Publications by authors named "Tim Board"

Background: Total hip arthroplasty is one of the most successful and cost-effective interventions for improving quality of life. Dislocation is a well-recognised complication with a significant health and economic burden. The aim of this study was to establish the current management practices for patients presenting with a prosthetic hip dislocation.

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Aims: This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip arthroplasty for aseptic loosening.

Methods: We conducted a cohort study of first-time, single-stage revision hip arthroplasties (RHAs) performed for aseptic loosening and recorded in the National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man between 2003 and 2019. Patient identifiers were used to link records to national mortality data, and to NJR data to identify subsequent re-revision procedures.

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Restoration of equal leg lengths is essential when performing total hip arthroplasty. Pre-operatively, surgeons should assess leg length discrepancy (LLD) on plain radiographs to help adequately plan their operation. Often the hips are in a minor windswept position on radiographs and this can make assessing LLD unreliable.

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Background: Effective surgical wound management in total knee arthroplasty (TKA) is crucial for optimal healing and patient outcomes. Despite surgical advances, managing wounds to prevent complications remains challenging. This study aimed to identify and address evidence gaps in TKA wound management, including preoperative optimization, intraoperative options, and postoperative complication avoidance.

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Article Synopsis
  • The study examined the outcomes of total hip arthroplasty (THA) in 70 patients with early-stage osteoarthritis (OA) compared to 200 patients with advanced OA, focusing on factors predicting success.
  • Results showed that younger patients with early OA had lower success rates (22.9% deemed successful) and effective outcomes were linked to the presence of subchondral cysts on imaging; those with cysts had better improvements in hip scores.
  • The findings suggest that THA in early OA patients should be approached with caution, and preoperative imaging is essential to assess potential outcomes, especially in the absence of cysts.
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Background: This modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures.

Methods: An international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty).

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Background: The purpose of this modified Delphi study was to obtain consensus on wound closure and dressing management in total knee arthroplasty (TKA).

Methods: The Delphi panel included 20 orthopaedic surgeons from Europe and North America. There were 26 statements identified using a targeted literature review.

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Introduction: The successful management of wound healing following total hip arthroplasty (THA) is multifaceted, relying on various intraoperative techniques and surgical variables. Recent reviews have evaluated many of these factors, including the comparison between mesh-adhesive dressings and other skin closure methods, the closing time of different suture techniques, and the four aspects of closure for THA (deep fascial layer; subdermal layer; intradermal layer). However, previous articles did not cover certain topics that can be directly influenced by the surgeon.

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Introduction: The successful management of wound healing after total knee arthroplasty (TKA) depends on several aspects of ancillary intraoperative techniques and surgical variables. Many of these have been evaluated in a few recent reports. The prior reviews studied many aspects of wound healing and, for example, found lower risks of wound complications with barbed sutures compared with interrupted closure with non-barbed sutures, no differences in wound complications between adhesives, subcuticular sutures, staples, glue, or mesh adhesives for the closure of the skin layer, and that mesh adhesives may be associated with faster closing times compared to subcuticular sutures or staples in TKA.

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Aims: This study describes the variation in the annual volumes of revision hip arthroplasty (RHA) undertaken by consultant surgeons nationally, and the rate of accrual of RHA and corresponding primary hip arthroplasty (PHA) volume for new consultants entering practice.

Methods: National Joint Registry (NJR) data for England, Wales, Northern Ireland, and the Isle of Man were received for 84,816 RHAs and 818,979 PHAs recorded between April 2011 and December 2019. RHA data comprised all revision procedures, including first-time revisions of PHA and any subsequent re-revisions recorded in public and private healthcare organizations.

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Background There is a number of studies showing no significant benefit of using drains after primary hip arthroplasty. However, there is no consensus in the literature about the usage of drains in revision hip replacement. This study aims to assess the effect of drains in revision hip arthroplasty.

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Background: Patients after total hip arthroplasty (THA) have altered hip kinematics compared to healthy controls, specifically hip extension and range of motion are lower. Exploring pelvis-thigh coordination patterns and coordination variability may help to elucidate why differences in hip kinematics are evident in patients following THA.

Research Question: Do sagittal plane hip, pelvis and thigh kinematics, and pelvis-thigh movement coordination and coordination variability differ between patients following THA and healthy controls during walking?

Methods: Sagittal plane hip, pelvis and thigh kinematics were collected using a three-dimensional motion capture system while 10 patients who had undergone THA and 10 controls walked at a self-selected pace.

