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Kearney R, McKeown R, Parsons N, Parsons H, Haque A, Brown J, Kefford S, Underwood M, Redmond A, Mason J, Nwankwo H, Costa M. Ankle Injury Rehabilitation (AIR): A multicentre randomised controlled trial and economic evaluation. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Parsons N, Outsikas A, Parish A, Clohesy R, D'Aprano F, Toomey F, Advani S, Poudel GR. Modelling the Anatomic Distribution of Neurologic Events in Patients with COVID-19: A Systematic Review of MRI Findings. AJNR Am J Neuroradiol 2021; 42:1190-1195. [PMID: 33888458 DOI: 10.3174/ajnr.a7113] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Neurologic events have been reported in patients with coronavirus disease 2019 (COVID-19). However, a model-based evaluation of the spatial distribution of these events is lacking. PURPOSE Our aim was to quantitatively evaluate whether a network diffusion model can explain the spread of small neurologic events. DATA SOURCES The MEDLINE, EMBASE, Scopus, and LitCovid data bases were searched from January 1, 2020, to July 19, 2020. STUDY SELECTION Thirty-five case series and case studies reported 317 small neurologic events in 123 unique patients with COVID-19. DATA ANALYSIS Neurologic events were localized to gray or white matter regions of the Illinois Institute of Technology (gray-matter and white matter) Human Brain Atlas using radiologic images and descriptions. The total proportion of events was calculated for each region. A network diffusion model was implemented, and any brain regions showing a significant association (P < .05, family-wise error-corrected) between predicted and measured events were considered epicenters. DATA SYNTHESIS Within gray matter, neurologic events were widely distributed, with the largest number of events (∼10%) observed in the bilateral superior temporal, precentral, and lateral occipital cortices, respectively. Network diffusion modeling showed a significant association between predicted and measured gray matter events when the spread of pathology was seeded from the bilateral cerebellum (r = 0.51, P < .001, corrected) and putamen (r = 0.4, P = .02, corrected). In white matter, most events (∼26%) were observed within the bilateral corticospinal tracts. LIMITATIONS The risk of bias was not considered because all studies were either case series or case studies. CONCLUSIONS Transconnectome diffusion of pathology via the structural network of the brain may contribute to the spread of neurologic events in patients with COVID-19.
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Affiliation(s)
- N Parsons
- From the Cognitive Neuroscience Unit (N.P.).,School of Psychology (N.P., A.O., A.P., R.C.)
| | - A Outsikas
- School of Psychology (N.P., A.O., A.P., R.C.)
| | - A Parish
- School of Psychology (N.P., A.O., A.P., R.C.)
| | - R Clohesy
- School of Psychology (N.P., A.O., A.P., R.C.)
| | - F D'Aprano
- Melbourne School of Psychological Sciences (F.D.), The University of Melbourne, Melbourne, Australia.,Department of Neurology (F.D.), Royal Melbourne Hospital, Melbourne, Australia
| | - F Toomey
- School of Medicine (F.T.), Deakin University, Melbourne, Australia
| | - S Advani
- Social Behavioural Research Branch (S.A.), National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - G R Poudel
- Department of Health Sciences (G.R.P.), Mary Mackillop Institute for Health Research, Australian Catholic University, Melbourne, Australia.
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Trompeter AJ, Knight R, Parsons N, Costa ML. Corrigenda. Bone Joint J 2021; 103-B:204. [PMID: 33380208 DOI: 10.1302/0301-620x.103b1.bjj-2020-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Geevarghese R, Harding J, Parsons N, Hutchinson C, Parsons C. The relationship of embolic particle size to patient outcomes in prostate artery embolisation for benign prostatic hyperplasia: a systematic review and meta-regression. Clin Radiol 2020; 75:366-374. [PMID: 32000985 DOI: 10.1016/j.crad.2019.12.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/24/2019] [Indexed: 01/06/2023]
Abstract
AIM To explore the relationship of embolic particle size used in prostate artery embolisation (PAE) to patient outcomes. MATERIALS AND METHODS A systematic review of PubMed, EMBASE, and the Cochrane database was undertaken to identify all existing studies using PAE for benign prostatic hyperplasia (BPH). Inclusion criteria included prospective studies reporting baseline and 12-month International Prostate Symptom Score (IPSS) and particle size. Exclusion criteria were overlapping studies, commentaries, abstracts, and letters. Data extraction from eligible studies included the size of embolic particle, particle material, and baseline and 12-month values for the following patient outcomes: IPSS, IPSS quality of life, urinary flow rate (Q-max), prostate volume, prostate specific antigen, and post-void residual volume. A meta-regression analysis was then undertaken to examine the relationship of particle size to patient outcome measures. RESULTS Six studies with a total of 687 patients were identified. Meta-regression analysis demonstrated particle size as a statistically significant (p<0.001) moderator of 12-month IPSS change following PAE. No statistically significant relationships were identified with other patient outcome measures. CONCLUSION Smaller embolic particle size is associated with a greater reduction in IPSS following PAE.
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Affiliation(s)
- R Geevarghese
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK.
| | - J Harding
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - N Parsons
- Department of Statistics and Epidemiology, Warwick Medical School, University of Warwick, Warwick, UK
| | - C Hutchinson
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK; Department of Population Evidence and Technologies, Warwick Medical School, University of Warwick, Warwick, UK
| | - C Parsons
- Department of Clinical and Interventional Radiology, University Hospital Coventry and Warwickshire, Coventry, UK
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Petrou S, Parker B, Masters J, Achten J, Bruce J, Lamb SE, Parsons N, Costa ML. Cost-effectiveness of negative-pressure wound therapy in adults with severe open fractures of the lower limb: evidence from the WOLLF randomized controlled trial. Bone Joint J 2019; 101-B:1392-1401. [DOI: 10.1302/0301-620x.101b11.bjj-2018-1228.r2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 01/30/2023]
Abstract
Aims The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. Results The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. Conclusion This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb. Cite this article: Bone Joint J 2019;101-B:1392–1401.
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Affiliation(s)
- S. Petrou
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - B. Parker
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - J. Masters
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Achten
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - S. E. Lamb
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - N. Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
| | - M. L. Costa
- Warwick Clinical Trials Unit, Warwick Medical School, The University of Warwick, Gibbet Hill Campus, Coventry, UK
- Oxford Trauma, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, UK
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Palinska-Rudzka KE, Ghobara T, Parsons N, Milner J, Lockwood G, Hartshorne GM. Five-year study assessing the clinical utility of anti-Müllerian hormone measurements in reproductive-age women with cancer. Reprod Biomed Online 2019; 39:712-720. [PMID: 31471141 DOI: 10.1016/j.rbmo.2019.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 02/26/2019] [Revised: 05/03/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Abstract
RESEARCH QUESTION An important discussion point before chemotherapy is ovarian toxicity, a side-effect that profoundly affects young women with cancer. Their quality of life after successful treatment, including the ability to conceive, is a major concern. We asked whether serum anti-Müllerian hormone (AMH) measurements before chemotherapy for two most common malignancies are predictive of long-term changes in ovarian reserve? DESIGN A prospective cohort study measured serum AMH in 66 young women with lymphoma and breast cancer, before and at 1 year and 5 years after chemotherapy, compared with 124 healthy volunteers of the same age range (18-43 years). Contemporaneously, patients reported their menses and live births during 5-year follow-up. RESULTS After adjustment for age, serum AMH was 1.4 times higher (95% CI 1.1 to 1.9; P < 0.02) in healthy volunteers than in cancer patients before chemotherapy. A strong correlation was observed between baseline and 5-year AMH in the breast cancer group (P < 0.001, regression coefficient = 0.58, 95% CI 0.29 to 0.89). No significant association was found between presence of menses at 5 years and serum AMH at baseline (likelihood ratio test from logistics regression analysis). CONCLUSIONS Reproductive-age women with malignancy have lower serum AMH than healthy controls even before starting chemotherapy. Pre-chemotherapy AMH was significantly associated with long-term ovarian function in women with breast cancer. At key time points, AMH measurements could be used as a reproductive health advisory tool for young women with cancer. Our results highlight the unsuitability of return of menstruation as a clinical indicator of ovarian reserve after chemotherapy.
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Affiliation(s)
- K E Palinska-Rudzka
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - T Ghobara
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK
| | - N Parsons
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK
| | - J Milner
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G Lockwood
- CARE Fertility Tamworth House, Ventura Park Road, Tamworth B78 3HL, UK
| | - G M Hartshorne
- Warwick Medical School, University of Warwick Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road Coventry CV2 2DX, UK.
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Metcalfe AJ, Ahearn N, Hassaballa MA, Parsons N, Ackroyd CE, Murray JR, Robinson JR, Eldridge JD, Porteous AJ. The Avon patellofemoral joint arthroplasty: two- to 18-year results of a large single-centre cohort. Bone Joint J 2018; 100-B:1162-1167. [PMID: 30168762 DOI: 10.1302/0301-620x.100b9.bjj-2018-0174.r1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [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] [Indexed: 11/05/2022]
Abstract
Aims This study reports on the medium- to long-term implant survivorship and patient-reported outcomes for the Avon patellofemoral joint (PFJ) arthroplasty. Patients and Methods A total of 558 Avon PFJ arthroplasties in 431 patients, with minimum two-year follow-up, were identified from a prospective database. Patient-reported outcomes and implant survivorship were analyzed, with follow-up of up to 18 years. Results Outcomes were recorded for 483 implants (368 patients), representing an 86% follow-up rate. The median postoperative Oxford Knee Score (0 to 48 scale) was 35 (interquartile range (IQR) 25.5 to 43) and the median Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC, 0 to 100 scale) was 35 (IQR 25 to 53) at two years. There were 105 revisions, 61 (58%) for progression of osteoarthritis. All documented revisions were to primary knee systems without augmentation. The implant survival rate was 77.3% (95% confidence interval (CI) 72.4 to 81.7, number at risk 204) at ten years and 67.4% (95% CI 72.4 to 81.7 number at risk 45) at 15 years. Regression analysis of explanatory data variable showed that cases performed in the last nine years had improved survival compared with the first nine years of the cohort, but the individual operating surgeon had the strongest effect on survivorship. Conclusion Satisfactory long-term results can be obtained with the Avon PFJ arthroplasty, with maintenance of patient-reported outcome measures (PROMs), satisfactory survival, and low rates of loosening and wear. Cite this article: Bone Joint J 2018;100-B:1162-7.
