JTO - March 2022
Volume 10 Issue 1
From the Executive Editor
March winds and April showers... but in February? Perhaps just another example of the somewhat topsy-turvy world we find ourselves in at the moment? Although we are told, ‘restrictions’ are ending and ‘things’ are returning to normal, from a T&O point of view, we may still beg to differ. However, as an endlessly naïve optimist, I do believe that the winds of change are passing through our specialty and now is a great opportunity for innovative thinking and sustainable solutions. We certainly need to think differently when you realise the scale of the problem as outlined in John’s ‘From the President’ article (page 5).
#SolvingTogether (https://solvingtogether.crowdicity.com) challenges you to submit your ideas that you think will make a difference for our patients – it gives you the opportunity to look at the ideas of others too and to vote for those you think will truly make a difference. So please just go ‘do it’ and put your idea forward.
Both our subspecialty section, (from page 46), and our recent online document www.boa.ac.uk/orthobiologics look at orthobiologic treatments critiquing the rationale and the evidence for their use in different situations and asking the question posed on our front cover: are they the right treatment for Ms X? This review of the evidence is balanced by two interesting and personal perspectives from a surgeon (page 58) and a patient (page 62).
My pledge to you for 2022 was to concentrate on the wider issues of diversity and engagement and as we approach #International Women’s Day it is pleasing to see how far IODA has come in the last two years (page 26). The BOA guidance on parental leave (www.boa.ac.uk/parenthood) is supported by James’s article (page 30) where he asks you to consider being the person you cannot see and supporting them when you do see them. Another group of trainees (page 42) show that you can demonstrate commitment to your profession whilst gaining experience and having fun all without spending a fortune.
There is perhaps no greater change that a person can make than exchanging their UK day job for a role providing humanitarian support to those in dire need in crisis areas (page 38) and encouraging us to recycle to boot! As I begin to introduce you to my presidential theme of sustainable systems, we all need to find ways in which we can contribute little and often.
I always like to learn so was delighted to read the article on implantable devices and MRI (page 22) – some common sense information that we can all put to use for patient benefit.
This issue of the JTO welcomes Fergal Monsell as Honorary Secretary and Simon Britten as Medico-legal Chair – both excellent additions to the BOA team. If you would like to join the team we will be looking for nominations for Trustee positions soon (page 9) – we need yet more diversity: northerners would be very welcome!
Unbelievably (to me!) this is my last editorial and as I hand over the JTO reins to the capable pair of hands that belong to Simon Hodkinson, your new Executive Editor, I would like to thank Nicholas Dunwell and Annette Heninger for guiding my editorial hands over the last 18 months and Hiro Tanaka and Fergal Monsell for helping to commission the content for JTO. Your help has been much appreciated. I will take a short breather before returning – albeit on a different page of the JTO!
Deborah Eastwood, Vice President
- Orthobiologic injectables; Yes-No-Don't know
- Orthobiologics: Scientific background
- Orthobiologics: Osteoarthritis
- Orthobiologics: Tendinopathy
- The decision to add PRP to my practice - a personal perspective
- PRP - a personal perspective
Breaking down barriers to flexible training in trauma and orthopaedics
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- Walls J. Flexible Training For A Modern Surgical Workforce. Ann R Coll Surg Engl (Suppl). 2006;88:44-7.
- Bellini MI, Graham Y, Hayes C, et al. A woman’s place is in theatre: women’s perceptions and experiences of working in surgery from the Association of Surgeons of Great Britain and Ireland women in surgery working group. BMJ Open. 2019;9:e024349.
- Royal College of Surgeons. Less Than Full Time (LTFT) Training in Surgery: JCST Policy Statement, 2017. Available at: www.rcseng.ac.uk/careers-in-surgery/careers-support/flexible-training-and-working/flexible-training-in-surgery.
- NHS Digital. Narrowing of NHS gender divide but men still the majority in senior roles. March 2018. Available at: https://digital.nhs.uk/news/2018/narrowing-of-nhs-gender-divide-but-men-still-the-majority-in-senior-roles. (Accessed 5th November 2021).
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- Harries RL, Rashid M, Smitham P, et al. What shape do UK trainees want their training to be? Results of a cross-sectional study. BMJ Open. 2016;6:e010461.
- Harries RL, Gokani VJ, Smitham P on behalf of the councils of the Association of Surgeons in Training and the British Orthopaedic Trainees Association, et al. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6:e010136.
- Hampton, T, Greenhalgh, R, Ryan, D, et al. Female surgical trainee attrition. Bull R Coll Surg Engl. 2016;98:134-7.
- Roche CD. Locked in – Locked out: Inflexibility in UK training. Trauma. 2021;23(2):87-9.
- Royal College of Surgeons. Less Than Full Time (LTFT) Training in Surgery: JCST Policy Statement, 2017. Available at: www.rcseng.ac.uk/careers-in-surgery/careers-support/flexible-training-and-working/flexible-training-in-surgery.
