Results
- Showing results for:
- Reset all filters
Search results
-
Journal articleKhattak M, Kierkegaard P, McGregor A, et al., 2025, , The Bone & Joint Journal, Vol: 107-B, Pages: 582-586, ISSN: 2049-4408
The deployment of AI in medical imaging, particularly in areas such as fracture detection, represents a transformative advancement in orthopaedic care. AI-driven systems, leveraging deep-learning algorithms, promise to enhance diagnostic accuracy, reduce variability, and streamline workflows by analyzing radiograph images swiftly and accurately. Despite these potential benefits, the integration of AI into clinical settings faces substantial barriers, including slow adoption across health systems, technical challenges, and a major lag between technology development and clinical implementation. This commentary explores the role of AI in healthcare, highlighting its potential to enhance patient outcomes through more accurate and timely diagnoses. It addresses the necessity of bridging the gap between AI innovation and practical application. It also emphasizes the importance of implementation science in effectively integrating AI technologies into healthcare systems, using frameworks such as the Consolidated Framework for Implementation Research and the Knowledge-to-Action Cycle to guide this process. We call for a structured approach to address the challenges of deploying AI in clinical settings, ensuring that AI’s benefits translate into improved healthcare delivery and patient care.
-
Journal articleHollmann VC, Darwood ARJ, Sarai PS, et al., 2025, , British Journal of Anaesthesia, Vol: 134, Pages: 1341-1349, ISSN: 0007-0912
BackgroundPatient-controlled sedation has potential benefits, including rapid recovery and improved patient satisfaction. During patient-controlled sedation, the recipient presses a button to self-administer the sedative. The safety and efficacy of this method is dependent upon the dose relationships between the sedative's desired effects, its impact on the ability to press a button, and adverse effect occurrence. This study aimed to investigate the relationship between sedation, psychomotor function, and adverse effect occurrence during clinician-controlled sevoflurane sedation.Methods15 healthy participants (10 males) were administered a sevoflurane dose-escalation protocol starting at 0 kPa and increasing in 0.2 kPa increments until a protocol endpoint occurred. Sevoflurane was delivered using conventional anaesthetic apparatus. At each sevoflurane dose, Richmond Agitation-Sedation Scale (RASS) and psychomotor function were assessed. Protocol endpoints included airway, respiratory, or cardiovascular compromise; agitation (RASS ≥+2); and sedation >3 h.ResultsThe protocol endpoint was sedation >3 h for nine (60%) participants, agitation for five (33%) participants, and tonic movements for one (7%) participant. The median [range] sevoflurane dose was 0.4 [0.2–1.0] kPa when RASS <0 (sedation dose), 1.2 [0.6–2.0] kPa when participants were unable to complete reaction time testing (button-press dose), and 1.6 [1.2–2.2] kPa at the protocol endpoint (endpoint dose). The sedation dose was less than the button-press dose (P<0.0001), and the button-press dose was less than the endpoint dose (P=0.002).ConclusionsPatient-controlled sevoflurane sedation is potentially feasible in a healthy population within the dose range 0.4–1.2 kPa. Concurrent reaction time monitoring could minimise the risk of agitation.
