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Bone & Joint 360
Vol. 9, Issue 6 | Pages 5 - 11
1 Dec 2020
Sharma V Turmezei T Wain J McNamara I


Orthopaedic Proceedings
Vol. 102-B, Issue SUPP_6 | Pages 53 - 53
1 Jul 2020
Taylor C Waters T Ries M Datta G Davis E Nathwani D Sutton P Trahey A McNamara I
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In light of recent regulatory initiatives, medical devices now require additional clinical evidence to prove their safety and efficacy. At the same time, patients' own assessment of their devices' function and performance has gained in importance. The collection of these data allows for a more comprehensive picture of clinical outcomes and complications following total knee arthroplasty (TKA).

These trends have led researchers to search for new methods of acquiring, interpreting and disseminating patient-reported outcome measurements (PROMs). The current study assesses the feasibility of a digital platform for collecting PROMs that was recently adapted for TKA patients. It sought to determine patient engagement, survey completion rates, and satisfaction with this platform.

Eighty-two patients (mean age, 63.7 years, 59% females) scheduled for TKA were enrolled from one US and six UK sites between January 12, 2018 and April 30, 2018. Patients were supplied with a mobile application (app) that collects a variety of PROMs, including four domains based on the Patient-Reported Outcome Information System (PROMIS™): physical function, depression, pain interference and pain behavior. The platform electronically administers questionnaires using computer-adaptive tests (CATs), which reduce the burden on patients by tailoring follow-up questions to account for their previous answers. Satisfaction with the app was assessed in subset of patients who evaluated its ease-of-use (n=45), likelihood that they would recommend it to family/friends (n=35), and whether they successfully used the information it provided during their recovery (n=31). These scores were taken on a 1 to 10 (worst to best) scale.

Patients demonstrated regular engagement with the platform, with 73% using the app at least once a week. Weekly engagement remained high throughout the seven-week post-operative period (Figure 1). There was a 69% completion rate of all PROMIS™ CAT surveys during the study. The four PROMIS™ CAT domains had similar survey completion rates (Figure 2). The subset of patients queried regarding their satisfaction with the app gave it favorable mean scores for ease-of-use (8.8), likelihood to recommend to a family member or friend (8.1), and their success at using its information to improve their recovery (7.4).

Initial results support this digital platform's potential for successfully and efficiently collecting large volumes of PROMs. Patients reported high levels of engagement and satisfaction.

For any figures or tables, please contact authors directly.


Bone & Joint Research
Vol. 9, Issue 5 | Pages 202 - 210
1 May 2020
Trotter AJ Dean R Whitehouse CE Mikalsen J Hill C Brunton-Sim R Kay GL Shakokani M Durst AZE Wain J McNamara I O’Grady J

Aims

This pilot study tested the performance of a rapid assay for diagnosing prosthetic joint infection (PJI), which measures synovial fluid calprotectin from total hip and knee revision patients.

Methods

A convenience series of 69 synovial fluid samples from revision patients at the Norfolk and Norwich University Hospital were collected intraoperatively (52 hips, 17 knees) and frozen. Synovial fluid calprotectin was measured retrospectively using a new commercially available lateral flow assay for PJI diagnosis (Lyfstone AS) and compared to International Consensus Meeting (ICM) 2018 criteria and clinical case review (ICM-CR) gold standards.


Bone & Joint 360
Vol. 8, Issue 6 | Pages 3 - 8
1 Dec 2019
Pulido PG Donell S McNamara I


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_10 | Pages 32 - 32
1 Oct 2019
Marjoram T Kaleel S McNamara I Best S Cameron R Sharp D
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Background

The rate of subsidence for lumbar fusion surgery is variable from 7- 89%. Subsidance can affect the outcome of surgery by compramising alignment, foraminal height and stability. Modic changes have been shown to affect the stiffness and strength of the vertebral end plate and shown to affect both fusion rates and clinical outcome. Ongoing laboratory investigations into the material properties of the degenerate lumbar spine show modic changes affect the end plate and trabecular bone mechanics. This study aims to bridge this basic science research into clinical practice.

