01 Sep 2022

Volume 10 Issue 3

From the Executive Editor

When I first put pen to paper as Editor, I referred to flaming June and the local weather which, at the time, was pouring down. How I regret my cynicism as flaming June morphed into boiling July and August and we are begging for rain down South!

The President referred to the green shoots of recovery and whilst that particular germinal episode may have struggled a bit due to yet another variant of COVID, in this edition we discuss the role of big data and Artificial Intelligence in the future of our profession. If data is the new soil, then it will need ‘water’ and maybe that is our role as professionals to embrace and mould this technology and use it for the good of our patients.

The first of three articles on this subject discusses healthcare data and in particular the issue of interoperability and standards in such data (page 56). An issue dear to us all as we rage at our inability to see a patients images taken down the road but not available in the clinic! We continue with a timely reminder of the rules and regulations concerning digital information and how not to fall foul of such (page 60).

Finally, a thought provoking article on artificial intelligence and machine learning, phrases that did not exist as I started in this profession (page 64). Is this the dawn of a new age in our profession, we shall see, but we need to embrace it if it is to develop in ways that benefit our patients.

Also, in this edition we continue the theme of equality and diversity with an article on the important topic of neurodiversity in our profession (page 30) and the issue of dyslexia (page 36), both so often hidden away for fear of stigmatisation.

In a similar vein, Sarah Eastwood and colleagues review the BHS mentorship scheme (page 44), its remit, development, and early results, with the potential for a much wider role out for this important development.

A timely article on the outlier status of certain implants illustrates the power of the NJR in arthroplasty practice (page 28) and Simon Gregg-Smith continues his review of case law in orthopaedic practice (page 52).

An excellent article on the use of remote virtual follow-up clinics in Malawi (page 48) and Fatima Rashid’s review of the Hull deformity course (page 40), the Best of the Best prize again this year complete this edition of the Journal.

I hope you enjoy it and I look forward to meeting colleagues in Birmingham for this year’s BOA Annual Congress.

