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The Bone & Joint Journal
Vol. 106-B, Issue 8 | Pages 808 - 816
1 Aug 2024
Hall AJ Cullinan R Alozie G Chopra S Greig L Clarke J Riches PE Walmsley P Ohly NE Holloway N

Aims

Total knee arthroplasty (TKA) with a highly congruent condylar-stabilized (CS) articulation may be advantageous due to increased stability versus cruciate-retaining (CR) designs, while mitigating the limitations of a posterior-stabilized construct. The aim was to assess ten-year implant survival and functional outcomes of a cemented single-radius TKA with a CS insert, performed without posterior cruciate ligament sacrifice.

Methods

This retrospective cohort study included consecutive patients undergoing TKA at a specialist centre in the UK between November 2010 and December 2012. Data were collected using a bespoke electronic database and cross-referenced with national arthroplasty audit data, with variables including: preoperative characteristics, intraoperative factors, complications, and mortality status. Patient-reported outcome measures (PROMs) were collected by a specialist research team at ten years post-surgery. There were 536 TKAs, of which 308/536 (57.5%) were in female patients. The mean age was 69.0 years (95% CI 45.0 to 88.0), the mean BMI was 32.2 kg/m2 (95% CI 18.9 to 50.2), and 387/536 (72.2%) survived to ten years. There were four revisions (0.7%): two deep infections (requiring debridement and implant retention), one aseptic loosening, and one haemosiderosis.


The Bone & Joint Journal
Vol. 105-B, Issue 9 | Pages 1013 - 1019
1 Sep 2023
Johansen A Hall AJ Ojeda-Thies C Poacher AT Costa ML

Aims

National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD.

Methods

We compared 17 hip fracture registries covering 20 countries (Argentina; Australia and New Zealand; China; Denmark; England, Wales, and Northern Ireland; Germany; Holland; Ireland; Japan; Mexico; Norway; Pakistan; the Philippines; Scotland; South Korea; Spain; and Sweden), setting each of these against the 20 core and 12 optional fields of the MCD.


Aims

Delirium is associated with adverse outcomes following hip fracture, but the prevalence and significance of delirium for the prognosis and ongoing rehabilitation needs of patients admitted from home is less well studied. Here, we analyzed relationships between delirium in patients admitted from home with 1) mortality; 2) total length of hospital stay; 3) need for post-acute inpatient rehabilitation; and 4) hospital readmission within 180 days.

Methods

This observational study used routine clinical data in a consecutive sample of hip fracture patients aged ≥ 50 years admitted to a single large trauma centre during the COVID-19 pandemic between 1 March 2020 and 30 November 2021. Delirium was prospectively assessed as part of routine care by the 4 A’s Test (4AT), with most assessments performed in the emergency department. Associations were determined using logistic regression adjusted for age, sex, Scottish Index of Multiple Deprivation quintile, COVID-19 infection within 30 days, and American Society of Anesthesiologists grade.


The Bone & Joint Journal
Vol. 104-B, Issue 11 | Pages 1266 - 1272
1 Nov 2022
Farrow L Brasnic L Martin C Ward K Adam K Hall AJ Clement ND MacLullich AMJ

Aims

The aim of this study was to examine perioperative blood transfusion practice, and associations with clinical outcomes, in a national cohort of hip fracture patients.

Methods

A retrospective cohort study was undertaken using linked data from the Scottish Hip Fracture Audit and the Scottish National Blood Transfusion Service between May 2016 and December 2020. All patients aged ≥ 50 years admitted to a Scottish hospital with a hip fracture were included. Assessment of the factors independently associated with red blood cell transfusion (RBCT) during admission was performed, alongside determination of the association between RBCT and hip fracture outcomes.


The Bone & Joint Journal
Vol. 104-B, Issue 6 | Pages 721 - 728
1 Jun 2022
Johansen A Ojeda-Thies C Poacher AT Hall AJ Brent L Ahern EC Costa ML

Aims

The aim of this study was to explore current use of the Global Fragility Fracture Network (FFN) Minimum Common Dataset (MCD) within established national hip fracture registries, and to propose a revised MCD to enable international benchmarking for hip fracture care.

Methods

We compared all ten established national hip fracture registries: England, Wales, and Northern Ireland; Scotland; Australia and New Zealand; Republic of Ireland; Germany; the Netherlands; Sweden; Norway; Denmark; and Spain. We tabulated all questions included in each registry, and cross-referenced them against the 32 questions of the MCD dataset. Having identified those questions consistently used in the majority of national audits, and which additional fields were used less commonly, we then used consensus methods to establish a revised MCD.