Methods

A retrospective analysis of all patients in two tertiary spinal centres who have undergone lumbar interbody fusion with the implantation of a ‘cage’ over the past 6 years were analysed by two independent spinal surgeons. Pre-operative MRI findings were correlated with post-operative interbody cage subsidence after 1 year.


Bone & Joint 360
Vol. 4, Issue 5 | Pages 31 - 31
1 Oct 2015
McNamara I


The Bone & Joint Journal
Vol. 96-B, Issue 12 | Pages 1578 - 1585
1 Dec 2014
Rankin KS Sprowson AP McNamara I Akiyama T Buchbinder R Costa ML Rasmussen S Nathan SS Kumta S Rangan A

Trauma and orthopaedics is the largest of the surgical specialties and yet attracts a disproportionately small fraction of available national and international funding for health research. With the burden of musculoskeletal disease increasing, high-quality research is required to improve the evidence base for orthopaedic practice. Using the current research landscape in the United Kingdom as an example, but also addressing the international perspective, we highlight the issues surrounding poor levels of research funding in trauma and orthopaedics and indicate avenues for improving the impact and success of surgical musculoskeletal research.

Cite this article: Bone Joint J 2014; 96-B:1578–85.


Bone & Joint Research
Vol. 2, Issue 11 | Pages 245 - 247
1 Nov 2013
Sprowson AP Rankin KS McNamara I Costa ML Rangan A

The peer review process for the evaluation of manuscripts for publication needs to be better understood by the orthopaedic community. Improving the degree of transparency surrounding the review process and educating orthopaedic surgeons on how to improve their manuscripts for submission will help improve both the review procedure and resultant feedback, with an increase in the quality of the subsequent publications. This article seeks to clarify the peer review process and suggest simple ways in which the quality of submissions can be improved to maximise publication success.

Cite this article: Bone Joint Res 2013;2:245–7.


Bone & Joint 360
Vol. 2, Issue 2 | Pages 37 - 37
1 Apr 2013
McNamara I


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 48 - 48
1 May 2012
McNamara I Rayment A Best S Rushton N
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In vitro femoral studies have demonstrated the addition of hydroxyapatite (HA), to morcellised bone graft (MBG) decreases femoral prosthesis subsidence. However, with an increased risk of femoral fracture during the impaction of a MBG:HA mixture, possibly due to greater force transmission to the femoral cortex via the HA. The aim was to compare the hoop strains and subsidence of a 1:1 mixture of MBG:HA with pure bone allograft during impaction and subsequent endurance testing in a revision hip arthroplasty model.

Materials and methods Large Sawbone femurs were prepared to represent a femur with bone loss (Sawbones, Sweden). 12 uniaxial strain gauges were attached to each femur at 0, 90, 180 and 270 degrees, at distal, midshaft, proximal points to measure hoop strain. Impaction grafting was performed using X-Change 2 instruments and an Instron servohydaulic machine for 2 distal impactions and 4 proximal impactions for 60 impactions each.

Study groups

The study consisted of four experimental groups: 1)Pure MBG, force of 1.98 kN 2)Pure MBG, force 3.63kN. 3)1:1 mixture of MBG: porous HA (pHA), 4)1:1 mixture MBG: non porous HA (npHA). 6 samples of each group were performed.

Endurance testing

The potted femur was loaded in a manner representing the walking cycle (1.98kN) at 1 Hz for 50 000 cycles. The displacement of the femoral head during loading was measured by two displacement transducers (LVDT) were mounted on aluminum brackets to measure vertical displacement and rotation.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 33 - 33
1 May 2012
McNamara I Ong M Rayment A Brooks R Prevost T Best S Rushton N
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Problems associated with allograft are well known. The addition of hydroxyapatite (HA) to allograft has various mechanical advantages, especially within revision arthroplasty. The mixing of bone and HA results in mechanical properties different from the individual parts. However, at present the changes in material properties the mix have not been fully investigated and the optimum mixing ratio not characterized. A compressive uniaxial chamber was used to investigate the change in mechanical properties occurring with the addition of HA in varying proportions to morcellised bone graft (MBG).

