Orthopaedics Current Research

The aim of this research is to find out how best to design a randomised trial to test if we can improve sleep before knee replacement surgery and reduce long-term pain.

Knee replacement is the second most common operation in the UK with over 100,000 performed yearly. Around 20% of patients experience long-term pain after surgery causing problems with knee function, decreased activity, and a negative impact on wellbeing. Additional treatments and appointments needed to address long-term pain come at increased cost to the NHS. People with higher levels of pain before their operation are more likely to have long-term pain afterwards. Sleep has a two-way relationship with pain.

Reduced sleep causes increased pain and improvement of sleep has been shown to reduce both immediate and long-term pain in people with joint problems. Our aim is to find out how best to design a larger study to test a pre-operative sleep intervention for improving long-term pain. Patients on the surgical waiting list will be recruited and randomised to receive either standard care or the sleep intervention. Patients taking part in the intervention will attend a one-to-one appointment with an healthcare practitioner to assess their sleep issues and needs. They will then be given tailored sleep advice and will be assigned to one of 3 existing sleep interventions, cognitive-behavioural therapy for insomnia, relaxation, and mindfulness.

An interview study with practitioners and patients will explore acceptability of delivering the intervention and the feasibility of a full trial.

Project Details
Principal Investigator: Nick Howells
Planned End Date: 31/08/2022
Local Ref: 4781

Helping patients to make informed decisions about their surgery is central to good care. Knee replacement is a common elective procedure, but there is no decision aid to enable informed decisions about this surgery. This study will address this gap by providing evidence to underpin a future decision aid to improve informed decision-making about knee replacement.

Project Details:

Chief Investigator: Rachael Gooberman-Hill

Principal Investigator: Nick Howells

Planned End Date: 31/08/2023

Local Ref: 5069

Between 2014 and 2020 we conducted the INFORM Programme to find out why some patients are prone to getting joint infections, how this affects patients, NHS resources, and to evaluate treatments. The randomised trial found that recovery was delayed in people receiving two operations, while people who only had one operation had better outcomes for pain, mobility, and quality of life up to a year after surgery, though these were similar at 18 months. NHS costs were lower when patients had one operation. We also found that conservative surgery (called debridement, antibiotics and implant retention, DAIR) performed within three weeks of infection has a far less negative impact on patients and clears infection in over 60% of cases. We will now put important findings from the programme into practice to improve patient outcomes and ensure that the NHS delivers the best possible care.

Project Details

Chief Investigator: Andrew Moore

Planned End Date: 31/10/2023

Local Ref: 5069

This study aims to see if we can improve recovery from surgery in older people having hip or knee replacements by giving them protein and asking them to exercise daily (according to ability) in the weeks before their operation. First, we want to see if people are willing to do this by running a small study. If they are, we will design a larger study to test whether it improves recovery.

Project details

Chief Investigator: Vikki Wylde

Principal Investigator: Mike Whitehouse

Planned End Date: 31/12/2023

Local Ref: 4999

Total knee replacement (TKR) is commonly used for treating severe arthritis, with over 100,000 performed annually in the UK. During TKR, surgeons can resurface the patella (replace the under surface of the kneecap with a plastic prosthesis) or leave the native patella to articulate with the femoral implant. Resurfacing the patella is initially more expensive (longer theatre time, higher implant cost, risk of additional post-operative complications), but in the long-term it can reduce the risk of on-going pain which can result in further surgery to resurface the patella. NICE recommends always resurfacing the patella rather than never doing so. NICE did not find sufficient evidence on selective resurfacing (intraoperative decision based on the state of the patellar surface and the patients' symptoms) to make a recommendation on that strategy, but did recommend specific research was conducted on this question. If effective, selective resurfacing could result in optimal individualised patient care. This study evaluates the clinical and cost-effectiveness of elective primary TKR with always patellar resurfacing compared to selective patellar resurfacing.

Project details

Chief Investigator: Ashley Blom

Principal Investigator: Sven Putnis

Planned End Date: 31/03/2026

Local Ref: 4999

Over 100,000 knee replacements are performed every year in the UK. Most people recover by three months after surgery, but one in five will have ongoing pain and be dissatisfied with the results of their surgery. Some patients will have operations cancelled at short notice for avoidable medical reasons, which can have negative impacts on satisfaction and well-being.

Many patients feel abandoned after their knee replacement operation. Some report a lack of continuity of care and having to tell their story repeatedly to different health professionals. In other medical conditions, patients have a named contact, such as a specialist nurse, who manages expectations, monitors risk factors and other health conditions, and provides care, support, and education. This approach may be useful for knee replacement patients from before to after surgery, and we plan to develop such a care plan.

