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The high prevalence of osteoarthritis (OA), as well as the current lack of disease-modifying drugs for OA, has provided a rationale for regenerative medicine as a possible treatment modality for OA treatment. In this editorial, the current status of regenerative medicine in OA including stem cells, exosomes, and genes is summarized along with the author’s perspectives. Despite a tremendous interest, so far there is very little evidence proving the efficacy of this modality for clinical application. As symptomatic relief is not sufficient to justify the high cost associated with regenerative medicine, definitive structural improvement that would last for years or decades and obviate or delay the need for joint arthroplasty is essential for regenerative medicine to retain a place among OA treatment methods. Cite this article:
The Bone &
Joint Journal provides
the latest evidence to guide the clinical practice of orthopaedic
surgeons. The benefits of one intervention compared with another
are presented using outcome measures; some may be specific to a
limb or joint and some are more general health-related quality of
life measures. Readers will be familiar with many of these outcome
measures and will be able to judge the relative benefits of different interventions
when measured using the same outcome tool; for example, different treatments
for
Traditionally, informed consent for clinical
research involves the patient reading an approved Participant Information
Sheet, considering the information presented and having as much time
as they need to discuss the study information with their friends
and relatives, their clinical care and the research teams. This
system works well in the ‘planned’ or ‘elective’ setting. But what
happens if the patient requires urgent treatment for an injury or emergency? This article reviews the legal framework which governs informed
consent in the emergency setting, discusses how the approach taken
may vary according to the details of the emergency and the treatment
required, and reports on the patients’ view of providing consent
following a serious injury. We then provide some practical tips
for managing the process of informed consent in the context of injuries
and emergencies. Cite this article:
Health economic evaluations potentially provide
valuable information to clinicians, health care administrators,
and policy makers regarding the financial implications of decisions
about the care of patients. The highest quality research should
be used to inform decisions that have direct impact on the access
to care and the outcome of treatment. However, economic analyses
are often complex and use research methods which are relatively unfamiliar
to clinicians. Furthermore, health economic data have substantial
national, regional, and institutional variability, which can limit
the external validity of the results of a study. Therefore, minimum
guidelines that aim to standardise the quality and transparency
of reporting health economic research have been developed, and instruments
are available to assist in the assessment of its quality and the
interpretation of results. The purpose of this editorial is to discuss the principal types
of health economic studies, to review the most common instruments
for judging the quality of these studies and to describe current
reporting guidelines. Recommendations for the submission of these
types of studies to Cite this article:
The limitations and benefits of patient-reported
outcome measures, in defining the merits of arthroplasty surgery,
are discussed. Cite this article:
The effective capture of outcome measures in
the healthcare setting can be traced back to Florence Nightingale’s
investigation of the in-patient mortality of soldiers wounded in
the Crimean war in the 1850s. Only relatively recently has the formalised collection of outcomes
data into Registries been recognised as valuable in itself. With the advent of surgeon league tables and a move towards value
based health care, individuals are being driven to collect, store
and interpret data. Following the success of the National Joint Registry, the British
Association of Spine Surgeons instituted the British Spine Registry.
Since its launch in 2012, over 650 users representing the whole
surgical team have registered and during this time, more than 27 000
patients have been entered onto the database. There has been significant publicity regarding the collection
of outcome measures after surgery, including patient-reported scores.
Over 12 000 forms have been directly entered by patients themselves,
with many more entered by the surgical teams. Questions abound: who should have access to the data produced
by the Registry and how should they use it? How should the results
be reported and in what forum? Cite this article:
Trauma and Orthopaedic care has been through
a rapid evolution over the past few decades. This Editorial discusses
some of the advances. Cite this article:
Due to economic constraints, it has been suggested that joint replacement patients can be followed up in primary care. There are clinical, ethical and academic reasons why we must ensure that our joint replacements are appropriately clinically and radiologically followed up to minimise complications. This Editorial discusses this.
