving, will ensure that the study remains pertinent to patients and their families. As it is being conducted in the clinical environment, this p-RCT has high external validity. Accordingly, if significant clinical benefits and cost-effectiveness are demonstrated, EMADE should become a worthwhile treatment option. A larger-scale, multicentre trial may be required to influence national guidelines. Trial registration ISRCTN, ID: ISRCTN11212729. Registered retrospectively on 20 March 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2691-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul A Matthews
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK. .,Nottingham University Hospitals NHS Trust, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, NG7 2UH, UK. .,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Arfan Ali
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, NG7 2UH, UK.,Division of Physiology, Pharmacology and Neuroscience, School of Life Sciences, University of Nottingham, Nottingham, NG7 2UH, UK
| | - Timothy Coughlin
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Jessica Nightingale
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Tanvir Khan
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
| | - Ben J Ollivere
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Sports Medicine, University of Nottingham, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Nottingham, NG7 2UH, UK.,Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, NG7 2UH, UK
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27
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Cooper DJ, Scammell BE, Batt ME, Palmer D. Factors associated with pain and osteoarthritis at the hip and knee in Great Britain's Olympians: a cross-sectional study. Br J Sports Med 2018; 52:1101-1108. [PMID: 29760167 DOI: 10.1136/bjsports-2017-098315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Knowledge of the epidemiology and potentially modifiable factors associated with musculoskeletal disease is an important first step in injury prevention among elite athletes. AIM This study investigated the prevalence and factors associated with pain and osteoarthritis (OA) at the hip and knee in Great Britain's (GB) Olympians aged 40 and older. METHODS This is a cross-sectional study. A survey was distributed to 2742 GB Olympians living in 30 countries. Of the 714 (26.0%) who responded, 605 were eligible for analysis (ie, aged 40 and older). RESULTS The prevalence of hip and knee pain was 22.4% and 26.1%, and of hip and knee OA was 11.1% and 14.2%, respectively. Using a multivariable model, injury was associated with OA at the hip (adjusted OR (aOR) 10.85; 95% CI 3.80 to 30.96) and knee (aOR 4.92; 95% CI 2.58 to 9.38), and pain at the hip (aOR 5.55; 95% CI 1.83 to 16.86) and knee (aOR 2.65; 95% CI 1.57 to 4.46). Widespread pain was associated with pain at the hip (aOR 7.63; 95% CI 1.84 to 31.72) and knee (aOR 4.77; 95% CI 1.58 to 14.41). Older age, obesity, knee malalignment, comorbidities, hypermobility and weight-bearing exercise were associated with hip and knee OA and/or pain. CONCLUSIONS This study detected an association between several factors and hip and knee pain/OA in retired GB Olympic athletes. These associations require further substantiation in retired athletes from other National Olympic Committees, and through comparison with the general population. Longitudinal follow-up is needed to investigate the factors associated with the onset and progression of OA/pain, and to determine if modulation of such factors can reduce the prevalence of pain and OA in this population.
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Affiliation(s)
- Dale J Cooper
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Brigitte E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, The University of Nottingham, and Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, UK
| | - Mark E Batt
- Nottingham University Hospitals NHS Trust and Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Queen's Medical Centre, Nottingham, UK
| | - Debbie Palmer
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
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28
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Hossain KMZ, Patel U, Kennedy AR, Macri-Pellizzeri L, Sottile V, Grant DM, Scammell BE, Ahmed I. Porous calcium phosphate glass microspheres for orthobiologic applications. Acta Biomater 2018; 72:396-406. [PMID: 29604438 DOI: 10.1016/j.actbio.2018.03.040] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/07/2018] [Accepted: 03/22/2018] [Indexed: 01/07/2023]
Abstract
Orthobiologics is a rapidly advancing field utilising cell-based therapies and biomaterials to enable the body to repair and regenerate musculoskeletal tissues. This paper reports on a cost-effective flame spheroidisation process for production of novel porous glass microspheres from calcium phosphate-based glasses to encapsulate and deliver stem cells. Careful selection of the glass and pore-forming agent, along with a manufacturing method with the required processing window enabled the production of porous glass microspheres via a single-stage manufacturing process. The morphological and physical characterisation revealed porous microspheres with tailored surface and interconnected porosity (up to 76 ± 5%) with average pore size of 55 ± 8 µm and surface areas ranging from 0.34 to 0.9 m2 g-1. Furthermore, simple alteration of the processing parameters produced microspheres with alternate unique morphologies, such as with solid cores and surface porosity only. The tuneable porosity enabled control over their surface area, degradation profiles and hence ion release rates. Furthermore, cytocompatibility of the microspheres was assessed using human mesenchymal stem cells via direct cell culture experiments and analysis confirmed that they had migrated to within the centre of the microspheres. The novel microspheres developed have huge potential for tissue engineering and regenerative medicine applications. STATEMENT OF SIGNIFICANCE This manuscript highlights a simple cost-effective one-step process for manufacturing porous calcium phosphate-based glass microspheres with varying control over surface pores and fully interconnected porosity via a flame spheroidisation process. Moreover, a simple alteration of the processing parameters can produce microspheres which have a solid core with surface pores only. The tuneable porosity enabled control over their surface area, degradation profiles and hence ion release rates. The paper also shows that stem cells not only attach and proliferate but more importantly migrate to within the core of the porous microspheres, highlighting applications for bone tissue engineering and regenerative medicine.