Bone & Joint Research
Vol. 11, Issue 6 | Pages 346 - 348
1 Jun 2022
Hall AJ Clement ND MacLullich AMJ Simpson AHRW Johansen A White TO Duckworth AD


Bone & Joint Research
Vol. 11, Issue 6 | Pages 342 - 345
1 Jun 2022
Hall AJ Clement ND MacLullich AMJ Simpson AHRW White TO Duckworth AD

Research into COVID-19 has been rapid in response to the dynamic global situation, which has resulted in heterogeneity of methodology and the communication of information. Adherence to reporting standards would improve the quality of evidence presented in future studies, and may ensure that findings could be interpreted in the context of the wider literature. The COVID-19 pandemic remains a dynamic situation, requiring continued assessment of the disease incidence and monitoring for the emergence of viral variants and their transmissibility, virulence, and susceptibility to vaccine-induced immunity. More work is needed to assess the long-term impact of COVID-19 infection on patients who sustain a hip fracture. The International Multicentre Project Auditing COVID-19 in Trauma & Orthopaedics (IMPACT) formed the largest multicentre collaborative audit conducted in orthopaedics in order to provide an emergency response to a global pandemic, but this was in the context of many vital established audit services being disrupted at an early stage, and it is crucial that these resources are protected during future health crises. Rapid data-sharing between regions should be developed, with wider adoption of the revised 2022 Fragility Fracture Network Minimum Common Data Set for Hip Fracture Audit, and a pragmatic approach to information governance processes in order to facilitate cooperation and meta-audit. This editorial aims to: 1) identify issues related to COVID-19 that require further research; 2) suggest reporting standards for studies of COVID-19 and other communicable diseases; 3) consider the requirement of new risk scores for hip fracture patients; and 4) present the lessons learned from IMPACT in order to inform future collaborative studies.

Cite this article: Bone Joint Res 2022;11(6):342–345.


Bone & Joint 360
Vol. 10, Issue 6 | Pages 3 - 5
1 Dec 2021
Hall AJ Duckworth AD Clement ND MacLullich AMJ Farrow L


The Bone & Joint Journal
Vol. 103-B, Issue 10 | Pages 1627 - 1632
4 Oct 2021
Farrow L Hall AJ Ablett AD Johansen A Myint PK

Aims

The aim of this study was to determine the impact of hospital-level service characteristics on hip fracture outcomes and quality of care processes measures.

Methods

This was a retrospective analysis of publicly available audit data obtained from the National Hip Fracture Database (NHFD) 2018 benchmark summary and Facilities Survey. Data extraction was performed using a dedicated proforma to identify relevant hospital-level care process and outcome variables for inclusion. The primary outcome measure was adjusted 30-day mortality rate. A random forest-based multivariate imputation by chained equation (MICE) algorithm was used for missing value imputation. Univariable analysis for each hospital level factor was performed using a combination of Tobit regression, Siegal non-parametric linear regression, and Mann-Whitney U test analyses, dependent on the data type. In all analyses, a p-value < 0.05 denoted statistical significance.


The Bone & Joint Journal
Vol. 103-B, Issue 5 | Pages 888 - 897
3 May 2021
Hall AJ Clement ND MacLullich AMJ White TO Duckworth AD

Aims

The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission.

Methods

A nationwide multicentre retrospective cohort study was conducted of all patients presenting with a hip fracture to 17 Scottish centres in March and April 2020. Demographics, presentation blood tests, COVID-19 status, Nottingham Hip Fracture Score, management, length of stay, and 30-day mortality were recorded.


The Bone & Joint Journal
Vol. 103-B, Issue 4 | Pages 681 - 688
1 Apr 2021
Clement ND Hall AJ Kader N Ollivere B Oussedik S Kader DF Deehan DJ Duckworth AD

Aims

The primary aim was to assess the rate of postoperative COVID-19 following hip and knee arthroplasty performed in March 2020 in the UK. The secondary aims were to assess whether there were clinical factors associated with COVID-19 status, the mortality rate of patients with COVID-19, and the rate of potential COVID-19 in patients not presenting to healthcare services.

Methods

A multicentre retrospective study was conducted of patients undergoing hip or knee arthroplasty during the first wave of the COVID-19 pandemic (1 March 2020 to 31 March 2020) with a minimum of 60 days follow-up. Patient demographics, American Society of Anesthesiologists grade, procedure type, primary or revision, length of stay (LOS), COVID-19 test status, and postoperative mortality were recorded. A subgroup of patients (n = 211) who had not presented to healthcare services after discharge were contacted and questioned as to whether they had symptoms of COVID-19.


Bone & Joint Research
Vol. 9, Issue 12 | Pages 873 - 883
8 Dec 2020
Clement ND Ng N Simpson CJ Patton RFL Hall AJ Simpson AHRW Duckworth AD

Aims

The aims of this meta-analysis were to assess: 1) the prevalence of coronavirus disease 2019 (COVID-19) in hip fracture patients; 2) the associated mortality rate and risk associated with COVID-19; 3) the patient demographics associated with COVID-19; 4) time of diagnosis; and 5) length of follow-up after diagnosis of COVID-19.

Methods

Searches of PubMed, Medline, and Google Scholar were performed in October 2020 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Search terms included “hip”, “fracture”, and “COVID-19”. The criteria for inclusion were published clinical articles reporting the mortality rate associated with COVID-19 in hip fracture patients. In total, 53 articles were identified and following full text screening 28 articles satisfied the inclusion criteria.