-
Journal articlePanhelleux B, Silverman A, McGregor A, 2025, , JOURNAL OF BIOMECHANICS, Vol: 184, ISSN: 0021-9290
-
Journal articleVella-Baldacchino M, Bottle A, Cobb J, et al., 2025, , BONE & JOINT JOURNAL, Vol: 107B, Pages: 514-521, ISSN: 2049-4394
- Cite
- Citations: 2
-
Journal articleVella-Baldacchino M, Davies AR, Bottle A, et al., 2025, , JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, Vol: 107, Pages: 819-828, ISSN: 0021-9355
-
Journal articleEvans T, Turna A, Stringfellow TD, et al., 2025, , PLOS Digital Health, Vol: 4, ISSN: 2767-3170
Augmented reality (AR) allows the real environment to be altered with superimposed graphics using a head-mounted-display (HMD), smartphone or tablet. AR in surgery is being explored as a potential disruptive technology and could be used to improve patient understanding of treatment and as an adjunct for surgery. The aim was to explore this use of AR and assess potential benefits for consent and patient education. A systematic review was conducted using PRISMA-SCR guidelines. 4 major bibliographic databases were searched using the terms: ‘(augmented reality OR mixed reality) AND surgery AND (consent OR patient education)’. Included papers evaluated an AR intervention on consenting patients for enhancing surgical consent or education about a procedure. Non-English language papers and studies which did evaluate an intervention were excluded. Three reviewers screened all abstracts and full text papers for inclusion. The review protocol was prospectively registered with PROSPERO (ID: CRD42020207360). 52 records were identified. Following removal of 13 duplicates, 21 were removed after abstract screening leaving 17 articles for full assessment. One article was a letter and 8 did not evaluate interventions, leaving 8 articles published between 2019 and 2023. 3 papers were randomised controlled trials comparing AR enhanced processes to standard consent, 2 cohort studies evaluated patient satisfaction with AR interventions and there was one randomised crossover trial of AR against traditional consent consultation. The Cochrane risk of bias tool was used most studies were deemed as high risk of bias. Patient satisfaction and understanding were improved using AR. However, advantages over other enhanced techniques are less clear. Using AR to enhance written literature was shown to require less mental effort from patients and was preferred to standard resources to understand complex surgery. The few randomised trials are limited by bias and lack of power calculation
-
Journal articleHampton M, Ali F, Nicolaou N, et al., 2025, , Knee Surg Sports Traumatol Arthrosc, Vol: 33, Pages: 1259-1269
PURPOSE: The prevalence and appreciation of meniscal tears in children have increased in both number and complexity. There is currently a paucity of high-quality evidence that can guide surgeons in treating skeletally immature patients with meniscal injuries. The aim of this study was to develop comprehensive recommendations for the management of isolated meniscal tears in skeletally immature children. METHODS: An international, two-round, modified Delphi consensus was completed. Included 'experts' were identified as having an established adult knee practice, including children and either: (1) Faculty at an international paediatric knee conference, (2) Active members of complex national paediatric multi-disciplinary groups or (3) Members of faculty on recognised national/international instructional courses aimed at teaching the management of meniscal lesions to knee surgeons. The currently available literature was reviewed, and areas of poor quality, inconclusive or absent evidence were examined and formed the focus of the study. A threshold of 70% was used to define consensus for our study based on other similar Delphi consensus studies in the literature. RESULTS: A total of 43 experts (Round 1) and 41 experts (Round 2) took part in the Delphi study, including surgeons from Europe, the United States of America and South America. 34 statements were identified exploring three main domains-clinical assessment, management and complex tears (bucket handle, discoid and radial). Following Round 1, consensus was reached on 17 (50%) statements; subsequently, after completion of Round 2, consensus was reached on 28 (82%) statements, leaving six (18%) with no consensus. The areas of no consensus included investigation of painless clicking, the most sensitive clinical test for meniscal pathology, treatment of small radial tears (less than 1/3 width), ability to reduce chronic bucket handle tears and timing of surgery. CONCLUSIONS: This is the first modified Delphi consensus th
-
Conference paperThakur A, Harris S, Dhaliwal J, et al., 2025, , British Hip Society 2025
-
Journal articleVella-Baldacchino M, Chughtai D, Kow J, et al., 2025, , JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, Vol: 20, ISSN: 1749-799X
- Cite
- Citations: 1
-
Journal articleSaggu R, Shaw C, Hughes C, et al., 2025, , BMC Women's Health, Vol: 25, ISSN: 1472-6874
Background: Prehabilitation has shown promise in improving post-operative outcomes for several solid tumour groups. However, prehabilitation programmes are not widely established. Patients with advanced ovarian cancer experience life changing debulking surgery and could benefit from prehabilitation. This study aims to explore the views, experiences, facilitators and barriers surrounding prehabilitation in a demographically diverse cohort of advanced ovarian cancer patients. This would help to inform an acceptable patient-centred working programme model for a diverse group of patients.Methods: Purposive, maximum variation sampling was used to recruit a diverse sample of women, due to undergo or following primary debulking surgery for advanced ovarian cancer, from two cancer centres in London. Semi-structured interviews were either conducted face to face or by telephone. All recordings were transcribed verbatim and analysed using thematic analysis. Results: Twenty-one participants were interviewed. Twelve were prehabilitation ‘naïve’ and nine had participated in the Marsden Integrated Lifestyle and Exercise programme (MILE). The age range was 46-76 years and 8/21 participants were of Black, Asian or Mixed heritage. Factors influencing engagement with prehabilitation can be categorised under four major emerging themes (1) Mindset (2) Actual preparation (3) Support system (4) Delivery of prehabilitation.Conclusion: Patients with ovarian cancer welcome the concept of prehabilitation, however a blanket approach is not suitable to meet the needs of a demographically diverse cohort. The components of prehabilitation must be tailored to individual needs, with attention to existing mindset and support systems, building on preparations that women are already making for surgery and offering flexible delivery options.
