01 Sep 2018

Volume 6 Issue 3


From the Executive Editor

Welcome to the first issue celebrating the Centenary of the British Orthopaedic Association. Our feature article by Ian Stephen and David Adams traces not only the development of our Association but also provides a fascinating outline of how our specialty has developed over the last 100 years. Starting from a meeting of 12 members on 2nd February 1918, we have grown to a membership of almost 5000 with just under 2000 attending our last Congress.

We are living in times of overt rationing of elective healthcare, delaying surgery on those same patients because of winter pressures due to a lack of resources and the inability of social care to keep vulnerable patients in their homes or provide suitable care to allow their return to the community. This does not absolve us of responsibility to ensure the care we do offer is efficient and effective. We have three articles focussing on the “Getting It Right First Time” project led by Prof Tim Briggs. He explains how variation is rife across the spectrum of medical and surgical care, and outlines the substantial impact of addressing the problems. Processes and practices have to change if any benefit is to be gained and two further articles look at how we may use GIRFT evidence to reduce costs and improve outcomes.

The financial theme continues in two paired articles by David Johnson and Ro Kulkarni that explore the somewhat arcane world of coding and tariff. I implore you to read them as they give a straightforward and comprehensible account of the topic which is so important to maintaining the viability of your department.

Teamwork within our specialty and across specialties is vital. The outcomes of hip fracture surgery are largely reliant on developing an effective system of care. Janet Lippett describes how she and her team transformed the pathway for these frail and elderly patients.

Pressure on the junior members of the orthopaedic team has a negative impact on continuity of care, patient experience and particularly on the educational development of young surgeons. The Medical Associate Professions may well be the solution. Karen Daly and Jeannie Watkins explain who they are what they can do.

As you explore this edition, consider what our forebears from 1918 would think about the content and wonder what the 2018 volume will look like.


Phil Turner – BOA Vice President




Reference Lists

Rationing and Barriers to Access in Orthopaedic Surgery

1. www.nhshealthatwork.co.uk/images/library/files/Bulletins/July_2016_Arthritis_Research_UK_WORKING_W ITH_ARTHRITIS_[June_2016]_Publication_5_July_2016.pdf.

2.  www.tandfonline.com/doi/pdf/10.1080/17453670610013501.

3. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/long-term-conditions-mental-health-cost- comorbidities-naylor-feb12.pdf.

4. www.england.nhs.uk/wp-content/uploads/2016/02/Mental-Health-Taskforce-FYFV-final.pdf.

5. Giori NJ, Amanatullah DF, Gupta S, Bowe T, Harris AHS. Risk Reduction Compared with Access to Care: Quantifying the Trade-Off of Enforcing a Body Mass Index Eligibility Criterion for Joint Replacement. JBJS 2018;100;539-45 [AN].

6. McElroyMJ, Pivec R, Issa K, Harwin SF, Mont MA. The effects of obesity and morbid obesity on outcomes in TKA. J Knee Surg. 2013 Apr;26(2):83-8. Epub 2013 Mar 11.

7. Workgroup of the American Association of Hip and Knee Surgeons Evidence Based Committee. Obesity and total joint arthroplasty: a literature based review. J Arthroplasty. 2013 May;28(5):714-21. Epub 2013 Mar 19.

8. Baker P, Petheram T, Jameson S, Reed M, Gregg P, Deehan D. The association between body mass index and the outcomes of total knee arthroplasty. J Bone Joint Surg Am. 2012 Aug 15;94(16):1501-8.

9. Jameson SS, Mason JM, Baker PN, Elson DW, Deehan DJ, Reed MR. The impact of body mass index on patient reported outcome measures (PROMs) and complications following primary hip arthroplasty. J Arthroplasty. 2014 Oct;29(10):1889-98. Epub 2014 Jun 2.

10. Judge A, Batra RN, Thomas GE, Beard D, Javaid MK, Murray DW, Dieppe PA, Dreinhoefer KE, Peter-Guenther K, Field R, Cooper C, Arden NK. Body mass index is not a clinically meaningful predictor of patient reported outcomes of primary hip replacement surgery: prospective cohort study. Osteoarthritis Cartilage. 2014Mar;22(3):431-9. Epub 2014 Jan 11.

