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We offer dedicated multi-disciplinary clinics with physiotherapy and specialist nurses.

A well established number of patients are on Biologic Therapy

Find out more information about AS and different treatments.

NASS Bristol (National Ankylosing Spondylitis Society) has been running groups from Southmead Hospital since 1998. Since March 2020, we moved to online stretch sessions due to COVID-19.

We run physiotherapist-led online stretch sessions every Monday afternoon at 1pm and on Wednesday evening at 6:30pm.

If you’re interested in joining in, we ask you to email and we will send you a medical questionnaire for you to complete before starting the session.

Find out more on the Nass Bristol website. 

There are dedicated clinics at Southmead Hospital Bristol for new and follow up patients. The service is run by Dr Harsha Gunawardena, Dr Sam Patel and Dr John Pauling, supported by a specialist nurse and pharmacist.

We have experience in management of all autoimmune connective tissues diseases such as:

• SLE (systemic lupus erythematosus).
• Scleroderma (systemic sclerosis).
• Inflammatory muscle diseases (Myositis).
• Sjogren's Syndrome.
• Vasculitis.
• Behcet’s Disease.

We take referrals from GPs and other hospital doctors (tertiary referral) for the more complex cases requiring high level expertise, such as inflammatory muscle disease, systemic sclerosis, and vasculitis.

We prescribe advanced therapies only available at a specialist centre including cyclophosophamide and Rituximab on Medical Day Care. 

For more information on drug treatment in rheumatology please visit the Versus Arthritis website.

Combined clinics with other specialist centres and specialties including Respiratory medicine (interstitial lung disease) and Royal Free Scleroderma service for complex conditions.

Respiratory CTD Lung ILD Combined Clinic

Week 1 and 3: Dr Adamali and Dr Barratt and Dr Harsha Gunawardena for patients with lung disease secondary to autoimmune connective tissue disease or vasculitis.

Royal Free North Bristol systemic sclerosis outreach clinic

Held every 6 months with Professor Chris Denton and Dr Voon Ong of the Royal Free Hospital, London and Dr Harsha Gunawardena for patients with complicated systemic sclerosis (scleroderma).

Combined Rheumatology and Neurology neuromuscular metabolic bone disease clinic

Held every three months with Dr Emma Clark and Dr Andria Merrison

We hold a specialised osteoporosis and metabolic bone disease clinic at Southmead Hospital Bristol with Dr Emma Clark.

We have a DEXA scanner (to measure bone density) at Southmead Hospital Bristol. We often do an additional scan as part of standard DXA scans to look at the spine for vertebral fractures (VFA). We have good links with our radiology colleagues and can offer vertebroplasty if it is required.

We also have two dedicated osteoporosis specialist nurses.

Specialist therapies such as Denosumab injections are administered within the nurse clinic and Zoledronic acid infusions are administered on the medical day care unit.

The Royal Osteoporosis Society has up to date information on understanding osteoporosis, the treatments available, information on exercise diet and lifestyle, and local support in your area, please visit the Royal Osteoporosis Society website.

We have close ties with the physiotherapists, elderly care services and the falls services.

Our fracture liaison service is led by Dr Katherine Walsh and Dr Bailey, who are orthogeriatricians assisted by a fracture liaison nurse. The service is designed to identify new patients of 50 years and over who have sustained low trauma fractures injuries (equivalent to fall from head height or less). 

The nurse offers telephone follow up to patients with a high risk of future fracture to assess adherence and tolerability of bone protection medication. Where patients have not started treatment or there are medication issues they will be contacting patients to help resolve any issues.

Further information can be found on the Versus Arthritis Website.

We have a Rapid Access “Hot” Clinic for people suspected to have giant cell arteritis (GCA) with referrals from GPs and also within secondary care.

You will have an urgent appointment arranged and a temporal artery ultrasound carried out.  A further follow up will be planned if Giant Cell Arteritis is diagnosed.

Further information can be found on the Versus Arthritis Website.

This study will compare two different ways to help people with their recovery from a broken shoulder. Patients with this injury are usually referred for physiotherapy appointments for advice on how to get their arm and shoulder working again

In this study, patients will be asked to follow one of two rehabilitation programmes. They will either be offered:  Outpatient physiotherapy appointments to be shown what exercises to do or advice and information about a self-directed exercise programme that can be done at home. Advice will be given by a health professional in the hospital clinic, and you will also be given a high-quality workbook to help guide your recovery. 

PI: Rhian Witham 

Start Date: Jan 2025

End Date: Dec 2026

Local Ref: 5639

Evaluation of safety and efficacy of a resorbable collagan IMplant in treatment of High Grade PArtical thiCkness Tear; A prosepctive, mulitcentre, randomized, control trial.

