Royal National Orthopaedic Hospital

United Kingdom

Royal National Orthopaedic Hospital

United Kingdom
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Singh D.,Royal National Orthopaedic Hospital
British Journal of Sports Medicine | Year: 2017

This is one of a series of occasional articles highlighting conditions that may be more common than many doctors realise or may be missed at first presentation. The series advisers are Anthony Harnden, professor of primary care, Department of Primary Care Health Sciences, University of Oxford, and Richard Lehman, general practitioner, Banbury. To suggest a topic for this series, please email us at © 2017 Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

Obaid H.,Royal Infirmary | Connell D.,Royal National Orthopaedic Hospital
American Journal of Sports Medicine | Year: 2010

Background: Various types of tissue-derived cells are being experimented with for the treatment of tendinopathy, tendon repair, and use in tissue engineering. Purpose: The aim of this systematic review is to explore the current evidence with a view to evaluate the potential of this therapeutic intervention. Study Design: Systematic review. Methods: A review of the literature was conducted using PubMed. Search criteria included keywords "tendinopathy," "tendinitis," "tendinosis," "epicondylitis," "stem cell," and "cell therapy." Articles not written in English language were excluded. Results: A total number of 379 articles were identified and a critical appraisal of the relevant articles was undertaken, which encompassed human and animal research. The review included articles related to various tissue-derived cells such as tendon progenitors, adipose tissue, synovium, muscle, bone marrow, and skin. The utility of cell therapy in tissue engineering and rotator cuff repair was also assessed. Conclusion: With the limitation of the available evidence, the literature suggests that cell therapy is applicable and may be effective for the treatment of tendinopathy. However, further research into the precise biological mechanisms, long-term implications, and cost-effectiveness is needed. © The Author(s), 2010.

Agency: GTR | Branch: EPSRC | Program: | Phase: Research Grant | Award Amount: 708.30K | Year: 2014

According to statistics from charities such as Every Eight Hours and Spinal Research, there are an estimated 40,000 spinal cord injured people in the UK and a new person is injured every eight hours. Many primary causes of death are now no longer direct results of spinal cord injury but are conditions linked to age and inactivity. This means that there are long-term demands on medical support; in particular, treatment of osteoporotic bone fractures often results in lengthy spells in hospital for individuals with spinal cord injury. It is therefore important to minimize the effect of osteoporosis after spinal cord injury; this highlights the need for exercise programmes to target bone health. The proposed research aims to develop effective Functional Electrical Stimulation (FES) induced weight bearing exercises to improve and maintain bone health in the lower extremities of spinal cord injury patients. The type of exercises proposed will be completed using a novel smart standing frame and FES system to cyclically activate different sets of muscles whilst maintaining standing and crouch poses. The hypothesis is that these exercises will induce sufficient joint contact forces to be beneficial for bone health in the ankle, knee and hip joints. Using biomechanical modelling software an optimal combination of these exercises will be sought in order to design a rehabilitation programme to target bone health. To be beneficial to bone health, these exercises need to be repeated several times a week and there is a good chance patients will get bored or frustrated doing the same thing every day. To solve this problem, rehabilitation aids will be developed to keep patients motivated. These aids will use video game technology (based on the Xbox Kinect), to make the sessions more engaging for the patient to encourage compliance and give a sense of achievement. This will also allow the patient and clinician to monitor the progress of a rehabilitation programme and modify it as necessary.

