Damian Russel Griffin

University of Warwick · Warwick Medical School (WMS)

In 2018, the International Society for Hip Preservation Surgery (ISHA) initiated a series of Delphi consensus studies to identify the global hip preservation community’s current opinion on best practices for different facets of hip preservation surgery. Arthroscopic procedures to treat hip pathologies, such as femoroacetabular impingement syndrome...

Aims: To evaluate if, for orthopaedic trainees, additional cadaveric simulation training or standard training alone yields superior radiological and clinical outcomes in patients undergoing dynamic hip screw (DHS) fixation or hemiarthroplasty for hip fracture. Methods: This was a preliminary, pragmatic, multicentre, parallel group randomized con...

Aims: Ankle fracture fixation is commonly performed by junior trainees. Simulation training using cadavers may shorten the learning curve and result in a technically superior surgical performance. Methods: We undertook a preliminary, pragmatic, single-blinded, multicentre, randomized controlled trial of cadaveric simulation versus standard train...

Background Although randomized controlled trials comparing hip arthroscopy with physical therapy for the treatment of femoroacetabular impingement (FAI) syndrome have emerged, no studies have investigated potential moderators or mediators of change in hip-related quality of life. Purpose To explore potential moderators, mediators, and prognostic i...

Background Assessing the long term effects of many surgical interventions tested in pragmatic RCTs may require extended periods of participant follow-up to assess effectiveness and use patient-reported outcomes that require large sample sizes. Consequently the RCTs are often perceived as being expensive and time-consuming, particularly if the resul...

Introduction People who sustain a hip fracture are typically elderly, frail and require urgent surgery. Hip fracture and the urgent surgery is associated with acute blood loss, compounding patients’ pre-existing comorbidities including anaemia. Approximately 30% of patients require a donor blood transfusion in the perioperative period. Donor blood...

7- How should athletes receiving chemical anticoagulation for VTE prophylaxis or treatment of active VTE be managed? Response/Recommendation: There is no consensus regarding the optimal management of venous thromboembolism (VTE) in athletes. Treatment of active VTE consists of early mobilization and uninterrupted anticoagulation for at least 3 mont...

Targeted physiotherapy programs (TPP), and surgery, using either open surgical hip dislocation or hip arthroscopy (HA), are the treatment modalities available for femoroacetabular impingement syndrome (FAIS). Randomized controlled trials have recently been performed to compare these treatment options. This review was performed to provide a focused...

Background Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery or with physiotherapist-led conservative care. Objective To compare the clinical effectiveness and cost-effectiveness of hip arthroscopy with best conservative care. Design The UK FASHIoN (full trial of...

Background Bony morphology is central to the pathomechanism of femoroacetabular impingement syndrome (FAIS), however isolated radiographic measures poorly predict symptom onset and severity. More comprehensive morphology measurement considered together with patient factors may better predict symptom presentation. This study aimed to determine the m...

Background Arthroscopic surgery for femoroacetabular impingement syndrome (FAI) is known to lead to self-reported symptom improvement. In the context of surgical interventions with known contextual effects and no true sham comparator trials, it is important to ascertain outcomes that are less susceptible to placebo effects. The primary aim of this...

A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qualitati...

Aims A multicentre, randomized, clinician-led, pragmatic, parallel-group orthopaedic trial of two surgical procedures was set up to obtain high-quality evidence of effectiveness. However, the trial faced recruitment challenges and struggled to maintain recruitment rates over 30%, although this is not unusual for surgical trials. We conducted a qual...

Aims We report the long-term outcomes of the UK Heel Fracture Trial (HeFT), a pragmatic, multicentre, two-arm, assessor-blinded, randomized controlled trial. Methods HeFT recruited 151 patients aged over 16 years with closed displaced, intra-articular fractures of the calcaneus. Patients with significant deformity causing fibular impingement, peri...