Materials and methods

MBG was prepared using femoral heads donated from patients undergoing total hip replacement surgery using a bone mill in a standard manner. Non porous HA (npHA) was prepared using a precipitation method of Calcium Carbonate and Orthophosphoric acid. The porous HA, (pHA) is a 60% macroporosity HA commercially prepared.

Chamber

The uniaxial compression chamber was a 30mm diameter, steel chamber. Holes were drilled to allow fluid drainage. Loads were applied using a 10 kN load cell. Specimens were prepared in the volumetric proportions pure HA, pure MBG, 2:1, 1:1, 1:2 ratio of MBG to HA. The samples were subjected to compressive forces of incrementally increasing loads of up to 2 KN for 60 cycles. The sample was then allowed to creep under a stress of 2 kN. MBG was also tested up to forces of 7 kN. The mechanical parameters that were examined were the stiffness of the sample at the 60th cycle, (Ec60), and creep


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 65 - 65
1 Mar 2012
Getgood A McNamara I Kili S Bhullar T
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Introduction

The aim of this study was to investigate whether methylene blue dye, commonly used in sterile surgical marker pens, would have an effect on human chondrocyte viability, when cultured on a collagen membrane in-vitro.

Methods

Bilayered collagen membranes were seeded in duplicate with 12 million human chondrocytes per ml and cultured for 24 hours under standard conditions. Group A consisted of a membrane marked with methylene blue ink on its smooth side, group B marked on its porous side, and group C acting as an unmarked control. At the end of the culture period the membranes were qualitatively analysed for cell survival by live/dead fluorescent staining under confocal microscopy.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 497 - 497
1 Oct 2010
Mcnamara I Parker M Prevost T Sharma A
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Background: Venous thromboembolism (VTE) remains a significant cause of morbidity and mortality of patients following hip fracture. It is not known preoperatively which patients are at greater risk of developing VTE complications following their surgery. This study reports the incidence of VTE following neck of femur fracture, the timing of the diagnosis of VTE and any risk factors associated with VTE development.

Materials and Methods: We analysed the prospectively recorded complications of patients that presented with a neck of femur fracture. Those patients that developed VTE were compared to those with no complications and their risk factors compared.

Results: A total of 5300 patients were analysed. The incidence of VTE was 2% despite thromboprophylaxis. The significant risk factors for VTE were poor pre operative mobility (p< 0.01), those preoperatively living in their own home (p< 0.01), low mental test score (p< 0.01), high postoperative haemoglobin (p< 0.03), intertrochanteric fractures and fixation with a dynamic hip screw (p< 0.01).

Conclusions: This is the largest group of patients to be prospectively analysed for risk factors for developing VTE following surgery for neck of femur fractures. There were a number of groups that were at a significantly higher risk of developing VTE than others. Orthopaedic surgeons should be aware of these groups in the management of these vulnerable patients.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_IV | Pages 554 - 554
1 Oct 2010
McNamara I Parker M Pryor G
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To determine the optimum choice of treatment for the displaced intracapsular fracture in the elderly, 455 patients aged over 70 years with a displaced intracapsular fracture were entered into a prospective randomised trial. Treatment was either an uncemented Austin Moore hemiarthroplasty or reduction and internal fixation with three AO cancellous screws. Analysis of pre-operative characteristics of patients showed there was no significant difference between the two groups.

Follow-up of surviving patients was continued for between seven to 15 years to determine the long-term outcome for the two treatment Methods: 90% of patients died during this follow-up period.

Regarding short term outcomes, internal fixation resulted in a reduced mean operative time, operative blood loss and transfusion requirements.

