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Optimising the outcome of lower limb arthroplasty

Student thesis: Doctoral Thesis

This study was an exploration of numerous factors that influence patient outcome following hip and knee arthroplasty surgery. Total hip and knee arthroplasty are two of the most commonly performed orthopaedic procedures to relieve pain and improve joint function the most commonly indication being osteoarthritis. Surprisingly, understanding which patients will achieve optimal benefit is important but remains difficult and controversial. This is confounded by an increasing active and ageing population, with high inherent expectations. Furthermore, young patients present for hip and knee replacement surgery hoping to restore their quality of life, which typically includes physically demanding activities.

Advances in bioengineering technology have driven prosthesis development but universal economic constraints in healthcare services dictate that further developments will be governed by their cost-effectiveness. It is with this background that necessitates every facet of patient care being evaluated to optimise outcome.

The narrative of this study reflects the patient clinical pathway:
• Pre-operative care and optimization
• Intraoperative interventions
- Biomechanical prosthesis stability
- Pharmaceutical adjuncts
- Infection eradication
• Post-operative complications
• Analysis of patient outcomes

This study incorporates 24 peer-reviewed journal articles published since 2006 representing a portion of my entire research portfolio. The published work spans my surgical career to date from junior doctor, Masters student, higher surgical trainee, clinical fellow, consultant surgeon and senior clinical lecturer. The data and development related to these articles originates from a spectrum of clinical and academic institutions, namely local district general hospital, UK teaching hospital, specialist orthopaedic hospitals and world renowned academic centres.

The conclusions drawn from this study highlight only some of the facets of the patient clinical pathway and demonstrate the need for ongoing research into this topic.
Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award dateOct 2017

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