-
Journal articleLogishetty K, Verhaegen J, Tse S, et al., 2025,
Does total hip arthroplasty benefit patients with minimal radiographic osteoarthritis?
, Bone & Joint Open, ISSN: 2633-1462 -
Journal articlevan Helden JFL, Cabral HV, Alexander E, et al., 2025, , Journal of Neurophysiology, Vol: 133, Pages: 727-741, ISSN: 0022-3077
Many individuals with incomplete spinal cord injury (SCI) exhibit reduced volitional control of trunk muscles, such as impaired voluntary contractions of the erector spinae (ES), due to damage to the neural pathways regulating sensorimotor function. Studies using conventional bipolar electromyography (EMG) showed alterations in the overall, or global, activation of the trunk muscles in people with SCI. However, how activation varied across specific regions within the ES, referred to as regional activation, remains unknown. The aim of the study was to investigate the regional distribution of the ES activity below the level of injury in individuals with incomplete SCI during postural tasks and multidirectional reaching tasks using high-density EMG. Twenty-one individuals with incomplete SCI and age-matched controls were recruited. The EMG amplitude of the thoracic ES and displacement of the arm, trunk, and center of pressure were recorded during the tasks. Activation was more in the lower region of the ES in individuals with SCI than in the controls during the postural tasks. In addition, activation was limited to a small area of the ES during the reaching tasks. The EMG amplitude was greater during reaching forward than returning to the upright posture in the controls; however, this phase-dependent difference in the EMG amplitude was not present in individuals with SCI. Our findings demonstrate changes in regional activation of the thoracic ES during postural and reaching tasks, likely reflecting injury-induced changes in selective neural control to activate residual muscle fibers of the ES for postural control and function after SCI.
-
Journal articleDavies A, Sabharwal S, Zamora Talaya B, et al., 2025, , BMJ Open, Vol: 15, ISSN: 2044-6055
Objectives The aim of this study was to compare the cost-effectiveness of total shoulder arthroplasty (TSA) and hemiarthroplasty (HA) and explore variation by age and gender.Design Cost-effectiveness analysis using a lifetime cohort Markov model.Setting National population registry data.Participants Model parameters were informed by propensity score-matched comparisons of TSA and HA in patients with osteoarthritis and an intact rotator cuff using data from the National Joint Registry.Interventions TSA and HA.Primary outcome measures Quality-adjusted life years (QALYs) and healthcare costs for age and gender subgroups. A probabilistic sensitivity analysis was performed.Results In all subgroups, TSA was more cost-effective, with the probability of being cost-effective about 70% for TSA versus 30% for HA at any willingness-to-pay threshold above £1100 per QALY. TSA was dominant in young patients (≤60 years) with a mean cost saving of £463 in men and £658 in women, and a mean QALY gain of 2 in both men and women. In patients aged 61–75 years, there was a mean cost saving following HA of £395 in men and £181 in women, while QALYs remained superior following TSA with a 1.3 gain in men and 1.4 in women. In the older cohort (> 75 years), the cost difference was highest and the QALY difference was lowest; there was a cost-saving following HA of £905 in men and £966 in women. The mean QALY gain remained larger after TSA: 0.7 in men and 0.9 in women.Conclusion TSA was more cost-effective than HA in patients with osteoarthritis. QALYs were superior following TSA in all patient groups. Cost differences varied by age and TSA was dominant in young patients.
