Where I've been, what I've been talking about and what I'm working on.
On 4 November I taught on a hip replacement instructional course in Cambridge, taking surgeons through the evidence behind a collared cementless stem: what the registries and studies show, and where the gaps still are. Thanks to the organisers and to everyone who came.
A new paper from our team has been published in Bone & Joint Open. We surveyed 111 healthcare professionals across the UK, including surgeons, microbiologists, GPs, physiotherapists and nurses, about early wound problems after hip and knee replacement.
Most respondents thought these problems were serious, yet they also said clearer guidance and more evidence are needed, especially on telling superficial from deep infection and on when to act. I hope this helps shape future research and, in time, better support for patients and the teams looking after them.
A new systematic review has been published in Bone & Joint Research, looking at the outcomes reported for patients who have a fracture around a hip or knee replacement after their operation. We looked at 564 studies to see what is measured and how.
Outcomes were reported in many different ways, and fewer than half came with a clear definition or named measurement tool. That makes studies hard to compare. The review is a step towards agreeing a core set of outcomes, so that future research reflects what matters to patients. I am grateful to my co-authors.
On 16 October I spent an afternoon at Southmead Hospital teaching the orthopaedic registrars of the Bristol region about fractures around hip replacements: how to classify them, when a fracture can be fixed and when the implant itself needs replacing, and how the design of the stem shapes both the break and the repair. Plenty of case discussion and a show of hands or two.
Teaching is one of the parts of my work I enjoy most, and well-trained surgeons coming through is good news for everyone with a hip replacement. Thank you to the Bristol trainees for the invitation and the questions.
In November I'm giving a keynote at TORC 2026 in Dundee, on raising standards in trauma and joint replacement. It's a privilege to be asked, and a good excuse to pull together what the national data now tell us about which operations go wrong and why.
I went to Edinburgh for the Fragility Fracture Network Congress. Most of the people there look after older patients with fragile bones, which is exactly the group most at risk of a break around a hip replacement.
I gave three short talks: how to choose an implant when the bone is fragile, whether special suction dressings help wounds heal after fracture surgery, and how these fractures are counted (and often missed) in national records.
A week after Munich I was at the British Orthopaedic Association Congress in Birmingham, presenting the same work to UK surgeons. The question we keep asking is how many patients who needed more surgery are missed if you only count operations to replace an implant.
The talk: Reoperations after primary hip replacement: a national study of 1.38 million cases →
I joined Smith+Nephew's Joint Decisions podcast for a long conversation about fractures around hip replacements: why they are becoming more common, why national figures that count only replaced implants miss many further operations, and what surgeons can do about it. It's aimed at surgeons, but if you're curious about how we think about these problems, it's an honest listen.
This month I went to Munich for the International Society for Technology in Arthroplasty, a meeting full of robots, navigation and new implant ideas. I was there to present our national research on further surgery after hip and knee replacement.
It was a useful reminder that new technology is only worth having if it means fewer patients come back for more surgery, and that we need honest ways of measuring that.
The talk: Reoperations after primary hip replacement: a national study of 1.38 million cases →
Professor Michael Whitehouse and I were invited by the Journal of Bone and Joint Surgery to write a review on preventing fractures around hip replacements. More people are living longer with their hips, so these fractures are rising. The good news is that much of the risk is within our control, especially in how we choose and fix the implant.
One of the projects I'm proudest of: patients, carers and clinicians working together, through the British Hip Society and the James Lind Alliance, to agree the ten most important unanswered questions about hip replacements that cause problems. Now published in BMJ Open, it gives researchers like me a list of what matters most to the people living with these problems.
At the International Society of Arthroplasty Registries meeting I presented three national studies: on bone cement and revision, on how NHS and independent hospitals compare, and on serious complications after hip replacement. Registry meetings are where you see how different countries track their patients, and there is a lot we can learn from each other.
The talk: Bone cement type and revision risk after primary total hip replacement →
The talk: Inequalities after NHS-funded elective primary total hip replacement: NHS vs private hospitals →
The talk: Serious adverse events after total hip replacement →
I was invited to speak in a symposium at the British Hip Society annual meeting in London, on a small design feature of some hip stems: a collar, a ledge that rests on the top of the thigh bone. In the studies presented, hips with this collar had fewer fractures around the implant.
The talk: Reducing fracture risk and enhancing survival: the evolving story of the stem collar →