Nuffield Orthopaedic Centre

About: Nuffield Orthopaedic Centre is a healthcare organization based out in Oxford, United Kingdom. It is known for research contribution in the topics: Population & Arthroplasty. The organization has 2082 authors who have published 2920 publications receiving 145718 citations.

Extending the use of PROMs in the NHS—using the Oxford Knee Score in patients undergoing non-operative management for knee osteoarthritis: a validation study

Abstract: OBJECTIVES: To assess the validity of the Oxford Knee Score (OKS) for use in patients undergoing non-operative management for their knee osteoarthritis (OA) within the National Health Service (NHS). DESIGN: Observational cohort study. SETTING: Single orthopaedic centre in England. PARTICIPANTS: 134 patients undergoing non-operative management for knee OA. MAIN OUTCOME MEASURES: OKS, the Intermittent and Constant Osteoarthritis Pain (ICOAP), the Knee Injury and Osteoarthritis Score-Physical Function Short Form (KOOS-PS), at baseline and 3-month follow-up, transition item of change at 3 months. RESULTS: The OKS summary scale and its pain and functional component subscales demonstrated good test-retest reliability (intraclass correlation coefficient 0.93, 0.91 and 0.92, respectively) and measurement precision which, allows its use with groups of patients with knee OA (research/audit) and with individuals (clinical practice). The results in this study were consistent with a priori set hypotheses about the relationship of OKS with other validated measures (KOOS-PS, ICOAP and short form 12 (SF-12)), which provided evidence of its construct validity and responsiveness. Confirmatory factor analysis confirmed the structural validity of OKS. However, there was a lack of satisfactory evidence of structural validity for ICOAP and KOOS. The minimum detectable change (MDC90) was ±6 for OKS (±16 for the Pain Component Score (OKS-PCS) and ±15 for the Functional Component Score (OKS-FCS)). Minimal important changes were ≈7 for OKS (≈17 for OKS-PCS and ≈11 for OKS-FCS) and minimal important differences were ≈6 for OKS (≈14 for OKS-PCS and ≈10 for OKS-FCS). These values were also calculated for ICOAP and KOOS-PS. CONCLUSIONS: The OKS summary scale, together with its pain and functional component subscales, has excellent measurement properties when used with patients with knee OA undergoing non-operative treatment and is superior to ICOAP and KOOS-PS for this purpose. This evidence provides support for the validity of the use of OKS when used across the spectrum of knee OA disease severity, both in research and clinical practice.

Linear regression analysis of Hospital Episode Statistics predicts a large increase in demand for elective hand surgery in England.

Abstract: Summary Introduction We integrated two factors, demographic population shifts and changes in prevalence of disease, to predict future trends in demand for hand surgery in England, to facilitate workforce planning. Methods We analysed Hospital Episode Statistics data for Dupuytren's disease, carpal tunnel syndrome, cubital tunnel syndrome, and trigger finger from 1998 to 2011. Using linear regression, we estimated trends in both diagnosis and surgery until 2030. We integrated this regression with age specific population data from the Office for National Statistics in order to estimate how this will contribute to a change in workload over time. Results There has been a significant increase in both absolute numbers of diagnoses and surgery for all four conditions. Combined with future population data, we calculate that the total operative burden for these four conditions will increase from 87,582 in 2011 to 170,166 (95% confidence interval 144,517–195,353) in 2030. Discussion The prevalence of these diseases in the ageing population, and increasing prevalence of predisposing factors such as obesity and diabetes, may account for the predicted increase in workload. The most cost effective treatments must be sought, which requires high quality clinical trials. Our methodology can be applied to other sub-specialties to help anticipate the need for future service provision.

The haemophilic pseudotumour or haemophilic subperiosteal haematoma

Abstract: 1. The case history of a haemophiliac in whom a large haematoma of the thigh was treated by amputation of the limb is described. 2. Examination of the available radiographs and of the histology led to the conclusion that the cyst was subperiosteal in origin. 3. Evidence is presented to support the hypothesis that haemophilic pseudotumours are always associated with subperiosteal haemorrhage, and that those haemophilic cysts which are confined to muscle have little or no effect on the adjacent bone.

Association study of genes related to bone formation and resorption and the extent of radiographic change in ankylosing spondylitis

Abstract: Objective To identify genetic associations with severity of radiographic damage in ankylosing spondylitis (AS). Method We studied 1537 AS cases of European descent; all fulfilled the modified New York Criteria. Radiographic severity was assessed from digitised lateral radiographs of the cervical and lumbar spine using the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS). A two-phase genotyping design was used. In phase 1, 498 single nucleotide polymorphisms (SNPs) were genotyped in 688 cases; these were selected to capture >90% of the common haplotypic variation in the exons, exon–intron boundaries, and 5 kb flanking DNA in the 5′ and 3′ UTR of 74 genes involved in anabolic or catabolic bone pathways. In phase 2, 15 SNPs exhibiting p Results Experiment-wise association was observed with the SNP rs8092336 (combined OR 0.32, p=1.2×10 −5 ), which lies within RANK (receptor activator of NFκB), a gene involved in osteoclastogenesis, and in the interaction between T cells and dendritic cells. Association was also found with the SNP rs1236913 in PTGS1 (prostaglandin-endoperoxide synthase 1, cyclooxygenase 1), giving an OR of 0.53 (p=2.6×10 −3 ). There was no observed association between radiographic severity and HLA-B*27 . Conclusions These findings support roles for bone resorption and prostaglandins pathways in the osteoproliferative changes in AS.