Papers by Gareth Turnbull
Archives of Orthopaedic and Trauma Surgery
Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and thr... more Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 year...
Bone is the second most commonly transplanted tissue worldwide, with over four million operations... more Bone is the second most commonly transplanted tissue worldwide, with over four million operations using bone grafts or bone substitute materials annually to treat bone defects. However, significant...
Injury, 2018
INTRODUCTION With rising NHS clinical and financial demands, improving theatre efficiency is esse... more INTRODUCTION With rising NHS clinical and financial demands, improving theatre efficiency is essential to maintain quality of patient care. Consistent teams and consultant presence have been shown to improve outcomes and productivity in elective orthopaedic surgery. The aim of this study was to investigate the impact on trauma theatre productivity of different surgeons and anaesthetists working together in a Major Trauma Centre. The influence of consultant presence and weekend operating on productivity was also considered. METHODS Data relating to a single orthopaedic trauma theatre was gathered retrospectively for a two-year period. Variables including orthopaedic and anaesthetic consultant presence, number and complexity of operations performed and procedure start times were collected for daily trauma lists. Individual anaesthetic and orthopaedic consultants were compared by productivity outcomes. The impact of surgeons operating more frequently with one anaesthetist was also exam...
Antimicrobial resistance (AMR) is projected to result in 10 million deaths every year globally by... more Antimicrobial resistance (AMR) is projected to result in 10 million deaths every year globally by 2050. Without urgent action, routine orthopaedic operations could become high risk and musculoskele...
Bone is the second most commonly transplanted tissue worldwide, with over four million operations... more Bone is the second most commonly transplanted tissue worldwide, with over four million operations using bone grafts or bone substitute materials annually to treat bone defects. However, significant limitations affect current treatment options and clinical demand for bone grafts continues to rise due to conditions such as trauma, cancer, infection and arthritis. Developing bioactive three-dimensional (3D) scaffolds to support bone regeneration has therefore become a key area of focus within bone tissue engineering (BTE). A variety of materials and manufacturing methods including 3D printing have been used to create novel alternatives to traditional bone grafts. However, individual groups of materials including polymers, ceramics and hydrogels have been unable to fully replicate the properties of bone when used alone. Favourable material properties can be combined and bioactivity improved when groups of materials are used together in composite 3D scaffolds. This review will therefore ...
Molecules, 2019
Fibrous hydrogel scaffolds have recently attracted increasing attention for tissue engineering ap... more Fibrous hydrogel scaffolds have recently attracted increasing attention for tissue engineering applications. While a number of approaches have been proposed for fabricating microfibers, it remains difficult for current methods to produce materials that meet the essential requirements of being simple, flexible and bio-friendly. It is especially challenging to prepare cell-laden microfibers which have different structures to meet the needs of various applications using a simple device. In this study, we developed a facile two-flow microfluidic system, through which cell-laden hydrogel microfibers with various structures could be easily prepared in one step. Aiming to meet different tissue engineering needs, several types of microfibers with different structures, including single-layer, double-layer and hollow microfibers, have been prepared using an alginate-methacrylated gelatin composite hydrogel by merely changing the inner and outer fluids. Cell-laden single-layer microfibers were...
Applied Materials Today, 2020
Effectively targeting and killing microbial pathogens is a major challenge in the treatment of in... more Effectively targeting and killing microbial pathogens is a major challenge in the treatment of infectious diseases. Inspired by the high efficacy of natural antimicrobial peptides (AMPs), in this study we prepared two types of carbon quantum dots (CQDs) by pyrolysis of lysine and arginine, the two major functional moieties of natural AMPs. Both lysine-derived CQDs (Lys-CQDs) and arginine-derived CQDs (Arg-CQDs) exhibited distinctive antibacterial activity against both Gram-negative and Gram-positive bacteria without inducing drug resistance. They also effectively inhibited the formation of bacterial biofilms. Such excellent antibacterial properties might be the result of positive charges derived from the amino acid residues on CQD surface and the generation of rich intracellular reactive oxygen species (ROS). Surprisingly, instead of being cytotoxic, CQDs dramatically promoted the growth of typical mammalian cells. Moreover, no hemolysis of red blood cells (RBCs) happened when CQD concentration was less than 4,000 g/mL. In vivo, administration of CQDs to infected wounds effectively inhibited bacterium growth and accelerated wound healing. Together, findings from this study indicate that Lys-CQDs and Arg-CQDs can simultaneously kill bacteria and facilitate cell growth, and may therefore be promising candidates for treating bacterial infections and promoting tissue repair.