-
Journal articleRistic M, Chappell KE, Lanz H, et al., 2025, , Magnetic Resonance in Medicine, Vol: 93, Pages: 1077-1089, ISSN: 0740-3194
Purpose: To report the first in-vivo results from exploiting the magic angle effect, using a dedicated low-field MRI scanner that can be rotated about two axes. The Magic Angle Directional Imaging (MADI) method is used to depict collagen microstructures with 3D collagen tractography of knee ligaments and the meniscus. Methods: A novel low-field MRI system was developed, based on a transverse field open magnet, where the magnet can be rotated about two orthogonal. Sets of volume scans at various orientations were obtained in healthy volunteers. The experiments focused on the anterior cruciate ligament (ACL) and the meniscus of the knee. The images were co-registered, anatomical regions of interest (RoI) were selected and the collagen fiber orientations in each voxel were estimated from the observed image intensity variations. The 3D collagen tractography was superimposed on conventional volume images. Results: The MADI method was successfully employed for the first time producing in-vivo results comparable to those previously reported for excised animal specimens using conventional MRI. Tractography plots were generated for the ACL and the menisci. These results are consistent with the known microstructure of collagen fibers in these tissues. Conclusion: Images obtained using low-field MRI with 1 mm3 resolution were of sufficient quality for the MADI method, which was shown to produce high quality in-vivo information of collagen microstructures. This was achieved using a cost effective and sustainable low-field magnet making the technique potentially accessible and scalable, potentially changing the way we image injuries or disease in joints.
-
Journal articleWoodbridge HR, Alexander CM, Brett SJ, et al., 2025, , PLOS ONE, Vol: 20, Pages: e0318150-e0318150
<jats:sec id="sec030"><jats:title>Background</jats:title><jats:p>Physical rehabilitation of critically ill patients may improve physical outcomes; however, the relative benefits and risks with patients requiring vasoactive drugs is currently unknown. A feasibility study is needed to inform the design of a future trial required to address this issue.</jats:p></jats:sec><jats:sec id="sec040"><jats:title>Methods</jats:title><jats:p>A two-phase exploratory observational feasibility study was carried out:</jats:p><jats:list list-type="order"><jats:list-item><jats:p>A retrospective study to clarify the current practice of rehabilitation with patients receiving vasoactive drugs to inform future trial interventions and design.</jats:p></jats:list-item><jats:list-item><jats:p>A prospective study exploring recruitment and outcome measurement. Intensive care patients receiving vasoactive drugs were recruited and asked about the acceptability of a future trial. The feasibility of using an adverse event tool was measured during rehabilitation. Patients were followed up after 60 days to describe the feasibility of measuring outcomes for a future trial.</jats:p></jats:list-item></jats:list></jats:sec><jats:sec id="sec032"><jats:title>Results</jats:title><jats:p>Retrospective study (n = 78): Twenty-one percent of patients took part in physical rehabilitation whilst receiving vasoactive drugs. Of 321 days with vasoactive drugs administered, physical rehabilitation occurred on 27 days (8%).</jats:p><jats:p>Prospective study (n = 40): Eighty-one percent of participants indicated acceptability of being recruited into a future trial (n = 37). Eighty-eight percent of clinicians found it acceptable to randomise patients into either early rehabilitation or standard care. The adverse ev
-
Journal articleZhou T, Kirby-Ginns S, Salman D, et al., 2025, , BMJ Open, Vol: 15, ISSN: 2044-6055
Objectives The aim of this study was to gather insights from a diverse group of stakeholders, identify existing challenges and explore associated solutions to develop a conceptual framework that assists in the development of a chronic low back pain (CLBP) self-management app.Design Codesign workshop methodology.Setting The study was conducted online, allowing for the participation of a diverse group of stakeholders.Participants Participants were recruited through social media platforms and professional networks, including individuals with LBP for at least 3 months, healthcare professionals experienced in CLBP management and app developers with a background in digital health applications.Interventions The study used codesign workshops focused on brainstorming, communication and reflection exercises designed to foster collaboration and gather insights from stakeholders.Outcome measures Identification of key challenges and potential solutions for mobile health (mHealth) apps targeting CLBP.Results Nine stakeholders identified four primary challenges in current back pain apps: belief and trust, motivation, safety and usability. The group also collaboratively developed and proposed practical solutions to these challenges.Conclusions This study illustrated the utility of the codesign workshop approach in generating critical insights for the development of a mHealth solution for CLBP. The insights gathered from these workshops can be used to inform future app development, potentially improving user engagement.