11. Losina E, Walensky RP, Kessler CL, Emrani PS, Reichmann WM, Wright EA, Holt HL, Solomon DH, Yelin E, Paltiel AD, Katz JN. Cost-effectiveness of total knee arthroplasty in the United States: patient risk and hospital volume. Arch Intern Med. 2009 Jun 22;169(12):1113-21; discussion 1121–2. 

The Use of the Internet by Orthopaedic Out-patients in 2015 compared to 2001

1. NUA Internet Systems.  www.nua.com/surveys/how_many_online/ europe.html.  

2. Wright J.E.D, Brown R.R.B., Chadwick C., Karadaglis D.  The use of the internet by Orthopaedic outpatients.  J Bone Joint Surg Br.  2001; 83(8):1096-7.  

3. Office of National Statistics, internet users, main points, January to March 2015.  http://www.ons.gov.uk/ons/rel/rdit2/internet-users/2015/stb-ia-2015.html. 4. Silberg W.M., Lundberg G.D., Musacchio R.A.  Assessing, controlling and assuring the quality of medical information on the Internet: caveant lector et viewor – let the reader and viewer beware.  JAMA 1997; 277:1244-5.

5. Kershaw A.  Patient use of the Internet to obtain health information.  Nurs Times.  2003; 99(36):30-2.

6. Murray E.  The impact of health information on the internet on the physician-patient relationship: patient perceptions.  Arch Intern Med.  2003; 163(14):1727–1734.  

7. Nguyen H.Q., Carrieri-Kohlman V., Rankin S.H., Slaughter R., Stulbarg M.S.  Internet-based patient education and support interventions: a review of evaluation studies and directions for future research.  Computers in Biology and Medicine.  2004; 34:95–112.

8. Wald H.S., Dube C.E., Anthony D.C.  Untangling the Web--the impact of Internet use on health care and the physician-patient relationship.  Patient Educ Couns.  2007; 68(3):218-24.  

9. Underhill C, McKeown L.  "Getting a second opinion: Health information and the internet." Health Reports.  2008; 19(1) Statistics Canada Catalogue no.  82-003-X.  p. 1-5.

10. MacCulloch R., Nyhof-Young J., Nicholas D., Donaldson S., Wright J.G.  Development of an online information and support resource for adolescent idiopathic scoliosis patients considering surgery: perspectives of health care providers.  Scoliosis.  2010; 5:13.  

11. Fraval A., Chong Y.M., Holcdorf D., Plunkett V., Tran P.  Internet use by orthopaedic outpatients - current trends and practices.  AMJ.  2012; 5(12):633-638.

12. Levy H., Janke A.T., Langa K.M.  Health Literacy and the Digital Divide Among Older Americans.  J Gen Intern Med.  2015; 30(3):284-289. 

Operations I No Longer Do ... MACI for Chondral Grafting

1. Knutsen G et al JBJS(Am) 2007  89:2105-2112.

2. Dye, S COOR 2005 July 436: 100-110.

3. Saris D et al AJSM 2014 42(6) 1384-1394.

4. Lim HC et al CORR 2012 Aug 470(8) 2261-7.

5. “Surgery, The Ultimate Placebo” Ian Harris ISBN 9781742234571.

6. Elson DW et al BMJ case reports 2014 doi:10.1136/bcr-2014-206492.

7. Parker DA et al AJSM 2011 39:5; 1039-1045.

8. Ferruzzi A et al The Knee 2014 Mar: 21(2); 445-450.

9. https://www.nice.org.uk/guidance/ta477. 10. Evolution of Autologous Chondrocyte Repair and Comparison to other Cartilage Repair Techniques.

10. Dewan AK, Gibson MA, Elisseeff JH, Trice ME. Biomedical Research International 2014 ID 272481

High Court Rejects Claims on Metal on Metal (MoM) Implants

1. A v National Blood Authority (2001) 3 All ER 289.

2. Consumer Protection Act (1987).

3. www.crownofficechambers.com/2018/05/21/pinnacle-metal-on-metal-hip-group-litigation/.  

4. Daily Telegraph (2016) 24th January edition.

5. Gee & others v DePuy International Ltd (2018) EWHC 1208 (QB).

6. PI Focus (2018) Court rejects action over hip implants 28 (5) p7.

7. Wilkes v DePuy International (2016) EWHC 3096 (QB).