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Affiliation(s)
- A J Metcalfe
- Warwick Medical School, Warwick University, Coventry, UK
| | - N Ahearn
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - M A Hassaballa
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - N Parsons
- Warwick Medical School, Warwick University, Coventry, UK
| | - C E Ackroyd
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - J R Murray
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - J R Robinson
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - J D Eldridge
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
| | - A J Porteous
- The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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Affiliation(s)
- M L Costa
- University of Oxford, John Radcliffe Hospital, Oxford, OX3 7UD, UK
| | - X L Griffin
- University of Oxford, John Radcliffe Hospital, Oxford, OX3 7UD, UK
| | - N Parsons
- University of Warwick, Warwick Medical School, Coventry, CV4 7AL, UK
| | - M Dritsaki
- University of Oxford, Oxford, OX3 7HE, UK
| | - D Perry
- University of Liverpool, Easton Rd, Liverpool, L12 2AP, UK
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Sims AL, Parsons N, Achten J, Griffin XL, Costa ML, Reed MR. A randomized controlled trial comparing the Thompson hemiarthroplasty with the Exeter polished tapered stem and Unitrax modular head in the treatment of displaced intracapsular fractures of the hip: the WHiTE 3: HEMI Trial. Bone Joint J 2018; 100-B:352-360. [PMID: 29589786 PMCID: PMC6413801 DOI: 10.1302/0301-620x.100b3.bjj-2017-0872.r2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Indexed: 12/21/2022]
Abstract
Aims This study aimed to compare the change in health-related quality of life of patients receiving a traditional cemented monoblock Thompson hemiarthroplasty compared with a modern cemented modular polished-taper stemmed hemiarthroplasty for displaced intracapsular hip fractures. Patients and Methods This was a pragmatic, multicentre, multisurgeon, two-arm, parallel group, randomized standard-of-care controlled trial. It was embedded within the WHiTE Comprehensive Cohort Study. The sample size was 964 patients. The setting was five National Health Service Trauma Hospitals in England. A total of 964 patients over 60 years of age who required hemiarthroplasty of the hip between February 2015 and March 2016 were included. A standardized measure of health outcome, the EuroQol (EQ-5D-5L) questionnaire, was carried out on admission and at four months following the operation. Results Of the 964 patients enrolled, 482 died or were lost to follow-up (50%). No significant differences were noted in EQ-5D between groups, with a mean difference at four months of 0.037 in favour of the Exeter/Unitrax implant (95% confidence interval (CI) 0.014 to 0.087, p = 0.156), rising to 0.045 (95% CI 0.007 to 0.098, p = 0.09) when patients who died were excluded. The minimum clinically important difference for EQ-5D-5L used in this study is 0.08, therefore any benefit between implants is unlikely to be noticeable to the patient. There was no difference in mortality or mobility score. Conclusion Allowing for the high rate of loss to follow-up, the use of the traditional Thompson hemiarthroplasty in the treatment of the displaced intracapsular hip fracture shows no difference in health outcome when compared with a modern cemented hemiarthroplasty. Cite this article: Bone Joint J 2018;100-B:352-60.
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Affiliation(s)
- A L Sims
- Health Education North East, Waterfront, 4 Goldcrest Way, Newburn Riverside, Newcastle Upon Tyne, NE15 8NY, UK
| | - N Parsons
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - J Achten
- Department of Orthopaedic Trauma, Oxford Trauma, University of Oxford, Kadoorie Centre, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - X L Griffin
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford and Oxford Trauma, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal Science, University of Oxford, OX3 9DU, UK
| | - M L Costa
- NDORMS, Oxford Trauma, Kadoorie Centre, University of Oxford, John Radcliffe Hospital, Windmill Road, Oxford, OX3 9DU, UK
| | - M R Reed
- Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, NE63 9JJ, UK
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Sprowson AP, Jensen C, Parsons N, Partington P, Emmerson K, Carluke I, Asaad S, Pratt R, Muller S, Ahmed I, Reed MR. The effect of triclosan-coated sutures on the rate of surgical site infection after hip and knee arthroplasty: a double-blind randomized controlled trial of 2546 patients. Bone Joint J 2018; 100-B:296-302. [PMID: 29589500 PMCID: PMC6427932 DOI: 10.1302/0301-620x.100b3.bjj-2017-0247.r1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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] [Indexed: 12/22/2022]
Abstract
Aims Surgical site infection (SSI) is a common complication of surgery with an incidence of about 1% in the United Kingdom. Sutures can lead to the development of a SSI, as micro-organisms can colonize the suture as it is implanted. Triclosan-coated sutures, being antimicrobical, were developed to reduce the rate of SSI. Our aim was to assess whether triclosan-coated sutures cause a reduction in SSIs following arthroplasty of the hip and knee. Patients and Methods This two-arm, parallel, double-blinded study involved 2546 patients undergoing elective total hip (THA) and total knee arthroplasty (TKA) at three hospitals. A total of 1323 were quasi-randomized to a standard suture group, and 1223 being quasi-randomized to the triclosan-coated suture group. The primary endpoint was the rate of SSI at 30 days postoperatively. Results The baseline characteristics of age, gender and comorbidities were well matched in the two groups. The rates of superficial SSI were 0.8% in the control group and 0.7% in the intervention group (p = 0.651), and when deep and superficial SSIs were combined the rates were 2.5% and 1.8 (p = 0.266). The length of stay in hospital and the rates of medical complications did not differ significantly between the groups (p = 1.000). Conclusion This trial provided no evidence that the use of triclosan-coated sutures at THA and TKA leads to a reduction in the rate of SSI. Cite this article: Bone Joint J 2018;100-B:296–302.
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Affiliation(s)
- A P Sprowson
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - C Jensen
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - N Parsons
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - P Partington
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - K Emmerson
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - I Carluke
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - S Asaad
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - R Pratt
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - S Muller
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
| | - I Ahmed
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M R Reed
- Wansbeck General Hospital, Woodhorn Lane, Northumberland NE63 9JJ, UK
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Sprowson† AP, Jensen C, Ahmed I, Parsons N, Partington P, Emmerson K, Carluke I, Asaad S, Pratt R, Muller S, Reed MR. Infographic: Triclosan-coated sutures and surgical site infections after hip and knee arthroplasty. Bone Joint J 2018; 100-B:294-295. [DOI: 10.1302/0301-620x.100b3.bjj-2018-0099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 11/05/2022]
Affiliation(s)
- A. P. Sprowson†
- University Hospital Coventry and Warwickshire, Clifford Bridge
Road, Coventry CV2 2DX, UK
| | - C. Jensen
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - I. Ahmed
- University Hospital Coventry and Warwickshire, Clifford Bridge
Road, Coventry CV2 2DX, UK
| | - N. Parsons
- University Hospital Coventry and Warwickshire, Clifford Bridge
Road, Coventry CV2 2DX, UK
| | - P. Partington
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - K. Emmerson
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - I. Carluke
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - S. Asaad
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - R. Pratt
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - S. Muller
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
| | - M. R. Reed
- Wansbeck General Hospital, Woodhorn
Lane, Northumberland NE63 9JJ, UK
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12
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Smith NA, Parsons N, Wright D, Hutchinson C, Metcalfe A, Thompson P, Costa ML, Spalding T. A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment. Bone Joint J 2018; 100-B:56-63. [PMID: 29305451 DOI: 10.1302/0301-620x.100b1.bjj-2017-0918.r1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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 Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months. PATIENTS AND METHODS A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions. RESULTS A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups. CONCLUSION This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Cite this article: Bone Joint J 2018;100-B:56-63.
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Affiliation(s)
- N A Smith
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - N Parsons
- University of Warwick, Coventry, CV7 4AL, UK
| | - D Wright
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - C Hutchinson
- Warwick Medical School, University of Warwick, Coventry CV7 4AL, UK
| | - A Metcalfe
- Warwick Clinical Trials Unit, University of Warwick, Coventry CV7 4AL, UK
| | - P Thompson
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M L Costa
- NDORMS, Windmill Road, Oxford OX3 7LD, UK
| | - T Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
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13
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Affiliation(s)
- N A Smith
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - N Parsons
- Warwick Medical School, Coventry CV4 7AL, UK
| | - D Wright
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - C Hutchinson
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - A Metcalfe
- Warwick Medical School, Coventry CV4 7AL, UK
| | - P Thompson
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M L Costa
- Warwick Clinical Trials Unit, Warwick Medical School, Coventry CV4 7AL, UK and NDORMs, University of Oxford, Oxford OX3 7LD, UK
| | - T Spalding
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, UK
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14
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Parsons N, Griffin XL, Achten J, Chesser TJ, Lamb SE, Costa ML. Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study. Bone Joint Res 2018; 7:1-5. [PMID: 29292297 PMCID: PMC5805834 DOI: 10.1302/2046-3758.71.bjr-2017-0199] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only. METHODS The World Hip Trauma Evaluation has previously reported changes in HRQoL using EuroQol-5D for patients with hip fractures. We performed additional analysis to investigate the effect of including or excluding those patients who died during the first four months of the follow-up period. RESULTS The dataset included 503 patients, 25 of whom died between 30 days and four months of injury. There was a statistically significant difference in 30-day HRQoL between those alive (mean 0.331 and standard deviation (sd) 0.360) and those dead (mean 0.156 and sd 0.421) by four months (independent-samples t-test; p 0.022). The estimated difference of 0.175 in HRQoL (95% confidence interval 0.025 to 0.325) was also highly clinically significant. CONCLUSION When reporting HRQoL for patients after a hip fracture, excluding patients who die during follow-up leads to an overestimate of the effects of the intervention or treatment pathway. We would recommend that death-adjusted estimates should be used routinely when reporting HRQoL in this population.Cite this article: N. Parsons, X. L. Griffin, J. Achten, T. J. Chesser, S. E. Lamb, M. L. Costa. Modelling and estimation of health-related quality of life after hip fracture: A re-analysis of data from a prospective cohort study. Bone Joint Res 2018;7:1-5.
