Institution
Nuffield Orthopaedic Centre
Healthcare•Oxford, United Kingdom•
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.
Papers published on a yearly basis
Papers
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TL;DR: The results demonstrate that, in the patient population, bilateral THR was equally safe whether performed as a 1-stage or 2-stage procedure, and this was the case in the low-risk (ASA 1 and 2) and high-risk patient subgroups.
Abstract: It is not clear whether bilateral hip replacement should be done in 1 or 2 stages. The total number of total hip replacements (THRs) done in our center between 1989 and 1995 was approximately 4,000. The number of hips that were bilateral was 404, or 9% of the total number of THRs performed during this time period. Of these bilateral hip replacements, 190 (95 patients) were done as a 1-stage procedure, whereas 214 (107 patients) were done in 2 stages with 2 to 24 months in between the operations. In contrast to previous studies, there were no significant preoperative differences between the 2 groups of patients having 1-stage or 2-stage THRs, and, in particular, the comorbidity assessed by the American Society of Anesthesiologists (ASA) grade was not significantly different. Our results demonstrate that, in our patient population, bilateral THR was equally safe whether performed as a 1-stage or 2-stage procedure. This was the case in the low-risk (ASA 1 and 2) and high-risk (ASA 3 and 4) patient subgroups. One-stage bilateral THR is cheaper and involves less time in the hospital.
116 citations
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TL;DR: The wide range of causative organisms and degree of resistance to commonly used anti-microbials supports the importance of extensive intra-operative sampling and provides important information to guide clinicians' choice of empirical antibiotics.
116 citations
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TL;DR: The authors think this technique for opening wedge high tibial osteotomy using hemicallotasis techniques is safer than, and the outcome comparable with, conventional techniques.
Abstract: High tibial osteotomy is an accepted treatment for unicompartmental osteoarthritis of the knee. Conventional osteotomy can be a demanding procedure with potential for complications. Opening wedge high tibial osteotomy using an external fixator is an alternative that may have advantages in comparison with classic methods. The aims of the current study were to determine if opening wedge osteotomy using hemicallotasis techniques is safer than, and the outcome comparable with that of, conventional techniques. Seventy-six high tibial osteotomies were performed in 65 patients for primary osteoarthritis. The mean age of the patients was 54.8 years (range, 36-70 years). The mean followup was 6 years. The only serious complication occurred in one patient, who had chronic osteomyelitis develop 2 years after surgery. There were no neurologic or vascular complications. The authors think this technique is safer than conventional techniques. Survivorship at 5 and 10 years was 89% and 63%, respectively. The mean knee score in osteotomies was 26.6 (maximum possible score, 48). The outcome is comparable with, or better than, that of other techniques for osteotomy. Subsequent knee replacement, in cases requiring conversion, was straightforward. The mean score in knees that had osteotomies that were converted to total knee replacements was 33.7.
116 citations
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01 Jan 2017TL;DR: A treatment protocol is proposed, based on the Cierny-Mader classification, to help guide the appropriate selection of a suitable ceramic antibiotic carrier in the surgical treatment of chronic osteomyelitis.
Abstract: . Local release of antibiotic has advantages in the treatment of chronic osteomyelitis and infected fractures. The adequacy of surgical debridement is still key to successful clearance of infection but local antibiotic carriers seem to afford greater success rates by targeting the residual organisms present after debridement and delivering much higher local antibiotic concentrations compared with systemic antibiotics alone. Biodegradable ceramic carriers can be used to fill osseous defects, which reduces the dead space and provides the potential for subsequent repair of the osseous defect as they dissolve away. A dissolving ceramic antibiotic carrier also raises the possibility of single stage surgery with definitive closure and avoids the need for subsequent surgery for spacer removal. In this article we provide an overview of the properties of various biodegradable ceramics, including calcium sulphate, the calcium orthophosphate ceramics, calcium phosphate cement and polyphasic carriers. We summarise the antibiotic elution properties as investigated in previous animal studies as well as the clinical outcomes from clinical research investigating their use in the surgical management of chronic osteomyelitis. Calcium sulphate pellets have been shown to be effective in treating local infection, although newer polyphasic carriers may support greater osseous repair and reduce the risk of further fracture or the need for secondary reconstructive surgery. The use of ceramic biocomposites to deliver antibiotics together with BMPs, bisphosphonates, growth factors or living cells is under investigation and merits further study. We propose a treatment protocol, based on the Cierny-Mader classification, to help guide the appropriate selection of a suitable ceramic antibiotic carrier in the surgical treatment of chronic osteomyelitis.
116 citations
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TL;DR: The aim of this paper is to provide an overview of the uses of data from large multi‐institution clinical databases for research.
Abstract: BACKGROUND: The routine collection of large amounts of clinical data, 'big data', is becoming more common, as are research studies that make use of these data source. The aim of this paper is to provide an overview of the uses of data from large multi-institution clinical databases for research. METHODS: This article considers the potential benefits, the types of data source, and the use to which the data is put. Additionally, the main challenges associated with using these data sources for research purposes are considered. RESULTS: Common uses of the data include: providing population characteristics; identifying risk factors and developing prediction (diagnostic or prognostic) models; observational studies comparing different interventions; exploring variation between healthcare providers; and as a supplementary source of data for another study. The main advantages of using such big data sources are their comprehensive nature, the relatively large number of patients they comprise, and the ability to compare healthcare providers. The main challenges are demonstrating data quality and confidently applying a causal interpretation to the study findings. CONCLUSION: Large clinical database research studies are becoming ubiquitous and offer a number of potential benefits. However, the limitations of such data sources must not be overlooked; each research study needs to be considered carefully in its own right, together with the justification for using the data for that specific purpose.
116 citations
Authors
Showing all 2120 results
Name | H-index | Papers | Citations |
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Douglas G. Altman | 253 | 1001 | 680344 |
George Davey Smith | 224 | 2540 | 248373 |
Cyrus Cooper | 204 | 1869 | 206782 |
James J. Collins | 151 | 669 | 89476 |
Richard J.H. Smith | 118 | 1308 | 61779 |
Andrew Carr | 111 | 842 | 54974 |
Paul Dieppe | 105 | 618 | 53529 |
Matthew A. Brown | 103 | 748 | 59727 |
David W. Murray | 97 | 699 | 43372 |
Ray Fitzpatrick | 95 | 477 | 40322 |
Derrick W. Crook | 92 | 474 | 29885 |
Richard W Morris | 91 | 519 | 35165 |
Richard J. K. Taylor | 91 | 1543 | 43893 |
Sharon J. Peacock | 90 | 494 | 33352 |
Derick T Wade | 90 | 398 | 37413 |