This project aims to develop a personalised care plan for patients undergoing total knee replacement to improve long-term outcomes after surgery. The care plan will be delivered by a named, dedicated healthcare professional who will provide continuity of care, and help patients to receive the treatments, support and education they need before and after their knee replacement surgery.

Project details

Chief Investigator: Wendy Bertram

Principal Investigator: Nick Howells

Planned End Date: 31/12/2024

Local Ref: 5336

Over 100,000 hip replacements are performed each year in the UK. Around 90% of patients report good pain relief and mobility after surgery, and most implants last 25 years or more.

Primary hip replacement involves replacing a damaged hip joint with an artificial implant that has two main parts. One part goes into the leg bone and ends in a ball which fits into a socket or cup attached to the pelvis, making a ball-and-socket joint. Implants can be fixed to bone with cement (cemented), without cement (uncemented), or partially cemented (hybrid). Cost ranges from £500 for some cemented to £2,000 for some uncemented implants.

When an implant fails, for example due to loosening or wear, it has to be re-done. Revision is a major operation, typically costing the NHS over £10,000. Cemented hip implants are safe, inexpensive, have a long track-record, and offer the best value-for-money for men aged over 75 and women aged over 65 years. There is no high-quality evidence to suggest more expensive uncemented or hybrid implants are any better than cemented implants for younger patients. Yet three quarters of NHS patients aged under 70 years receive uncemented or hybrid implants.

This Programme of research aims to find out which hip implants are best for patients under 70 years of age.

Project details

Chief Investigator: Elsa Marques

Principal Investigator: Mike Whitehouse

Planned End Date: 01/07/2031

Local Ref: 5258, 5259

This is a commercial study reviewing progress of patients who have undergone total hip replacement surgery using the Furlong short stem implant. The potential benefit for using a short stem implant is that it aids early mobilisations and preserves the femoral bone should further surgery be required.

Project Details
Principal Investigator: Mr Tony Ward
Planned End Date: 30/09/2027
Local Ref: 3275

This is a commercial study involving patients who need shoulder replacement surgery. It involves reviewing the progress of patient who have a LIMA stemless total shoulder replacement. Having a stemless implant preserves the bone stock in the upper arm bone (humerus) should further surgery be required. This can be anatomical or reverse arthroplasty.

Project Details
Principal Investigator: Mr Mark Crowther
Planned End Date: 01/10/2029
Local Ref: 3650

This is a commercial study involving patients who need shoulder replacement surgery. It involves reviewing progress of patient with Global Icon Stemless Total Shoulder replacement. Having a stemless implant preserves the bone stock in the upper arm bone (humerus) should further surgery be required. This can only be used anatomically.

Project Details
Principal Investigator: Mr Iain Packham
Planned End Date: 01/01/2030
Local Ref: 4005

A commercial study involving review of patients treated with an INFINITY Total Ankle Replacement. The study is collecting clinical and patient reported outcomes up to 10 years following surgery.

Principal Investigator: Mr Steve Hepple
Planned End Date: 31/12/2029
Local Ref: 4168

The meniscus is a cartilage-based structure within the knee which is susceptible to damage or tears following high energy injury or low energy injury in a knee with signs of arthritis. Treatment for meniscal tears can include either physiotherapy or surgery where the damaged meniscus is removed. Recent high-quality studies have shown physiotherapy is as effective as surgery in patients over 55. A potential reason for this is in patients over 55 there may be coexisting arthritis within the knee which is the source of symptoms rather than the meniscal tear. There is a clear need for high quality trial in younger patients aged under 55. Before a trial is commenced it is imperative to understand the trial population better.

The purpose of this study is to identify the symptoms patient present with, the presence of signs of arthritis on imaging and whether these features influence treatment outcome. We also aim to explore patient experiences of living with a meniscal tear.

We aim to perform a multicentre study where will follow up patients under 55 with an isolated meniscal tear to identify the symptoms and imaging findings patients present with. We will then follow up these patients over one year to identify if these symptoms or imaging signs affect treatment success. In addition, we will identify the current treatment pathways for patients with a meniscal tear.

20 participants from the main study will be invited to take part in interviews where we aim to identify patient experiences on living with a meniscal tear and views on a future large-scale trial.

This study will provide clinicians with a greater understanding of meniscal tears in young patients and help aid treatment decisions.