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29
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das Nair R, Mhizha-Murira JR, Anderson P, Carpenter H, Clarke S, Groves S, Leighton P, Scammell BE, Topcu G, Walsh DA, Lincoln NB. Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial. Clin Rehabil 2018; 32:777-789. [PMID: 29424236 PMCID: PMC5987849 DOI: 10.1177/0269215518755426] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the feasibility of conducting a trial of a pre-surgical psychological intervention on pain, function, and mood in people with knee osteoarthritis listed for total knee arthroplasty. DESIGN Multi-centre, mixed-methods feasibility randomized controlled trial of intervention plus usual care versus usual care. SETTING Participants' homes or hospital. PARTICIPANTS Patients with knee osteoarthritis listed for total knee arthroplasty and score >7 on either subscales of Hospital Anxiety and Depression Scale. INTERVENTION Up-to 10 sessions of psychological intervention (based on cognitive behavioural therapy). MAIN MEASURES Feasibility outcomes (recruitment and retention rates, acceptability of trial procedures and intervention, completion of outcome measures), and standardized questionnaires assessing pain, function, and mood at baseline, and four and six months post-randomisation. RESULTS Of 222 people screened, 81 did not meet inclusion criteria, 64 did not wish to participate, 26 were excluded for other reasons, and 51 were randomized. A total of 30 completed 4-month outcomes and 25 completed 6-month outcomes. Modal number of intervention sessions completed was three (range 2-8). At 6-month follow-up, mood, pain, and physical function scores were consistent with clinically important benefits from intervention, with effect sizes ranging from small ( d = 0.005) to moderate ( d = 0.74), and significant differences in physical function between intervention and usual care groups ( d = 1.16). Feedback interviews suggested that participants understood the rationale for the study, found the information provided adequate, the measures comprehensive, and the intervention acceptable. CONCLUSION A definitive trial is feasible, with a total sample size of 444 people. Pain is a suitable primary outcome, but best assessed 6 and 12 months post-surgery.
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Affiliation(s)
- Roshan das Nair
- 1 Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK.,2 Institute of Mental Health, Nottinghamshire Healthcare Trust, Nottingham, UK
| | | | - Pippa Anderson
- 4 Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Hannah Carpenter
- 5 Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Simon Clarke
- 6 Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Sam Groves
- 4 Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Paul Leighton
- 7 NIHR Research Design Service for the East Midlands, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Brigitte E Scammell
- 8 Arthritis Research UK Pain Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Gogem Topcu
- 1 Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| | - David A Walsh
- 8 Arthritis Research UK Pain Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.,9 Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, UK
| | - Nadina B Lincoln
- 5 Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, UK
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Cooper DJ, Scammell BE, Batt ME, Palmer D. Development and validation of self-reported line drawings of the modified Beighton score for the assessment of generalised joint hypermobility. BMC Med Res Methodol 2018; 18:11. [PMID: 29343224 PMCID: PMC5772709 DOI: 10.1186/s12874-017-0464-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 12/20/2017] [Indexed: 12/01/2022] Open
Abstract
Background The impracticalities and comparative expense of carrying out a clinical assessment is an obstacle in many large epidemiological studies. The purpose of this study was to develop and validate a series of electronic self-reported line drawing instruments based on the modified Beighton scoring system for the assessment of self-reported generalised joint hypermobility. Methods Five sets of line drawings were created to depict the 9-point Beighton score criteria. Each instrument consisted of an explanatory question whereby participants were asked to select the line drawing which best represented their joints. Fifty participants completed the self-report online instrument on two occasions, before attending a clinical assessment. A blinded expert clinical observer then assessed participants’ on two occasions, using a standardised goniometry measurement protocol. Validity of the instrument was assessed by participant-observer agreement and reliability by participant repeatability and observer repeatability using unweighted Cohen’s kappa (k). Validity and reliability were assessed for each item in the self-reported instrument separately, and for the sum of the total scores. An aggregate score for generalised joint hypermobility was determined based on a Beighton score of 4 or more out of 9. Results Observer-repeatability between the two clinical assessments demonstrated perfect agreement (k 1.00; 95% CI 1.00, 1.00). Self-reported participant-repeatability was lower but it was still excellent (k 0.91; 95% CI 0.74, 1.00). The participant-observer agreement was excellent (k 0.96; 95% CI 0.87, 1.00). Validity was excellent for the self-report instrument, with a good sensitivity of 0.87 (95% CI 0.81, 0.91) and excellent specificity of 0.99 (95% CI 0.98, 1.00). Conclusions The self-reported instrument provides a valid and reliable assessment of the presence of generalised joint hypermobility and may have practical use in epidemiological studies. Electronic supplementary material The online version of this article (10.1186/s12874-017-0464-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dale J Cooper
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England
| | - Brigitte E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England. .,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England. .,Nottingham University Hospitals NHS Trust, Nottingham, England.