News Article | February 17, 2017

A review of 25 clinical trials in 14 countries, some with conflicting results, yielded "the first definitive evidence" of a link between vitamin D and flu prevention, researchers claim (AFP Photo/JUSTIN SULLIVAN) Paris (AFP) - Taking extra vitamin D can protect against colds, flu and other respiratory infections, said a study Thursday which reopened a debate on the usefulness of over-the-counter supplements. A review of 25 clinical trials in 14 countries, some with conflicting results, yielded "the first definitive evidence" of a link between vitamin D and flu prevention, researchers claimed in The BMJ medical journal. The effects were strongest for people with very low levels of the nutrient which is found in some foods and can be synthesised by the body when the skin is exposed to ultraviolet light. Many people, especially in grey, cloudy climes, do not have enough vitamin D. Scientific studies over the years have delivered contradictory conclusions on the topic. Some have shown that low levels of the vitamin increase the risk of bone fractures, heart disease, colorectal cancer, diabetes, depression, Alzheimer's disease and death. Others said there is no evidence of a link to disease risk. For the new study, researchers from the Queen Mary University of London conducted the biggest-ever survey of trials involving nearly 11,000 people. And they found clues as to why supplements seem to work in some trials but not in others. "The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely-spaced doses," lead researcher Adrian Martineau said in a statement. Vitamin D is thought to protect against respiratory infections, including bronchitis and pneumonia, by boosting levels of antibiotic-like peptides in the lungs, said the team. This fits with an observation that colds and flu are more common in winter and spring, when vitamin D levels are lowest. It may also explain why vitamin D seems to protect against asthma attacks, they said. In an editorial published with the study, experts Mark Bolland and Alison Avenell said it should be viewed as a hypothesis in need of scientific confirmation. Louis Levy, head of nutrition science at Public Health England, shared their caution. "This study does not provide sufficient evidence to support recommending vitamin D for reducing the risk of respiratory tract infections," he said via the Science Media Centre in London. Other observers were more optimistic. The case for universal vitamin D supplements, or food fortification, "is now undeniable," concluded Benjamin Jacobs of the Royal National Orthopaedic Hospital.

Dhinsa B.S.,Royal National Orthopaedic Hospital | Adesida A.B.,University of Alberta
Current Stem Cell Research and Therapy | Year: 2012

The management of osteochondral defects of articular cartilage, whether from trauma or degenerative disease, continues to be a significant challenge for Orthopaedic surgeons. Current treatment options such as abrasion arthroplasty procedures, osteochondral transplantation and autologous chondrocyte implantation fail to produce repair tissue exhibiting the same mechanical and functional properties of native articular cartilage. This results in repair tissue that inevitably fails as it is unable to deal with the mechanical demands of articular cartilage, and does not prevent further degeneration of the native cartilage. Mesenchymal stem cells have been proposed as a potential source of cells for cell-based cartilage repair due to their ability to self-renew and undergo multi-lineage differentiation. This proposed procedure has the advantage of not requiring harvesting of cells from the joint surface, and its associated donor site morbidity, as well as having multiple possible adult donor tissues such as bone marrow, adipose tissue and synovium. Mesenchymal stem cells have multi-lineage potential, but can be stimulated to undergo chondrogenesis in the appropriate culture medium. As the majority of work with mesenchymal stem cell-derived articular cartilage repair has been carried out in vitro and in animal studies, more work still has to be done before this technique can be used for clinical purposes. This includes realizing the ideal method of harvesting mesenchymal stem cells, the culture medium to stimulate proliferation and differentiation, appropriate choice of scaffold incorporating growth factors directly or with gene therapy and integration of repair tissue with native tissue. © 2012 Bentham Science Publishers.

Mills L.A.,University of Edinburgh | Mills L.A.,Royal National Orthopaedic Hospital | Simpson A.H.R.W.,University of Edinburgh
Journal of Bone and Joint Surgery - Series B | Year: 2012

This review is aimed at clinicians appraising preclinical trauma studies and researchers investigating compromised bone healing or novel treatments for fractures. It categorises the clinical scenarios of poor healing of fractures and attempts to match them with the appropriate animal models in the literature. We performed an extensive literature search of animal models of long bone fracture repair/nonunion and grouped the resulting studies according to the clinical scenario they were attempting to reflect; we then scrutinised them for their reliability and accuracy in reproducing that clinical scenario. Models for normal fracture repair (primary and secondary), delayed union, nonunion (atrophic and hypertrophic), segmental defects and fractures at risk of impaired healing were identified. Their accuracy in reflecting the clinical scenario ranged greatly and the reliability of reproducing the scenario ranged from 100% to 40%. It is vital to know the limitations and success of each model when considering its application. ©2012 British Editorial Society of Bone and Joint Surgery.