 Simon Hodkinson, Vice President Elect


Subspecialty Section



Neurodiversity - What do we understand

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  2. Kenny L, Hattersley C, Molins B, Buckley C, Povey C, Pellicano E. Which terms should be used to describe autism? Perspectives from the UK autism community. Autism. 2016;20(4):442-62
  3. Baumer N and Frueh J. (2021) What is neurodiversity? - Harvard Health. Available at: www.health.harvard.edu/blog/what-is-neurodiversity-202111232645. (Accessed: March 24, 2022).
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  5. National Institute of Mental Health (NIMH). Autism Spectrum Disorder.. Available at: www.nimh.nih.gov/health/topics/autism-spectrum-disorders-asd. (Accessed: November 9, 2021).
  6. National Autistic Society. What is autism? Available at: www.autism.org.uk/advice-and-guidance/what-is-autism. (Accessed: March 24, 2022).
  7. Russell G, Stapley S, Newlove-Delgado T, Salmon A, White R, Warren F, et al. Time trends in autism diagnosis over 20 years: a UK population-based cohort study. J Child Psychol Psychiatry. 2022;63(6):674-82.
  8. Doherty M, Neilson S, O'Sullivan J, Carravallah L, Johnson M, Cullen W, Shaw S. Barriers to healthcare and self-reported adverse outcomes for autistic adults: a cross-sectional study. BMJ Open. 2022;12:e056904. 
  9. Hatfield T, Brown R, Giummarra M, Lenggenhager B. Autism spectrum disorder and interoception: Abnormalities in global integration? Autism. 2017;23(1):212-22.
  10. Nicolaidis C, Raymaker D, Ashkenazy E, McDonald K, Dern S, Baggs A, et al. “Respect the way I need to communicate with you”: Healthcare experiences of adults on the autism spectrum. Autism. 2015;19(7):824-31.
  11. Nicolaidis, C., Raymaker, D., McDonald, K., Dern, S., Boisclair, W., Ashkenazy, E. and Baggs, A. (2013) ‘Comparison of Healthcare Experiences in Autistic and Non-Autistic Adults: A Cross-Sectional Online Survey Facilitated by an Academic-Community Partnership’, Journal of General Internal Medicine, 28(6), pp.761-769.
  12. Nicolaidis, C., Schnider, G., Lee, J., Raymaker, D., Kapp, S., Croen, L., Urbanowicz, A. and Maslak, J. (2020) ‘Development and psychometric testing of the AASPIRE Adult Autism Healthcare Provider Self-Efficacy Scale’, Autism, 25(3), pp.767-773.
  13. Lever, A. and Geurts, H., (2016) ‘Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder’ Journal of Autism and Developmental Disorders, 46(6), pp.1916-1930. doi:10.1007/s10803-016-2722-8.
  14. Lai, M. and Baron-Cohen, S. (2015) ‘Identifying the lost generation of adults with autism spectrum conditions’, The Lancet Psychiatry, 2(11), pp.1013-1027.
  15. Hirvikoski, T., Mittendorfer-Rutz, E., Boman, M., Larsson, H., Lichtenstein, P. and Bölte, S., 2016. Premature mortality in autism spectrum disorder. British Journal of Psychiatry, 208(3), pp.232-238.
  16. Cassidy, S., Gould, K., Townsend, E., Pelton, M., Robertson, A. and Rodgers, J. (2019) ‘Is Camouflaging Autistic Traits Associated with Suicidal Thoughts and Behaviours? Expanding the Interpersonal Psychological Theory of Suicide in an Undergraduate Student Sample’, Journal of Autism and Developmental Disorders, 50(10), pp.3638-3648.
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  22. Baron-Cohen, S., Wheelwright, S., Scahill, V. and Spong, A. (2001) “Are intuitive physics and intuitive psychology independent? A test with children with Asperger Syndrome,” Journal of Developmental and Learning Disorders , 5, pp. 47–78. Available at: https://www.researchgate.net/publication/237239741_Are_intuitive_physics_and_intuitive_psychology_independent_A_test_with_children_with_Asperger_Syndrome (Accessed: April 9, 2022).
  23. Meng, C., Huo, C., Ge, H., Li, Z., Hu, Y. and Meng, J. (2021) “Processing of expressions by individuals with autistic traits: Empathy deficit or sensory hyper-reactivity?,” PLoS ONE, 16(7 July 2021). doi:10.1371/JOURNAL.PONE.0254207.
  24. Han, E., Scior, K., Avramides, K. and Crane, L. (2022) “A systematic review on autistic people’s experiences of stigma and coping strategies,” Autism Research, 15(1), pp. 12–26. doi:10.1002/AUR.2652.
  25. Ventriglio, A., Watson, C. and Bhugra, D. (2020) “Suicide among doctors: A narrative review,” Indian Journal of Psychiatry, 62(2), p. 114. doi:10.4103/PSYCHIATRY.INDIANJPSYCHIATRY_767_19.
  26. General Medical Council. (2018) Welcomed and valued: Supporting disabled learners in medical education and training. [ebook] pp.5-8. Available at: https://www.gmc-uk.org/-/media/documents/welcomed-and-valued-2021-english_pdf-86053468.pdf [Accessed 4 January 2022].
  27. Moore, S., Kinnear, M. and Freeman, L. (2020) ‘Autistic doctors: overlooked assets to medicine’, The Lancet Psychiatry, 7(4), pp. 306-307. doi:10.1016/S2215-0366(20)30087-0.
  28. Doherty, M., Johnson, M. and Buckley, C. (2021) 'Supporting autistic doctors in primary care: challenging the myths and misconceptions', British Journal of General Practice, 71(708), pp. 294–295. doi:10.3399/bjgp21X716165
  29. Milton, D. (2012) ‘On the ontological status of autism: the “double empathy problem”, Disability & Society, 27(6), pp.883-887.
  30. Crompton, C., Ropar, D., Evans-Williams, C., Flynn, E. and Fletcher-Watson, S. (2020) ‘Autistic peer-to-peer information transfer is highly effective’, Autism, 24(7), pp.1704-1712.
  31. Croen, L., Zerbo, O., Qian, Y., Massolo, M., Rich, S., Sidney, S. and Kripke, C. (2015) ‘The health status of adults on the autism spectrum’, Autism, 19(7), pp.814-823.
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  34. Valkanova, V., Rhodes, F., and Allan, C. (2013) 'Diagnosis and management of autism in adults', Practitioner, 257(1761), pp. 2-3.
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  36. Office for National statistics: Outcomes for disabled people in the UK;2020; Published February2021