Appendix 1 - Thematic AnalysisAppendix 1: Thematic analysis with a sample of the direct quotes from which the themes and subthemes were derived
Diversity in trauma and orthopaedics: Rationale for an inclusive culture
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- Emery SE, Carousel Presidents. Diversity in Orthopaedic Surgery: International Perspectives: AOA Critical Issues. J Bone Joint Surg Am. 2019;101(21):e113.
- 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.
- Hiemstra LA WT, Mulpuri K, Vezina C, Kerslake S. Dissecting disaprity: improvements towards gender parity in leadership and on the podium within the Canadian Orthopaedic Association. Journal of ISAKOS. 2019;4(5):227-32.
- Green J, Chye V, Hiemstra L, Fellander-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(1):44-51. Available at: www.boa.ac.uk/resources/knowledge-hub/jto-march-2020.html.
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- Bucknall V, Pynsent PB. Sex and the orthopaedic surgeon: a survey of patient, medical student and male orthopaedic surgeon attitudes towards female orthopaedic surgeons. Surgeon. 2009;7(2):89-95.
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- O'Connor MI. Medical School Experiences Shape Women Students' Interest in Orthopaedic Surgery. Clin Orthop Relat Res. 2016;474(9):1967-72.
- Siddiqua A, Bhandari M, Hiemstra L, Hiasat N. Championing Women Orthopaedic Surgeons: Preparing for an Inclusive Future. OE Insights [Internet]. 2021. Available at: https://myorthoevidence.com/Insight/Show/102?vgo_ee=XF2MKDPnRXov+c4dv3UaxjLD70TX2s/[email protected]_President.
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- Rotenstein L, Harry E, Wickner P, Gupte A, Neville BA, Lipsitz S, et al. Contributors to Gender Differences in Burnout and Professional Fulfillment: A Survey of Physician Faculty. Jt Comm J Qual Patient Saf. 2021;47(11):723-30.
- Cohen M, Kiran T. Closing the gender pay gap in Canadian medicine. CMAJ. 2020;192(35):E1011-E1017.
- Bellini MI, Graham Y, Hayes C, Zakeri R, Parks R, Papalois V. A woman's place is in theatre: women's perceptions and experiences of working in surgery from the Association of Surgeons of Great Britain and Ireland women in surgery working group. BMJ Open. 2019;9(1):e024349.
- Fleming S, Fisher R. Sexual assault in surgery: a painful truth. Bulletin of the Royal College of Surgeon of England. 2021;September:282-5.
- Ayers CE. Minorities and the orthopaedic profession. Clin Orthop Relat Res. 1999 May;(362):58-64.
- Poon S, Kiridly D, Mutawakkil M, Wendolowski S, Gecelter R, Kline M, et al. Current Trends in Sex, Race, and Ethnic Diversity in Orthopaedic Surgery Residency. J Am Acad Orthop Surg. 2019;27(16):e725-e33.
- Ramirez RN, Franklin CC. Racial Diversity in Orthopedic Surgery. Orthop Clin North Am. 2019;50(3):337-44.
- Ode GE, Williams RJ, Harrington MA, Bennett CH, Hogan MV, Porter S. Achieving a Diverse, Equitable, and Inclusive Environment for the Black Orthopaedic Surgeon: Part 2: Obstacles Faced in Inclusion and Retention of Black Orthopaedic Residents. J Bone Joint Surg Am. 2021;103(11):1040-5.
- Hunt V, Layton D, Prince S. Diversity Matters. Mckinsey & Company; 2015. Available at: www.mckinsey.com/insights/organization/~/media/2497d4ae4b534ee89d929cc6e3aea485.ashx.
- McDonald TC, Drake LC, Replogle WH, Graves ML, Brooks JT. Barriers to Increasing Diversity in Orthopaedics: The Residency Program Perspective. JB JS Open Access. 2020;5(2).
- Dixon-Fyle S, Hunt V, Dolan K, Prince S. Diversity Wins - How Inclusion Matters. Mckinsey & Company; 2020. Available at: www.mckinsey.com/~/media/mckinsey/featured%20insights/diversity%20and%20inclusion/diversity%20wins%20how%20inclusion%20matters/diversity-wins-how-inclusion-matters-vf.pdf.
- Leopold SS. Editorial: What You Can Do to Support Women in Orthopaedics Worldwide. Clin Orthop Relat Res. 2021;479(9):1881-4.
- Leopold SS. Editorial: Fears About #MeToo are No Excuse to Deny Mentorship to Women in Orthopaedic Surgery. Clin Orthop Relat Res. 2019;477(3):473-6.
- Ibarra H. A Lack of Sponsorship is Keeping Women from Advancing into Leadership. Harvard Business Review; 2021. Available at: https://hbr.org/2019/08/a-lack-of-sponsorship-is-keeping-women-from-advancing-into-leadership.
