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Tag: orthopaedics

A British Orthopaedic Association message to people waiting for joint replacement and other orthopaedic surgery

Growing waiting lists are affecting all planned surgery, but particularly orthopaedics which has the largest overall waiting list of any individual specialty. The BOA’s statement [published 26 June 2020] is a response to the concern, frustration and a lack of information available to people waiting for surgery. It explains how services can restart, gives advice on what to do, and provides resources to help people while they wait, as well as some FAQs.

Access the statement here.

Guest blog by

Cormac Kelly, Consultant Upper Limb Surgeon at The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust


Peter Kay, National Orthopaedic Alliance (NOA) Lead Clinician and Consultant Orthopaedic Surgeon at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust

The COVID-19 crisis has changed the delivery of planned orthopaedic surgery drastically. As the pandemic continues to subside, the NHS, with various guidance from Public Health England, Medical and Surgical Colleges, the British Orthopaedic Association, and others, is working on a plan to get surgery back on track.

The information on the risks to patients and staff when operating during this crisis continues to emerge. In light of research from around the world indicating an increase in complication rates and mortality if patients contract COVID-19 around the time of surgical intervention, we are taking every precaution possible to develop processes to reduce the risk to our patients. These have included the appropriate use of PPE (personal protective equipment), routine testing and using a “clean” area for surgery away from COVID-19 positive patients. Despite this, it is clear that the risk to patients is likely to be higher than normal. How much higher, we do not know. Thus, we are progressing slowly and carefully to restore the delivery of non-urgent orthopaedic surgery. Through organisations such as the National Orthopaedic Alliance (NOA), providers of orthopaedic care are working together to ensure the restoration of planned orthopaedic surgery is safe for both patients and staff.

We are aware that some patients are at home – possibly in self-isolation suffering joint and soft tissue pain. Some are in high risk categories because of lung diseases, diabetes and other medical conditions, and may wish to wait several months and see how the pandemic recovery unfolds before moving forward with planned orthopaedic surgery. Others are living with progressive pain and may be reluctant to let us know that they need help for fear of ‘disturbing’ an already stretched NHS. We ask these patients to please not suffer in silence.

Recovery planning and restarting planned orthopaedic surgery is complicated as we have to consider joint issues along with other conditions such as cancer treatments and progressive sight loss. The volume of work we can do as we restart will be reduced because of factors including the availability of staff, PPE and resources such as theatres as these facilities are still being used to treat sick COVID-19 patients.

We all now know how to socially distance but this also needs to be considered when bringing elective orthopaedic patients back into hospital. Many patients have admitted to us that they are frightened of this new world and thoughts of visiting hospital. We understand that and have been investigating ways to help. Many patients are now able to take advantage of virtual clinics and are receiving telephone and video calls which we hope helps.

We continue to work to make sure patients have all the information, tricks and tips they need to help with pain as our therapists and nurses are constantly looking at new ways to deliver care. The ARMA website has some useful information on managing pain during the crisis. Although we strive, for patient’s protection, to avoid unnecessary face to face contact, this can be made possible after we discuss the risks and possible benefits. We are redesigning outpatients so that if patients do have to attend in person, it is as safe as possible.

Remember that we are still here for patients and we encourage them to let their orthopaedic care provider know if they are in trouble and are dealing with uncontrolled pain. Providers can work with them on a short-term solution while we work to restore elective and planned orthopaedic surgery post COVID-19.


About Cormac Kelly

Cormac is a Consultant Upper Limb surgeon at The Robert Jones and Agnes Hunt Orthopaedic Hospital in Oswestry, Shropshire. He assists with the facilitation of the National Orthopaedic Alliance (NOA) COVID-19 webinar series.


About Peter Kay

Peter is a Consultant Orthopaedic Surgeon at Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust and Honorary Clinical Professor of Orthopaedic Surgery at Manchester University. He is the current Clinical Lead for the National Orthopaedic Alliance.