Patients who are 18 years and over, with a partial rotator cuff injury who’s symptoms persist following 3-6 months of conservative treatment are eligible for this study.

Impact study compares two types of surgery:

The rotator cuff is a group of muscles and their tendons that act to stabilize (hold in place) the shoulder. Torn rotator cuff tendons are common injuries that result in shoulder weakness and pain. These injuries can be treated with medications, injections, and physical therapy. However, when symptoms continue despite these treatments, surgery is often recommended to repair the injured tendon. An alternative to standard surgical procedures for repairing torn rotator cuff tendons involves applying a protective layer of collagen over the injured tendons to aid in healing and stop disease progression. Collagen is the most commonly found protein in the body and is present in the skin, bones, tendons and ligaments. The collagen is extracted from bovine Achilles tendons (from cows).  

The purpose of this study is to find out if the marketed REGENETEN™ Bioinductive Implant is better than standard repair techniques for surgically treating partial-thickness rotator cuff tears. Smith+Nephew is the company paying for the study and REGENETEN is one of their products.

Project Details:

Principal investigator: Iain Packham

Start date: March 2023

End date: June 2026

Local ref: 5311

Peri-Op Iron and Erythropoietin (EPO) Intervention Study 

Anaemia after major emergency surgery in older people with hip fractures is common and is associated with increased mortality, longer length of hospital stay and poorer quality of health. The POP-I trial aims to recruit patients 60 and over, who are anaemic in the postoperative period following either hip fractures. Participants who give their consent will be assigned randomly into one of three study groups: Usual care, Iron Infusion, or iron infusion and an injection that will stimulate red blood cell production.

PI: Katherine Walsh 

Start Date: Nov 2024

End Date: July 2025

Local Ref: 5535

This study aims to find out the best treatment for patients 16 years and over with repeated dislocations of their kneecap (patella). The study is comparing personalised knee therapy, delivered by a Physiotherapist, to surgical stabilisation for improving patient function following repeated dislocation.

Project Details:

PI: Mr Damian Clark

Start Date: Dec 2023

End Date: Aug 2025

Local Ref: 5440

This study compares surgery to sling immobilisation in the management of adults with a displaced fracture of the distal clavicle (Collarbone) in patients over the age of 18 years old with 21 days of injury. 

When the outer end of the collarbone has broken, parts of the bone may separate and not line up. This can rupture the ligaments connecting the collarbone to the shoulder blade. Doctors commonly treat this type of injury that have had with: A sling, to help support the shoulder while the bone heals naturally; or surgery that uses metal work to try the separated bone while they knit together naturally.  Both treatments work but we do not know which one works the best. The aim of this study is to find this out. 

Project Details:

PI: Iain Packham 

Start Date: December 2023

End Date: 30 June 2025

Local Ref: 5405

Following surgery for a hip fracture (broken hip) hospitals aim to help patients out of bed within 48 hours of surgery. Patients should also receive a minimum of 2 hours of rehabilitation per week. Patients who receive more than this seem to recover quicker and return home sooner. This study aims to find out if increasing the level of ward-based mobilisation activities for patients following hip fractures allows them to return home sooner.

Project Details:

PI: Kirsty Derrick

Start Date: August 2024

End Date: August 2025

Local Ref: 5285

Distal Radius Acute Fracture 3: Cast verus Splint; a randomised non-inferiority trial comparing clinical and cost-effectiveness of a standard cast versus removable splint in Adults with a distal fracture tat does not require Manipulation.

When a person breaks their wrist, the treatment usually involves a support for the injured wrist. This support provides pain relief. It also protects the fracture (the break) whilst it heals.

In most hospitals in the UK, people with a broken wrist are given a plaster cast. After 4 to 6 weeks, they go back to hospital to have the cast taken off.

The results of a recent research study show that a removable wrist splint might provide the wrist with the same amount of support as a cast.

The benefit of this is that you can take it off yourself at home, so you don’t need to have it removed at a hospital. This could be more convenient for you. Providing people with a splint instead of a cast might also save money for the NHS.

At the moment, doctors, physiotherapists and other healthcare professionals are not completely sure if having a splint gives the same level of pain relief and support as a cast.

In this study, we will directly compare people receiving a cast with people receiving a splint for treating broken wrists. We want to find out if levels of pain and the ability to do everyday tasks are similar between the two groups. We will also have a look at the cost of both treatment options to the NHS, and society as a whole.