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Affiliation(s)
- N Parsons
- Statistics and Epidemiology, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - X L Griffin
- University of Oxford, Oxford Trauma, Kadoorie Centre, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU, UK
| | - J Achten
- University of Oxford, Oxford Trauma, Kadoorie Centre, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU, UK
| | - T J Chesser
- North Bristol NHS Trust, Southmead Hospital, Southmead Road, Westbury-on-Trym BS10 5NB, UK
| | - S E Lamb
- Director, Centre for Statistics in Medicine, University of Oxford, Oxford Trauma, Kadoorie Centre, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU, UK
| | - M L Costa
- University of Oxford, Oxford Trauma, Kadoorie Centre, John Radcliffe Hospital, Oxford, Oxfordshire OX3 9DU, UK
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15
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Affiliation(s)
- D C Perry
- University of Liverpool, Institute of Translational Medicine, Institute in the Park, Eaton Road, Liverpool, L12 2AP, UK
| | - X L Griffin
- University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, Oxfordshire, OX3 9DU, UK
| | - M Dritsaki
- University of Oxford, Oxford Clinical Trails Research Unit (OCTRU), Botnar Research Centre, OX3 7LD, UK
| | - M L Costa
- University of Oxford, Kadoorie Centre, John Radcliffe Hospital, Oxford, Oxfordshire, OX3 9DU, UK
| | - N Parsons
- Warwick Medical School, University of Warwick, Coventry, West Midlands, CV4 7AL, UK
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16
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Abstract
OBJECTIVES The Sliding Hip Screw (SHS) is commonly used to treat trochanteric hip fractures. Fixation failure is a devastating complication requiring complex revision surgery. One mode of fixation failure is lag screw cut-out which is greatest in unstable fracture patterns and when the tip-apex distance of the lag screw is > 25 mm. The X-Bolt Dynamic Hip Plating System (X-Bolt Orthopaedics, Dublin, Ireland) is a new device which aims to reduce this risk of cut-out. However, some surgeons have reported difficulty minimising the tip-apex distance with subsequent concerns that this may lead to an increased risk of cut-out. PATIENTS AND METHODS We measured the tip-apex distance from the intra-operative radiographs of 93 unstable trochanteric hip fractures enrolled in a randomised controlled trial (Warwick Hip Trauma Evaluation, WHiTE One trial). Participants were treated with either the sliding hip screw or the X-Bolt dynamic hip plating system. We also recorded the incidence of cut-out in both groups, at a median follow-up time of 17 months. RESULTS There was a significantly increased tip-apex distance with the use of the X-Bolt (mean difference 3.7mm (95% confidence interval 1.58 to 5.73); SHS mean 17.1 mm, X-Bolt mean 20.8; p = 0.001. However, this was not associated with an increased incidence of cut-out at a median follow-up time of 17 months, with three cut-outs (6%) in the SHS group and 0 (0%) in the X-Bolt group. CONCLUSION The X-Bolt is a safe implant with no increased risk for cut-out. Concerns about minimising the tip-apex distance may be justified but do not appear to be clinically important.Cite this article: M. A. Fernandez, A. Aquilina, J. Achten, N. Parsons, M. L. Costa, X. L. Griffin. The tip-apex distance in the X-Bolt dynamic plating system. Bone Joint Res 2017;6:-207. DOI: 10.1302/2046-3758.64.BJR-2015-0016.R2.
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Affiliation(s)
- M A Fernandez
- University of Oxford, NDORMS, John Radcliffe Hospital, Oxford OX3 9DU and Specialty Registrar, Trauma and Orthopaedic Surgery, University Hospital Coventry, Clifford Bridge Road, Coventry, CV2 2DX, UK
| | - A Aquilina
- University of Oxford, NDORMS, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - J Achten
- University of Oxford, NDORMS, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - N Parsons
- Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - M L Costa
- University of Oxford, NDORMS, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - X L Griffin
- University of Oxford, NDORMS, John Radcliffe Hospital, Oxford OX3 9DU, UK
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17
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Griffin XL, Parsons N, McArthur J, Achten J, Costa ML. The Warwick Hip Trauma Evaluation One: a randomised pilot trial comparing the X-Bolt Dynamic Hip Plating System with sliding hip screw fixation in complex extracapsular hip fractures: WHiTE (One). Bone Joint J 2017; 98-B:686-9. [PMID: 27143742 DOI: 10.1302/0301-620x.98b5.37350] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 09/29/2015] [Accepted: 01/13/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to inform a definitive trial which could determine the clinical effectiveness of the X-Bolt Dynamic Hip Plating System compared with the sliding hip screw for patients with complex pertrochanteric fragility fractures of the femur. PATIENTS AND METHODS This was a single centre, participant blinded, randomised, standard-of-care controlled pilot trial. Patients aged 60 years and over with AO/ASIF A2 and A3 type femoral pertrochanteric fractures were eligible. RESULTS The primary outcome was the EuroQoL 5 Dimension Score (EQ-5D-3L) at one year following index fixation. A total of 100 participants were recruited, and primary outcome data were available for 88 patients following losses to follow-up and withdrawals. The mean difference in EQ-5D was 0.03 (95% confidence interval -0.17, 0.120; p = 0.720.) There were no significant differences in any of the secondary outcomes measures. The recruitment and follow-up rates from this feasibility study were as predicted. CONCLUSION A definitive trial with 90% power to find a clinically important difference in EQ-5D would require 964 participants based upon the data from this study. We plan to start recruitment to this trial in Spring 2016. TAKE HOME MESSAGE A definitive trial of X-Bolt Dynamic Hip Plating System is feasible and should be conducted now in order to quantify the clinical effectiveness of this novel implant. Cite this article: Bone Joint J 2016;98-B:686-9.
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Affiliation(s)
- X L Griffin
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU, UK
| | - N Parsons
- University of Warwick, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - J McArthur
- University Hospital Coventry, Clifford Bridge Road, CV2 2DX, UK
| | - J Achten
- University of Oxford , Headley Way, Oxford OX3 9DU, UK
| | - M L Costa
- University of Oxford , Headley Way, Oxford OX3 9DU, UK
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18
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Griffin XL, Parsons N, Achten J, Costa ML. A randomised feasibility study comparing total hip arthroplasty with and without dual mobility acetabular component in the treatment of displaced intracapsular fractures of the proximal femur : The Warwick Hip Trauma Evaluation Two : WHiTE Two. Bone Joint J 2017; 98-B:1431-1435. [PMID: 27803216 DOI: 10.1302/0301-620x.98b11.bjj-2016-0478.r1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 06/01/2016] [Accepted: 08/02/2016] [Indexed: 11/05/2022]
Abstract
AIMS The optimal treatment for independent patients with a displaced intracapsular fracture of the hip remains controversial. The recognised alternatives are hemiarthroplasty and total hip arthroplasty. At present there is no established standard of care, with both types of arthroplasty being used in many centres. PATIENTS AND METHODS We conducted a feasibility study comparing the clinical effectiveness of a dual mobility acetabular component compared with standard polyethylene component in total hip arthroplasty for independent patients with a displaced intracapsular fracture of the hip, for a 12-month period beginning in June 2013. The primary outcome was the risk of dislocation one year post-operatively. Secondary outcome measures were EuroQol 5 Dimensions, ICEpop CAPability measure for Older people, Oxford hip score, mortality and re-operation. RESULTS Only 20 patients were recruited during this time. The baseline demographics were similar in the two groups and no patient suffered a dislocation. Differences in secondary outcomes were not analysed due to the small sample. CONCLUSION This feasibility study suggests that any trial investigating the effectiveness of total hip arthroplasty for fracture of the hip might not be deliverable within the constraints of current systems of care in the United Kingdom. Cite this article: Bone Joint J 2016;98-B:1431-5.
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Affiliation(s)
- X L Griffin
- University of Oxford, Kadoorie Centre, Oxford OX3 9DU, UK
| | - N Parsons
- University of Warwick, Gibbet Hill, Coventry, CV4 7AL, UK
| | - J Achten
- University of Oxford, Kadoorie Centre, Oxford OX3 9DU, UK
| | - M L Costa
- University of Oxford, Kadoorie Centre, Oxford OX3 9DU, UK
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19
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Fernandez M, Achten J, Parsons N, Griffin X, Costa M. The X-Bolt dynamic hip plating system: Evaluating a novel surgical device for hip fracture surgery. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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20
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Kearney R, Parsons N, Underwood M, Costa M. Study of tendo Achilles Rupture Rehabilitation (STAR): a feasibility randomised controlled trial comparing plaster cast with functional bracing rehabilitation. Physiotherapy 2016. [DOI: 10.1016/j.physio.2016.10.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Griffin D, Dickenson E, Wall P, Realpe A, Adams A, Parsons N, Hobson R, Achten J, Costa M, Foster N, Hutchinson C, Petrou S, Donovan J. The feasibility of conducting a randomised controlled trial comparing arthroscopic hip surgery to conservative care for patients with femoroacetabular impingement syndrome: the FASHIoN feasibility study. J Hip Preserv Surg 2016; 3:304-311. [PMID: 29632690 PMCID: PMC5883184 DOI: 10.1093/jhps/hnw026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 06/24/2016] [Indexed: 11/13/2022] Open
Abstract
To determine whether it was feasible to perform a randomized controlled trial (RCT) comparing arthroscopic hip surgery to conservative care in patients with femoroacetabular impingement (FAI). This study had two phases: a pre-pilot and pilot RCT. In the pre-pilot, we conducted interviews with clinicians who treated FAI and with FAI patients to determine their views about an RCT. We developed protocols for operative and conservative care. In the pilot RCT, we determined the rates of patient eligibility, recruitment and retention, to investigate the feasibility of the protocol and we established methods to assess treatment fidelity. In the pre-pilot phase, 32 clinicians were interviewed, of which 26 reported theoretical equipoise, but in example scenarios 7 failed to show clinical equipoise. Eighteen patients treated for FAI were also interviewed, the majority of whom felt that surgery and conservative care were acceptable treatments. Surgery was viewed by patients as a 'definitive solution'. Patients were motivated to participate in research but were uncomfortable about randomization. Randomization was more acceptable if the alternative was available at the end of the trial. In the pilot phase, 151 patients were assessed for eligibility. Sixty were eligible and invited to take part in the pilot RCT; 42 consented to randomization. Follow-up was 100% at 12 months. Assessments of treatment fidelity were satisfactory. An RCT to compare arthroscopic hip surgery with conservative care in patients with FAI is challenging but feasible. Recruitment has started for a full RCT.