Project Details
Principal Investigator: Mr Andrew Metcalfe
Planned End Date: 30/05/2022
Local Ref: 4647

The primary objective of this multicentre Randomised Controlled Trial is to determine in patients with non-acute (greater than 4 months since injury) Anterior Cruciate Ligament Deficiency (ACLD) whether a strategy of non-surgical management [physiotherapy rehabilitation with option for later ACL reconstruction only if required) is more clinically effective and cost effective than a strategy of surgical management [reconstruction].

Undergoing structured rehabilitation first may prevent the need for surgery. This was observed in a Scandinavian study, where ACL injury treatment is given more immediately following injury (when injury is acute) unlike in the UK where treatment generally commences after a few months following injury (injury is non-acute). If it is found that rehabilitation treatment of non-acute ACL injuries is successful, it will mean that patients may not need to undergo surgery. The treatments provided in this study will be the standard operative or non-operative treatment currently provided in the UK.

Having surgery includes NHS waiting times, potential operative and anaesthetic risks and is a more expensive treatment option. Both treatment groups will be monitored to make sure the treatment allocated to them is appropriate. However, if rehabilitation is unsuccessful, patients with continued instability may still require surgery. Furthermore, the participant will be required to complete a baseline questionnaire and three follow-up questionnaires at six, twelve and eighteen months.

Project Details
Principal Investigator: Mr James Murray
Planned End Date: 12/02/2022
Local Ref: 3896

This study aims to compare two different plates currently used in knee realignment surgery (high tibial osteotomy). The purpose of the metal plates is to maintain the correct realignment achieved at surgery whilst the bone heals. The two plates, TomoFix and ActivMotion are both used in current practice and comply safety regulations.

Once the knee correction has healed (approx. 12 months) the plate can be left in. Some patients may however experience discomfort that related to the plate and benefit from plate removal ,  about a year after their initial operation. The ActivMotion plate design is a smaller than the Tomofix and it is therefore potentially less likely to cause discomfort . It is anticipated that second operations for plate removal will be less frequent than for the Tomofix plate.

In this study we would like to compare the number of plates that need removal following surgery, assess pain levels in patients in the first two years following surgery and compare the amount of pain relief used in the immediate post-operative recovery period.

Participants will be asked to complete a questionnaire before they have their operation and twelve months after the operation to assess their pain and function. This information will be used to compare the outcome of the plates.

Project Details
Principal Investigator: Mr James Murray
Planned End Date: 31/03/2024
Local Ref: 3810

This study is a prospective, post-market, global, multi-center, non-controlled, observational clinical evaluation of the commercially available Persona® Partial knee implant. The primary objective of the study is to obtain survivorship data and assess clinical performance (outcomes) using outcome measurement tools (e.g. patient questionnaires), radiographic assessments and adverse event data.

In total, there will be 30 global sites in the US and Europe. In the UK, the multi-centre study is being conducted at four sites in England with a maximum of 40 patients at each centre. Male and female individuals aged 18 years and over, with a confirmed diagnosis of osteoarthritis and who qualify for unicompartmental (partial) knee surgery will be potentially eligible to take part. Each Investigator will offer study participation to each consecutive eligible patient who satisfies the Inclusion/Exclusion criteria for partial knee arthroplasty using the commercially available Partial Persona Knee.

Following completion of the informed consent process, participants will undergo preoperative clinical evaluations prior to their partial knee arthroplasty. Patients will then be asked to attend post-operative follow-up clinic visits at 3 months, 1 year, 2 year, 5 year and 10 year. At these follow-up visits, clinical and radiographic evaluations will be conducted.

Project Details

Principal Investigator: Mr Andrew Porteous
Planned End Date: 31/12/2028
Local Ref: 3905

Knee replacement surgery is a common treatment for osteoarthritis of the knee. There are different types of knee replacement systems, or ‘implants’, that can be used in the surgery. The Knee replacement surgery is a common treatment for osteoarthritis of the knee. There are different types of knee replacement systems, or ‘implants’, that can be used in the surgery. The research looking at modifications and design changes to these implants is limited. Research is needed to consider the changing characteristics of the patients who require knee surgery. Currently there is an increase in demand for knee replacement in a younger and more active population, who desire less limitation on their activities following knee replacement surgery.

Current knee replacement designs sacrifice one of the main ligaments in the knee, called the Anterior Cruciate Ligament (ACL). By preserving natural knee structures, such as the ACL, it is thought that the knee will retain more normal function following surgery.

The Vanguard CR is a commonly used knee replacement, and it sacrifices the ACL. Zimmer Biomet have developed a new knee replacement implant called the Vanguard XP which keeps all the main knee ligaments intact. This new design may benefit the younger, more active population.