The British Hip Society mentorship programme: Supporting the next generation

  1. Hoyle A, Walsh A,  Chatterji S, McNeill H, Davis N. Mentorship for female orthopaedic Surgeons. Are we behind the curve? Orthopaedics Online, March 2021. Available at: www.boa.ac.uk/resources/mentorship-for-female-orthopaedic-surgeons-are-we-behind-the-curve.html.
  2. General Medical Council. Leadership and management for all doctors. [Clauses 53, and 56-59]. Available at: https://www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/leadership-and-management-for-all-doctors/duties-of-a-doctor-in-the-workplace.
  3. Sinclair P, Fitzgerald J E F, Hornby S T, Shalhoub J. Mentorship in surgical training: Current status and a needs assessment for future mentoring programs in surgery. World J Surg. 2015;39(2):303-13; discussion 314.
  4. Clutterbuck D. 2014. Everyone needs a mentor. Fifth Edition. London: CIPD.
  5. Mulcahey MK, Waterman BR, Hart R, Daniels AH. The role of mentoring in the development of successful orthopaedic surgeons. J Am Acad Orthop Surg. 2018;26(13):463-71.
  6. Day MA, Owens JM, Caldwell LS. Breaking barriers: a brief overview of diversity in orthopedic surgery. Iowa Orthop J. 2019;39(1):1.
  7. Choi S, Ooi S, Carpenter E. A Cross-Sectional Study of Undergraduate Teaching of Trauma and Orthopaedics in the UK and the Relationship Between Medical Schools and Interest in Trauma and Orthopaedics as a Career. J Med Educ Curric Dev. 2022;9:23821205211072764.
  8. NHS Digital (2019). Medical and Dental staff by gender specialty and grade AH2667. Available at https://digital.nhs.uk/data-and-information/find-data-and-publications/supplementary-information/2019-supplementary-information-files/medical-and-dental-staff-by-gender-specialty-and-grade-ah2667 (Accessed 6th April 2022).
  9. Green JA, Chye VP, Hiemstra LA, Felländer-Tsai L, Incoll I, Weber K, et al. Diversity: Women in orthopaedic surgery–a perspective from the International Orthopaedic Diversity Alliance. Journal of Trauma and Orthopaedics. 2020;8(3):44-51.
  10. Acuña AJ, Sato EH, Jella TK, Samuel LT, Jeong SH, Chen AF, Kamath AF. How long will it take to reach gender parity in orthopaedic surgery in the United States? An analysis of the National Provider Identifier Registry. Clin Orthop Relat Res. 2021;479(6):1179-89.

A remote virtual follow-up strategy for outreach surgery – developing the Malawi model

  1. Malhotra AK, Martin N, Jacoby M, Tarrant J, Guilford K, Wolfe LG, et al. What Are We Missing: Results of a 13-Month Active Follow-Up Program at a Level I Trauma Center. Journal of Trauma and Acute Care Surgery. 2009;66(6).
  2. Kable A, Gibberd R, Spigelman A. Complications after discharge for surgical patients. ANZ J Surg. 2004;74(3):92-7.
  3. Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, et al. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. The Lancet Infectious Diseases. 2016;16(12):e288-e303.
  4. Wismayer R. Progress and Challenges Associated With Telemedicine in the Surgical Field and Beyond in Sub-Saharan Africa. 2022.
  5. Webster P. Virtual health care in the era of COVID-19. Lancet. 2020;395(10231):1180-1.
  6. Chin BZ, Nashi N, Lin S, Yik K, Tan G, Kagda FH. Telemedicine use in orthopaedics: Experience during the COVID-19 pandemic. Journal of Telemedicine and Telecare.0(0):1357633X211041011.
  7. Green MA, McKee M, Katikireddi SV. Remote general practitioner consultations during COVID-19. Lancet Digit Health. 2022;4(1):e7.
  8. Chen JS, Buchalter DB, Sicat CS, Aggarwal VK, Hepinstall MS, Lajam CM, et al. Telemedicine during the COVID-19 pandemic : adult reconstructive surgery perspective. Bone Joint J. 2021;103-B(6 Supple A):196-204.
  9. McVay MR, Kelley KR, Mathews DL, Jackson RJ, Kokoska ER, Smith SD. Postoperative follow-up: is a phone call enough? Journal of pediatric surgery. 2008;43(1):83-6.
  10. British Orthopaedic Association. Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic2021. Available from: https://www.boa.ac.uk/static/782e0b20-f9ce-4fc9-819f943740161405/201ebd61-5828-4c81-b45a8b80ac47fd50/COVID-19-BOASTs-Combined-v3FINAL.pdf.
  11. Adepoju P. Africa turns to telemedicine to close mental health gap. The Lancet Digital Health. 2020;2(11):e571-e2.
  12. Morshed S, Shearer DW, Coughlin RR. Collaborative partnerships and the future of global orthopaedics. Clinical Orthopaedics and Related Research®. 2013;471(10):3088-92.
  13. Mobasheri MH, Johnston M, Syed UM, King D, Darzi A. The uses of smartphones and tablet devices in surgery: A systematic review of the literature. Surgery. 2015;158(5):1352-71.
  14. NHS England. Outpatient Transformation Programme 2022 [Available from: https://www.england.nhs.uk/outpatient-transformation-programme/.
  15. Congdon N, Yan X, Lansingh V, Sisay A, Müller A, Chan V, et al. Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study. Lancet Glob Health. 2013;1(1):e37-45.
  16. Kishiki E, Shirima S, Lewallen S, Courtright P. Improving postoperative follow-up of children receiving surgery for congenital or developmental cataracts in Africa. Journal of American Association for Pediatric Ophthalmology and Strabismus. 2009;13(3):280-2.
  17. Ologunde R, Rufai SR. Surgical follow-up in low-income and middle-income countries. The Lancet Global Health. 2013;1(3):e132.