Biofabrication, 2019
The potential to bioprint and study 3D bacterial biofilm constructs could have great clinical sig... more The potential to bioprint and study 3D bacterial biofilm constructs could have great clinical significance at a time when antimicrobial resistance is rising to dangerously high levels worldwide. In this study, clinically relevant bacterial species including Escherichia coli, Staphylococcus aureus (MSSA), Methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa were 3D bioprinted using a double-crosslinked alginate bioink to form mature bacteria biofilms, characterized by confocal laser scanning microscopy (CLSM) and fluorescent staining. Solid and porous bacteria-laden constructs were reproducibly bioprinted with thicknesses ranging from 0.25 to 4 mm. We demonstrated 3D bioprinting of thicker biofilms (>4 mm) than found in currently available in vitro models. Bacterial viability was excellent in the bioprinted constructs, with CLSM observation of bacterial biofilm production and maturation possible for at least 28 d in culture. Importantly, we observed the co...
Advanced Healthcare Materials, 2019
Advanced Healthcare Materials, 2019
Soft tissue injuries (STIs) affect patients of all age groups and represent a common worldwide cl... more Soft tissue injuries (STIs) affect patients of all age groups and represent a common worldwide clinical problem, resulting from conditions including trauma, infection, cancer and burns. Within the spectrum of STIs a mixture of tissues can be injured, ranging from skin to underlying nerves, blood vessels, tendons and cartilaginous tissues. However, significant limitations affect current treatment options and clinical demand for soft tissue and cartilage regenerative therapies continues to rise. Improving the regeneration of soft tissues has therefore become a key area of focus within tissue engineering. As an emerging technology, 3D bioprinting can be used to build complex soft tissue constructs "from the bottom up," by depositing cells, growth factors, extracellular matrices and other biomaterials in a layer-by-layer fashion. In this way, regeneration of cartilage, skin, vasculature, nerves, tendons and other bodily tissues can be performed in a patient specific manner. This review will focus on recent use of 3D bioprinting and other biofabrication strategies in soft tissue repair and regeneration. Biofabrication of a variety of soft tissue types will be reviewed following an overview of available cell sources, bioinks and bioprinting techniques.
The Journal of Arthroplasty, 2019
Background: The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fo... more Background: The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative function will be increasingly important to help counsel patients. The primary aim of this study was to examine factors influencing return to physical activity following revision TKA. Methods: Patients who had undergone tibiofemoral revision between 2003 and 2013 at a single UK teaching hospital were retrospectively identified from a prospectively collected arthroplasty database. Preoperative activity level (University of California, Los Angeles [UCLA] score), patient demographics, indication, implant used, and Oxford Knee Scores (OKSs) were recorded in the database. At a mean follow-up of 3.9 years (standard deviation, 2.2), UCLA score, OKS, EuroQol-5 Dimension Score (EQ-5D), satisfaction, complications, and WORQ scores (Work, Osteoarthritis and Joint-Replacement Questionnaire) were sampled via postal questionnaire. Patient experience of complications and related surgery was also identified from healthcare records. Univariate and multivariate analyses were performed. Results: Responses were received from 112 revision TKAs (112 patients; mean age, 71 years). Mean UCLA activity scores improved from preoperative levels (P < .001): activity levels improved in 47% of patients with 58% engaging in moderate or more intensive activities (UCLA score !5). Postoperative activity level was independently predicted by male gender (P ¼ .042) and preoperative UCLA score (P < .001). Increasing social deprivation was associated with inferior UCLA (P ¼ .005), EQ-5D (P < .005), and OKS (P ¼ .006) scores. Indication, implant type, and patient body mass index did not affect functional outcome or satisfaction (P > .05). Patients <65 years old were more likely to be dissatisfied (P ¼ .009), and patients aged 55 years were more likely to report difficulties with WORQ criteria (P < .05). Conclusion: Although 90% of patients maintain activity levels following revision TKA, less than half increase levels and this is predicted by male sex and pre-revision activity level.
