Publications by authors named "N Howells"
Background: Unicompartmental knee replacements (UKRs) are performed by surgeons at various stages in training with varying levels of supervision, but we do not know if this is a safe practice with comparable outcomes to consultant-performed UKR. The aim of this study was to use registry data for England and Wales to investigate the association between surgeon grade (consultant, or trainee), the senior supervision of trainees (supervised by a scrubbed consultant, or not), and the risk of revision surgery following UKR.
Methods And Findings: We conducted an observational study using prospectively collected data from the National Joint Registry for England and Wales (NJR).
Article Synopsis
- Risk communication is crucial in shared decision-making regarding total knee replacements, as unintended outcomes can significantly impact patients.
- Analysis of 62 recorded consultations revealed varied methods of risk communication, with both surgeons and patients often avoiding in-depth discussions about risks, focusing instead on building trust.
- The realities of patients’ deteriorating conditions sometimes led to decisions that felt more coerced by circumstances rather than made through informed self-determination, challenging the policy norms of patient responsibility.
Aims: The aim of this study was to describe the prevalence and patterns of neuropathic pain over one year in a cohort of patients with chronic post-surgical pain at three months following total knee arthroplasty (TKA).
Methods: Between 2016 and 2019, 363 patients with troublesome pain, defined as a score of ≤ 14 on the Oxford Knee Score pain subscale, three months after TKA from eight UK NHS hospitals, were recruited into the Support and Treatment After Replacement (STAR) clinical trial. Self-reported neuropathic pain and postoperative pain was assessed at three, nine, and 15 months after surgery using the painDETECT and Douleur Neuropathique 4 (DN4) questionnaires collected by postal survey.
Objectives: To test the feasibility of a randomised controlled trial (RCT) of a novel preoperative tailored sleep intervention for patients undergoing total knee replacement.
Design: Feasibility two-arm two-centre RCT using 1:1 randomisation with an embedded qualitative study.
Setting: Two National Health Service (NHS) secondary care hospitals in England and Wales.
Background: The Support and Treatment After Replacement (STAR) care pathway is a clinically important and cost-effective intervention found to improve pain outcomes over one year for people with chronic pain three months after total knee replacement (TKR). We followed up STAR trial participants to evaluate the longer-term clinical- and cost-effectiveness of this care pathway.
Methods: Participants who remained enrolled on the trial at one year were contacted by post at a median of four years after randomisation and invited to complete a questionnaire comprising the same outcomes collected during the trial.