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Despite their emerging use, the current understanding of the in-vivo functional mechanisms of Dual Mobility (DM) Total Hip Replacements (THRs) is poor, and current characterisation methodologies are not suitable for the unique function and design of these types of devices. Therefore, the aim of this study was to develop a geometric characterisation methodology to estimate dimensional change across the articulating surfaces of retrieved DM polyethylene liners so that their invivo function may be better understood. The method involves the acquisition of three-dimensional coordinate data from the internal and external surfaces of DM liners.

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Dual mobility (DM) implants are being increasingly used for total hip arthroplasties due to the additional range of motion and joint stability they afford over more traditional implant types. Currently, there are no reported methods for monitoring their motions under realistic operating conditions while in vitro and, therefore, it is challenging to predict how they will function under clinically relevant conditions and what failure modes may exist. This study reports the development, calibration, and validation of a novel inertial tracking system that directly mounts to the mobile liner of DM implants.

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Background: People with avascular necrosis of the hip have very limited treatment options currently available to stop the progression of this disease; this often results in the need for a hip replacement. There is some weak evidence that a class of drugs called bisphosphonates may delay the course of the disease, and this trial was commissioned and set up to provide robust evidence regarding the use of bisphosphonates in adults aged ≥ 18 years with this condition.

Objectives: The aim of the Managing Avascular Necrosis Treatments: an Interventional Study ( MANTIS ) trial was to evaluate the clinical effectiveness and cost-effectiveness of a 12-month course of alendronate in the treatment of avascular necrosis.

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Aims: Restoration of normal hip biomechanics in arthroplasty surgery is important in order to achieve good muscle function and joint stability.

Methods: In this retrospective cohort study, we examined the postoperative radiographs of 131 femoral revision arthroplasty procedures using a monoblock, fully hydroxyapatite (HA)-coated titanium stem. Femoral offset, modified-global offset and leg length were measured of the operated and contralateral hips.

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Different hip pathologies can cause geometric variation of the acetabulum and femoral head. These variations have been considered as an underlying mechanism that affects the tribology of the natural hip joint and changes the stress distribution on the articular surface, potentially leading to joint degradation. To improve understanding of the damage mechanisms and abnormal mechanics of the hip joint, a reliable in-vitro methodology that represents the in vivo mechanical environment is needed where the position of the joint, the congruency of the bones and the loading and motion conditions are clinically relevant and can be modified in a controlled environment.

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Aims: The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England.

Methods: This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index.

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Background: Mortality following revision hip surgery for periprosthetic fracture (PPF) is comparable to neck of femur fractures. Our institution provides a regional "PPF Service". The aim of this study was to determine the time to surgery and mortality rate for PPF, compared to revision for infection or aseptic loosening.

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Aims: The aim of this modified Delphi process was to create a structured Revision Hip Complexity Classification (RHCC) which can be used as a tool to help direct multidisciplinary team (MDT) discussions of complex cases in local or regional revision networks.

Methods: The RHCC was developed with the help of a steering group and an invitation through the British Hip Society (BHS) to members to apply, forming an expert panel of 35. We ran a mixed-method modified Delphi process (three rounds of questionnaires and one virtual meeting).

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A multi-centre, registry-based cohort study was conducted to assess the effect of the coronavirus disease 2019 (COVID-19) pandemic on the provision of non-arthroplasty hip surgery (NAHS) in the UK by (i) comparing the number of NAHS performed during the pandemic to pre-pandemic levels, (ii) prospectively auditing compliance to established guidance and (iii) evaluating post-operative outcomes and their predictors. Patients who underwent NAHS during the pandemic/pre-pandemic were selected from the Non-Arthroplasty Hip Registry, which collects demographic, procedural and pre-operative outcome data. Patients during the pandemic period were emailed separate COVID-19 surveillance questionnaires, which evaluated adherence to guidelines and post-operative outcomes.

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Aims: This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum.

Methods: Data on adult patients who underwent arthroscopic labral debridement or repair between 1 January 2012 and 31 July 2019 were extracted from the UK Non-Arthroplasty Hip Registry. Patients who underwent microfracture, osteophyte excision, or a concurrent extra-articular procedure were excluded.

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Aims: Hip arthroplasty aims to accurately recreate joint biomechanics. Considerable attention has been paid to vertical and horizontal offset, but femoral head centre in the anteroposterior (AP) plane has received little attention. This study investigates the accuracy of restoration of joint centre of rotation in the AP plane.

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