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Journal articleHamawandi M, Zhou X, Mudway I, et al., 2025, , Medical Hypotheses, Vol: 200, ISSN: 0306-9877
Long-term air pollution exposures, particularly to fine particulate matter, have been linked to a wide range of health issues, including cardiovascular and respiratory diseases. Recent studies have expanded this scope to include skeletal disorders, such as osteoporosis and bone fragility. This is particularly concerning given the global burden of osteoporosis, which affects 500 million people worldwide and causes 13.5 million fractures annually. While traditional air pollution sources like exhaust emissions have been extensively studied, the role of non-exhaust sources, such as brake and tyre wear, remains largely unexplored. These non-exhaust sources are becoming a critical environmental concern, especially with the adoption of heavier electric vehicles. We hypothesize that lifetime accumulation of metals from non-exhaust traffic emissions contributes to the development of osteoporosis. This hypothesis is supported by several lines of evidence: epidemiological studies showing associations between air pollution exposures and increased fracture risk, particularly in populations living near busy roads; clinical studies demonstrating metal accumulation in the bone of individuals with osteoporosis and molecular studies showing the disruptive effects of metals on bone remodeling processes, including bone formation and resorption. To investigate this further, we propose a research approach combining in vitro, in vivo, ex vivo and computational modeling techniques. By studying the effects of metals on bone cells, analyzing the impact of metal exposure in animal models and simulating long-term exposure scenarios, we aim to elucidate the mechanisms underlying air pollution-induced bone damage. This research could inform urban planning policies, vehicle design and public health interventions protecting bone health.
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Journal articleKnight KJ, Beasley M, Mcconnell J, et al., 2025, , RADIOGRAPHY, Vol: 31, ISSN: 1078-8174
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- Citations: 1
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Journal articleKhattak M, Bowness JS, Yonis R, et al., 2025, , BONE & JOINT JOURNAL, Vol: 107B, Pages: 666-672, ISSN: 2049-4394
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Journal articleGill SS, Sugand K, Gupte CM, 2025, , ARCHIVES OF ORTHOPAEDIC AND TRAUMA SURGERY, Vol: 145, ISSN: 0936-8051
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Journal articleWatson F, Bennett A, McGregor A, et al., 2025, , BMJ Military Health, ISSN: 2633-3767
Introduction Biopsychosocial factors influence low back pain (LBP) in the general population but may affect people with lower limb loss (LLL) differently. The first aim was to investigate the relationship between LBP, disability and injury status. We hypothesised that those with LLL (no lumbosacral injury) will have more LBP and functional disability than those with (i) non-lumbosacral and non-amputation trauma and (ii) a non-injured comparison group, but less LBP and functional disability than those with (iii) lumbosacral trauma. The second aim was to report the biopsychosocial factors of LBP for those with LLL (no lumbosacral injury), stratified by functional disability.Methods Military and veteran personnel who did (‘exposed’, n=578) and did not (‘unexposed’, n=565) sustain combat trauma completed questionnaires for LBP severity, functional disability and biopsychosocial factors. The exposed group was subdivided into participants with lumbosacral injuries (exposed-lumbosacral (Exp-L)), those with LLL and no lumbosacral injuries (exposed-lower limb amputee (Exp-A)) and those with neither LLL nor lumbosacral injuries (exposed-non-lower limb amputee (Exp-NA)). LBP and functional disability were statistically compared for Exp-A versus unexposed, Exp-A versus Exp-L and Exp-A versus Exp-NA. Biopsychosocial factors were descriptively compared for Exp-A with and without functional disability.Results Exp-A had worse LBP and functional disability than unexposed (both p<0.001), less LBP (p=0.02) and functional disability (p=0.001) than Exp-L, but no different from Exp-NA. Exp-A with functional disability experienced more LBP prior to LLL, higher body mass index, greater current opioid use, increased phantom and residuum pain and higher depression scores than those without.Conclusion LBP and functional disability were significantly worse in participants with LLL (without comorbid lumbosacral combat injury) than controls, although LBP and functional
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Journal articleElzeiny A, Giai Via R, Donis A, et al., 2025, , EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY, Vol: 35, ISSN: 1633-8065
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Journal articleMontin E, Namireddy S, Ponniah HS, et al., 2025, , JOURNAL OF CLINICAL MEDICINE, Vol: 14
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Journal articleCowell I, McGregeor AH, O Sullivan P, et al., 2025, , Qualitative Health Research, ISSN: 1049-7323
Reassuring patients with low back pain to reduce their concerns is important for good clinical practice. However, guidelines provide little information on how physiotherapists should best deliver reassurance. This study explores how “reassurance” is enacted by physiotherapists and back pain patients during an initial consultation. The research setting was primary care. Twenty initial physiotherapy consultations were video-recorded and transcribed. The patient–physiotherapist interactions were analyzed using conversation analysis, a qualitative observational method. These data highlighted how some physiotherapists gave reassurance directed by what they considered to be important but not always grounded in patients’ expressed concerns. We also observed examples where physiotherapists developed a better understanding of patients’ concerns, which provided more patient-focused and targeted reassurance with less interactional “trouble” and greater patient affiliation. These findings suggest that physiotherapists should develop a good understanding of patients’ concerns, and take them into consideration, before delivering their reassurance. This will require that physiotherapists be responsive to patients’ concerns and adapt their communication to the individual needs of the patient.
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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.
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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.
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Journal articlePanhelleux B, Silverman A, McGregor A, 2025, , JOURNAL OF BIOMECHANICS, Vol: 184, ISSN: 0021-9290
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Journal articleVella-Baldacchino M, Bottle A, Cobb J, et al., 2025, , BONE & JOINT JOURNAL, Vol: 107B, Pages: 514-521, ISSN: 2049-4394
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- Citations: 2
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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
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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
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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
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Conference paperThakur A, Harris S, Dhaliwal J, et al., 2025, , British Hip Society 2025
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Journal articleVella-Baldacchino M, Chughtai D, Kow J, et al., 2025, , JOURNAL OF ORTHOPAEDIC SURGERY AND RESEARCH, Vol: 20, ISSN: 1749-799X
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- Citations: 1
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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.
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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.
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