- Ode GE, Bradford L, Ross WA, Carson EW, Brooks JT. Achieving a Diverse, Equitable, and Inclusive Environment for the Black Orthopaedic Surgeon: Part 1: Barriers to Successful Recruitment of Black Applicants. J Bone Joint Surg Am. 2021;103(3):e9.
- Balch Samora J, Van Heest A, Weber K, Ross W, Huff T, Carter C. Harassment, Discrimination, and Bullying in Orthopaedics: A Work Environment and Culture Survey. J Am Acad Orthop Surg. 2020;28(24):e1097-e104.
- Whicker E, Williams C, Kirchner G, Khalsa A, Mulcahey MK. What Proportion of Women Orthopaedic Surgeons Report Having Been Sexually Harassed During Residency Training? A Survey Study. Clin Orthop Relat Res. 2020;478(11):2598-606.
- Harbold D, Dearolf L, Buckley J, Lattanza L. The Perry Initiative's Impact on Gender Diversity Within Orthopedic Education. Curr Rev Musculoskelet Med. 2021;14(6):429-33.
- Mason BS, Ross W, Ortega G, Chambers MC, Parks ML. Can a Strategic Pipeline Initiative Increase the Number of Women and Underrepresented Minorities in Orthopaedic Surgery? Clin Orthop Relat Res. 2016;474(9):1979-85.
Knife before wife, or so they say
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- British Orthopaedic Association (2021). Survey on burnout and wellbeing among trauma and orthopaedic surgeons. Available at: www.boa.ac.uk/latest-news/survey-on-burnout-and-wellbeing.html.
- Khoushhal Z, Hussain M, Greco E, Mamdani M, Verma S, Rotstein O, et al. Prevalence and Causes of Attrition Among Surgical Residents: A Systematic Review and Meta-analysis. JAMA Surg. 2017;152(3):265-72.
- General Medical Council. Chapter 2: Our data on medical students and doctors in training in the UK Doctors. 2018;57–72. Available at: www.gmc-uk.org/-/media/gmc-site-images/about/what-we-do-and-why/data-and-research/somep-2017/somep-2017-final-full.pdf.
- Moberly T. A fifth of surgeons in England are female. BMJ. 2018;363(k4530).
- Statista (2019). Number of female held CEO positions in FTSE companies in the United Kingdom (UK) as of June 2019. Available at: www.statista.com/statistics/685208/number-of-female-ceo-positions-in-ftse-companies-uk.
- Harries RL, Gokani VJ, Smitham P, Fitzgerald JE; councils of Association of Surgeons in Training and British Orthopaedic Trainees Association. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6(4):e010136.
- British Medical Association (2021). Shared Parental Leave. Available at: www.bma.org.uk/pay-and-contracts/maternity-paternity-and-adoption/leave/shared-parental-leave.
James Lind Alliance Priority Setting Partnership - ‘Top 10’ research priorities in foot and ankle surgery
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- Crowe S, Fenton M, Hall M, Cowan K, Chalmers I. Patients’, clinicians’ and the research communities’ priorities for treatment research: there is an important mismatch. Res Involv Engagem. 2015;1:2.
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- Partridge N, Scadding J. The James Lind Alliance: patients and clinicians should jointly identify their priorities for clinical trials. Lancet. 2004;364(9449):1923-4.
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- Houchen et al on behalf of the PHOSP-COVID consortium. Joint patient and clinician priority setting to identify ten key research questions regarding the long-term sequelae of COVID-19. Thorax, In press.
- Rowbotham NJ, Smith SJ, Elliott ZC, Leighton PA, Rayner OC, Morley R, Smyth AR. Adapting the James Lind Alliance priority setting process to better support patient participation: an example from cystic fibrosis. Res Involv Engagem. 2019;5:24.
Orthobiologics: Scientific background
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- Wiggers TG, Winters M, Van den Boom NA, et al. Autologous stem cell therapy in knee osteoarthritis: a systematic review of randomised controlled trials. Br J Sports Med 2021;55(20):1161-69.
- Murray IR, Robinson PG, West CC, et al. Reporting Standards in Clinical Studies Evaluating Bone Marrow Aspirate Concentrate: A Systematic Review. Arthroscopy 2018;34(4):1366-75.
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- Mahmoudian A, Lohmander LS, Mobasheri A, et al. Early-stage symptomatic osteoarthritis of the knee - time for action. Nat Rev Rheumatol 2021;17(10):621-32.
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- Gong H, Li K, Xie R, et al. Clinical therapy of platelet-rich plasma vs hyaluronic acid injections in patients with knee osteoarthritis: A systematic review and meta-analysis of randomized double-blind controlled trials. Medicine (Baltimore) 2021;100(12):e25168.
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- Gobbi A, Dallo I, Rogers C, et al. Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study. Int Orthop 2021;45(5):1179-88.
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