The Bone & Joint Journal, 2018
Aims The aim of this study was to identify predictors of return to work (RTW) after revision lowe... more Aims The aim of this study was to identify predictors of return to work (RTW) after revision lower limb arthroplasty in patients of working age in the United Kingdom. Patients and Methods We assessed 55 patients aged ≤ 65 years after revision total hip arthroplasty (THA). There were 43 women and 12 men with a mean age of 54 years (23 to 65). We also reviewed 30 patients after revision total knee arthroplasty (TKA). There were 14 women and 16 men with a mean age of 58 years (48 to 64). Preoperatively, age, gender, body mass index, social deprivation, mode of failure, length of primary implant survival, work status and nature, activity level (University of California, Los Angeles (UCLA) score), and Oxford Hip and Knee Scores were recorded. Postoperatively, RTW status, Oxford Hip and Knee Scores, EuroQol-5D (EQ-5D), UCLA score, and Work, Osteoarthritis and Joint-Replacement Questionnaire (WORQ) scores were obtained. Univariate and multivariate analysis was performed. Results Overall, 9...
Archives of Orthopaedic and Trauma Surgery, 2018
Return to activity following revision total hip arthroplasty Background: Demand for revision tota... more Return to activity following revision total hip arthroplasty Background: Demand for revision total hip arthroplasty (RTHA) continues to grow worldwide and is expected to more than double within the next 1-2 decades. The primary aim of this study was to examine return to function following revision THA in a UK population. Patients & methods: We assessed 118 patients (132 RTHAs, mean age 65 years SD 13, range 23 to 88) at a mean follow-up of 7.9 years (SD 4.4) postoperatively. Preoperative age, gender, BMI, social deprivation, operative indication, comorbidities, activity level (UCLA score) and Oxford Hip Scores (OHS) were recorded. Postoperative UCLA score, OHS, EQ-5D, satisfaction levels and performance in activities of daily living (ADLs) were obtained and univariate and multivariate analysis performed. Results: Mean UCLA activity score improved following RTHA (p<0.001): UCLA activity score improved in 37% and was unchanged in 50%; 49% of patients engaged in at least moderate level activities (UCLA score ≥ 6). Patient BMI, gender, age and reason for revision did not influence levels of pain, stiffness or activity at follow up. Preoperative UCLA activity scores (p<0.001) independently predicted long-term UCLA scores. Independent predictors (p<0.05) of poor hip specific function (OHS) following revision included social deprivation, revision for peri-prosthetic fracture and lower preoperative OHS. Difficulties with ADLs were associated with increasing deprivation, ≥3 comorbidities, and revision for periprosthetic fracture or infection (p<0.05). Overall, 79% of patients remained satisfied or very satisfied following revision THA. Following RTHA, 10% suffered a dislocation and 13% required reoperation for complications. Conclusion: Revision THA facilitates long-term return to preoperative levels of physical activity in the majority of patients, though activity levels increase in one third only. Overall over three quarters are satisfied with their outcome, but revision for periprosthetic fracture or dislocation gives the worse overall outcomes and lower satisfaction levels.
Scottish Medical Journal, 2018
Introduction The Clostridia species are responsible for life-threatening conditions such as tetan... more Introduction The Clostridia species are responsible for life-threatening conditions such as tetanus, botulism and gas gangrene. Clostridium septicum is a rare cause of clinical infection, accounting for less than 1% of blood culture samples that test positive for Clostridia. However, C. septicum bacteraemia is associated with greater than 60% mortality and in over 80% of cases is associated with an underlying malignancy. Case presentation We present a review of the literature and the first case of an acute arthroplasty infection and concurrent infective aortitis caused by this organism in the absence of an identified underlying malignancy. Early diagnosis and multi-disciplinary input resulted in the patient surviving a rare and potentially fatal infective aortitis and septic arthritis. Conclusion This case demonstrates the importance of early systemic investigation to exclude occult infective aortitis in C. septicum infection. The key role of multi-disciplinary input into the manage...