Digital technology: How to get it right – Data governance, storage of data, and the regulations

  1. GOV.UK. Data Protection Act 2018 - The Data Protection Act 2018 is the UK’s implementation of the General Data Protection Regulation (GDPR). Available at: www.gov.uk/data-protection.
  2. WhatDoTheyKnow. AI agreements with orth.ai. Available at: www.whatdotheyknow.com/request/ai_agreements_with_orthai.
  3. Jones H. What does the end of COPI mean for digital health innovation? digitalhealth Feature Article 23 June 2022. Available at: www.digitalhealth.net/2022/06/what-does-the-end-of-copi-mean-for-digital-health-innovation.
  4. NHSX / NHS Transformation Directorate. Using mobile messaging. 8 Feb 2022. Available at: www.nhsx.nhs.uk/information-governance/guidance/use-mobile-messaging-software-health-and-care-settings.
  5. Department of Health & Scoal Care. [withdrawn] Coronavirus (COVID-19): notice under regulation 3(4) of the Health Service (Control of Patient Information) Regulations 2002 – general. Updated 30 June 2022. Available at: www.gov.uk/government/publications/coronavirus-covid-19-notification-of-data-controllers-to-share-information/coronavirus-covid-19-notice-under-regulation-34-of-the-health-service-control-of-patient-information-regulations-2002-general--2.
  6. Department of Health and Social Care. Independent Goldacre Review. Better, broader, safer: using health data for research and analysis. 7 April 2022. Available at: www.gov.uk/government/publications/better-broader-safer-using-health-data-for-research-and-analysis/better-broader-safer-using-health-data-for-research-and-analysis.
  7. Department of Health and Social Care. Data saves lives: reshaping health and social care with data. 15 June 2022. Available at: www.gov.uk/government/publications/data-saves-lives-reshaping-health-and-social-care-with-data/data-saves-lives-reshaping-health-and-social-care-with-data.
  8. Department of Health and Social Care. A plan for digital health and social care. 29 June 2022; Available at: www.gov.uk/government/publications/a-plan-for-digital-health-and-social-care/a-plan-for-digital-health-and-social-care.
  9. Craggs, H. A Quality Improvement Project to assess the functionality and safety of the current medical referral process and to develop a safer and more usable referral and patient tracking system. Annual Scientific Conference, Faculty of Clinical Informatics. 16 June 2022; Available at: https://facultyofclinicalinformatics.org.uk/courses-conferences.
  10. Hamblin-Brown DD. How Careful Plans To Get Doctors And Patients Talking At Last. 28 June 2022. Available at: www.forbes.com/sites/davidprosser/2022/06/28/how-careful-plans-to-get-doctors-and-patients-talking-at-last/?sh=16c13ecc1c34.
  11. Stokes P. The ‘Five Safes’ – Data Privacy at ONS. Office for National Statistics. 27 January 2017. Available at: https://blog.ons.gov.uk/2017/01/27/the-five-safes-data-privacy-at-ons.
  12. Bennett Institute for Applied Data Science. ABout OpenSAFELY. Available at: www.opensafely.org/about.