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Affiliation(s)
- D.R. Griffin
- Warwick Medical School, University of Warwick, Warwick, UK
| | - E.J. Dickenson
- Warwick Medical School, University of Warwick, Warwick, UK
| | - P.D.H. Wall
- Warwick Medical School, University of Warwick, Warwick, UK
| | - A. Realpe
- Warwick Medical School, University of Warwick, Warwick, UK
| | - A. Adams
- Division of Mental Health and Wellbeing, University of Warwick, Warwick, UK
| | - N. Parsons
- Department of Statistics and Epidemiology, University of Warwick, Warwick, UK
| | - R. Hobson
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - J. Achten
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - M.L. Costa
- Warwick Clinical Trials Unit, University of Warwick, Warwick, UK
| | - N.E. Foster
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | | | - S. Petrou
- Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - J.L. Donovan
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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22
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Griffin DR, Dickenson EJ, Wall PDH, Donovan JL, Foster NE, Hutchinson CE, Parsons N, Petrou S, Realpe A, Achten J, Achana F, Adams A, Costa ML, Griffin J, Hobson R, Smith J. Protocol for a multicentre, parallel-arm, 12-month, randomised, controlled trial of arthroscopic surgery versus conservative care for femoroacetabular impingement syndrome (FASHIoN). BMJ Open 2016; 6:e012453. [PMID: 27580837 PMCID: PMC5013508 DOI: 10.1136/bmjopen-2016-012453] [Citation(s) in RCA: 16] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to compare the clinical and cost-effectiveness of arthroscopic surgery versus best conservative care for patients with FAI syndrome. METHODS We will conduct a multicentre, pragmatic, assessor-blinded, two parallel arm, RCT comparing arthroscopic surgery to physiotherapy-led best conservative care. 24 hospitals treating NHS patients will recruit 344 patients over a 26-month recruitment period. Symptomatic adults with radiographic signs of FAI morphology who are considered suitable for arthroscopic surgery by their surgeon will be eligible. Patients will be excluded if they have radiographic evidence of osteoarthritis, previous significant hip pathology or previous shape changing surgery. Participants will be allocated in a ratio of 1:1 to receive arthroscopic surgery or conservative care. Recruitment will be monitored and supported by qualitative intervention to optimise informed consent and recruitment. The primary outcome will be pain and function assessed by the international hip outcome tool 33 (iHOT-33) measured 1-year following randomisation. Secondary outcomes include general health (short form 12), quality of life (EQ5D-5L) and patient satisfaction. The primary analysis will compare change in pain and function (iHOT-33) at 12 months between the treatment groups, on an intention-to-treat basis, presented as the mean difference between the trial groups with 95% CIs. The study is funded by the Health Technology Assessment Programme (13/103/02). ETHICS AND DISSEMINATION Ethical approval is granted by the Edgbaston Research Ethics committee (14/WM/0124). The results will be disseminated through open access peer-reviewed publications, including Health Technology Assessment, and presented at relevant conferences. TRIAL REGISTRATION NUMBER ISRCTN64081839; Pre-results.
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Affiliation(s)
- D R Griffin
- University of Warwick, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E J Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - P D H Wall
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J L Donovan
- University of Bristol, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - N E Foster
- Arthritis Research UK Primary Care Centre, Research Institute of Primary Care and Health Sciences NIHR, Keele University, Keele, UK
| | - C E Hutchinson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - N Parsons
- Warwick Medical School, University of Warwick, Coventry, UK
| | - S Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Realpe
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Achten
- Warwick Medical School, University of Warwick, Coventry, UK
| | - F Achana
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Adams
- Warwick Medical School, University of Warwick, Coventry, UK
| | - M L Costa
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Griffin
- Warwick Medical School, University of Warwick, Coventry, UK
| | - R Hobson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Smith
- Warwick Medical School, University of Warwick, Coventry, UK
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23
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Cooper JA, Moss SM, Smith S, Seaman HE, Taylor-Phillips S, Parsons N, Halloran SP. FIT for the future: a case for risk-based colorectal cancer screening using the faecal immunochemical test. Colorectal Dis 2016; 18:650-3. [PMID: 27135192 DOI: 10.1111/codi.13365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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] [Received: 02/08/2016] [Accepted: 03/09/2016] [Indexed: 12/12/2022]
Abstract
Worldwide, the guaiac faecal occult blood test (gFOBT) is being replaced with the more accurate faecal immunochemical test (FIT) for colorectal cancer (CRC) screening. From January 2016, the National Screening Committee in the UK has recommended a change from the gFOBT to the FIT following a successful Bowel Cancer Screening Programme pilot study with over 40 000 participants. Although the test has shown improved uptake and the ability to detect significantly more colorectal cancers and advanced adenomas, the higher uptake and test positivity will challenge the capacity of colonoscopy services. One of the main advantages of the FIT is that it provides a quantitative haemoglobin concentration which has been shown to relate to the risk of CRC. Risk scoring systems which combine the FIT concentration with risk factor assessment have been shown to improve the sensitivity of the test. This individualized approach to screening could enable those at greatest risk to be referred for colonoscopy, optimizing resource use and ultimately patient outcomes.
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Affiliation(s)
- J A Cooper
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK.
| | - S M Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S Smith
- Midlands and North West Bowel Cancer Screening Hub, Hospital of St Cross, University Hospitals Coventry and Warwickshire NHS Trust, Rugby, UK
| | - H E Seaman
- Surrey Research Park, NHS Bowel Cancer Screening Southern Programme Hub, Guildford, Surrey, UK
| | - S Taylor-Phillips
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - N Parsons
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - S P Halloran
- Department of Biochemistry and Physiology, University of Surrey, Guildford, Surrey, UK
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24
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Hoskins W, Sheehy R, Edwards ER, Hau RC, Bucknill A, Parsons N, Griffin XL. Nails or plates for fracture of the distal femur? Bone Joint J 2016; 98-B:846-50. [DOI: 10.1302/0301-620x.98b6.36826] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [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] [Received: 07/02/2015] [Accepted: 02/01/2016] [Indexed: 11/05/2022]
Abstract
Aims Fractures of the distal femur are an important cause of morbidity. Their optimal management remains controversial. Contemporary implants include angular-stable anatomical locking plates and locked intramedullary nails (IMNs). We compared the long-term patient-reported functional outcome of fixation of fractures of the distal femur using these two methods of treatment. Patients and Methods A total of 297 patients were retrospectively identified from a State-wide trauma registry in Australia: 195 had been treated with a locking plate and 102 with an IMN. Baseline characteristics of the patients and their fractures were recorded. Health-related quality-of-life, functional and radiographic outcomes were compared using mixed effects regression models at six months and one year. Results There was a clinically relevant and significant difference in quality-of-life at six months in favour of fixation with an IMN (mean difference in EuroQol-5 Dimensions Score (EQ-5D) = 0.12; 95% CI 0.02 to 0.22; p = 0.025). There was weak evidence that this trend continued to one year (mean difference EQ-5D = 0.09; 95% CI -0.01 to 0.19; p = 0.073). There was a significant although very small reduction in angular deformity using an IMN (mean difference -1.02; 95% CI -1.99 to -0.06; p = 0.073). There was no evidence that there was a difference in any other outcomes at any time point. Take home message: IMN may be a superior treatment compared with anatomical locking plates for fractures of the distal femur. These findings are concordant with other data from pilot randomised studies which favour treatment of these fractures with an IMN. This study strongly supports the need for a definitive randomised trial. Cite this article: Bone Joint J 2016;98-B:846–50.
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Affiliation(s)
- W. Hoskins
- Royal Melbourne Hospital, Parkville
3050, Victoria, Australia
and the Faculty of Medicine, Dentistry and
Health Sciences, The University of Melbourne, Parkville
3010, Victoria, Australia
| | - R. Sheehy
- Royal Melbourne Hospital, Parkville
3050, Victoria, Australia
| | - E. R. Edwards
- Monash University, Commercial
Rd, Prahran, Victoria
3181, Australia
| | - R. C. Hau
- The Northern Hospital, 185
Cooper Street, Epping, Victoria
3076, Australia
| | - A. Bucknill
- Royal Melbourne Hospital, Parkville
3050, Victoria, Australia
and the Faculty of Medicine, Dentistry and
Health Sciences, The University of Melbourne, Parkville
3010, Victoria, Australia
| | - N. Parsons
- University of Warwick, Coventry
CV4 7AL, UK
| | - X. L. Griffin
- John Radcliffe Hospital, Oxford University
Hospitals NHS Foundation Trust, Headley Way, Oxford
OX3 9DU, UK
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25
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Sims AL, Parsons N, Achten J, Griffin XL, Costa ML, Reed MR. The World Hip Trauma Evaluation Study 3: Hemiarthroplasty Evaluation by Multicentre Investigation - WHITE 3: HEMI - An Abridged Protocol. Bone Joint Res 2016; 5:18-25. [PMID: 26825319 PMCID: PMC4756728 DOI: 10.1302/2046-3758.51.2000473] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Approximately half of all hip fractures are displaced intracapsular fractures. The standard treatment for these fractures is either hemiarthroplasty or total hip arthroplasty. The recent National Institute for Health and Care Excellence (NICE) guidance on hip fracture management recommends the use of ‘proven’ cemented stem arthroplasty with an Orthopaedic Device Evaluation Panel (ODEP) rating of at least 3B (97% survival at three years). The Thompsons prosthesis is currently lacking an ODEP rating despite over 50 years of clinical use, likely due to the paucity of implant survival data. Nationally, adherence to these guidelines is varied as there is debate as to which prosthesis optimises patient outcomes. Design This study design is a multi-centre, multi-surgeon, parallel, two arm, standard-of-care pragmatic randomised controlled trial. It will be embedded within the WHiTE Comprehensive Cohort Study (ISRCTN63982700). The main analysis is a two-way equivalence comparison between Hemi-Thompson and Hemi-Exeter polished taper with Unitrax head. Secondary outcomes will include radiological leg length discrepancy measured as per Bidwai and Willett, mortality, re-operation rate and indication for re-operation, length of index hospital stay and revision at four months. This study will be supplemented by the NHFD (National Hip Fracture Database) dataset. Discussion Evidence on the optimum choice of prosthesis for hemiarthroplasty of the hip is lacking. National guidance is currently based on expert opinion rather than empirical evidence. The incidence of hip fracture is likely to continue to increase and providing high quality evidence on the optimum Cite this article: A. L. Sims. The World Hip Trauma Evaluation Study 3: Hemiarthroplasty Evaluation by Multicentre Investigation – WHITE 3: HEMI – An Abridged Protocol. Bone Joint Res 2016;5:18–25. DOI: 10.1302/2046-3758.51.2000473
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Affiliation(s)
- A L Sims
- Northumbria NHS, Foundation Trust, Northumbria Healthcare, NE63 9JJ, UK
| | - N Parsons
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - J Achten
- Trauma Unit, Kadoorie Centre, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - X L Griffin
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 9DU and Oxford Trauma, Nuffield Department of Rheumatology Orthopaedics and Musculoskeletal Science, University of Oxford, OX3 9DU, UK
| | - M L Costa
- Trauma Unit, Kadoorie Centre, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - M R Reed
- University of Newcastle, and Northumbria Healthcare, Northumberland, NE63 9JJ, UK
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Wall PDH, Sprowson AP, Parsons N, Parsons H, Achten J, Balasubramanian S, Costa ML. Protocol for a single-centre randomised controlled trial of multimodal periarticular anaesthetic infiltration versus single-agent femoral nerve blockade as analgesia for total knee arthroplasty: Perioperative Analgesia for Knee Arthroplasty (PAKA). BMJ Open 2015; 5:e009898. [PMID: 26692559 PMCID: PMC4691770 DOI: 10.1136/bmjopen-2015-009898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) surgery causes postoperative pain. The use of perioperative injections around the knee containing local anaesthetic, opiates and non-steroidal anti-inflammatory drugs has increased in popularity to manage pain. Theoretical advantages include reduced requirements for analgesia and earlier mobilisation. We propose a single-centre randomised controlled trial of multimodal periarticular anaesthetic infiltration versus femoral nerve anaesthetic blockade as analgesia for TKA. The aim is to determine, in patients undergoing TKA, if there is a difference in patient-reported pain scores on the visual analogue scale (VAS) prior to physiotherapy on day 1 postoperatively between treatment groups. METHODS AND ANALYSIS Patients undergoing a primary unilateral TKA at University Hospitals Coventry and Warwickshire Hospitals will be assessed for eligibility. A total of 264 patients will provide 90% power to detect a difference of 12 mm on the VAS on day 1 postoperatively at the 5% level. The trial will use 1:1 randomisation, stratified by mode of anaesthetic. Primary outcome measure will be the VAS for pain prior to physiotherapy on day 1. Secondary outcome measures include VAS on day 2, total use of opiate analgesia up to 48 h, ordinal pain scores up to 40 min after surgery, independent functional knee physiotherapist assessment on days 1 and 2. Oxford knee Scores (OKS), EuroQol (EQ-5D) and Douleur Neuropathic Pain Scores (DN2) will be recorded at baseline, 6 weeks and 12 months. Adverse events will be recorded up to 12 months. Analysis will investigate differences in VAS on day 1 between the two treatment groups on an intention-to-treat basis. Tests will be two-sided and considered to provide evidence for a significant difference if p values are less than 0.05. ETHICS AND DISSEMINATION NRES Committee West Midlands, 23 September 2013 (ref: 13/WM/0316). The results will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBERS ISRCTN 60611146 and EUDRACT Number 2013-002439-10 (protocol code number PAKA-33601-AS117013); Pre-results.