ALLIKAT is a research study which will evaluate the early outcomes of the Vanguard XP compared to the Vanguard CR. Patients will be followed up for 3 years, with information about complications both during and following the surgery, as well as patient reported outcomes. 200 patients will be randomised to receive either the Vanguard CR or the Vanguard XP, and they will not know which one they receive. There will also be a smaller group of 60 participants who will only receive the Vanguard XP. The data from this cohort group will contribute to safety and efficacy evaluation of the new implant. 260 patients will be recruited in total from 5-6 NHS sites around the UK.

Non-identifiable data collected from the cohort group combined with the data from those randomised to the Vanguard XP will contribute to the Beyond Compliance Program which has been set up in the interest of patients, to support the safe and stepwise introduction of new or modified medical implants such as joint replacements.

Project Details
Principal Investigator: Mr Andrew Porteous
Planned End Date: 30/06/2021
Local Ref: 3770

Hip replacements are a very common operation for people with painful arthritis. However, sometimes these hip replacements need to be done again because of pain and loosening.  We think that similar things may lead to loss of bone density (thinning of the bones) and loosening of joint replacements.  Because of this there is concern that loss of bone density may increase the need for further surgery to correct the loose joint replacement.

The study aims to see if there are differences in bone density and other factors that may explain why some people need their hip replacements done again (revised) and some do not.

Principal Investigator: Dr Emma Clark
Planned end date: 31/12/2025
Local Ref: 2503

Patient aged 60 years or over with painful OA of the shoulder and an intact rotator cuff presenting to secondary care and through shared making, having completed non-surgical treatments, proceeding to shoulder replacement. In shoulder replacement surgery, doctors remove the damaged parts of the shoulder and replace them with plastic or metal parts. 

The RAPSODI-UK study compares two types of shoulder replacement: the Total shoulder  replacement, and the Reverse Shoulder replacement.  These are the two types of shoulder replacement that NHS doctors use most often for patients with arthritis who need a shoulder replacement.  

They both help to reduce pain, and maintain or improve movement. However, doctors genuinely don’t know yet which one works best. 

Principal Investigator: Mr Mark Crowther  

Planned end date: 30/08/2024 

Local Ref: 5267 

Patients who sustain hip fractures that involve minimal displacement of the bone fragments may be treated surgically with either replacement of the hip joint of fixation of the fragments. The study is randomly allocating patients with these types of fracture to either type of surgery. Patients will be monitored up to 12 months post surgery.

Principal Investigator: Mr Tim Chesser
Planned End Date: 31/01/2029
Local Ref: 4695

This study is investigating the best way to treat patients aged 65 and over who have broken the top end of the upper arm bone (humerus) near the shoulder where the bone is broken into more than two parts.

There are currently three commonly used treatment options for fractures of this kind, which are two types of joint replacement surgery or structured non-surgical treatment. It is currently not known what the ‘best’ treatment is so this study is comparing non-surgical treatment and two types of joint replacement; ‘hemiarthroplasty’ which involves replacing only the broken ‘ball’ of the joint (top end of the arm bone), or ‘Reverse Shoulder Arthroplasty’ which replaces both the ball and socket, but replaces the ball with a socket and the socket with a ball (hence ‘reverse’).

Project Details
Principal Investigator: Mr Mark Crowther
Planned End Date: 01/05/2023
Local Ref: 4202

Treatments for ankle fractures aim to keep the bones in the right position while the breaks in the bones heal. For more severe fractures treatment often involves an operation where cuts are made around the ankle, and plates and screws are fitted against the bone fragments to keep them in place. An alternative non-surgical treatment involves applying a snug plaster cast called a close contact cast, carefully shaped to the ankle, to hold the bones correctly while they heal.

This study will investigate whether the non-surgical treatment option will provide patients with comparable ankle function and quality of life to those treated with surgery.

Project Details
Principal Investigator: Mr Mike Kelly
Planned End Date: 01/01/2027
Local Ref: 4607

Displaced fractures of the Olecranon (elbow) are usually managed surgically using metal wires or plate & screws to repair the broken bone. In some patients this can cause long term discomfort and require further surgery to remove the metalwork. Fixation of the bone fragments using a strong suture may reduce the incidence of this discomfort and the need for further surgery. Patients in this study are randomly allocated to undergo fixation with either the suture or wire fixation. Patients are monitored up to 2 years post-surgery.

Project Details
Principal Investigator: Mr Iain Packham
Planned End Date: 31/03/2024
Local Ref: 4862

Fractures, or breaks, to the bone in the upper arm (Humerus) may either be treated with surgery to fix the broken bone with metal implants, such as plates & screws, or non-operative management in a brace or plaster. The aim of this study is to compare these two treatments to see if surgical or non-surgical treatment of these injuries provides patients with better function of their arm and quality of life.