| | - Mark E Batt
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England.,Nottingham University Hospitals NHS Trust, Nottingham, England
| | - Debbie Palmer
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, England.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Nottingham, Nottingham, England.,School of Applied Sciences, Edinburgh Napier University, Edinburgh, Scotland
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Khan T, Alvand A, Prieto-Alhambra D, Culliford DJ, Judge A, Jackson WF, Scammell BE, Arden NK, Price AJ. ACL and meniscal injuries increase the risk of primary total knee replacement for osteoarthritis: a matched case-control study using the Clinical Practice Research Datalink (CPRD). Br J Sports Med 2018; 53:965-968. [PMID: 29331994 DOI: 10.1136/bjsports-2017-097762] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether ACL injury (ACLi) or meniscal injury increases the risk of end-stage osteoarthritis (OA) resulting in total knee replacement (TKR). METHODS A matched case-control study of all TKRs performed in the UK between January 1990 and July 2011 and recorded in the Clinical Practice Research Datalink (CPRD) was undertaken. The CPRD contains longitudinal data on approximately 3.6 million patients. Two controls were selected for each case of TKR, matched on age, sex and general practitioner location as a proxy for socioeconomic status. Individuals with inflammatory arthritis were excluded. The odds of having TKR for individuals with a CPRD-recorded ACLi were compared with those without ACLi using conditional logistic regression, after adjustment for body mass index, previous knee fracture and meniscal injury. The adjusted odds of TKR in individuals with a recorded meniscal injury compared with those without were calculated. RESULTS After exclusion of individuals with inflammatory arthritis, there were 49 723 in the case group and 104 353 controls. 153 (0.31%) cases had a history of ACLi compared with 41 (0.04%) controls. The adjusted OR of TKR after ACLi was 6.96 (95% CI 4.73 to 10.31). 4217 (8.48%) individuals in the TKR group had a recorded meniscal injury compared with 669 (0.64%) controls. The adjusted OR of TKR after meniscal injury was 15.24 (95% CI 13.88 to 16.69). CONCLUSION This study demonstrates that ACLi is associated with a sevenfold increased odds of TKR resulting from OA. Meniscal injury is associated with a 15-fold increase odds of TKR for OA.
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Affiliation(s)
- Tanvir Khan
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Abtin Alvand
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Daniel Prieto-Alhambra
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - David J Culliford
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Andrew Judge
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - William F Jackson
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nigel K Arden
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Andrew James Price
- NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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32
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Walker JA, Scammell BE, Bayston R. A web-based survey to identify current practice in skeletal pin site management. Int Wound J 2017; 15:250-257. [PMID: 29250909 DOI: 10.1111/iwj.12858] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/11/2017] [Indexed: 11/30/2022] Open
Abstract
Infections associated with percutaneous pins and wires are common complications which can have a significant impact on patient outcomes. A survey was undertaken to identify current practice and gain insight into variations of clinical practice. Invitations were sent by email to complete an electronic questionnaire using SurveyMonkey. The survey was left open for 100 days. The single largest group of respondents (37.4%, n = 120) cleansed pin sites daily, with significant differences identified between medical and nursing professions (P = 0.02), and country of practice (P < 0.001). Significant differences were also identified in the use of different cleansing solutions between medical and nursing professions (P < 0.001) and country (P < 0.001). The majority group preferences were saline 30% (n = 96) and alcoholic chlorhexidine 29.6% (n = 95). Pin site crusts were routinely removed by 57.9% (n = 186). Pin sites were left exposed by 50.3% (n = 160). Dry gauze was identified as the most common dressing used to dress pin sites, however, substantial variation was identified in the types of dressings used. Compression was not routinely applied to pin sites by 51.6% (n = 165). There remains considerable diversity of practice when caring for pin sites. Further research is required to identify the most effective methods in preventing pin site infection.
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Affiliation(s)
- Jennie A Walker
- Surgery Division, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Brigitte E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - Roger Bayston
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
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33
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Huang J, Burston JJ, Li L, Ashraf S, Mapp PI, Bennett AJ, Ravipati S, Pousinis P, Barrett DA, Scammell BE, Chapman V. Targeting the D Series Resolvin Receptor System for the Treatment of Osteoarthritis Pain. Arthritis Rheumatol 2017; 69:996-1008. [PMID: 27860453 PMCID: PMC5763389 DOI: 10.1002/art.40001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
Abstract
Objective Pain is a major symptom of osteoarthritis (OA); currently available analgesics either do not provide adequate pain relief or are associated with serious side effects. The aim of this study was to investigate the therapeutic potential of targeting the resolvin receptor system to modify OA pain and pathology. Methods Gene expression of 2 resolvin receptors (ALX and ChemR23) was quantified in synovium and medial tibial plateau specimens obtained from patients with OA at the time of joint replacement surgery. Two models of OA joint pain were used for the mechanistic studies. Gene expression in the joint and central nervous system was quantified. The effects of exogenous administration of the D series resolvin precursor 17(R)‐hydroxy‐docosahexaenoic acid (17[R]‐HDoHE) on pain behavior, joint pathology, spinal microglia, and astroglyosis were quantified. Plasma levels of relevant lipids, resolvin D2, 17(R)‐HDoHE, and arachidonic acid, were determined in rats, using liquid chromatography tandem mass spectrometry. Results There was a positive correlation between resolvin receptor and interleukin‐6 (IL‐6) expression in human OA synovial and medial tibial plateau tissue. In rats, synovial expression of ALX was positively correlated with expression of IL‐1β, tumor necrosis factor, and cyclooxygenase 2. Treatment with 17(R)‐HDoHE reversed established pain behavior (but not joint pathology) in 2 models of OA pain. This was associated with a significant elevation in the plasma levels of resolvin D2 and a significant reduction in astrogliosis in the spinal cord in the monosodium iodoacetate–induced OA rat model. Conclusion Our preclinical data demonstrate the robust analgesic effects of activation of the D series resolvin pathways in 2 different animal models of OA. Our data support a predominant central mechanism of action in clinically relevant models of OA pain.