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Affiliation(s)
- P D H Wall
- Warwick Clinical Trials Unit, Warwick University, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - A P Sprowson
- Warwick Clinical Trials Unit, Warwick University, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - N Parsons
- Warwick Clinical Trials Unit, Warwick University, Coventry, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - H Parsons
- Warwick Clinical Trials Unit, Warwick University, Coventry, UK
| | - J Achten
- Warwick Clinical Trials Unit, Warwick University, Coventry, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
| | - S Balasubramanian
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - M L Costa
- Warwick Clinical Trials Unit, Warwick University, Coventry, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, Oxford, UK
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Smith NA, Achten J, Parsons N, Wright D, Parkinson B, Thompson P, Hutchinson CE, Spalding T, Costa ML. Meniscal Transplantation and its Effect on Osteoarthritis Risk: an abridged protocol for the MeTEOR study: a comprehensive cohort study incorporating a pilot randomised controlled trial. Bone Joint Res 2015; 4:93-8. [PMID: 26036203 PMCID: PMC4468929 DOI: 10.1302/2046-3758.46.2000318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Subtotal or total meniscectomy in the medial or lateral compartment of the knee results in a high risk of future osteoarthritis. Meniscal allograft transplantation has been performed for over thirty years with the scientifically plausible hypothesis that it functions in a similar way to a native meniscus. It is thought that a meniscal allograft transplant has a chondroprotective effect, reducing symptoms and the long-term risk of osteoarthritis. However, this hypothesis has never been tested in a high-quality study on human participants. This study aims to address this shortfall by performing a pilot randomised controlled trial within the context of a comprehensive cohort study design. METHODS Patients will be randomised to receive either meniscal transplant or a non-operative, personalised knee therapy program. MRIs will be performed every four months for one year. The primary endpoint is the mean change in cartilage volume in the weight-bearing area of the knee at one year post intervention. Secondary outcome measures include the mean change in cartilage thickness, T2 maps, patient-reported outcome measures, health economics assessment and complications. RESULTS This study is expected to report its findings in 2016. Cite this article: Bone Joint Res 2015;4:93-8.
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Affiliation(s)
- N A Smith
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - J Achten
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - N Parsons
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - D Wright
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - B Parkinson
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - P Thompson
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - C E Hutchinson
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - T Spalding
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M L Costa
- University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
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Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML. Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick Hip Trauma Evaluation--a prospective cohort study. Bone Joint J 2015; 97-B:372-82. [PMID: 25737522 DOI: 10.1302/0301-620x.97b3.35738] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [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
Hip fracture is a global public health problem. The National Hip Fracture Database provides a framework for service evaluation in this group of patients in the United Kingdom, but does not collect patient-reported outcome data and is unable to provide meaningful data about the recovery of quality of life. We report one-year patient-reported outcomes of a prospective cohort of patients treated at a single major trauma centre in the United Kingdom who sustained a hip fracture between January 2012 and March 2014. There was an initial marked decline in quality of life from baseline measured using the EuroQol 5 Dimensions score (EQ-5D). It was followed by a significant improvement to 120 days for all patients. Although their quality of life improved during the year after the fracture, it was still significantly lower than before injury irrespective of age group or cognitive impairment (mean reduction EQ-5D 0.22; 95% confidence interval (CI) 0.17 to 0.26). There was strong evidence that quality of life was lower for patients with cognitive impairment. There was a mean reduction in EQ-5D of 0.28 (95% CI 0.22 to 0.35) in patients < 80 years of age. This difference was consistent (and fixed) throughout follow-up. Quality of life does not improve significantly during recovery from hip fracture in patients over 80 years of age (p = 0.928). Secondary measures of function showed similar trends. Hip fracture marks a step down in the quality of life of a patient: it accounts for approximately 0.22 disability adjusted life years in the first year after fracture. This is equivalent to serious neurological conditions for which extensive funding for research and treatment is made available.
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Affiliation(s)
- X L Griffin
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - N Parsons
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - J Achten
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - M Fernandez
- University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - M L Costa
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
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Kearney RS, Parsons N, Underwood M, Costa ML. Achilles tendon rupture rehabilitation: a mixed methods investigation of current practice among orthopaedic surgeons in the United Kingdom. Bone Joint Res 2015; 4:65-9. [PMID: 25868938 PMCID: PMC4448123 DOI: 10.1302/2046-3758.44.2000400] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [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] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The evidence base to inform the management of Achilles tendon rupture is sparse. The objectives of this research were to establish what current practice is in the United Kingdom and explore clinicians' views on proposed further research in this area. This study was registered with the ISRCTN (ISRCTN68273773) as part of a larger programme of research. METHODS We report an online survey of current practice in the United Kingdom, approved by the British Orthopaedic Foot and Ankle Society and completed by 181 of its members. A total of ten of these respondents were invited for a subsequent one-to-one interview to explore clinician views on proposed further research in this area. RESULTS The survey showed wide variations in practice, with patients being managed in plaster cast alone (13%), plaster cast followed by orthoses management (68%), and orthoses alone (19%). Within these categories, further variation existed regarding the individual rehabilitation facets, such as the length of time worn, the foot position within them and weight-bearing status. The subsequent interviews reflected this clinical uncertainty and the pressing need for definitive research. CONCLUSIONS The gap in evidence in this area has resulted in practice in the United Kingdom becoming varied and based on individual opinion. Future high-quality randomised trials on this subject are supported by the clinical community. Cite this article: Bone Joint Res 2015;4:65-9.
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Affiliation(s)
- R S Kearney
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - N Parsons
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - M Underwood
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
| | - M L Costa
- University of Warwick, Gibbet Hill Road, Coventry CV4 7AL, UK
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Abstract
The extent and depth of routine health care data are growing at an ever-increasing rate, forming huge repositories of information. These repositories can answer a vast array of questions. However, an understanding of the purpose of the dataset used and the quality of the data collected are paramount to determine the reliability of the result obtained. This Editorial describes the importance of adherence to sound methodological principles in the reporting and publication of research using ‘big’ data, with a suggested reporting framework for future Bone & Joint Journal submissions. Cite this article: Bone Joint J 2014;96-B:1575–7.
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Affiliation(s)
- D. C. Perry
- Warwick Clinical Trials Unit, University
of Warwick, Gibbet Hill Road, Coventry, CV4
7AL, UK
| | - N. Parsons
- Statistics and Epidemiology, Warwick Medical
School, University of Warwick, Gibbet
Hill Road, Coventry, CV4
7AL, UK
| | - M. L. Costa
- Warwick Clinical Trials Unit, University
of Warwick, Gibbet Hill Road, Coventry, CV4
7AL, UK
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Abstract
The Bone & Joint Journal provides the latest evidence to guide the clinical practice of orthopaedic surgeons. The benefits of one intervention compared with another are presented using outcome measures; some may be specific to a limb or joint and some are more general health-related quality of life measures. Readers will be familiar with many of these outcome measures and will be able to judge the relative benefits of different interventions when measured using the same outcome tool; for example, different treatments for pain in the knee measured using a particular knee score. But, how should readers compare outcomes between different clinical areas using different outcome measures? This article explores the use of standardised effect sizes. Cite this article: Bone Joint J 2014;96-B:853–4.
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Affiliation(s)
- N. Parsons
- Warwick Medical School, University
of Warwick, Coventry, CV4
7AL, UK
| | - X. L. Griffin
- University of Warwick, Warwick Medical
School, Coventry, CV4 7AL, UK
| | - D. Stengel
- Centre for Clinical Research, Department
of Trauma and Orthopaedic Surgery, Unfalkrankenhaus
Berlin, Warener Street 7, 12683
Berlin, Germany
| | - R. Carey Smith
- Sir Charles Gairdner Hospital and The
University of Western Australia, Nedlands, Perth 6009, Western
Australia, Australia
| | - D. C. Perry
- University of Warwick, Warwick Medical
School, Coventry, CV4 7AL, UK
| | - M. L. Costa
- University of Warwick, Warwick Medical
School, Coventry, CV4 7AL, UK
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Griffin XL, Parsons N, Achten J, Costa ML. The Targon Femoral Neck hip screw versus cannulated screws for internal fixation of intracapsular fractures of the hip. Bone Joint J 2014; 96-B:652-7. [DOI: 10.1302/0301-620x.96b5.33391] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 11/05/2022]
Abstract
We compared a new fixation system, the Targon Femoral Neck (TFN) hip screw, with the current standard treatment of cannulated screw fixation. This was a single-centre, participant-blinded, randomised controlled trial. Patients aged 65 years and over with either a displaced or undisplaced intracapsular fracture of the hip were eligible. The primary outcome was the risk of revision surgery within one year of fixation. A total of 174 participants were included in the trial. The absolute reduction in risk of revision was of 4.7% (95% CI 14.2 to 22.5) in favour of the TFN hip screw (chi-squared test, p = 0.741), which was less than the pre-specified level of minimum clinically important difference. There were no significant differences in any of the secondary outcome measures. We found no evidence of a clinical difference in the risk of revision surgery between the TFN hip screw and cannulated screw fixation for patients with an intracapsular fracture of the hip. Cite this article: Bone Joint J 2014;96-B:652–7.