Project Details:

Principal investigators: Alasdair Bott and Fran Verey

Start date: 03/2023

End date: 12/2024

Local ref: 5350

Lidocaine Intravenous Trial

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: June 2025

Local Ref: 5120

Fix or Replace Undisplaced Intracapsular fractures Trial of Interventions (FRUITI).

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.

Project Details:

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

The clinical and cost-effectiveness of elective primary total knee replacement with PAtellar Resurfacing compared to selective patellar resurfacing. A pragmatic multicentre randomised controlled Trial with blinding.

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

Hip Implant Prosthesis Programme for the Younger total hip replacement patient.

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 study aims to assess the performance and function of the newly introduced INFINITY™ with ADAPTIS™ and EVERLAST™ technology Total Ankle System for total ankle replacement or arthroplasty in patients with severe osteoarthritis of the ankle.

Project Details:
Principal Investigator: Steven Hepple

Start Date: 02/09/24
Planned End Date: 01/09/2025
Local Ref: 5570

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: William Poole
Planned End Date: 30/09/2027
Local Ref: 3275

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.

Project Details:

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

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

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.

Project Details:

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

 Reverse or Anatomical replacement for Painful Shoulder Osteoarthritis, Differences between Interventions (RAPSODI): a multi-centre, pragmatic, parallel group, superiority randomised controlled trial. 

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. 

 Project Details:

Principal Investigator: Mr Mark Crowther  

Planned end date: 04/2026

Local Ref: 5267 

This recipe makes a fruit cake with a lighter sponge and all the flavours of Christmas. It doesn’t need to mature like a traditional Christmas fruit cake.

Serves 16.

Ingredients

• 10oz/250g glace cherries, quartered
• 10oz/250g mixed peel
• 8 oz/200g tinned prunes, drained and chopped
• 5 eggs
• 2 dessert spoons of brandy/rum
• ½ teaspoon of almond essence (optional)
• 10oz/250g plain flour
• 1 teaspoon baking powder
• 7oz/175g soft brown sugar
• 10oz/250g unsalted butter, softened
• ½ teaspoon ground cinnamon
• 1 teaspoon ground mixed spice

Method

1. Place the cherries, mixed peel and prunes in a large bowl, add the brandy/rum and leave to soak overnight.
2. Grease a 7” (18cm) round cake tin, and double line with greaseproof paper. Preheat the oven to 140oC/120oC fan assisted.
3. Beat the butter, sugar, flour, eggs and spices in a large mixing bowl until well combined. Fold in the pre-soaked fruit and pour into the prepared cake tin.
4. Place a double layer of greaseproof paper loosely on top of the cake, and bake in the oven for 3 ½ to 4 hours. Remove greaseproof paper 15 minutes towards the end of cooking.
5. Leave to cool in the tin, and once cooled decorate with the icing of your choice. Store in an airtight container.

Ingredients

• 120g icing sugar
• 1tsp ground cinnamon
• 1tsp (5ml) water
• 2tsp (10ml) juice of an orange

Method

Sieve the icing sugar together with 1 tsp cinnamon, and mix with the water and juice of an orange. The icing should be thick enough to coat the back of the spoon. If it is too runny add a little extra sieved icing sugar, or if it is too thick then add a little more water.

Ingredients

• 8oz/200g plain flour
• 1 apple, grated
• 1 carrot, grated
• 4oz/100g sugar
• 4oz/100g mixed peel
• 3oz/75g glacé cherries
• 4oz/100g white breadcrumbs
• 3oz/75g tinned plums, drained and chopped
• 4oz/100g tinned prunes, drained and chopped
• 2 teaspoons mixed spice
• 1 egg
• 6 fl oz/150 ml milk
• 2 fl oz/50 ml brandy
• Caramel colouring
• 2 teaspoons lemon juice

Method

1. Mix together the flour, apple, carrot, sugar, mixed peel, cherries, breadcrumbs, plums, prunes and mixed spice.
2. Add the milk, brandy, egg, a little caramel colouring and lemon juice. Mix well.
3. Line a pudding bowl with a floured pudding cloth and place the mixture in the centre. Tie securely.
4. Put into a large pan half filled with hot water and boil the pudding for 4 hours. Cool and keep in the fridge.
5. Steam again for 4 hours before serving hot.

Foods to choose from

Turkey, chicken, duck, goose, beef, lamb, pork or fish.

Foods to choose from

Dishes made with tofu, Quorn, lentils, pumpkin,or squash. Cheese or brie and cranberry pastry parcels.

Foods high in potassium

Dishes made with nuts, courgette, mushrooms, spinach, sweet potato.

Foods to choose from

Boil potatoes first to make roast or mashed potatoes.

Foods high in potassium

Potatoes which have not been boiled.