Mills L.A.,Royal National Orthopaedic Hospital | Simpson A.H.R.W.,University of Edinburgh
BMJ Open | Year: 2013

Objectives: In the UK there are approximately 850 000 new fractures seen each year. Rates of non-union of 5-10% of fractures have been suggested, the cost to the National Health Service of treating non-union has been reported to range between £7000 and £79 000 per person yet there are little actual data available. The objective of this epidemiological study therefore is for the first time to report the rates of fracture non-union. Design: A cross-sectional epidemiological study. Setting: The population of Scotland. Participants: All patient admissions to hospital in Scotland are coded according to diagnosis. These data are collected by (and were obtained from) Information Services Department Scotland. Those who have been coded for a bone non-union between 2005 and 2010 were included in the study. No patients were excluded. Population data were obtained from the Registrar General for Scotland. Outcome measure: The number of fracture nonunions per 100 000 population of Scotland according to age, sex and anatomical distribution of non-union. Results: 4895 non-unions were treated as inpatients in Scotland between 2005 and 2010, averaging 979 per year, with an overall incidence of 18.94 per 100 000 population per annum. The distribution according to gender was 57% male and 43% female. The overall peak incidence according to age was between 30 and 40 years. The mean population of Scotland between 2005 and 2010 was 5 169 140 people. Conclusion: Fracture non-union in the population as a whole remains low at less than 20 per 100 000 population and peaks in the fourth decade of life. Further research is required to determine the risk of non-union per fracture according to age/sex/anatomical distribution.

Cannon S.R.,Royal National Orthopaedic Hospital
International Orthopaedics | Year: 2015

Purpose: The optimum treatment for periprosthetic fractures in the region of the distal femur is undefined. Although internal fixation for prostheses which are stable is commonly utilised, this can lead to very prolonged morbidity and failure of the fracture to unite. Where the prosthesis is either loose or infected, revision surgery is required and a ‘tumour type’ prosthesis can be successfully utilised. Methods: The outcome of 27 patients treated by an endoprosthetic replacement for periprosthetic fracture of the distal femur between 1988 and 2013 are reported. Two cases were treated by two-stage revision due to persistent infection. Clinical outcomes were assessed by Knee Society score and Knee Society pain scores. Results: All 27 patients mobilised rapidly in the post-operative period and infection where present was eradicated by the technique. There have been no cases of further revision in the patients where clinical follow-up is available. Knee Society scores following treatment averaged 88 and pain scores 43 at six months post-operatively. Eight patients have died during the long study period reflecting the age of the study population. Conclusions: The use of a tumour-type endoprosthesis in situations of comminuted periprosthetic fractures associated with a loose prosthesis shows favourable results with low complication rates and rapid mobilisation. © 2015, SICOT aisbl.

Singh D.,Royal National Orthopaedic Hospital
Foot and Ankle Surgery | Year: 2013

Nils Silfverskiö ld was an orthopaedic surgeon, Swedish aristocrat, bon vivant, Olympic gymnast, left wing intellectual and anti-Nazi who described that the force required to dorsiflex the ankle in spastic equinus contracture decreased with knee flexion in isolated gastrocnemius contracture. He advocated detaching the origins of the gastrocnemii from the femur and reattaching them tothe tibia. The Silfverskiö ld knee flexion test has now also been adapted to distinguish between isolated gastrocnemius contracture and combined shortening of the gastrocnemius-soleus complex in non-spastic contracture by measuring the range of ankle dorsiflexion with the knee flexed and the knee straight. © 2012 European Foot and Ankle Society.

Grimer R.J.,Royal Orthopaedic Hospital | Briggs T.W.R.,Royal National Orthopaedic Hospital
Journal of Bone and Joint Surgery - Series B | Year: 2010

Although bone and soft-tissue sarcomas are rare, early diagnosis and prompt referral to a specialised unit offers the best chance of a successful outcome both in terms of survival and surgical resection. This paper highlights the clinical and radiological features that might suggest the possibility of a bone or soft-tissue sarcoma and suggests a succinct management pathway for establishing whether a suspicious bone or soft-tissue lesion could be malignant. ©2010 British Editorial Society of Bone and Joint Surgery.

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