Background UK FASHIoN was a multicentre randomised controlled trial comparing hip arthroscopic surgery (HA) with personalised hip therapy (PHT, physiotherapist-led conservative care), for patients with hip pain attributed to femoroacetabular impingement (FAI) syndrome. Our aim was to describe the treatment and trial participation experiences of pat...

This is a qualitative research study using in-depth, semi-structured interviews with CT1–ST3 trainees in trauma & orthopaedics (T&O) to characterise the factors that affect core surgical trainees’ access to the operating theatre for training. There were significant reported difficulties in accessing the operating theatre among core surgical T&O tra...

Abstract Introduction: We designed an ultra-high-fidelity military cadaveric surgical simulation course to train military medical teams for specific battlefield injuries. Our aim was to deliver a highly realistic, immersive simulation training experience, teaching both technical and non-technical skills necessary for the management of war-injuries...

Background Studies of walking in those with femoroacetabular impingement syndrome have found altered pelvis and hip biomechanics. But a whole body, time-contiuous, assessment of biomechanical parameters has not been reported. Additionally, larger cam morphology has been associated with more pain, faster progression to end-stage osteoarthritis and i...

Hip preservation surgery is now an established part of orthopedic surgery and sports medicine. This report describes the key findings of the 11th Annual Scientific Meeting of International Society for Hip Arthroscopy-the International Hip Preservation Society-in Madrid, Spain from 16 to 19 October 2019. Lectures, seminars and debates explored the m...

Introduction We designed an ultra-high-fidelity military cadaveric surgical simulation course to train military medical teams for specific battlefield injuries. Our aim was to deliver a highly realistic, immersive simulation training experience, teaching both technical and non-technical skills necessary for the management of war-injuries in the aus...

Introduction: The quantity and quality of surgical training in the UK has been negatively affected by reduced working hours and National Health Service (NHS) financial pressures. Traditionally surgical training has occurred by the master-apprentice model involving a process of graduated responsibility, but a modern alternative is to use simulation...

Aims To develop a core outcome set of measurements from postoperative radiographs that can be used to assess technical skill in performing dynamic hip screw (DHS) and hemiarthroplasty, and to validate these against Van der Vleuten’s criteria for effective assessment. Methods A Delphi exercise was undertaken at a regional major trauma centre to ide...

Background: Robust assessment of skills acquisition and surgical performance during training is vital to ensuring operative competence among orthopaedic surgeons. A move to competency-based surgical training requires the use of tools that can assess surgical skills objectively and systematically. The aim of this systematic review was to describe t...

Aims The primary aim of the survey was to map the current provision of simulation training within UK and Republic of Ireland (RoI) trauma and orthopaedic (T&O) specialist training programmes to inform future design of a simulation based-curriculum. The secondary aims were to characterize; the types of simulation offered to trainees by stage of trai...

Aims The primary aim of the survey was to map the current provision of simulation training within UK and Republic of Ireland (RoI) trauma and orthopaedic (T&O) specialist training programmes to inform future design of a simulation based-curriculum. The secondary aims were to characterize; the types of simulation offered to trainees by stage of trai...

Objective The objectives of this study were to understand how cadaveric simulation impacts learning in orthopedic residents, why it is a useful training tool, and how skills learnt in the simulated environment translate into the workplace. Design This is a qualitative research study using in-depth, semistructured interviews with orthopedic residen...

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare th...

BACKGROUND The quantity and quality of surgical training in the UK has been negatively affected by reduced working hours and NHS financial pressures. Traditionally surgical training has occurred by the master-apprentice model involving a process of graduated responsibility, but a modern alternative is to use simulation for the early stages of train...

There is no agreement on how to classify, define or diagnose hip-related pain—a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how t...

Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clini...

Arthroscopic procedures to treat hip pathologies such as femoroacetabular impingement (FAI) syndrome are now established in mainstream orthopaedic practice. Surgical techniques, rehabilitation protocols and outcomes are widely published. However, consensus on standards of practice remains to be determined. The International Hip Preservation Society...

The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist...

Background: There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric s...