About The National Orthopaedic Alliance

The National Orthopaedic Alliance (NOA) brings together orthopaedic centres around the UK to share best practice and address shared challenges. The alliance is based on a quality standards membership model founded on evidence-based descriptors of ‘what good looks like’ in orthopaedic care. For more information visit or email

The BOA is nearing the end of our Centennial year and reflecting on 100 years of developments in orthopaedic surgery. While innovation in surgical techniques has dramatically improved patient care, the changing nature of healthcare delivery systems, rationing and access to care mean that many patients are still struggling with the day-to-day impact of MSK conditions.

During our Congress last week we heard powerful stories from patients on the impact of waiting for surgery. From a patient waiting for carpal tunnel release who was struggling to deal with basic daily tasks such as handling money, preparing food or getting dressed to another describing his wait for knee surgery, in huge amounts of pain with increasingly reduced mobility impacting on overall fitness and the ability to enjoy life.

It is undoubtedly a challenging time for MSK patients in the NHS. There is chronic under supply of resources for NHS services, and huge increases in the numbers of people waiting longer for surgery in many parts of the UK. In April this year we issued a press statement to highlight the situation in England, and shockingly, at the time of the release, there were still some trusts that had not resumed elective operations after the winter moratorium. The number of people who had waited over 18 weeks was at its highest level for many years and the graph below shows that this has been progressively deteriorating for several years (source: Waiting times data).

The number of people waiting over a year has also increased markedly in England, while the situation in Northern Ireland is even more stark, and we are speaking to the Chief Medical Officer there about this next month (see graphs below – source: Waiting times data).

The figures overall are stark:

  • The number of people in England waiting over a year for T&O surgery reached a high of 978 in June 2018, which compared to 375 a year earlier (a 260% increase).
  • The number of people waiting more than 18 weeks reached a peak of 81,663 in April 2018; the highest level since reporting began November 2010.
  • A BOA survey of hospitals in England received 84 replies from BOA Link people and 31 % of these had experienced winter closures of 3 months or more.

These delays have also had a major impact on orthopaedic trainees, who are losing opportunities to learn. This impacts the future workforce and is a situation we are continuing to monitor closely.

At our Congress we discussed access to Elective Care in further detail. The HSJ recently reported our concerns about Sussex CCGs policies that patients for hip surgery meet the requirement of: “uncontrolled, intense, persistent pain resulting in a substantial impact on quality of life … which have failed a reasonable period of conservative treatment of at least 6 months.” (HSJ article) We highlighted the BMJ coverage of growing numbers of Individual Funding Requests for hip and knee replacement as a result of more restrictive CCG policies. (BMJ article).

During the year we’ve done as much as we could to get our messages out to the media and speak out on behalf of our patients about the restrictions on access to care. Besides the articles above, have received coverage in the Telegraph, Times, and Daily Mail among others. We are making plans to develop relationships with key decision makers, both through ARMA, but also directly. We also continue to promote and highlight the joint position statement from ARMA.

Most recently we have been working with four specialist societies (BESS, BSSH, BASS and BASK*) to respond to the latest attempt to limit seven orthopaedic operations through the Evidence Based Interventions consultation. We as a profession agree that there are some operations where this is appropriate, but for others we have raised issues about the proposals, the consultation and the data it is based on. Our full response was posted online last week, here in our News section.

The BOA is very aware that our concerns are shared right across the ARMA community and are pleased to be part of this alliance, working together to shine a light on these important issues as part of our continued commitment to be “Caring for Patients, Supporting Surgeons”.

(*British Elbow and Shoulder Society – BESS, British Society for Surgery of the Hand – BSSH, British Association of Spine Surgeons – BASS and British Association for Surgery of the Knee – BASK.)

The London Choosing Wisely programme is a clinically-led review of evidence for a set of surgical procedures. It looks to ensure they are used consistently across London and their use follows a criteria that ultimately improves the health of patients.

Aim of the review
To make sure people with an equal need, wherever they live in London, have equal access to treatments. A standard approach across London means people will achieve better healthcare and doctors will have better guidance on what should be offered to patients.