-
Journal articleSzepietowski O, Ertman H, Chiou S-Y, et al., 2025, , Journal of Electromyography and Kinesiology, Vol: 80, ISSN: 1050-6411
BackgroundTranscranial magnetic stimulation (TMS) has been used to assess voluntary activation (VA) of limb and back muscles, however its ability to assess abdominal muscle VA is unknown. The assessment of abdominal muscle VA using TMS could be applied to patients with trunk dysfunction to enable further understanding of the neurophysiology of trunk control, inform practice and enable the development and monitoring of rehabilitation programmes.AimThe aim of this study was to investigate use of TMS and the twitch interpolation technique to measure voluntary activation of abdominal muscles.MethodsTwenty healthy participants performed sets of isometric abdominal contractions of varying levels, during which TMS was applied to the primary motor cortex. The evoked twitches were measured as torque, while simultaneous surface electromyographic (EMG) activity was recorded bilaterally from rectus abdominis, erector spinae, tensor fasciae latae, and rectus femoris. VA was calculated as: (1 – superimposed twitch amplitude/estimated resting twitch amplitude) x 100. Estimated resting twitch amplitude was calculated by extrapolation using linear regression of superimposed twitch amplitude against torque for contraction strengths 50–100 % maximum voluntary contraction (MVC).ResultsThere was a strong linear relationship between voluntary torque of 50–100 % MVC and TMS-evoked twitch amplitude (r2 = 0.994, p = 0.035), and voluntary torque between 50–100 % MVC and VA (r2 = 0.997, p = 0.025). VA at a target torque of 100 % MVC was less than 100 % (86.20 ± 2.29 %).ConclusionsVA of abdominal muscles can be assessed with twitch interpolation using TMS. VA has been shown to be submaximal during maximum voluntary contractions, and it has been demonstrated that superimposed twitch amplitude decreases in a linear fashion with increasing contraction intensity. Using this technique to explore trunk muscle function could help to improve understanding of the neurophy
-
Journal articleWang E, Strutton P, Alexander C, 2025, , BMC Musculoskeletal Disorders, Vol: 26, ISSN: 1471-2474
BackgroundPeople with joint hypermobility have excessive joint flexibility, which is more common in young women. The people with symptomatic hypermobility report poor balance and even falls. This scoping review aims to identify and map the available evidence related to balance and falling in adults with joint hypermobility to support research planning and ideas for treatment direction.MethodsA framework for the search was constructed using the Joanna Briggs Institute (JBI) approach. Electronic searches of primary evidence were performed using the following databases: Medline, Web of Science, CINAHL, Scopus and EMBASE. Papers written in English and published between 1946 and November 2023 were included. Titles, abstracts, and full papers were independently screened by two reviewers. Data extracted related to the population, the concept under investigation, the method of measurement, the level of evidence and the result.ResultsNineteen of 1,950 screened articles were included. In terms of the population, details related to ethnicity of the research participants was missing. The hypermobility classification criteria varied; it was not always clear if people who were hypermobile had symptoms. Concepts related to fear of falling, balance and adaptive strategies prompted by different postural tasks with and without vision were explored. Centre of pressure, muscle activity, kinematics and psychological factors were measured using force plates, electromyography (EMG), motion capture, patient and clinician reported outcome measures, focus groups and interviews. Most papers were low on the hierarchy of evidence (i.e. equal or lower than a case control study). The participants with joint hypermobility had increased sway, different muscle activity, and different kinematics compared to people without hypermobility. When surveyed, they commonly fell and had a fear of falling.ConclusionsIt is unclear whether the participants represent the population of people with hypermobility. D