Project Details
Principal Investigator: Mr Alasdair Bott
Planned End Date: 01/10/2023
Local Ref: 4852

Shoulder dislocations occur when the upper end of the arm bone is forced out of its joint socket. Most people do not need an operation, but there is no research available to tell us what to do next.

Currently in the UK, some hospitals offer a single session of physiotherapy and some offer a course of physiotherapy. The UK guidelines currently say a course of physiotherapy ‘may be helpful’; whilst other national guidelines say a single session alone is needed.

The purpose of this research study is to find out if the ARTISAN Programme with additional sessions is any better than the ARTISAN Programme alone for patients who have dislocated their shoulder. It is important to carry out a study in which the two methods are compared so in the future, individuals with similar injuries will receive the best possible treatment.

Project Details
Principal Investigators: Mr Iain Packham & Mrs Rhian Witham
Planned End Date: 01/07/2022
Local Ref: 4330

Getting back to work, voluntary work or education after an injury can be difficult. Many patients with serious injuries can have difficulties returning to work because of the physical and psychologists’ effects of problems. This can lead to financial and other problems. Overall, being in work is better for health than unemployment or prolonged sick leave. We therefore want to find out the best of healing patients make a successful return voluntary work or education. The Rowtate study aims to test the return-to-work programme support versus the standard trauma care at people returning to work after traumatic injury.

Project Details

Principal Investigator: Edd Carlton

Planned end date:31/05/2024

Local Ref: 4927

A broken hip is a very serious injury that requires surgery to repair or replace the broken bone followed by a period of recovery in hospital. Around a quarter of patients who have a hip fracture have an episode of ‘delirium’ following surgery. Delirium is a condition where the patient loses awareness of themselves and the environment, and has difficulty thinking clearly. Inflammation, caused by the hip fracture and by the surgery to repair the hip, is thought to be the root cause of delirium. 
This study investigates the use of a drug called ‘lidocaine’ to see if it reduces the risk of delirium during surgery for a hip fracture.

Project Details

Principal Investigator: Dr Paddy Morgan

Planned end date: 04/2023

Local Ref: 5120

The odontoid process is a bony protuberance from the body of the second vertebra in the neck. Fracture of the odontoid, also known as the dens, can occur following low impact fall in frail and older people, and are increasing in incidence as the number of older people in the population increase. 

The Duration of External Neck Stabilisation (DENS) study is a randomised controlled trial comparing treatment in a hard collar for 12 weeks with early removal of a hard collar in older or frail adults with odontoid (dens) fractures. The aim of the study is to determine whether management without a collar improves outcome, compared to management with a collar. Cost efficiency will be assessed over the observed 12 months.

Project Details:

Principal Investigator: Dr Phillip Braude
Planned end date: 31/08/2023

 

After a broken ankle, the lower leg is usually placed in a cast or boot for a number of weeks so the broken bone can heal. When the cast or boot is removed the ankle initially feels stiff and sore. At this time, patients are given advice by health professionals on how to gradually get back to their usual activities and are given exercises to do at home.

In some hospitals, patients are asked to attend physiotherapy sessions. In other hospitals, patients will just receive advice. There is currently no scientific evidence showing that seeing a physiotherapist after an ankle fracture improves recovery. As physiotherapy appointments aren’t always convenient for patients, and because it’s important to make the best use of NHS time and resources, we want to find out if attending physiotherapy after an ankle fracture really does help improve recovery.

In the AFTER study, all participants will receive high quality information that will guide them with their recovery, with half of the participants also being asked to attend 4-6 physiotherapy sessions. Information on how quickly and how well patients are able to return to the majority of their usual activities will be used to make a comparison between the two treatments.

The AFTER study has been developed by patients and healthcare professionals, including physiotherapists and doctors. Their experience and knowledge have been used to plan this study which could provide an answer as to what type of rehabilitation is best.

Project details:

Principal Investigator: Andy Riddick

Planned End Date: 31/09/2023

Local ref: 5215

Hip fracture is the most common reason for older people require emergency anaesthesia and surgery and the most common cause of death after an accident. This surgery is often high-risk as patients with hip fracture may already be frail and have other health problems such as heart disease and anaemia.

Research suggests that 30-40% of these patients have a blood transfusion around the time of operation. These patients often already have anaemia before surgery and lose more blood during their operations.

It will investigate whether a liberal or restrictive transfusion strategy around the time of surgery is more beneficial to patients.

Project details:

Principal Investigator: Katherine Walsh

Planned end date: 28/02/2025

Local ref: 5209