Background Open fractures of the lower limb occur when a broken bone penetrates the skin and is exposed to the outside environment. These are life-changing injuries. The risk of deep infection may be as high as 27%. The type of dressing applied after surgical debridement could potentially reduce the risk of infection in the open-fracture wound. Ob...

Hip arthroscopy has become very popular in the last decade. Numbers are increasing rapidly worldwide. More than 11,000 hip arthroscopies were performed at the English public health system from 2002 to 2013. It means an increase of more than 700%. Similar numbers were published in North America, with an increase of more than 350% in the period 2004–...

Objective: Cam hip morphology is associated with femoroacetabular impingement (FAI) syndrome and causes hip osteoarthritis (OA). We aimed to assess the prevalence of cam hip morphology in a sample representative of the general population, using a measure with a predefined diagnostic accuracy. Design: Patients aged 16-65, who were admitted to a m...

Background Femoroacetabular impingement syndrome is an important cause of hip pain in young adults. It can be treated by arthroscopic hip surgery, including reshaping the hip, or with physiotherapist-led conservative care. We aimed to compare the clinical effectiveness of hip arthroscopy with best conservative care. Methods UK FASHIoN is a pragmat...

Doctor patient relationships in decision making surrounding joint replacement

Objectives: Total knee replacement (TKR) is an effective means of alleviating the symptoms of end stage osteoarthritis. However, 20% of patients report dissatisfaction one year post-operatively. Previous literature has demonstrated contradictory evidence regarding the relationship between alignment and tibial component sizing with patient reported...

Background Femoroacetabular impingement syndrome (FAI), a hip disorder affecting active young adults, is believed to be a leading cause of hip osteoarthritis (OA). Current management approaches for FAI include arthroscopic hip surgery and physiotherapy-led non-surgical care; however, there is a paucity of clinical trial evidence comparing these app...

Background: Osteoarthritis is a significant cause of burden to the ageing population and knee replacement is a common operation for treatment of end-stage disease. We aimed to explore these factors to help understand patients' decision-making, which is critical in informing patient-centred care. These can be used to enhance decision-making and dia...

Total knee replacement has reliably been shown to have a beneficial effect in knee osteoarthritis; however, around 17 % of patients are dissatisfied with the result. A commonly proposed mechanism driving the dissatisfaction rate is a discrepancy between expected and actual/perceived outcome. Our aim was to conduct a systematic review examining any...

Background: Total knee replacement is an effective treatment for knee arthritis. While the majority of TKAs have demonstrated promising long-term results, up to 20 % of patients remain dissatisfied with the outcome of surgery at 1 year. Implant malalignment has been implicated as a contributing factor to less successful outcomes. Recent evidence h...

To determine whether it was feasible to perform a randomized controlled trial (RCT) comparing arthroscopic hip surgery to conservative care in patients with femoroacetabular impingement (FAI). This study had two phases: a pre-pilot and pilot RCT. In the pre-pilot, we conducted interviews with clinicians who treated FAI and with FAI patients to dete...

The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to t...

Introduction: Femoroacetabular impingement (FAI) syndrome is increasingly recognised as a cause of hip pain. As part of the design of a randomised controlled trial (RCT) of arthroscopic surgery for FAI syndrome, we developed a protocol for non-operative care and evaluated its feasibility. Methods: In phase one, we developed a protocol for non-op...

Introduction Femoroacetabular impingement (FAI) syndrome is a recognised cause of young adult hip pain. There has been a large increase in the number of patients undergoing arthroscopic surgery for FAI; however, a recent Cochrane review highlighted that there are no randomised controlled trials (RCTs) evaluating treatment effectiveness. We aim to c...

Background: There is approximately a 17 % dissatisfaction rate with knee replacements. Calls for tools that can pre-operatively identify patients at risk of being dissatisfied have been widespread. However, it is not known how to present such information to patients, how it would affect their decision making process, and at what part of the pathwa...