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Affiliation(s)
| | | | - Li Li
- University of Nottingham, Nottingham, UK
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34
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Rodrigues JN, Zhang W, Scammell BE, Davidson D, Fullilove S, Chakrabarti I, Russell PG, Davis TRC. Recovery, responsiveness and interpretability of patient-reported outcome measures after surgery for Dupuytren's disease. J Hand Surg Eur Vol 2017; 42:301-309. [PMID: 27872343 DOI: 10.1177/1753193416677712] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This prospective cohort study investigated the responsiveness and interpretability of the Disabilities of the Arm, Shoulder and Hand (DASH) and Unité Rhumatologique des Affections de la Main (URAM) outcome measures for assessing recovery after fasciectomy and dermofasciectomy for Dupuytren's disease. DASH outcome scores at 1 year were significantly better than at 6 weeks, suggesting that recovery is not complete by 6 weeks. Of the 101 patients recruited to the DASH cohort, 71 completed preoperative, 6 week and 1 year postoperative DASH scores; 68 of them completed preoperative and 1 year postoperative DASH scores and an external anchor question. In the URAM cohort, 30/44 completed the preoperative and the 1 year postoperative URAM scores and the anchor question. The DASH score exhibited moderate responsiveness but poor interpretability on receiver operating characteristic curve analysis, such that a minimal important change could not be estimated. The URAM score showed acceptable responsiveness, and an MIC of 10.5 on receiver operating characteristic analysis. LEVEL OF EVIDENCE II.
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Affiliation(s)
- J N Rodrigues
- 1 Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - W Zhang
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D Davidson
- 3 St John's Hospital at Howden, Livingston, UK
| | | | | | - P G Russell
- 6 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| | - T R C Davis
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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35
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Karam E, Shivji FS, Bhattacharya A, Bryson DJ, Forward DP, Scammell BE, Ollivere BJ. A cross-sectional study of the impact of physiotherapy and self directed exercise on the functional outcome of internally fixed isolated unimalleolar Weber B ankle fractures. Injury 2017; 48:531-535. [PMID: 27889109 DOI: 10.1016/j.injury.2016.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/29/2016] [Accepted: 11/16/2016] [Indexed: 02/02/2023]
Abstract
This study aimed to measure the functional outcome and quality of life in a group of patients with the same fracture type (unimalleolar Weber B ankle fractures) treated operatively at various time points and to explore the determinants of such outcomes. A cross-sectional retrospective population study was conducted. Validated Patient Related Outcome Measures (PROMs) and patient interviews were used. Fifty-one patients were included with a mean age of 54.9 years. Mean follow-up was 25 months (range 4-46 months). Mean functional scores were high (mean AOFAS 79.2, O&M 75.7, VAS-FA 80.5). However, 32% of patients did not classify themselves as fully recovered during interviews. Patient reported self-directed exercise had a statistically significant positive effect on self-reported patient perceptions of outcome (p=0.022) and PROMs (AOFAS p=0.01, O&M p=0.016, VAS-FA p=0.011). Formal physiotherapy rehabilitation was found to have no effect on self-reported patient perceptions (p=0.242) or PROMs (AOFAS p=0.8, O&M p=0.73, VAS-FA p=0.46). Our finding that physical activity is associated with improved outcome would suggest structured exercise programmes should be considered in place of physiotherapy to optimise patient outcomes.
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Affiliation(s)
- E Karam
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - F S Shivji
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Bhattacharya
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D J Bryson
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D P Forward
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - B J Ollivere
- University of Nottingham and Nottingham University Hospitals NHS Trust, Nottingham, UK
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Wyatt LA, Moreton BJ, Mapp PI, Wilson D, Hill R, Ferguson E, Scammell BE, Walsh DA. Histopathological subgroups in knee osteoarthritis. Osteoarthritis Cartilage 2017; 25:14-22. [PMID: 27720884 DOI: 10.1016/j.joca.2016.09.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Revised: 09/01/2016] [Accepted: 09/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a heterogeneous, multi-tissue disease. We hypothesised that different histopathological features characterise different stages during knee OA progression, and that discrete subgroups can be defined based on validated measures of OA histopathological features. DESIGN Medial tibial plateaux and synovium were from 343 post-mortem (PM) and 143 OA arthroplasty donations. A 'chondropathy/osteophyte' group (n = 217) was classified as PM cases with osteophytes or macroscopic medial tibiofemoral chondropathy lesions ≥grade 3 to represent pre-surgical (early) OA. 'Non-arthritic' controls (n = 48) were identified from the remaining PM cases. Mankin histopathological scores were subjected to Rasch analysis and supplemented with histopathological scores for subchondral bone marrow replacement and synovitis. Item weightings were derived by principle components analysis (PCA). Histopathological subgroups were sought using latent class analysis (LCA). RESULTS Chondropathy, synovitis and osteochondral pathology were each associated with OA at arthroplasty, but each was also identified in some 'non-arthritic' controls. Tidemark breaching in the chondropathy/osteophyte group was greater than in non-arthritic controls. Three histopathological subgroups were identified, characterised as 'mild OA', or 'severe OA' with mild or moderate/severe synovitis. CONCLUSIONS Presence and severity of synovitis helps define distinct histopathological OA subgroups. The absence of a discrete 'normal' subgroup indicates a pathological continuum between normality and OA status. Identifying specific pathological processes and their clinical correlates in OA subgroups has potential to accelerate the development of more effective therapies.