Procedures that are being reviewed
Eight procedures will be reviewed by primary and secondary care clinicians, patient representatives, equality and diversity leads and public health experts:

  • Surgical removal of benign skin lesions (abnormal growth or abnormal appearance of skin)
  • Hip arthroplasty (replacement)
  • Knee arthroplasty (replacement)
  • Knee arthroscopy (keyhole surgery)
  • Interventional treatments for back pain
  • Varicose vein procedures
  • Shoulder decompression (removing bone spurs and soft tissue through keyhole surgery)
  • Cataract surgery (replacing a clouded eye lens with an artificial lens)

Read more – and check back for updates – on the website.
Further information will be published in the resources section as the programme develops.

The final scope and equality impact assessment for this NICE guideline have now been published, along with all the stakeholder comments that were received during consultation and the NICE responses to these comments.

The ARMA organisation was identified as a key stakeholder for this topic; NICE would like to thank the ARMA members for our continued involvement and interest in this guideline. The comments received during the consultation period helped to develop and refine the scope.

NICE will contact ARMA again when the draft guideline is released for consultation, and they ask that we prioritise sending them our comments.

by Mark Brandreth, NOA Lead CEO and
CEO of the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation

As the new lead CEO for the National Orthopaedic Alliance (NOA), I am proud to be part of a group of organisations and people who are working to drive improvements in orthopaedic care nationwide. I’m pleased to have been given the opportunity to contribute a guest blog to ARMA’s newsletter to share an update on our work with you. At Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH), our work with the NOA, and its vanguard work in particular, is vital to our future – and to the future of orthopaedic care received by patients across the country.

Ultimately, the NOA wants to improve the services that its members provide and through the vanguard project, create a framework (or pathway) others can follow leading to consistent high quality care for patients across the country. The objectives of the vanguard are:

  1. Agree what good looks like in orthopaedics and set a formal quality standard for this
  2. Recruit, assess and support members
  3. Grow membership across the country to spread provision of consistent high quality care
  4. Support the development of Quality Standards by members
  5. Support the development of a quality assured system for orthopaedic care

Progress with the vanguard to date has been centred on mobilising and recruiting members to help build our orthopaedic quality standards. Development of these standards is well underway and once launched will help ensure that patients, no matter where they are treated receive the same quality of care and are looked after using the same evidence-based, reliable and safe processes.

The success of the NOA so far has been driven by input from members and we are ever grateful for their support. Just recently, members contributed to producing The NOA Short Guide to Clinical Coding for Clinicians – a useful guide to help address an area needing attention across many NOA member organisations. More detailed guidance, including the full NOA suite of standards will be available to members once the vanguard launches its quality standards.

I for one am proud to be part of this movement. If you want to find out more about the NOA vanguard work, I encourage you to read the latest newsletter here. You can also follow @NOA_Vanguard on Twitter.

BASEM is excited to launch its new partnership with OrthoEvidence (OE).

OE is the global source for summarized, high quality orthopaedic research from around the globe and the service will provide BASEM members with premium access to summaries and critical appraisals of high quality orthopaedic research making them part of a growing community of more than 37,000 practitioners who rely on the highest-quality orthopaedic research to help improve their practice. 60% of OE members surveyed last year even stated that they had changed their practice as a result of reading OE reports.

For further information of this new membership benefit, read more from the OrthoEvidence page on the BASEM website.

Challenges and innovations: orthopaedics and trauma across the lifespan Society of Orthopaedics and Trauma Nursing Conference and Exhibition 2017

14 November 2017
Crowne Plaza Chester

Royal College of Nursing (RCN)

This year’s one-day conference will explore the challenges and innovations in orthopaedic and fracture trauma care for patients, ranging from children and young people to the older person.

Themes include:

  • musculoskeletal care in the child and young person
  • musculoskeletal care in the adult and older person
  • orthopaedic and trauma knowledge and skills: across the life span
  • contemporary approaches in education for the musculoskeletal practitioner.

The hashtag for the event will be #RCNSOTN2017