Past projects

A national, trainee-led audit assessed adherence to British Orthopaedic Oncology Society (BOOS) and British Orthopaedic Association (BOA) guidelines in the management of metastatic bone disease (MBD) across 84 UK hospitals. Analyzing data from 846 patients with pelvic and appendicular MBD, the study identified significant gaps in compliance. Key findings included the absence of a designated MBD lead in 39% of centres, inadequate radiographic assessment in 19% of cases, and a lack of up-to-date staging CT scans in 29%. Only 69% of patients received oncological input, and prognosis was estimated in just 38%. Among patients undergoing surgery (38%), essential preoperative investigations and specialist consultations were frequently missing. Additionally, only 60% of those with solitary metastases received a tertiary MBD centre opinion and biopsy. The findings highlight the urgent need for improved adherence to national standards, particularly in preoperative assessment and multidisciplinary involvement. The study underscores the importance of the recently published BOAST guidelines in driving improvements for this vulnerable patient group. 

This multi-centre, retrospective cohort study analyzed 1,109 patients with periprosthetic fractures (PPFs) around the hip over a 10-year period to identify factors influencing in-hospital mortality. The overall mortality rate was 5.3%, with key independent predictors including advanced age, male sex, low Abbreviated Mental Test Score (AMTS), pneumonia, renal failure, and a history of peripheral vascular disease (PVD). Each additional year of age correlated with a 7% increase in mortality risk, while patients developing pneumonia or renal failure during admission had nearly threefold and sevenfold higher mortality risks, respectively. A history of PVD increased the risk sixfold. Notably, fracture subtype and mode of management were not significant predictors of mortality. These findings highlight the critical need for perioperative optimization of modifiable risk factors, particularly pulmonary and renal function, to improve outcomes in patients with PPFs around the hip.