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Affiliation(s)
- L A Wyatt
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.
| | - B J Moreton
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - P I Mapp
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D Wilson
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - R Hill
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
| | - E Ferguson
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; School of Psychology, University of Nottingham, Nottingham, UK
| | - B E Scammell
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK
| | - D A Walsh
- Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, UK; Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK; Department of Rheumatology, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, UK
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Rodrigues JN, Zhang W, Scammell BE, Chakrabarti I, Russell PG, Fullilove S, Davidson D, Davis TRC. Functional outcome and complications following surgery for Dupuytren's disease: a multi-centre cross-sectional study. J Hand Surg Eur Vol 2017; 42:7-17. [PMID: 27474501 DOI: 10.1177/1753193416660045] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Variables associated with recurrent Dupuytren's disease, or a 'diathesis', have been investigated, but those associated with functional outcome and complications are less well studied. Outcomes 1 or 5 years after an aponeurotomy, fasciectomy or dermofasciectomy were assessed by patient interview and examination at five UK centres. A total of 432 procedures were studied. The reoperation rate did not differ at 1 year ( p = 0.396, Chi-square test with Monte Carlo simulation), but was higher after aponeurotomy in the 5-year group (30%, versus 6% after fasciectomy and 0% after dermofasciectomy, p = 0.003, Chi square test with Monte Carlo simulation). Loss of function (DASH>15) did not differ between procedures at 5 years, even when reoperation and other variables were controlled. Diabetes, female gender and previous ipsilateral surgery were associated with poorer function in logistic regression analysis. The variables associated with poor function after treatments differ from diathesis variables. Aponeurotomy had lower complication rates than fasciectomy and dermofasciectomy. This may counterbalance the former's higher recurrence rate and explain why aponeurotomy demonstrated similar long-term functional outcome compared with excisional surgery in this study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- J N Rodrigues
- 1 Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | - W Zhang
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - B E Scammell
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - P G Russell
- 4 Pulvertaft Hand Centre, Royal Derby Hospital, Derby, UK
| | | | - D Davidson
- 6 St John's Hospital at Howden, Livingston, UK
| | - T R C Davis
- 2 Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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Pearson RG, Clement RGE, Edwards KL, Scammell BE. Do smokers have greater risk of delayed and non-union after fracture, osteotomy and arthrodesis? A systematic review with meta-analysis. BMJ Open 2016; 6:e010303. [PMID: 28186922 PMCID: PMC5129177 DOI: 10.2106/jbjs.f.00186 10.1136/bmjopen-2015-010303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 09/17/2023] Open
Abstract
OBJECTIVES Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions. SETTING Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Observational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible. DATA EXTRACTION AND OUTCOME MEASURES 2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated. RESULTS The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3). CONCLUSIONS Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.
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Affiliation(s)
- R G Pearson
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - R G E Clement
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - K L Edwards
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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Abstract
OBJECTIVES Systematic review and meta-analysis of published observational cohort studies. To quantify the increased risk smokers have of experiencing a delayed and/or non-union in fractures, spinal fusion, osteotomy, arthrodesis or established non-unions. SETTING Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Allied and Complementary Medicine Database (AMED) and Web of Science Core Collection from 1966 to 2015. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS Observational cohort studies that reported adult smokers and non-smokers with delayed and/or non-union or time to union of the fracture, spinal fusion, osteotomy, arthrodesis or established non-union were eligible. DATA EXTRACTION AND OUTCOME MEASURES 2 authors screen titles, abstracts and full papers. Data were extracted by 1 author and checked independently by a second. The relative risk ratios of smoking versus non-smoking and the mean difference in time to union patients developing a delayed and/or non-union were calculated. RESULTS The search identified 3013 articles; of which, 40 studies were included. The meta-analysis of 7516 procedures revealed that smoking is linked to an increased risk of delayed and/or non-union. When considered collectively, smokers have 2.2 (1.9 to 2.6) times the risk of experiencing delayed and/or non-union. In all the subgroups, the increased risk was always ≥1.6 times that of non-smokers. In the patients where union did occur, it was a longer process in the smokers. The data from 923 procedures were included and revealed an increase in time to union of 27.7 days (14.2 to 41.3). CONCLUSIONS Smokers have twice the risk of experiencing a non-union after fracture, spinal fusion, osteotomy, arthrodesis or treatment of non-union. Time to union following fracture, osteotomy, arthrodesis or treatment of an established non-union is longer in smokers. Smokers should be encouraged to abstain from smoking to improve the outcome of these orthopaedic treatments.