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Affiliation(s)
- X. L. Griffin
- Warwick Orthopaedics, Warwick
Medical School, University of Warwick, Coventry, CV4
7AL, UK
| | - N. Parsons
- University of Warwick, Warwick
Medical School, University of Warwick, Coventry
CV4 7AL, UK
| | - J. Achten
- University of Warwick, Warwick
Orthopaedics, Warwick Medical School, University
of Warwick, Coventry CV4 7AL, UK
| | - M. L. Costa
- University of Warwick, Clinical
Trials Unit, Coventry CV4 7AL, UK
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Abstract
The surgical community is plagued with a reputation for both failing to engage and to deliver on clinical research. This is in part due to the absence of a strong research culture, however it is also due to a multitude of barriers encountered in clinical research; particularly those involving surgical interventions. 'Trauma' amplifies these barriers, owing to the unplanned nature of care, unpredictable work patterns, the emergent nature of treatment and complexities in the consent process. This review discusses the barriers to clinical research in surgery, with a particular emphasis on trauma. It considers how barriers may be overcome, with the aim to facilitate future successful clinical research. Cite this article: Bone Joint Res 2014;3:123-9.
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Affiliation(s)
- D C Perry
- University of Warwick, Warwick MedicalSchool, Clinical Sciences Research Laboratories, Clifford BridgeRoad, Coventry, CV2 2DX, UK
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Abstract
Objectives To study the measurement properties of a joint specific patient
reported outcome measure, a measure of capability and a general
health-related quality of life (HRQOL) tool in a large cohort of
patients with a hip fracture. Methods Responsiveness and associations between the Oxford Hip Score
(a hip specific measure: OHS), ICEpop CAPability (a measure of capability
in older people: ICECAP-O) and EuroQol EQ-5D (general health-related
quality of life measure: EQ-5D) were assessed using data available
from two large prospective studies. The three outcome measures were assessed
concurrently at a number of fixed follow-up time-points in a consecutive
sequence of patients, allowing direct assessment of change from
baseline, inter-measure associations and validity using a range
of statistical methods. Results ICECAP-O was not responsive to change. EQ-5D was responsive to
change from baseline, with an estimated standardised effect size
for the two datasets of 0.676 and 0.644 at six weeks and four weeks
respectively; this was almost as responsive to change as OHS (1.14 at
four weeks). EQ-5D correlated strongly with OHS; Pearson correlation
coefficients were 0.74, 0.77 and 0.70 at baseline, four weeks and
four months. EQ-5D is a moderately good predictor of death at 12
months following hip fracture. Furthermore, EQ-5D reported by proxies
(relatives and carers) behaves similarly to self-reported scores. Conclusions Our findings suggest that a general HRQOL tool such as EQ-5D
could be used to measure outcome for patients recovering from hip
fracture, including those with cognitive impairment. Cite this article: Bone Joint Res 2014;3:69–75.
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Affiliation(s)
- N Parsons
- University of Warwick, Statisticsand Epidemiology, Warwick Medical School, Coventry, CV47AL, UK
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Abstract
The importance for observing the intention-to-treat approach in clinical studies is explained. Cite this article: Bone Joint J 2013;95-B:1443–4.
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Affiliation(s)
- X. L. Griffin
- Warwick Orthopaedics, Warwick
Medical School, University of Warwick, Clinical Sciences
Research Laboratories, Clifford Bridge Road, Coventry
CV2 2DX, UK
| | - N. Parsons
- Statistics and Epidemiology, Warwick
Medical School, University of Warwick, Gibbet Hill
Road, Coventry CV4 7AL, UK
| | - R. Carey Smith
- Sir Charles Gairdner Hospital and The
University of Western Australia, Nedlands, Perth 6009, Western
Australia, Australia
| | - D. Stengel
- Unfallkrankenhaus Berlin, Centre
for Clinical Research, Department of Trauma
and Orthopaedic Surgery, Warener Street 7, 12683 Berlin, Germany
| | - M. L. Costa
- Clinical Trials Unit, Warwick Medical
School, University of Warwick, Gibbet
Hill Road, Coventry CV4 7AL, UK
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Abstract
The variation in surgical performance, both between centres and individual surgeons, has recently been of significant political, media and public interest. Within the United Kingdom, a government agenda to increase accountability amongst surgeons has led to the online publication of ‘surgeon-level’ data. Surgeons, journalists and the public need to understand these data if they are to be useful in driving up standards of surgical care. This Editorial describes the use of Funnel Plots, which are the common means by which such data are presented, and discusses how the plots are generated. Cite this article: Bone Joint J 2013;95-B:1156–7.
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Kearney RS, Parsons N, Costa ML. Achilles tendinopathy management: A pilot randomised controlled trial comparing platelet-richplasma injection with an eccentric loading programme. Bone Joint Res 2013; 2:227-32. [PMID: 24135556 PMCID: PMC3809715 DOI: 10.1302/2046-3758.210.2000200] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [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] [Indexed: 11/29/2022] Open
Abstract
Objectives To conduct a pilot randomised controlled trial to evaluate the
feasibility of conducting a larger trial to evaluate the difference
in Victorian Institute of Sports Assessment-Achilles (VISA-A) scores
at six months between patients with Achilles tendinopathy treated
with a platelet-rich plasma (PRP) injection compared with an eccentric
loading programme. Methods Two groups of patients with mid-substance Achilles tendinopathy
were randomised to receive a PRP injection or an eccentric loading
programme. A total of 20 patients were randomised, with a mean age
of 49 years (35 to 66). All outcome measures were recorded at baseline,
six weeks, three months and six months. Results The mean VISA-A score for the injection group at the primary
endpoint of six months was 76.0 (95% confidence interval (CI) 58.3
to 93.7) and for the exercise group was 57.4 (95% CI 38.1 to 76.7).
There was no statistically significant difference between these
scores (p = 0.171), which was expected from such a pilot study. Conclusions This pilot study has been key to providing data to inform a larger
study and shows that the methodology is feasible. Cite this article: Bone Joint Res 2013;2:227–32.
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Affiliation(s)
- R S Kearney
- University of Warwick, WarwickMedical School, Coventry CV2 2DX, UK
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Griffin XL, McArthur J, Achten J, Parsons N, Costa ML. The Warwick Hip Trauma Evaluation One -an abridged protocol for the WHiTE One Study: An embedded randomised trial comparing the X-bolt with slidinghip screw fixation in extracapsular hip fractures. Bone Joint Res 2013; 2:206-9. [PMID: 24089290 PMCID: PMC3791484 DOI: 10.1302/2046-3758.210.2000183] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/04/2013] [Indexed: 11/10/2022] Open
Abstract
Fractures of the proximal femur are one of the greatest challenges facing the medical community, constituting a heavy socioeconomic burden worldwide. Controversy exists regarding the optimal treatment for patients with unstable trochanteric proximal femoral fractures. The recognised treatment alternatives are extramedullary fixation usually with a sliding hip screw and intramedullary fixation with a cephalomedullary nail. Current evidence suggests that best results and lowest complication rates occur using a sliding hip screw. Complications in these difficult fractures are relatively common regardless of type of treatment. We believe that a novel device, the X-Bolt dynamic plating system, may offer superior fixation over a sliding hip screw with lower reoperation risk and better function. We therefore propose to investigate the clinical effectiveness of the X-bolt dynamic plating system compared with standard sliding hip screw fixation within the framework of a the larger WHiTE (Warwick Hip Trauma Evaluation) Comprehensive Cohort Study. Cite this article: Bone Joint Res 2013;2:206-9.
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Affiliation(s)
- X. L. Griffin
- Warwick Orthopaedics, Warwick Medical
School, University of Warwick, Coventry
CV4 7AL, UK, and University
Hospitals Coventry and Warwickshire NHS Trust, Clifford
Bridge Road, Coventry CV2 2DX, UK
| | - J. McArthur
- University Hospitals Coventry and Warwickshire
NHS Trust, Clifford Bridge Road, Coventry CV2
2DX, UK
| | - J. Achten
- Warwick Orthopaedics, Warwick Medical
School, University of Warwick, Coventry
CV4 7AL, UK
| | - N. Parsons
- Warwick Medical School, University
of Warwick, Coventry CV4 7AL, UK
| | - M. L. Costa
- Warwick Medical School, Clinical Trials
Unit, University of Warwick, Coventry
CV4 7AL, UK, and University
Hospitals Coventry and Warwickshire NHS Trust, Clifford
Bridge Road, Coventry CV2 2DX, UK
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Griffin XL, McArthur J, Achten J, Parsons N, Costa ML. The Warwick Hip Trauma Evaluation Two -an abridged protocol for the WHiTE Two Study: An embedded randomised trial comparing the Dual-Mobility withpolyethylene cups in hip arthroplasty for fracture. Bone Joint Res 2013; 2:210-3. [PMID: 24089291 PMCID: PMC3791483 DOI: 10.1302/2046-3758.210.2000186] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fractures of the proximal femur are one of the
greatest challenges facing the medical community, constituting a
heavy socioeconomic burden worldwide. Controversy exists regarding
the optimal treatment for independent patients with displaced intracapsular fractures
of the proximal femur. The recognised alternatives are hemiarthroplasty
and total hip replacement. At present there is no established standard
of care, with both types of arthroplasty being used in many centres.
The principal advantages of total hip replacement are a functional
benefit over hemiarthroplasty and a reduced risk of revision surgery.
The principal criticism is the increased risk of dislocation. We
believe that an alternative acetabular component may reduce the
risk of dislocation but still provide the functional benefit of
total hip replacement in these patients. We therefore propose to
investigate the dislocation risk of a dual-mobility acetabular component
compared with standard polyethylene component in total hip replacement
for independent patients with displaced intracapsular fractures
of the proximal femur within the framework of the larger WHiTE (Warwick
Hip Trauma Evaluation) Comprehensive Cohort Study. Cite this article: Bone Joint Res 2013;2:210–13.
