Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Oswestry, United Kingdom

Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Oswestry, United Kingdom
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Cool P.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Cribb G.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Bone and Joint Research | Year: 2017

Objectives In this cross sectional study, the impact and the efficacy of a surveillance programme for sarcomas of the extremities was analysed. Methods All patients who had treatment with curative intent for a high-grade sarcoma and were diagnosed before 2014 were included and followed for a minimum of two years. Results Of the 909 patients who had a review appointment in 2014, 131 were under review for a high-grade sarcoma of the extremities following treatment with curative intent. Of these patients, three patients died of disease, two patients died of other causes, 12 are alive, with disease, and 114 have no evidence of disease. The surveillance programme accounts for 14% of all review appointments. Four of five patients (80%) who developed local recurrence identified the recurrence themselves. Chest radiographs are adequate in identifying metastatic disease and 11 (73%) of metastases were diagnosed during a routine follow up visit. However, the chance of cure is small and only two patients were referred for a metastatectomy. Of these only one survived for more than two years. The mean time for developing metastatic disease and local recurrence was 2.0 and 3.9 years respectively. Once identified, the mean time to death was 2.1 years for patients with metastatic disease. Conclusions Surveillance of sarcoma patients makes up a substantial amount of the workload of a sarcoma unit. The chance of cure following identification of local recurrence or metastatic disease, however, is small. Alternative methods of surveillance that allow better evaluation of the patient's needs are recommended.


McClure J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Mangham D.C.,University of Manchester | Freemont T.,University of Manchester
Diagnostic Histopathology | Year: 2017

Surface tumours of bone may be a cause of confusion and diagnostic difficulty. Confusion may arise from the several descriptive adjectives used - parosteal, periosteal and juxtacortical. Diagnostic difficulties may arise from the lack of awareness of less common entities, insufficient biopsy sampling and a failure to understand the precise relationship of a lesion and the bone surface. In this review we define and classify the important lesions and indicate imaging, macroscopic and microscopic features which are useful for diagnosis. © 2017.


Garcia J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Garcia J.,Keele University | Wright K.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Wright K.,Keele University | And 9 more authors.
Scientific Reports | Year: 2016

The infrapatellar fat pad (FP) and synovial fluid (SF) in the knee serve as reservoirs of mesenchymal stromal cells (MSCs) with potential therapeutic benefit. We determined the influence of the donor on the phenotype of donor matched FP and SF derived MSCs and examined their immunogenic and immunomodulatory properties before and after stimulation with the pro-inflammatory cytokine interferon-gamma (IFN-γ 3). Both cell populations were positive for MSC markers CD73, CD90 and CD105, and displayed multipotency. FP-MSCs had a significantly faster proliferation rate than SF-MSCs. CD14 positivity was seen in both FP-MSCs and SF-MSCs, and was positively correlated to donor age but only for SF-MSCs. Neither cell population was positive for the co-stimulatory markers CD40, CD80 and CD86, but both demonstrated increased levels of human leukocyte antigen-DR (HLA-DR) following IFN-γ 3 stimulation. HLA-DR production was positively correlated with donor age for FP-MSCs but not SF-MSCs. The immunomodulatory molecule, HLA-G, was constitutively produced by both cell populations, unlike indoleamine 2, 3-dioxygenase which was only produced following IFN-γ 3 stimulation. FP and SF are accessible cell sources which could be utilised in the treatment of cartilage injuries, either by transplantation following ex-vivo expansion or endogenous targeting and mobilisation of cells close to the site of injury.


Winn N.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Spratt J.,Sunderland General Hospital | Wright E.,Durham University | Cox J.,Hexham General Hospital
Multidisciplinary Respiratory Medicine | Year: 2014

Background: CT guided lung biopsy is a commonly performed procedure to obtain tissue for a histological diagnosis in cases of suspected lung cancer. Methods: This is a prospective cohort study to obtain information directly from patients about their experiences of the biopsy procedure, thus obtaining a more accurate picture of complications compared with previously performed retrospective reviews. Patients participated in a post-procedure telephone interview and information was gathered about any procedural complications and personal experiences. We also compared the patient reported complications with those obtained from a retrospective review of hospital databases, analogous to previously performed retrospective studies. Results: In our patient group, reported procedural complication rates were 10% pneumothorax rate (4% requiring a chest drain) and 10% haemoptysis. Post-procedural pain and shortness of breath showed positive correlation, with one patient experiencing prolonged pain. No statistical difference was found between the patient reported complication rates and those obtained from retrospective review of the hospital database. Conclusions: Our study demonstrates CT guided lung biopsy is a safe procedure and is generally well tolerated. Some patients may experience significant and lasting pain and therefore should be counselled about this pre-procedure. © 2014 Winn et al.