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Affiliation(s)
- R G Pearson
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - R G E Clement
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - K L Edwards
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - B E Scammell
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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40
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Palmer-Green DS, Batt ME, Scammell BE. Simple advice for a simple ankle sprain? The not so benign ankle injury. Osteoarthritis Cartilage 2016; 24:947-8. [PMID: 26778532 DOI: 10.1016/j.joca.2015.12.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/27/2015] [Indexed: 02/02/2023]
Affiliation(s)
- D S Palmer-Green
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK; University of Nottingham, UK
| | - M E Batt
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK; Nottingham University Hospitals NHS Trust, UK
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das Nair R, Anderson P, Clarke S, Leighton P, Lincoln NB, Mhizha-Murira JR, Scammell BE, Walsh DA. Home-administered pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): study protocol for a randomised controlled trial. Trials 2016; 17:54. [PMID: 26818407 PMCID: PMC4730777 DOI: 10.1186/s13063-016-1165-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 01/11/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Knee replacement surgery reduces pain for many people with osteoarthritis (OA). However, surgical outcomes are partly dependent on patients' moods, and those with depression or anxiety have worse outcomes. Approximately one-third of people with OA have mood problems. Cognitive behavioural therapy (CBT), a psychological therapy, is recommended by the National Institute for Health and Care Excellence for improving mood. However, evidence for the effectiveness of CBT before knee surgery in improving pain, mood, and quality of life following this surgery for people with knee OA is lacking. METHODS/DESIGN This is a multi-centre, mixed-methods feasibility randomised controlled trial to compare treatment as usual (TAU) plus a brief CBT-based intervention with a TAU-only control, for people with knee OA. We will recruit 50 patients with knee OA, listed for knee replacement surgery, with high levels of distress (assessed using a mood questionnaire), and who consent to take part. Participants will be randomly allocated to receive TAU plus intervention or TAU. Up to 10 sessions of CBT will be offered on an individual basis by a psychologist. The assessments and interventions will be completed before surgery. Repeat assessments at 4 and 6 months after randomisation will be sent and received by post. Two patient-partners will conduct feedback interviews with some participants to assess what aspects of the intervention were helpful or unhelpful, the acceptability of randomisation, the experience of being in a control group, and the appropriateness of the measures used. Interviews will be audio-recorded, transcribed, and analysed using the framework approach. We will examine the feasibility and acceptability of patient-partners conducting the interviews by also interviewing the patient-partners. DISCUSSION Findings from this study will be used to design a definitive study that will examine the clinical and cost-effectiveness of the CBT intervention in improving patient outcomes following knee surgery. TRIAL REGISTRATION Current Controlled Trials ISRCTN80222865; Date: 19 June 2014.
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Affiliation(s)
- Roshan das Nair
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. .,Department of Clinical Psychology & Neuropsychology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
| | - Simon Clarke
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. .,Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK. .,Physical Health Clinical Psychology Services, Nottinghamshire Healthcare NHS Trust, Pain Management Suite, Clinic 9, King's Mill Hospital, Mansfield, NG17 4JL, UK.
| | - Paul Leighton
- School of Medicine, University of Nottingham, Room 2104, C Floor South Block, Queen's Medical Centre, Nottingham, NG7 2UH, UK.
| | - Nadina B Lincoln
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK. .,Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK.
| | - Jacqueline R Mhizha-Murira
- Division of Rehabilitation & Ageing, Queens Medical Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Brigitte E Scammell
- Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK.
| | - David A Walsh
- Arthritis Research UK Pain Centre, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK. .,Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, NG5 1 PB, UK.
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Karantana A, Scammell BE, Davis TRC, Whynes DK. Cost-effectiveness of volar locking plate versus percutaneous fixation for distal radial fractures: Economic evaluation alongside a randomised clinical trial. Bone Joint J 2015; 97-B:1264-70. [PMID: 26330595 DOI: 10.1302/0301-620x.97b9.35560] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This study compares the cost-effectiveness of treating dorsally displaced distal radial fractures with a volar locking plate and percutaneous fixation. It was performed from the perspective of the National Health Service (NHS) using data from a single-centre randomised controlled trial. In total 130 patients (18 to 73 years of age) with a dorsally displaced distal radial fracture were randomised to treatment with either a volar locking plate (n = 66) or percutaneous fixation (n = 64). The methodology was according to National Institute for Health and Care Excellence guidance for technology appraisals. . There were no significant differences in quality of life scores between groups at any time point in the study. Both groups returned to baseline one year post-operatively. NHS costs for the plate group were significantly higher (p < 0.001, 95% confidence interval 497 to 930). For an additional £713, fixation with a volar locking plate offered 0.0178 additional quality-adjusted life years in the year after surgery. The incremental cost-effectiveness ratio (ICER) for plate fixation relative to percutaneous fixation at list price was £40 068. When adjusting the prices of the implants for a 20% hospital discount, the ICER was £31 898. Patients who underwent plate fixation did not return to work earlier. We found no evidence to support the cost-effectiveness, from the perspective of the NHS, of fixation using a volar locking plate over percutaneous fixation for the operative treatment of a dorsally displaced radial fracture.