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Affiliation(s)
- X L Griffin
- Warwick Orthopaedics, Warwick MedicalSchool, University of Warwick, CoventryCV4 7AL, UK, and UniversityHospitals Coventry and Warwickshire NHS Trust, CliffordBridge Road, Coventry CV2 2DX, UK
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40
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Amarasekera HW, Campbell PC, Parsons N, Achten J, Masters J, Griffin DR, Costa ML. The effect of surgical approach on the histologyof the femoral head following resurfacing of the hip: Analysis of retrieval specimens. Bone Joint Res 2013; 2:200-5. [PMID: 24049140 PMCID: PMC3780557 DOI: 10.1302/2046-3758.29.2000179] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES We aimed to determine the effect of surgical approach on the histology of the femoral head following resurfacing of the hip. METHODS We performed a histological assessment of the bone under the femoral component taken from retrieval specimens of patients having revision surgery following resurfacing of the hip. We compared the number of empty lacunae in specimens from patients who had originally had a posterior surgical approach with the number in patients having alternative surgical approaches. RESULTS We found a statistically significant increase in the percentage of empty lacunae in retrieval specimens from patients who had the posterior approach compared with other surgical approaches (p < 0.001). CONCLUSIONS This indicates that the vascular compromise that occurs during the posterior surgical approach does have long-term effects on the bone of the femoral head, even if it does not cause overt avascular necrosis. Cite this article: Bone Joint Res 2013;2:200-5.
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Affiliation(s)
- H W Amarasekera
- Warwick Medical School, WarwickUniversity, Coventry CV4 7AL, UK
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41
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Affiliation(s)
- N. Parsons
- Statistics and Epidermiology, Warwick
Medical School, University of Warwick, Gibbet
Hill Road, Coventry, CV4
7AL, UK
| | - R. Carey Smith
- Sir Charles Gardiner Hospital and The
University of Western Australia, Nedlands, Perth
6009, Western Australia, Australia
| | - X. L. Griffin
- Warwick Medical School, University
of Warwick, Clinical Sciences Research Laboratories, Clifford
Bridge Road, Coventry, CV2
2DX, UK
| | - D. Stengel
- Centre for Clinical Research, Department
of Trauma and Orthopaedic Surgery, Unfallkrankenhaus
Berlin, Warener Street 7, 12683
Berlin, Germany
| | - M. L. Costa
- Warwick Clinical Trials Unit, University
of Warwick, Gibbet Hill Road, Coventry, CV4
7AL, UK
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Cornell P, Trehane A, Thompson P, Rahmeh F, Greenwood M, Baqai TJ, Cambridge S, Shaikh M, Rooney M, Donnelly S, Tahir H, Ryan S, Kamath S, Hassell A, McCuish WJ, Bearne L, Mackenzie-Green B, Price E, Williamson L, Collins D, Tang E, Hayes J, McLoughlin YM, Chamberlain V, Campbell S, Shah P, McKenna F, Cornell P, Westlake S, Thompson P, Richards S, Homer D, Gould E, Empson B, Kemp P, Richards AG, Walker J, Taylor S, Bari SF, Alachkar M, Rajak R, Lawson T, O'Sullivan M, Samant S, Butt S, Gadsby K, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Edwards KR, Rowe I, Sanders T, Dunn K, Konstantinou K, Hay E, Jones LE, Adams J, White P, Donovan-Hall M, Hislop K, Barbosa Boucas S, Nichols VP, Williamson EM, Toye F, Lamb SE, Rodham K, Gavin J, Watts L, Coulson N, Diver C, Avis M, Gupta A, Ryan SJ, Stangroom S, Pearce JM, Byrne J, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Taylor J, Morris M, Dures E, Hewlett S, Wilson A, Adams J, Larkin L, Kennedy N, Gallagher S, Fraser AD, Shrestha P, Batley M, Koduri G, Scott DL, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P, Ferguson AM, Ibrahim F, Scott DL, Lempp H, Tierney M, Fraser A, Kennedy N, Barbosa Boucas S, Hislop K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J, Nutland H, Dean A, Laxminarayan R, Gates L, Bowen C, Arden N, Hermsen L, Terwee CB, Leone SS, vd Zwaard B, Smalbrugge M, Dekker J, vd Horst H, Wilkie R, Ferguson AM, Nicky Thomas V, Lempp H, Cope A, Scott DL, Simpson C, Weinman J, Agarwal S, Kirkham B, Patel A, Ibrahim F, Barn R, Brandon M, Rafferty D, Sturrock R, Turner D, Woodburn J, Rafferty D, Paul L, Marshall R, Gill J, McInnes I, Roderick Porter D, Woodburn J, Hennessy K, Woodburn J, Steultjens M, Siddle HJ, Hodgson RJ, Hensor EM, Grainger AJ, Redmond A, Wakefield RJ, Helliwell PS, Hammond A, Rayner J, Law RJ, Breslin A, Kraus A, Maddison P, Thom JM, Newcombe LW, Woodburn J, Porter D, Saunders S, McCarey D, Gupta M, Turner D, McGavin L, Freeburn R, Crilly A, Lockhart JC, Ferrell WR, Goodyear C, Ledingham J, Waterman T, Berkin L, Nicolaou M, Watson P, Lillicrap M, Birrell F, Mooney J, Merkel PA, Poland F, Spalding N, Grayson P, Leduc R, Shereff D, Richesson R, Watts RA, Roussou E, Thapper M, Bateman J, Allen M, Kidd J, Parsons N, Davies D, Watt KA, Scally MD, Bosworth A, Wilkinson K, Collins S, Jacklin CB, Ball SK, Grosart R, Marks J, Litwic AE, Sriranganathan MK, Mukherjee S, Khurshid MA, Matthews SM, Hall A, Sheeran T, Baskar S, Muether M, Mackenzie-Green B, Hetherington A, Wickrematilake G, Williamson L, Daniels LE, Gwynne CE, Khan A, Lawson T, Clunie G, Stephenson S, Gaffney K, Belsey J, Harvey NC, Clarke-Harris R, Murray R, Costello P, Garrett E, Holbrook J, Teh AL, Wong J, Dogra S, Barton S, Davies L, Inskip H, Hanson M, Gluckman P, Cooper C, Godfrey K, Lillycrop K, Anderton T, Clarke S, Rao Chaganti S, Viner N, Seymour R, Edwards MH, Parsons C, Ward K, Thompson J, Prentice A, Dennison E, Cooper C, Clark E, Cumming M, Morrison L, Gould VC, Tobias J, Holroyd CR, Winder N, Osmond C, Fall C, Barker D, Ring S, Lawlor D, Tobias J, Davey Smith G, Cooper C, Harvey NC, Toms TE, Afreedi S, Salt K, Roskell S, Passey K, Price T, Venkatachalam S, Sheeran T, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kingsbury D, Quartier P, Patel G, Arora V, Kupper H, Mozaffarian N, Kearsley-Fleet L, Baildam E, Beresford MW, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Saunders E, Baildam E, Chieng A, Davidson J, Foster H, Gardner-Medwin J, Wedderburn L, Thomson W, Hyrich K, McErlane F, Beresford M, Baildam E, Chieng SE, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Thomson W, Hyrich K, Rooney M, Finnegan S, Gibson DS, Borg FA, Bale PJ, Armon K, Cavelle A, Foster HE, McDonagh J, Bale PJ, Armon K, Wu Q, Pesenacker AM, Stansfield A, King D, Barge D, Abinun M, Foster HE, Wedderburn L, Stanley K, Morrissey D, Parsons S, Kuttikat A, Shenker N, Garrood T, Medley S, Ferguson AM, Keeling D, Duffort P, Irving K, Goulston L, Culliford D, Coakley P, Taylor P, Hart D, Spector T, Hakim A, Arden N, Mian A, Garrood T, Magan T, Chaudhary M, Lazic S, Sofat N, Thomas MJ, Moore A, Roddy E, Peat G, Rees F, Lanyon P, Jordan N, Chaib A, Sangle S, Tungekar F, Sabharwal T, Abbs I, Khamashta M, D'Cruz D, Dzifa Dey I, Isenberg DA, Chin CW, Cheung C, Ng M, Gao F, Qiong Huang F, Thao Le T, Yong Fong K, San Tan R, Yin Wong T, Julian T, Parker B, Al-Husain A, Yvonne Alexander M, Bruce I, Jordan N, Abbs I, D'cruz D, McDonald G, Miguel L, Hall C, Isenberg DA, Magee A, Butters T, Jury E, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Lazarus MN, Isenberg DA, Ehrenstein M, Carter LM, Isenberg DA, Ehrenstein MR, Chanchlani N, Gayed M, Yee CS, Gordon C, Ball E, Rooney M, Bell A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Sutton EJ, Watson KD, Isenberg D, Rahman A, Gordon C, Yee CS, Lanyon P, Jayne D, Akil M, D'Cruz D, Khamashta M, Lutalo P, Erb N, Prabu A, Edwards CJ, Youssef H, McHugh N, Vital E, Amft N, Griffiths B, Teh LS, Zoma A, Bruce I, Durrani M, Jordan N, Sangle S, D'Cruz D, Pericleous C, Ruiz-Limon P, Romay-Penabad Z, Carrera-Marin A, Garza-Garcia A, Murfitt L, Driscoll PC, Giles IP, Ioannou Y, Rahman A, Pierangeli SS, Ripoll VM, Lambrianides A, Heywood WE, Ioannou J, Giles IP, Rahman A, Stevens C, Dures E, Morris M, Knowles S, Hewlett S, Marshall R, Reddy V, Croca S, Gerona D, De La Torre Ortega I, Isenberg DA, Leandro M, Cambridge G, Reddy V, Cambridge G, Isenberg DA, Glennie M, Cragg M, Leandro M, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Artim Esen B, Pericleous C, MacKie I, Ioannou Y, Rahman A, Isenberg DA, Giles I, Skeoch S, Haque S, Pemberton P, Bruce I. BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- M. L. Costa
- Warwick Medical School, University
of Warwick, Clinical Sciences Research Institute, Clinical
Sciences Building, Clifford Bridge Road, Coventry
CV4 7AL, UK
| | - D. Stengel
- Centre for Clinical Research, Department
of Trauma and Orthopaedic Surgery, Unfalkrankenhaus
Berlin, Warener Street 7, 12683
Berlin, Germany
| | - X. L. Griffin
- Warwick Orthopaedics, Warwick Medical
School, University of Warwick, Coventry
CV2 2DX, UK
| | - R. Carey Smith
- Sir Charles Gairdner Hospital and The
University of Western Australia, Nedlands, Perth
6009, Western Australia, Australia
| | - N. Parsons
- Statistics and Epidemiology, Warwick
Medical School, University of Warwick, Coventry CV4
7AL, UK
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Griffin XL, Achten J, Parsons N, Boardman F, Griffiths F, Costa ML. The Warwick Hip Trauma Evaluation - an abridged protocol for the WHiTE Study: A multiple embedded randomised controlled trial cohort study. Bone Joint Res 2012; 1:310-4. [PMID: 23610662 PMCID: PMC3626204 DOI: 10.1302/2046-3758.111.2000127] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/23/2012] [Indexed: 11/05/2022] Open
Abstract
Fractures of the proximal femur are one of the greatest challenges facing the medical community, constituting a heavy socioeconomic burden worldwide. The National Hip Fracture Audit currently provides a framework for service evaluation. This evaluation is based upon the assessment of process rather than assessment of patient-centred outcome and therefore it fails to provide meaningful data regarding the clinical effectiveness of treatments. This study aims to capture data from the cohort of patients who present with a fracture of the proximal femur at a single United Kingdom Major Trauma Centre. Patient-centred outcomes will be recorded and provide a baseline cohort within which to test the clinical effectiveness of experimental interventions.