The Bone & Joint Journal
Vol. 102-B, Issue 12 | Pages 1774 - 1781
1 Dec 2020
Clement ND Hall AJ Makaram NS Robinson PG Patton RFL Moran M Macpherson GJ Duckworth AD Jenkins PJ

Aims

The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period.

Methods

A multicentre retrospective study was conducted of all patients presenting to nine centres over a 50-day period during the COVID-19 pandemic (1 March 2020 to 19 April 2020) with a minimum of 50 days follow-up. Patient demographics, American Society of Anesthesiologists (ASA) grade, priority (urgent or elective), procedure type, COVID-19 status, and postoperative mortality were recorded.


The Bone & Joint Journal
Vol. 102-B, Issue 9 | Pages 1219 - 1228
14 Sep 2020
Hall AJ Clement ND Farrow L MacLullich AMJ Dall GF Scott CEH Jenkins PJ White TO Duckworth AD

Aims

The primary aim was to assess the independent influence of coronavirus disease (COVID-19) on 30-day mortality for patients with a hip fracture. The secondary aims were to determine whether: 1) there were clinical predictors of COVID-19 status; and 2) whether social lockdown influenced the incidence and epidemiology of hip fractures.

Methods

A national multicentre retrospective study was conducted of all patients presenting to six trauma centres or units with a hip fracture over a 46-day period (23 days pre- and 23 days post-lockdown). Patient demographics, type of residence, place of injury, presentation blood tests, Nottingham Hip Fracture Score, time to surgery, operation, American Society of Anesthesiologists (ASA) grade, anaesthetic, length of stay, COVID-19 status, and 30-day mortality were recorded.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 12 | Pages 1684 - 1689
1 Dec 2012
Perry DC Bruce CE Pope D Dangerfield P Platt MJ Hall AJ

Perthes’ disease is an osteonecrosis of the juvenile hip, the aetiology of which is unknown. A number of comorbid associations have been suggested that may offer insights into aetiology, yet the strength and validity of these are unclear. This study explored such associations through a case control study using the United Kingdom General Practice Research database. Associations investigated were those previously suggested within the literature. A total of 619 cases of Perthes’ disease were included, as were 2544 controls. The risk of Perthes’ disease was significantly increased with the presence of congenital anomalies of the genitourinary and inguinal region, such as hypospadias (odds ratio (OR) 4.04 (95% confidence interval (CI) 1.41 to 11.58)), undescended testis (OR 1.83 (95% CI 1.12 to 3.00)) and inguinal herniae (OR 1.79 (95% CI 1.02 to 3.16)). Attention deficit hyperactivity disorder was not associated with Perthes’ disease (OR 1.01 (95% CI 0.48 to 2.12)), although a generalised behavioural disorder was (OR 1.55 (95% CI 1.10 to 2.17)). Asthma significantly increased the risk of Perthes’ disease (OR 1.44 (95% CI 1.17 to 1.76)), which remained after adjusting for oral/parenteral steroid use.

Perthes’ disease has a significant association with congenital genitourinary and inguinal anomalies, suggesting that intra-uterine factors may be critical to causation. Other comorbid associations may offer insight to support or refute theories of pathogenesis.


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 6 | Pages 999 - 1000
1 Nov 1996
Hall AJ


The Journal of Bone & Joint Surgery British Volume
Vol. 56-B, Issue 1 | Pages 144 - 147
1 Feb 1974
Hall AJ

1. A case of late infection about a total knee prosthesis secondary to urinary tract infection is described, indicating that haematogenous spread of infection to a prosthetic joint can occur.

2. The prophylactic use of antibiotics to cover surgical and dental treatment and the energetic treatment of intercurrent infection are urged for patients with artificial joints.

3. Any conservative treatment of established infection in such cases should include complete excision of all necrotic material from the joint.


The Journal of Bone & Joint Surgery British Volume
Vol. 55-B, Issue 4 | Pages 698 - 714
1 Nov 1973
Kemp HBS Jackson JW Jeremiah JD Hall AJ

1. Pyogenic infection of the intervertebral disc in fifteen patients is described.

2. The importance of certain radiological signs in establishing the diagnosis is discussed.

3. Delayed diagnosis is believed to be responsible for the high incidence of paraplegia in this condition.

4. The place of operation in the management of this lesion is considered.


The Journal of Bone & Joint Surgery British Volume
Vol. 55-B, Issue 3 | Pages 497 - 505
1 Aug 1973
Hall AJ Mackay NNS

1. One hundred and sixty cases of incomplete or complete paraplegia due to extradural malignant tumour have been reviewed. Between 1959 and 1969 laminectomy for decompression of the cord was performed in 154 of these cases as an urgent measure and the results in 129 cases with full records have been assessed.

2. Immediate laminectomy, a palliative procedure, gave worthwhile improvement in 35 percent of cases of incomplete paraplegia; such patients could walk and had satisfactory control of bladder function at least six months after operation.

3. There were no satisfactory results when the paraplegia was complete.

4. The relief of pain following decompression may be gratifying, even if the patient does not improve sufficiently to fulfil the criteria of a satisfactory result.

5. The results emphasise the importance of early diagnosis, myelography and decompression if a patient with incomplete paralysis is to be offered any chance of relief.