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Affiliation(s)
- A Karantana
- Academic Orthopaedics, Trauma and Sports Medicine, Arthritis Research UK Pain and Sports, Exercise and Osteoarthritis Centres, School of MedicineUniversity of Nottingham and Nottingham University Hospitals NHS Trust
| | - B E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, Arthritis Research UK Pain and Sports, Exercise and Osteoarthritis Centres, School of MedicineUniversity of Nottingham and Nottingham University Hospitals NHS Trust
| | - T R C Davis
- Nottingham University Hospitals NHS Trust, C Floor, West Block, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - D K Whynes
- University of Nottingham, School of Economics, University Park, Nottingham NG7 2RD, UK
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Stoppiello LA, Mapp PI, Wilson D, Hill R, Scammell BE, Walsh DA. Structural associations of symptomatic knee osteoarthritis. Arthritis Rheumatol 2015; 66:3018-27. [PMID: 25049144 PMCID: PMC4309484 DOI: 10.1002/art.38778] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 07/03/2014] [Indexed: 01/01/2023]
Abstract
Objective Structural changes of osteoarthritis (OA) may occur in the absence of pain. In this study, we aimed to identify histopathologic features that are associated with symptomatic knee OA. Methods Medial tibial plateaus and synovium samples were obtained at the time of total knee replacement (TKR) surgery for OA (advanced OA group) or were obtained postmortem from subjects who had not sought medical attention for knee pain during the last year of life (non-OA control group). To identify features of OA, we compared the patients with advanced OA with the age-matched non-OA controls (n = 26 per group). To identify OA features associated with symptoms, we compared two additional groups of subjects who were matched for severity of chondropathy (n = 29 per group): patients undergoing TKR for symptomatic OA (symptomatic chondropathy group) and postmortem subjects with similar severity of chondropathy who were asymptomatic during the last year of life (asymptomatic chondropathy group). The histologic features of the samples were graded, and immunoreactivities for macrophages (CD68) and nerve growth factor (NGF) in the synovium were quantified. The cellular localization of synovial NGF was determined by double immunofluorescence analysis. Results Advanced OA cases displayed more severe changes in the synovium (synovitis, increased synovial NGF, and CD68-immunoreactive macrophages) and cartilage (loss of cartilage surface integrity, loss of proteoglycan, tidemark breaching, and alterations in chondrocyte morphology) than did the non-OA controls. Synovial NGF was localized predominantly to fibroblasts and to some macrophages. The symptomatic chondropathy group displayed greater levels of synovitis, synovial NGF, and loss of cartilage integrity, in addition to alterations in chondrocyte morphology, than did the asymptomatic chondropathy group (P < 0.05 for each comparison). Conclusion Synovitis, increased synovial NGF, alterations in chondrocyte morphology, and loss of cartilage integrity are features of knee OA that may be associated with symptoms.
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Affiliation(s)
- Laura A Stoppiello
- Arthritis Research UK Pain Centre and University of Nottingham, Nottingham, UK
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Rodrigues JN, Zhang W, Scammell BE, Davis TRC. What patients want from the treatment of Dupuytren's disease--is the Unité Rhumatologique des Affections de la Main (URAM) scale relevant? J Hand Surg Eur Vol 2015; 40:150-4. [PMID: 24563499 DOI: 10.1177/1753193414524689] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Patients awaiting surgery for Dupuytren's contractures listed the problems from their Dupuytren's disease that had led them to request surgery and their relative priorities of the results of surgery. The listed problems were compared with the nine items comprising the Unité Rhumatologique des Affections de la Main (URAM) Dupuytren's disease-specific outcome measure. One hundred and ten patients reported 278 problems. Ninety-four different combinations of problems were provided by patients, and over half (55%) of the problems were not captured by items in the URAM scale. The long-term outcome from surgery was relatively more important to patients than speed of recovery. The URAM tool may not be relevant to patients in the UK, and further assessment of its face validity is required before it is used.
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Affiliation(s)
- J N Rodrigues
- Division of Orthopaedic & Accident Surgery, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - W Zhang
- Division of Academic Rheumatology, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, UK
| | - B E Scammell
- Division of Orthopaedic & Accident Surgery, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - T R C Davis
- Division of Orthopaedic & Accident Surgery, University of Nottingham & Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
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Abstract
Dynamism of Dupuytren's contractures may occur if a contracture crosses over both the metacarpophalangeal (MCPJ) and proximal interphalangeal (PIPJ) joints of one finger. In this situation the extension deficit at one joint can be influenced by the position of the other. This may affect clinical measurements and introduce errors and bias into research using angular deformity as an endpoint. This study reports the dynamism encountered when measuring passive joint extension deficits in pre-operative contractures. Eighty-five digits with a contracture affecting the PIPJ or MCPJ and PIPJ on 72 hands from 70 patients were studied. Seventy-six digits showed dynamism at either the MCPJ or PIPJ (89%). Seventy-four showed dynamism at the PIPJ (87%). The mean dynamism observed was 6° at the MCPJ and 14° at the PIPJ. Previous Dupuytren's surgery to the finger did not influence the amount of dynamism seen. Dynamism is common and may be a source of error or bias in trials of Dupuytren's disease treatment.