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Affiliation(s)
- X L Griffin
- Warwick Orthopaedics, Warwick Medical School, University of Warwick, Clifford Bridge Road, Coventry CV2 2DX, UK
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Friede T, Parsons N, Stallard N. A conditional error function approach for subgroup selection in adaptive clinical trials. Stat Med 2012; 31:4309-20. [DOI: 10.1002/sim.5541] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 05/14/2012] [Accepted: 07/03/2012] [Indexed: 11/10/2022]
Affiliation(s)
- T. Friede
- Department of Medical Statistics; University Medical Center Göttingen; Göttingen Germany
| | - N. Parsons
- Warwick Medical School; The University of Warwick; Coventry U.K
| | - N. Stallard
- Warwick Medical School; The University of Warwick; Coventry U.K
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Dutton T, De-Souza R, Parsons N, Costa ML. The timing of tourniquet release and 'retransfusion' drains in total knee arthroplasty: A stratified randomised pilot investigation. Knee 2012; 19:190-2. [PMID: 21440444 DOI: 10.1016/j.knee.2011.02.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 12/08/2010] [Revised: 02/18/2011] [Accepted: 02/21/2011] [Indexed: 02/02/2023]
Abstract
The timing of tourniquet release is a potential confounding factor in the use of retransfusion drains in total knee arthroplasty. A pilot randomised trial was performed using retransfusion drains to determine whether releasing the tourniquet after wound closure reduced the overall blood loss and allogenic transfusion rate. Forty eight patients undergoing total knee arthroplasty were randomly allocated to receive either a retransfusion drain or no drain. Within each group the tourniquet was released before or after wound closure at the discretion of the surgeon. The peri-operative fall in haemoglobin, allogenic blood transfusion rate and complication rate were measured. There was an overall transfusion rate of 16%. There was no difference in the peri-operative fall in haemoglobin or the allogenic transfusion rates between the No Drain and Retransfusion Drain groups for patients undergoing total knee arthroplasty. Furthermore, the timing of the tourniquet release did not alter these findings. The results of this study suggest that the timing of the tourniquet release does not impact upon the ability of retransfusion drains to reduce the peri-operative fall in haemoglobin or the requirement for allogenic blood transfusion in total knee arthroplasty.
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Affiliation(s)
- T Dutton
- University Hospitals Coventry and Warwickshire, Coventry, CV2 2DX, UK
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Amarasekera HW, Roberts P, Costa ML, Parsons N, Achten J, Griffin DR, Williams NR. Scintigraphic assessment of bone status at one year following hip resurfacing: Comparison of two surgical approaches using SPECT-CT scan. Bone Joint Res 2012; 1:86-92. [PMID: 23610676 PMCID: PMC3626242 DOI: 10.1302/2046-3758.15.2000046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 11/30/2011] [Accepted: 05/09/2012] [Indexed: 12/02/2022] Open
Abstract
Objectives To study the vascularity and bone metabolism of the femoral head/neck
following hip resurfacing arthroplasty, and to use these results
to compare the posterior and the trochanteric-flip approaches. Methods In our previous work, we reported changes to intra-operative
blood flow during hip resurfacing arthroplasty comparing two surgical
approaches. In this study, we report the vascularity and the metabolic
bone function in the proximal femur in these same patients at one
year after the surgery. Vascularity and bone function was assessed
using scintigraphic techniques. Of the 13 patients who agreed to
take part, eight had their arthroplasty through a posterior approach
and five through a trochanteric-flip approach. Results One year after surgery, we found no difference in the vascularity
(vascular phase) and metabolic bone function (delayed phase) at
the junction of the femoral head/neck between the two groups of
patients. Higher radiopharmaceutical uptake was found in the region
of the greater trochanter in the trochanteric-flip group, related
to the healing osteotomy. Conclusions Our findings using scintigraphic techniques suggest that the
greater intra-operative reduction in blood flow to the junction
of the femoral head/neck, which is seen with the posterior approach
compared with trochanteric flip, does not result in any difference
in vascularity or metabolic bone function one year after surgery.
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Affiliation(s)
- H W Amarasekera
- Warwick Orthopaedics, University of Warwick, Clinical Sciences Research Institute, Clinical Sciences Building, Clifford Bridge Road, Coventry CV2 2DX, UK
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Mauffrey C, McGuinness K, Parsons N, Achten J, Costa ML. A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia. ACTA ACUST UNITED AC 2012; 94:704-8. [DOI: 10.1302/0301-620x.94b5.28498] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The ideal form of fixation for displaced, extra-articular fractures of the distal tibia remains controversial. In the UK, open reduction and internal fixation with locking-plates and intramedullary nailing are the two most common forms of treatment. Both techniques provide reliable fixation but both are associated with specific complications. There is little information regarding the functional recovery following either procedure. We performed a randomised pilot trial to determine the functional outcome of 24 adult patients treated with either a locking-plate (n = 12) or an intramedullary nailing (n = 12). At six months, there was an adjusted difference of 13 points in the Disability Rating Index in favour of the intramedullary nail. However, this was not statistically significant in this pilot trial (p = 0.498). A total of seven patients required further surgery in the locking-plate group and one in the intramedullary nail group. This study suggests that there may be clinically relevant, functional differences in patients treated with nail versus locking-plate fixation for fractures of the distal tibia and differences in related complications. Further trials are required to confirm the findings of this pilot investigation.
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Affiliation(s)
- C. Mauffrey
- Denver Health Medical Centre, Orthopedic
Department, 777 Bannock Street, Denver, Colorado
80204, USA
| | - K. McGuinness
- Warwick Orthopaedics, University of Warwick, Clinical
Science Building, Clifford Bridge Road, Coventry
CV2 2DX, UK
| | - N. Parsons
- Warwick Orthopaedics, University of Warwick, Clinical
Science Building, Clifford Bridge Road, Coventry
CV2 2DX, UK
| | - J. Achten
- Warwick Orthopaedics, University of Warwick, Clinical
Science Building, Clifford Bridge Road, Coventry
CV2 2DX, UK
| | - M. L. Costa
- Warwick Orthopaedics, University of Warwick, Clinical
Science Building, Clifford Bridge Road, Coventry
CV2 2DX, UK
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Costa ML, Griffin XL, Pendleton N, Pearson M, Parsons N. Does cementing the femoral component increase the risk of peri-operative mortality for patients having replacement surgery for a fracture of the neck of femur? Data from the National Hip Fracture Database. ACTA ACUST UNITED AC 2011; 93:1405-10. [PMID: 21969443 DOI: 10.1302/0301-620x.93b10.26690] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Concerns have been reported to the United Kingdom National Patient Safety Agency, warning that cementing the femoral component during hip replacement surgery for fracture of the proximal femur may increase peri-operative mortality. The National Hip Fracture Database collects demographic and outcome data about patients with a fracture of the proximal femur from over 100 participating hospitals in the United Kingdom. We conducted a mixed effects logistic regression analysis of this dataset to determine whether peri-operative mortality was increased in patients who had undergone either hemiarthroplasty or total hip replacement using a cemented femoral component. A total of 16,496 patients from 129 hospitals were included in the analysis, which showed a small but significant adjusted survival benefit associated with cementing (odds ratio 0.83, 95% confidence interval 0.72 to 0.96). Other statistically significant variables in predicting death at discharge, listed in order of magnitude of effect, were gender, American Society of Anesthesiologists grade, age, walking accompanied outdoors and arthroplasty. Interaction terms between cementing and these other variables were sequentially added to, but did not improve, the model. This study has not shown an increase in peri-operative mortality as a result of cementing the femoral component in patients requiring hip replacement following fracture of the proximal femur.
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Affiliation(s)
- M L Costa
- University of Warwick, Clinical Sciences Building, Clifford Bridge Road, Coventry CV2 2DX, UK.
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Allen CS, Deyle GD, Wilken JM, Gill NW, Baker SM, Rot JA, Cook CE, Beaty S, Kissenberth M, Siffri P, Hawkins R, Cook CE, Hegedus EJ, Ross MD, Cook CE, Beaty S, Kissenberth M, Siffri P, Pill S, Hawkins R, Erhardt JW, Harris KD, Deyle GD, Gill NW, Howes RR, Koch WK, Kramer CD, Kumar SP, Adhikari P, Jeganathan PS, D’Souza SC, Misri ZK, Manning DM, Dedrick GS, Sizer PS, Brismée JM, Matthijs OC, Dedrick GS, Brismée JM, McGalliard MK, James CR, Sizer PS, Ross MD, Childs JD, Middel C, Kujawa J, Brown D, Corrigan M, Parsons N, Schmidt SG, Grant R, Spryopolous P, Dansie D, Taylor J, Wang H, Silvernail JL, Gill NW, Teyhen DS, Allison SC, Sueki DG, Almaria SM, Bender MA, Kamara M, Magpali A, Mancilla A, McConnell BJ, Montoya RC, Murphy AW, Romero ML, Viti JA, Rot JA, Augustsson H, Werstine RJ, Birmingham T, Jenkyn T, Yung EY, Tonley JC. AAOMPT platform presentations selection. J Man Manip Ther 2011; 19:239-46. [DOI: 10.1179/106698111x12998437860712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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