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.

The role of surgery in frozen shoulder.

Abstract: Frozen shoulder is a common disorder which is characterised by pain and loss of movement. Its cause is poorly understood and its management is disputed because of lack of supporting evidence. Duplay, 1 in 1872, used the term “peri-arthritis scapulohumerale” to describe the condition. In 1934, Codman 2 introduced the term frozen shoulder and set certain criteria for diagnosis and management. Neviaser 3 used the term adhesive capsulitis to reflect his findings at surgery and at post-mortem. Zuckerman and Cuomo 4 defined the condition as one of uncertain aetiology characterised by substantial restriction of both active and passive movement in the shoulder occurring in the absence of a known intrinsic disorder of the shoulder. The aetiology remains unknown, although some aspects of the pathophysiology have recently been documented. 5 The symptoms are generally self-limiting over one to three years. The role of treatment which includes physiotherapy, analgesics, injection of cortisone, manipulation and surgical release, must be assessed in the context of a tendency to self-resolution. This review examines the evidence to support interventional procedures in treating this painful and often debilitating condition.

The operative management of basilar impression in osteogenesis imperfecta.

Abstract: Four patients with osteogenesis imperfecta and neurologically significant basilar impression have been treated over the past 8 years. The experience has resulted in changes in our therapeutic strategy for this particularly difficult problem. These cases are discussed with respect to the disease process, neurological involvement, radiological findings, and modes of surgical therapy. The errors in management as well as the success resulting from our learning experience are described. Currently, we recommend the extensive removal of the anterior bony compression by a transoral approach. This should be followed by a posterior rigid fixation that transfers the weight of the head to the thoracic spine, in an effort to prevent further basilar invagination.

A systematic review of lateral wedge orthotics--how useful are they in the management of medial compartment osteoarthritis?

Abstract: Studies on the use of lateral wedge orthotics in the conservative management of medial compartment osteoarthritis are widely quoted. This approach, however, does not consider the disruption of the interaction between lower limb and foot and ankle function that lateral wedges would produce. This comprehensive, systematic review was therefore undertaken to evaluate all available literature to determine whether evidence exists to support their use. MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine, PubMed, EBSCO HOST and PEDro, Abstracts of Reviews of Effects in the National Electronic Library for Health for Cochrane Reviews and manual searching were used to identify studies. was searched for trials in progress. Data extraction was performed by the three authors using a paper data extraction form which was based on the CONSORT statement and Critical Skills Appraisal Programme (CASP) guidelines. Overall, the results of this review suggest that, based on current evidence there are no major or long-term beneficial effects with the use of lateral wedges.

Oxford medial unicompartmental arthroplasty for focal spontaneous osteonecrosis of the knee

Abstract: Background Spontaneous osteonecrosis of the knee (SONK) is a distinct clinical condition occurring in patients without any associated risk factors. There is controversy as to the best method of treatment, and the available literature would suggest that patients with SONK have a worse outcome than those with primary osteoarthrosis when arthroplasty is performed.We assessed the outcome of medial unicompartmental knee arthroplasty (UKA) using the Oxford prosthesis for end-stage focal spontaneous osteonecrosis of the knee (SONK; Ahlback grades III & IV).Patients and methods We assessed 29 knees (27 patients) with spontaneous osteonecrosis of the knee using the Oxford Knee Score. 26 knees had osteonecrosis of the medial femoral condyle and 3 had osteonecrosis of the medial tibial plateau. All had been operated on using the Oxford Medial Unicompartmental Knee Arthroplasty (UKA). This group was compared to a similar group (28 knees, 26 patients) who had undergone the same arthroplasty, but because of primary ost...

Predicting the Risk of Rheumatoid Arthritis and Its Age of Onset through Modelling Genetic Risk Variants with Smoking

Abstract: The improved characterisation of risk factors for rheumatoid arthritis (RA) suggests they could be combined to identify individuals at increased disease risks in whom preventive strategies may be evaluated. We aimed to develop an RA prediction model capable of generating clinically relevant predictive data and to determine if it better predicted younger onset RA (YORA). Our novel modelling approach combined odds ratios for 15 four-digit/10 two-digit HLA-DRB1 alleles, 31 single nucleotide polymorphisms (SNPs) and ever-smoking status in males to determine risk using computer simulation and confidence interval based risk categorisation. Only males were evaluated in our models incorporating smoking as ever-smoking is a significant risk factor for RA in men but not women. We developed multiple models to evaluate each risk factor's impact on prediction. Each model's ability to discriminate anti-citrullinated protein antibody (ACPA)-positive RA from controls was evaluated in two cohorts: Wellcome Trust Case Control Consortium (WTCCC: 1,516 cases; 1,647 controls); UK RA Genetics Group Consortium (UKRAGG: 2,623 cases; 1,500 controls). HLA and smoking provided strongest prediction with good discrimination evidenced by an HLA-smoking model area under the curve (AUC) value of 0.813 in both WTCCC and UKRAGG. SNPs provided minimal prediction (AUC 0.660 WTCCC/0.617 UKRAGG). Whilst high individual risks were identified, with some cases having estimated lifetime risks of 86%, only a minority overall had substantially increased odds for RA. High risks from the HLA model were associated with YORA (P<0.0001); ever-smoking associated with older onset disease. This latter finding suggests smoking's impact on RA risk manifests later in life. Our modelling demonstrates that combining risk factors provides clinically informative RA prediction; additionally HLA and smoking status can be used to predict the risk of younger and older onset RA, respectively.