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Affiliation(s)
- J N Rodrigues
- Division of Orthopaedic & Accident Surgery, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - W Zhang
- Division of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - B E Scammell
- Division of Orthopaedic & Accident Surgery, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T R C Davis
- Division of Orthopaedic & Accident Surgery, University of Nottingham & Nottingham University Hospitals NHS Trust, Nottingham, UK
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Abstract
INTRODUCTION Dislocation following hip hemiarthroplasty (HHA), its incidence, predictors, treatment outcomes and mortality were investigated in a single centre series. METHODS The prospectively collected data on neck of femur fracture admissions compiled over 11 years were reviewed. Place of residence, place of fall, past medical history, intraoperative factors (grade of surgeon, delay in surgery, type of implant and operative time), postoperative complications and mortality were compared between patients who suffered a dislocation and those who did not. In the dislocation group, the mean number of dislocations, reduction method, type and fate of implant, and mortality were investigated. RESULTS Prospective data on 8,631 admissions were collected; 41% of these were managed with a HHA. The dislocation rate was 0.76%. A delay in surgery of >24 hours was associated with a fourfold increase in the dislocation risk. The majority (81%) of dislocations occurred in the first six weeks and closed manipulation was the definitive treatment in only 23% of the cases. The mortality rate was not increased following HHA dislocation. CONCLUSIONS The delay in surgery was the most important predictor of HHA dislocation. Closed reduction was associated with a high failure rate. While an initial attempt at closed reduction for a first dislocation is recommended, for redislocators, we recommend early exploration/revision as an alternative to repeat manipulations.
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Affiliation(s)
- K M I Salem
- Nottingham University Hospitals NHS Trust, UK
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47
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Affiliation(s)
- Brigitte E Scammell
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Queen's Medical Centre, Nottingham, UK
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48
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Beaudreuil J, Orcel P, Bardin T, Rodrigues JN, Zhang W, Scammell BE, Davis TRC. Re: Rodrigues JN, Zhang W, Scammell BE, Davis TRC. What patients want from the treatment of Dupuytren's disease - is the Unité Rhumatologique des Affections de la Main (URAM) scale relevant? J Hand Surg Eur. Epub ahead of print 21 February 2014. DOI: 10.1177/1753193414524689. J Hand Surg Eur Vol 2014; 39:673-4. [PMID: 24939553 DOI: 10.1177/1753193414535885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- J Beaudreuil
- Unité Rhumatologique des Affections de la Main (URAM), service de Rhumatologie, Hôpital Lariboisière, Paris, France
| | - P Orcel
- Unité Rhumatologique des Affections de la Main (URAM), service de Rhumatologie, Hôpital Lariboisière, Paris, France
| | - T Bardin
- Unité Rhumatologique des Affections de la Main (URAM), service de Rhumatologie, Hôpital Lariboisière, Paris, France
| | - J N Rodrigues
- Unité Rhumatologique des Affections de la Main (URAM), service de Rhumatologie, Hôpital Lariboisière, Paris, France
| | - W Zhang
- Division of Orthopaedic & Accident Surgery, University of Nottingham, Nottingham, UK
| | - B E Scammell
- Unité Rhumatologique des Affections de la Main (URAM), service de Rhumatologie, Hôpital Lariboisière, Paris, France
| | - T R C Davis
- Unité Rhumatologique des Affections de la Main (URAM), service de Rhumatologie, Hôpital Lariboisière, Paris, France
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Rodrigues JN, Zhang W, Scammell BE, Davis TRC. Re: Rodrigues JN, Zhang W, Scammell BE, Davis TRC. What patients want from the treatment of Dupuytren's disease - is the Unité Rhumatologique des Affections de la Main (URAM) scale relevant? J Hand Surg Eur. Epub ahead of print 21 February 2014. DOI: 10.1177/1753193414524689. J Hand Surg Eur Vol 2014; 39:674-5. [PMID: 25992403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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50
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McLaren JS, White LJ, Cox HC, Ashraf W, Rahman CV, Blunn GW, Goodship AE, Quirk RA, Shakesheff KM, Bayston R, Scammell BE. A biodegradable antibiotic-impregnated scaffold to prevent osteomyelitis in a contaminated in vivo bone defect model. Eur Cell Mater 2014; 27:332-49. [PMID: 24908426 DOI: 10.22203/ecm.v027a24] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Open fractures are at risk of serious infection and, if infected, require several surgical interventions and courses of systemic antibiotics. We investigated a new injectable formulation that simultaneously hardens in vivo to form a porous scaffold for bone repair and delivers antibiotics at high concentrations to the local site of infection. Duration of antimicrobial activity against Staphylococcus aureus was determined using the serial plate transfer test. Ultimate compressive strength and porosity of the material was measured with and without antibiotics. The material was evaluated in vivo in an ovine medial femoral condyle defect model contaminated with S. aureus. Sheep were sacrificed at either 2 or 13 weeks and the defect and surrounding bone assessed using micro-computed tomography and histology. Antimicrobial activity in vitro persisted for 19-21 days. Sheep with antibiotic-free material and bacteria became infected, while those with antibiotic-containing material and bacteria did not. Similarly, new bone growth was seen in uninoculated animals with plain polymer, and in those with antibiotic polymer with bacteria, but not in sheep with plain polymer and bacteria. The antibiotic-impregnated scaffolds were effective in preventing S. aureus infections whilst supporting bone growth and repair. If translated into clinical practice, this approach might reduce the need for systemic antibiotics.
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Affiliation(s)
- J S McLaren
- University of Nottingham, Academic Orthopaedics, Trauma and Sports Medicine, Queen's Medical Centre, Nottingham, NG7 2UH,
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