Aim During a golf swing, the lead hip (left hip in a right-handed player) rotates rapidly from external to internal rotation, while the opposite occurs in the trail hip. This study assessed the morphology and pathology of golfers’ hips comparing lead and trail hips. Methods A cohort of elite golfers were invited to undergo MRI of their hips. Hip mo...

Objectives: To examine the effectiveness of a "systems" approach using Lean methodology to improve surgical care, as part of a programme of studies investigating possible synergy between improvement approaches. Setting: A controlled before-after study using the orthopaedic trauma theatre of a UK Trust hospital as the active site and an elective...

Aims: This study aimed to determine the prevalence of hip pain in professional golfers, comparing the lead (left hip in right-handed golfer) and trail hips, and to establish what player characteristics predicted hip symptoms. Methods: Male elite professional golf players were invited to complete questionnaires and undergo clinical and MR examina...

Femoroacetabular impingement (FAI) is a syndrome of hip or groin pain associated with shape abnormalities of the hip joint. Treatments include arthroscopic surgery and conservative care. This study explored the feasibility of a randomised controlled trial to compare these treatments. Objectives The objectives of this study were to estimate the num...

Objective: How a randomised controlled trial (RCT) is explained to patients is a key determinant of recruitment to that trial. This study developed and implemented a simple six-step model to fully inform patients and to support them in deciding whether to take part. Study design and setting: Ninety-two consultations with 60 new patients were rec...

Objective: Cam hip shape morphology is a recognised cause of femoroacetabular impingement and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without...

Importance: Patient safety improvement interventions usually address either work systems or team culture. We do not know which is more effective, or whether combining approaches is beneficial. Objective: To compare improvement in surgical team performance after interventions addressing teamwork culture, work systems, or both. Design: Suite of...

To ensure implant durability following Modern total knee replacement (TKR) surgery, one long held principle in condylar total knee arthroplasty is positioning the components in alignment with the mechanical axis and restoring the overall limb alignment to 180° ± 3°. However, this view has been challenged recently. Given the high number of TKR perfo...

Objective: The mode of delivery of trial information is a key determinant of recruitment to randomised controlled trials (RCTs), which can be modified in order to encourage patients to participate. This paper presents the development and initial validation of a simple six-step model to support recruitment. Study design and setting: 92 recruitmen...

Objectives: A patient-centred approach, usually achieved through shared decision making, has the potential to help improve decision making around knee arthroplasty surgery. However, such an approach requires an understanding of the factors involved in patient decision making. This review's objective is to systematically examine the qualitative lit...

Background: To investigate the effectiveness of combining teamwork training and lean process improvement, two distinct approaches to improving surgical safety. We conducted a controlled interrupted time series study in a specialist UK Orthopaedic hospital incorporating a plastic surgery team (which received the intervention) and an Orthopaedic the...

Background: Microvascular blood flow in the tendon plays an important role in the pathogenesis of rotator cuff abnormalities. There are conflicting views about the presence of a hypovascular zone in the supraspinatus tendon. Besides, no studies have looked at the pattern of blood flow around a partial-thickness tear. Our aim was to measure microva...

Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area. The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions. A one-day agreement meeting was held...

Objectives To evaluate the effectiveness of aviation-style teamwork training in improving operating theatre team performance and clinical outcomes. Setting 3 operating theatres in a UK district general hospital, 1 acting as a control group and the other 2 as the intervention group. Participants 72 operations (37 intervention, 35 control) were obser...

Knee arthroscopy has historically been a common treatment for knee osteoarthritis. A Cochrane review of the literature up to 2006 has resulted in guidance that arthroscopy is not effective in knee osteoarthritis. It cited that deficiencies in the evidence base prevented widespread acceptance of the recommendations. The aim of this review is to upda...

Knee osteoarthritis affects 10% of the UK population over 55 years, resulting in pain and decreased quality of life. Knee replacement surgery has a proven benefit, with over 85,000 performed each year in the UK; however, approximately 17% of people are dissatisfied after surgery. Consequently, some Primary Care Trusts have reduced the funding avail...