2-3 portions

1 portion = 2-3 tablespoons

Foods to choose from

Boil vegetables. Choose those lower in potassium such as carrots, red cabbage and cauliflower. Limit Brussel
sprouts to 6.

Foods high in potassium

Vegetables such as mushrooms, parsnips, spinach, vegetable/tomato soup.

Foods to choose from

Yorkshire pudding, apple sauce, cranberry sauce, homemade bread sauce, mint sauce and horseradish.

Foods to choose from

Fruit pie or crumble (except for rhubarb, blackcurrant or apricot), artic roll, gateaux, ice cream, sorbet, pavlova,
profiteroles or trifle. Brandy/rum butter or double cream with puddings.

Foods high in potassium

Try to limit to 1 portion of either Christmas pudding or Christmas cake or 1 mince pie or 1 slice of Yule log.

Foods to choose from

Clementines, satsumas, apple, raspberries, tinned fruit.

Foods high in potassium

Fruits such as apricots, bananas, dried fruit and fruit juices.

Foods to choose from

Plain breadsticks, unsalted popcorn, corn, maize or wheat snacks (choose those without potassium chloride), pickled onions, cheese and biscuits. Carrot or cucumber sticks with cottage/cream cheese or sour cream or mayonnaise dips. Cranberries. Chestnuts (5)

Foods high in potassium

Potato crisps, Twiglets, guacamole, salsa, nuts and dried fruit.

Foods to choose from

Chicken or fish goujons, mini sausages, blinis or crispbreads with pate or salmon and cream cheese, prawns, arancini balls, mini quiches or vol au vents.

Foods to choose from

Sponge cake, gateaux, cream cakes, jam tarts, jam or cream swiss roll, brandy snaps, gingerbread or shortbread.

Foods high in potassium

Stollen, biscuits, cake containing dried fruit, nuts.

Foods to choose from

Jelly sweets, mint creams, marshmallows and Turkish delight.

Foods high in potassium

Liquorice, hot chocolate. Limit chocolate to 4 pieces / squares or 2 chocolate coated biscuits.

Foods to choose from

Liqueurs, port, sherry, spirits. 1 small beer/lager or 1 glass of wine/mulled wine or champagne.

Foods high in potassium

Cider and strong ales. Drinks/cocktails with fruit juice.

Disease of the small blood vessels in the brain (cerebral small vessel disease or SVD) causes a quarter of all strokes (lacunar stroke) and is the most common cause of vascular dementia. Despite its importance we understand relatively little about what causes this disease.  However we know genetic factors are important. If we can identify the responsible genes it will provide new insights into what causes SVD, and may help us identify new possible treatments.  

We are leading a worldwide collaboration to identify new genes for lacunar stroke. To identify new genes requires us to collect many thousands of cases of lacunar stroke, with the diagnosis confirmed on MRI. In a previous study, DNA lacunar 1, we collected 1000 cases. Using this data we have recently carried out an analysis which identified 11 new genes for SVD, and has provided completely new insights into what causes the disease. 

We are now extending this work aiming for a target of 5000 cases worldwide.

PI: Dr Sandeep Buddha

Planned End Date: 31/12/2025

Local ref: 5603

The “SPEEDY Trial” is a randomized controlled trial aimed at evaluating a new pre-hospital pathway designed to enhance access to thrombectomy treatment. Thrombectomy is a time-sensitive surgical procedure that can significantly improve outcomes for stroke patients. However, this treatment is currently only available in larger regional hospitals, limiting its accessibility.

In the trial, some patients will receive care according to the new “SPEEDY” pathway, while others will continue to receive standard care. Ambulance stations and teams will be randomly assigned to either implement the SPEEDY pathway or continue with the usual standard of care. The trial is currently open in the WMAS region and is expected to expand to NWAS, SWASFT, and NEAS in the coming months. Its primary aim is to assess whether this new approach can improve access to thrombectomy treatment for stroke patients.

PI: Dr Rose Bosnell

Planned End Date: 30/11/2025

Local ref: 5404

The objective is to assess the clinical effectiveness of tranexamic acid (TXA) after stroke versus usual care. With the primary objective being assess the effect of TXA on early deaths and the secondary objective to assess the effect of TXA on          dependency 6 months after Intracerebral Haemorrhage (ICH). The team are measuring the cost effectiveness of TXA versus usual care. Incremental cost effectiveness ratios (ICERs), net monetary benefit and cost effectiveness of usual care versus TXA. HE data collection will include Health Care Resource Use and the EQ5D-5L.

PI: Dr Sandeep Buddha

Planned End Date: 01/08/2027

Local reg: 4756