Craig P.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Bancroft G.,Staffordshire University | Burton A.,Cannock Chase Hospital | Collier S.,Cannock Chase Hospital | And 2 more authors.
Bone and Joint Journal | Year: 2014

The issues surrounding raised levels of metal ions in the blood following large head metalonmetal total hip replacement (THR), such as cobalt and chromium, have been well documented. Despite the national popularity of uncemented metal-on-polyethylene (MoP) THR using a large-diameter femoral head, few papers have reported the levels of metal ions in the blood following this combination. Following an isolated failure of a 44 mm Trident-Accolade uncemented THR associated with severe wear between the femoral head and the trunnion in the presence of markedly elevated levels of cobalt ions in the blood, we investigated the relationship between modular femoral head diameter and the levels of cobalt and chromium ions in the blood following this THR. A total of 69 patients received an uncemented Trident-Accolade MoP THR in 2009. Of these, 43 patients (23 men and 20 women, mean age 67.0 years) were recruited and had levels of cobalt and chromium ions in the blood measured between May and June 2012. The patients were then divided into three groups according to the diameter of the femoral head used: 12 patients in the 28 mm group (controls), 18 patients in the 36 mm group and 13 patients in the 40 mm group. A total of four patients had identical bilateral prostheses in situ at phlebotomy: one each in the 28 mm and 36 mm groups and two in the 40 mm group. There was a significant increase in the mean levels of cobalt ions in the blood in those with a 36 mm diameter femoral head compared with those with a 28 mm diameter head (p = 0.013). The levels of cobalt ions in the blood were raised in those with a 40 mm diameter head but there was no statistically significant difference between this group and the control group (p = 0.152). The levels of chromium ions in the blood were normal in all patients. The clinical significance of this finding is unclear, but we have stopped using femoral heads with a diameter of ≤ 36 mm, and await further larger studies to clarify whether, for instance, this issue particularly affects this combination of components. © 2014 The British Editorial Society of Bone & Joint Surgery.


Wilson S.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Sharp C.A.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Davie M.W.J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Osteoporosis International | Year: 2012

To review whether osteoporosis in the absence of vertebral fracture (VFX) affects health-related quality of life (HRQoL), a systematic search of the main literature databases for HRQoL in patients with osteoporosis without VFX was undertaken. This was undertaken. This identified 1,327 articles as potentially relevant to the review. After screening of abstracts and reviewing 168 articles in detail, 27 were considered relevant. HRQoL data were extracted and collated into tables and, where possible, were converted into normative scores and further analysed. Data relating to the associations between HRQoL and bone mineral density (BMD) were also collated. Of the 27 articles included, only 5 directly compared osteoporosis without VFX with a control group (BMD T-score>-1.0, without VFX). Extracted raw data from 21 articles demonstrated that patients with osteoporosis without VFX had clinically relevant reductions in role physical, general health, vitality, mental health domains and the mental component summary score, using SF36. Using Qualeffo-41, pain and physical function were worse in these patients. Also, HRQoL was related to upper femur, but not lumbar spine BMD. HRQoL data in patients with osteoporosis without VFX are limited and variable but suggest that HRQoL is adversely affected by osteoporosis in the absence of VFX. The association of lower BMD and worse HRQoL suggests that more attention should be paid to HRQoL in those without VFX. Future studies are needed to investigate HRQoL in patients with osteoporosis in the absence of fracture, controlling for co-morbidities and social and economic status. © International Osteoporosis Foundation and National Osteoporosis Foundation 2012.


Cool P.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Ockendon M.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust
Bone and Joint Journal | Year: 2015

Plots are an elegant and effective way to represent data. At their best they encourage the reader and promote comprehension. A graphical representation can give a far more intuitive feel to the pattern of results in the study than a list of numerical data, or the result of a statistical calculation. The temptation to exaggerate differences or relationships between variables by using broken axes, overlaid axes, or inconsistent scaling between plots should be avoided. A plot should be self-explanatory and not complicated. It should make good use of the available space. The axes should be scaled appropriately and labelled with an appropriate dimension. Plots are recognised statistical methods of presenting data and usually require specialised statistical software to create them. The statistical analysis and methods to generate the plots are as important as the methodology of the study itself. The software, including dates and version numbers, as well as statistical tests should be appropriately referenced. Following some of the guidance provided in this article will enhance a manuscript. © 2015 The British Editorial Society of Bone & Joint Surgery.