-
Journal articleAbdulhadi Alagha M, Cobb J, Liddle AD, et al., 2025, , Bone & Joint Research, Vol: 14, Pages: 46-57
<jats:sec><jats:title>Aims</jats:title><jats:p>While cementless fixation offers potential advantages over cemented fixation, such as a shorter operating time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture (PPFF) necessitating revision and reoperation after elective total hip arthroplasty (THA).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We included 154,519 primary elective THAs from the Swedish Arthroplasty Register (SAR), encompassing 21 patient-, surgical-, and implant-specific features, for model derivation and validation in predicting 30-day, 60-day, 90-day, and one-year revision and reoperation due to PPFF. Model performance was tested using the area under the curve (AUC), and feature importance was identified in the best-performing algorithm.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The Lasso regression excelled in predicting 30-day revisions (area under the receiver operating characteristic curve (AUC) = 0.85), while the Gradient Boosting Machine (GBM) model outperformed other models by a slight margin for all remaining endpoints (AUC range: 0.79 to 0.86). Predictive factors for revision and reoperation were identified, with patient features such as increasing age, higher American Society of Anesthesiologists grade (> III), and World Health Organization obesity classes II to III associated with elevated risks. A preoperative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small (< 35 mm) or large (> 52 mm) femoral head
-
Journal articleAlagha MA, Cobb J, Liddle A, et al., 2025, , Bone & Joint Research, Vol: 14, Pages: 46-57, ISSN: 2046-3758
Introduction While cementless fixation offers potential advantages, such as a shorter operative time, concerns linger over its higher cost and increased risk of periprosthetic fractures. If the risk of fracture can be forecasted, it would aid the shared decision-making process related to cementless stems. Our study aimed to develop and validate predictive models of periprosthetic femoral fracture(PPFF) necessitating revision and re-operation after elective THR.Methods We included 154,519 primary elective THRs from the Swedish Arthroplasty Register(SAR), encompassing twenty-one patient-,surgical-,and implant-specific features, for model derivation and validation in predicting 30-,60-,90-day and 1-year revision and re operation due to PPFF. Model performance was tested using the area under the curve(AUC), and features importance were identified in the best performing algorithm.Results The Lasso regression excelled in predicting 30-day revisions(AUC=0.85), while the Gradient Boosting Machine(GBM) model outperformed other models by a slight margin for all remaining endpoints(AUC range:0.79-0.86). Predictive factors for revision and re-operation were identified, with patient features such as increasing age, higher ASA grade(> 3), and obesity classes II-III were associated with elevated risks. A pre-operative diagnosis of idiopathic necrosis increased revision risk. Concerning implant design, factors such as cementless femoral fixation, reverse-hybrid fixation, hip resurfacing, and small(< 35 mm) or large(> 52 mm) femoral heads increased both revision and re-operation risks.Conclusion This is the first study to develop machine learning models to forecast the risk of periprosthetic femoral fracture necessitating re-do surgery. Future studies are required to externally validate our algorithm and assess its applicability in clinical practice.
This data is extracted from the Web of Science and reproduced under a licence from Thomson Reuters. You may not copy or re-distribute this data in whole or in part without the written consent of the Science business of Thomson Reuters.