Bioactive Materials, 2018
Bone is the second most commonly transplanted tissue worldwide, with over four million operations... more Bone is the second most commonly transplanted tissue worldwide, with over four million operations using bone grafts or bone substitute materials annually to treat bone defects. However, significant limitations affect current treatment options and clinical demand for bone grafts continues to rise due to conditions such as trauma, cancer, infection and arthritis. Developing bioactive three-dimensional (3D) scaffolds to support bone regeneration has therefore become a key area of focus within bone tissue engineering (BTE). A variety of materials and manufacturing methods including 3D printing have been used to create novel alternatives to traditional bone grafts. However, individual groups of materials including polymers, ceramics and hydrogels have been unable to fully replicate the properties of bone when used alone. Favourable material properties can be combined and bioactivity improved when groups of materials are used together in composite 3D scaffolds. This review will therefore consider the ideal properties of bioactive composite 3D scaffolds and examine recent use of polymers, hydrogels, metals, ceramics and bio-glasses in BTE. Scaffold fabrication methodology, mechanical performance, biocompatibility, bioactivity, and potential clinical translations will be discussed.
The Bone & Joint Journal, 2017
Aims Little is known about employment following total knee arthroplasty (TKA). This study aims to... more Aims Little is known about employment following total knee arthroplasty (TKA). This study aims to identify factors which predict return to work following TKA in patients of working age in the United Kingdom. Patients & Methods We prospectively assessed 289 patients (289 TKAs) aged ≤ 65 years who underwent TKA between 2010 and 2013. There were 148 women. The following were recorded pre-operatively: age, gender, body mass index, social deprivation, comorbidities, indication for surgery, work status and nature of employment, activity level as assessed by the University of California, Los Angeles (UCLA) activity score and Oxford Knee Score (OKS). The intention of patients to return to work or to retire was not assessed pre-operatively. At a mean of 3.4 years (2 to 4) post-operatively, the return to work status, OKS, the EuroQol-5 dimensions (EQ-5D) score, UCLA activity score and Work, Osteoarthritis and joint-Replacement (WORQ) score were obtained. Univariate and multivariate analyses w...
Knee, 2017
Little is known about employment following TKR and the assumption that young patients are more ac... more Little is known about employment following TKR and the assumption that young patients are more active, putting greater demands on their arthroplasty, is lacking in evidence. This study aims to identify predictors of return to work following TKR in patients of working age. We prospectively assessed 289 TKRs in 289 patients b65 years (141 male) from 2010 to 2013. Preoperatively age, gender, BMI, social deprivation, indication, work status and nature, activity level (UCLA score) and Oxford Knee Scores (OKSs) were recorded. At mean 3.3 years (range 2-4) return to work status, OKS, EQ-5D, UCLA activity score and a WORQ score (Work, Osteoarthritis and Joint-Replacement Questionnaire) were obtained. Univariate and multivariate analysis was performed. Of 261/289 patients working prior to TKR, 104/261 (40%) returned to work, 89 (34%) to the same job. UCLA activity scores improved in 58% (125/214) from median 4 (mild activity) to 6 (moderate activity) (pb0.001). Preoperatively 37% (88/241) had UCLA scores N 6 increasing to 72% (165/228) postoperatively. Significant (pb0.05) predictors of return to any job included: age, sedentary/light manual work, better postoperative UCLA score and OKS, and EQ-5D general health score. For return to the same job significant predictors included: age, sedentary/light manual work, and postoperative OKS. Multivariate analysis confirmed age and sedentary/light manual work to independently predict return to both any and the same job. 60% of patients b 65 years do not return to work following TKR and this is best predicted by older age and heavy/moderate manual work rather than by PROMs or activity levels.
The Journal of Arthroplasty
Medical Engineering & Physics
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Papers by Gareth Turnbull