MacDonald J.H.,Bangor University | Evans S.F.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Davies H.L.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Wilson S.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | And 2 more authors.
Arthritis Care and Research | Year: 2012

Objective. To determine the effect of 6 years of routine management on body composition, physical functioning, and quality of life, and their interrelationships, in men with idiopathic vertebral fracture. Methods. Twenty men with idiopathic vertebral fracture (patients: mean ± SD age 58 ± 6 years) were age and height matched to 28 healthy controls with no known disease. The primary outcome was skeletal muscle mass (appendicular lean mass by dual X-ray absorptiometry) assessed at 2 visits (0 and 6 years). Physical functioning and quality of life domains were assessed by the Senior Fitness Test and Short Form 36 (SF-36) questionnaire at visit 2 only. Data were analyzed by repeated-measures analysis of variance, independent t-tests, and correlation. Results. At visit 1, appendicular lean mass was 9% lower in patients than controls. Although patients better maintained appendicular lean mass between visits (interaction P = 0.016), at visit 2 appendicular lean mass remained 5% lower in patients than controls. Furthermore, patients' appendicular lean mass change was correlated with femoral neck bone density change (r = 0.507, P = 0.023). Physical function tests were 13-27% lower in patients compared with controls (P = 0.056 to 0.003), as were SF-36 quality of life physical domains (13-26% lower; P = 0.028 to <0.001). Conclusion. Despite an association between changes in muscle mass and bone density, routine management of men with idiopathic vertebral fracture does not address muscle loss. Combined with the observation of reduced physical functioning and quality of life, this study identifies novel targets for intervention in men with idiopathic vertebral fracture. © 2012, American College of Rheumatology.


Turner S.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Turner S.,Keele University | Balain B.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Caterson B.,University of Cardiff | And 3 more authors.
European Spine Journal | Year: 2014

Purpose: There is much interest in the development of a cellular therapy for the repair or regeneration of degenerate intervertebral discs (IVDs) utilising autologous cells, with some trials already underway. Clusters of cells are commonly found in degenerate IVDs and are formed via cell proliferation, possibly as a repair response. We investigated whether these clusters may be more suitable as a source of cells for biological repair than the single cells in the IVD. Methods: Discs were obtained at surgery from 95 patients and used to assess the cell viability, growth kinetics and stem or progenitor cell markers in both the single and clustered cell populations. Results: Sixty-nine percent (±15) of cells in disc tissue were viable. The clustered cell population consistently proliferated more slowly in monolayer than single cells, although this difference was only significant at P0–1 and P3–4. Both populations exhibited progenitor or notochordal cell markers [chondroitin sulphate epitopes (3B3(−), 7D4, 4C3 and 6C3), Notch-1, cytokeratin 8 and 19] via immunohistochemical examination; stem cell markers assessed with flow cytometry (CD73, 90 and 105 positivity) were similar to those seen on bone marrow-derived mesenchymal stem cells. Conclusions: These results confirm those of previous studies indicating that progenitor or stem cells reside in adult human intervertebral discs. However, although the cell clusters have arisen via proliferation, there appear to be no greater incidence of these progenitor cells within clusters compared to single cells. Rather, since they proliferate more slowly in vitro than the single cell population, it may be beneficial to avoid the use of clustered cells when sourcing autologous cells for regenerative therapies. © 2014, Springer-Verlag Berlin Heidelberg.


Gandhi M.J.,Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust | Anderton M.J.,Royal Blackburn HospitalBlackburn | Funk L.,Wrightington Hospital
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2015

Purpose To evaluate correlations between objective performances measured by a new online arthroscopic skills acquisition tool (ASAT, in which "shape match" with inverted controls requires lifting shapes and releasing them into their corresponding silhouettes) and a validated virtual reality (VR) shoulder arthroscopy simulator (Insight Arthro VR; GMV, Madrid, Spain). Methods Forty-nine medical students familiarized themselves with 5 ASATs. They were then assessed using a sixth ASAT (shape match with inverted controls) and 4 VR tasks (operating room, visualize, locate and palpate, and pendulum) on the VR simulator. Correlations were assessed between 11 ASAT measures and 15 VR measures using Pearson correlation coefficients. Results Time taken and delta distance (actual distance minus minimum distance traveled) were the most frequent and correlated ASAT measures. Time taken correlated with the VR locate-and-palpate time (r = 0.596, P <.001), visualize time (r = 0.381, P =.007), and pendulum time (r = 0.646, P <.001), whereas delta distance correlated with the locate-and-palpate camera distance (r = 0.667, P <.001), instrument distance (r = 0.664, P <.001), visualize distance (r = 0.4, P =.004), pendulum camera distance (r = 0.538, P <.001), and instrument distance (r = 0.539, P <.001). Conclusions There were significant correlations between performance measures on the ASAT and a validated arthroscopic VR simulator. Clinical Relevance Arthroscopic simulators are available but are limited by their high cost and availability. ASATs may overcome these limitations by using widely available Internet-based software and basic input devices. © 2015 Arthroscopy Association of North America.

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