There was no significant difference in the length of hospital stay or incidence of general post-operative complications. There was no difference in either the short term or long-term mortality between the two procedures. The need for revision surgery to the hip was increased for those treated by internal fixation (7% versus 38% implant revision rate). There was no difference in the degree of residual pain between groups neither was there any difference in the number of patients requiring institutional care. There was a tendency to slightly better mobility for those treated by internal fixation although the Results: were not statistically significant. These results demonstrate that both treatment methods produce comparable final outcomes but internal fixation is associated with an increased re-operation rate.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_II | Pages 290 - 290
1 May 2010
Mcnamara I Leivadiotou D Cole N Chitnavis J
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Background: A common question asked by patients who have undergone knee arthroplasty is whether they will activate the security scanners at airports. This has become a greater issue for the patient in the post 9/11 era.

This study surveys our patients to determine their experiences at airport security, establishes the detectability of common orthopaedic implants in an airport security scanner

Materials and Methods: A survey of a single surgeon series of knee arthroplasty patients was conducted to ascertain the frequency with which they activated airport security scanners. Their experiences were documented and their preferences for identification were ascertained.

A volunteer with metal implants strapped on and patients with implants in-situ walked through a gate scanner at a UK airport. Also, standard operating procedures at UK airports were ascertained.

Results: 150 patients were surveyed. 61 male, 89 female with an average age of 71 years.

There were 111 total knee replacements (TKR), 20 unicompartmental knee replacements (UKR), 2 bilateral UKR replacements, 17 bilateral TKR.

Unlike previous studies from the U.K., virtually all patients with a TKR activated the gate scanner. Conversely, those with unicompartmental replacements did not.

Patients are concerned about this possibility but are not informed at time of surgery and do not know what the procedures are if their implant is detected.

The patient with the bilateral UKR did not set off the scanners where as the patient with the TKR did.

A variety of surprisingly large trauma implants escaped detection.

Conclusion: In contrast to previous work this study demonstrates that patients with TKR do activate the scanner, possibly due to heightened security. Other implants do to a variable extent. Patients are concerned about this possibility and should be made aware both of this and the further checks to which they will be exposed. Our survey demonstrated differences in how passengers with metal implants are screened by airport security around the World and particularly in the United States. In line with the International Air Transport Association (IATA) we propose the development of a more harmonised approach to screen international travellers.


The Journal of Bone & Joint Surgery British Volume
Vol. 92-B, Issue 5 | Pages 617 - 623
1 May 2010
McNamara I Deshpande S Porteous M

The clinical and radiological results of 50 consecutive acetabular reconstructions in 48 patients using impaction grafting have been retrospectively reviewed. A 1:1 mixture of frozen, ground irradiated bone graft and Apapore 60, a synthetic bone graft substitute, was used in all cases. There were 13 complex primary and 37 revision procedures with a mean follow-up of five years (3.4 to 7.6). The clinical survival rate was 100%, with improvements in the mean Harris Hip Scores for pain and function. Radiologically, 30 acetabular grafts showed evidence of incorporation, ten had radiolucent lines and two acetabular components migrated initially before stabilising.

Acetabular reconstruction in both primary and revision surgery using a 1:1 mixture of frozen, ground, irriadiated bone and Apapore 60 appears to be a reliable method of managing acetabular defects. Longer follow-up will be required to establish whether this technique is as effective as using fresh-frozen allograft.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_I | Pages 61 - 61
1 Mar 2010
Getgood* A Kent M McNamara I Dickinson A Elmadbouh H Bhullar T
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The purpose of this study was to describe our experience of the Calaxo Osteoconductive interference screw (Smith & Nephew) when used for both femoral and tibial graft fixation in Double Bundle ACL reconstruction.

Since May 2006, all patients with an ACL deficient knee were reconstructed using the Double Bundle technique. All were followed prospectively and outcome data collected. Evidence of fixation failure was established subjectively by clinical examination (Lachman, Anterior Draw, Pivot Shift) and objectively via KT-1000 arthrometer. Following ethical approval, post-operative CT scans (immediate and 1 year) were performed on our first 10 patients allowing assessment of tunnel dimensions/fill.

Thirty two patients (29 male, 3 female) with a mean age of 30 (range 18-46) were included. At last follow-up, no evidence of graft/fixation failure was found; KT-1000 mean side-side difference 1.4mm (range −3 to +6). All patients had a positive pivot shift preoperatively which was abolished postoperatively. One patient had a postoperative infection with no other complications reported. Radiologically the screws did not show complete resorption but areas of new bone were identified.

We have shown satisfactory results with use of the Calaxo screw when used in Double Bundle Reconstruction. We have not had any cases of the adverse local soft tissue reaction, which has led to this screw being withdrawn from clinical use. Even when using a total of four screws in each knee. A previous study published by Seibold (2007) has shown tunnel widening and communication when suspensory fixation is used in Double Bundle reconstruction. This has the potential risk of leading to fracture between the tunnels. This has not been seen with the Calaxo screw which may be a result of the biological action of the screw which should ultimately lead to a reduction in these risks.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 422 - 422
1 Sep 2009
Getgood A Kent M McNamara I Dickinson A Elmadbouh H Bhullar T
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Introduction: The purpose of this study was to describe our experience of the Calaxo Osteoconductive interference screw (Smith & Nephew) when used for both femoral and tibial graft fixation in Double Bundle ACL reconstruction.

Methods: Since May 2006, all patients with an ACL deficient knee were reconstructed using the Double Bundle technique. All were followed prospectively and outcome data collected.

Evidence of fixation failure was established subjectively by clinical examination (Lachman, Anterior Draw, Pivot Shift) and objectively via KT-1000 arthrometer.

Following ethical approval, post-operative CT scans (immediate and 1 year) were performed on our first 10 patients allowing assessment of tunnel dimensions/fill.

Results: Thirty two patients (29 male, 3 female) with a mean age of 30 (range 18–46) were included. At last follow-up, no evidence of graft/fixation failure was found; KT-1000 mean side-side difference 1.4mm (range −3 to +6). All patients had a positive pivot shift preoperatively which was abolished postoperatively. One patient had a postoperative infection with no other complications reported. Radiologically the screws did not show complete resorption but areas of new bone were identified.

Discussion: We have shown satisfactory results with use of the Calaxo screw when used in Double Bundle Reconstruction. We have not had any cases of the adverse local soft tissue reaction, which has led to this screw being withdrawn from clinical use. Even when using a total of four screws in each knee.

A previous study published by Seibold (2007) has shown tunnel widening and communication when suspensory fixation is used in Double Bundle reconstruction. This has the potential risk of leading to fracture between the tunnels.

This has not been seen with the Calaxo screw which may be a result of the biological action of the screw which should ultimately lead to a reduction in these risks.


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_I | Pages 104 - 104
1 Mar 2006
Crawford J McNamara I Edwards D
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Aims: Outpatient clinic follow-up of patients after knee arthroscopy is routine practice in many orthopaedic units. It can be inconvenient and expensive for patients and may be unnecessary.The aim of our study was to compare oupatient follow-up with telephone follow-up after knee arthroscopy in a prospective randomised trial

Patients and method: Over a four-month period, 50 patients (mean age 41 years) were included in our study. Each patient underwent a day-case knee arthroscopy as previously planned. After surgery, each patient was randomised to either attend for an outpatient clinic follow-up after two weeks or to receive a telephone follow-up after two weeks from operation. All patients were assessed after four weeks from surgery by an independent assessor who was blinded to the type of follow-up each patient had received. No patients in the study were lost to follow-up.

Results: No significant difference was found in patient satisfaction scores between the outpatient and telephone groups (mean 7.78 vs mean 7.92). However, 81% patients in the telephone group and 57% patients in the clinic group (p< 0.01) preferred telephone follow-up if they were to undergo another knee arthroscopy. There was a significant increase in patello-femoral problems in those preferring outpatient follow-up (64%) compared to telephone follow-up (24%), p< 0.05. No difference in complication rates between the two groups was found.

Conclusion: Telephone follow-up provides a satisfactory and safe alternative to outpatient follow-up after knee arthroscopy. It is preferred by the majority of patients and could relieve pressure on outpatient resources.