James Oliver Smith

Dorset County Hospital NHS Foundation Trust · Department of Orthopaedics

The osteo-regenerative properties of allograft have recently been enhanced by addition of autogenous human bone marrow stromal cells (HBMSCs). Limitations in the use of allograft have prompted the investigation of tantalum trabecular metal (TTM) as a potential alternative. TTM is already in widespread orthopaedic use, although in applications where...

Purpose This article summarises the history and evolution of osteotomy around the knee, examining the changes in principles, operative technique and results over three distinct periods: Historical (pre 1940), Modern Early Years (1940–2000) and Modern Later Years (2000–Present). We aim to place the technique in historical context and to demonstrate...

Binary blend polymers offer the opportunity to combine different desirable properties into a single scaffold, to enhance function within the field of tissue engineering. Previous in vitro and murine in vivo analysis identified a polymer blend of poly(l-lactic acid)-poly(ε-caprolactone) (PLLA:PCL 20:80) to have characteristics desirable for bone reg...

PurposeFluoroscopic knee kinematics have historically been quantified at least 1 year after total knee arthroplasty (TKA). The purpose of this study was to longitudinally assess knee kinematics at 6–12 weeks, 6 months, and 1 year after TKA to determine if earlier evaluation may be justified.Methods Twenty-one patients participated after undergoing...

Distal interlocking during intramedullary femoral, tibial, and humeral nailing is frequently challenging. In the traditional image intensifier (II) 'bull's eye' technique, the implant's interlocking screw hole can be obscured by the radio-opaque chuck, necessitating multi-planar checks by tilting the drill bit before drilling. This manoeuvre can ad...

Background Although predictable implant longevity in total knee replacement (TKR) is now established, work continues to satisfy the demands of patients who seek full restoration of the painless function of the native knee following TKR. This prospective study examines the early clinical outcomes of 156 patients implanted with a novel ‘kinematic-ret...

Aims The purpose of this study was to determine the weightbearing practice of operatively managed fragility fractures in the setting of publically funded health services in the UK and Ireland. Methods The Fragility Fracture Postoperative Mobilisation (FFPOM) multicentre audit included all patients aged 60 years and older undergoing surgery for a f...

Distal interlocking of long intramedullary nails may be technically challenging, particularly following an initial failed attempt. The technique described below and shown in this video solves the problem with a cost-effective solution. Using standard fluoroscopy techniques, a sharp-tipped 2.8mm DHS guide wire is used to create a pilot hole prior t...

Background: Periprosthetic joint infection (PJI) is a devastating complication after total hip arthroplasty (THA). The potential to define and modify risk factors for infection represents an important opportunity to reduce the incidence of PJI. This study uses New Zealand Joint Registry data to identify independent risk factors associated with PJI...

Binary blend polymers offer the opportunity to combine different desirable properties into a single scaffold , to enhance function within the field of tissue engineering. Previous in vitro and murine in vivo analysis identified a polymer blend of poly(L-lactic acid)–poly(ε-caprolactone) (PLLA:PCL 20:80) to have characteristics desirable for bone re...

Purpose Instability following non-operative treatment of anterior cruciate ligament (ACL) rupture in young children frequently results in secondary chondral and/or meniscal injuries. Therefore, many contemporary surgeons advocate ACL reconstruction in these patients, despite the challenges posed by peri-articular physes and the high early failure r...

Although anatomic anterior cruciate ligament (ACL) reconstruction is established for the surgical treatment of anterolateral knee instability, there remains a significant cohort of patients who continue to experience post-operative instability. Recent advances in our understanding of the anatomic, biomechanical and radiological characteristics of t...

Binary blend polymers offer the opportunity to combine different desirable properties into a single scaffold, to enhance function within the field of tissue engineering. Previous in vitro and murine in vivo analysis identified a polymer blend of poly(L-lactic acid)–poly(ε-caprolactone) (PLLA:PCL 20:80) to have characteristics desirable for bone reg...

Purpose: To assess distance changes between the femoral and tibial attachment points of 3 different anterior cruciate ligament (ACL) tunnel entry positions throughout the range of knee motion in cadaveric knees. Methods: The ACLs of 11 fresh-frozen cadaveric knees (from 6 men and 5 women) were removed using radiofrequency. Three tibial tunnel pl...

Tissue engineering offers enormous potential for bone regeneration. Despite extensive in vitro and in vivo work, few strategies translate into clinical practice. This paper describes the combination of skeletal stem cells (SSCs) and impaction bone grafting (IBG) for the treatment of patients with bone defects associated with avascular necrosis of t...

Previous in vitro work demonstrated porous PLA and PLGA both had the mechanical strength and sustained the excellent skeletal stem cell (SSC) growth required of an osteogenic bonegraft substitute, for use in impaction bone grafting. The purpose of this investigation was to assess the effects of the addition of hydroxyapatite (HA) to the scaffolds p...

The development of an osteogenic bone graft substitute has important practical and cost implications in many branches of medicine where bone regeneration is required. Previous in vitro and small animal (murine) in vivo studies highlighted a porous hydroxyapatite/ poly (DL-lactic acid) composite scaffold in combination with skeletal stem cells (SSCs...

Cadaveric and clinical biomechanical studies show improved kinematic restoration using double-bundle anterior cruciate ligament (ACL) reconstruction techniques. These have been criticized in the past for being technically challenging. We present a novel 3-socket approach for anatomic "all-inside" double-bundle reconstruction using a single hamstrin...

Skeletal stem cell (SSC) growth on a novel porous HA/TCP scaffold has been investigated in vivo. The effect of porosity on osteogenic differentiation was assessed by comparing two groups of scaffolds with differing porosity but controlled pore size. Histology, microCT, scanning electron microscopy, and biochemical analysis were used to assess SSC p...

Surgical reconstruction of the posterior cruciate ligament (PCL) is technically demanding. Potential challenges include visualization of the tibial footprint and drilling of the tibial tunnel without damaging posterior neurovascular structures, as well as graft selection, deployment, tensioning, and fixation. We present a novel TransMedial all-insi...

Skeletal tissue regeneration is often required following trauma, where substantial bone or cartilage loss may be encountered and is a significant driver for the development of biomaterials with a defined 3D structural network. Solvent blending is a process that avoids complications associated with conventional thermal or mechanical polymer blending...

There is growing evidence that anatomic placement of the femoral tunnel in anterior cruciate ligament reconstruction confers biomechanical advantages over the traditional tunnel position. The anteromedial portal technique for anatomic anterior cruciate ligament reconstruction has many well-described technical challenges. This article describes the...

Background: Strategies to improve mechanical strength, neovascularization, and the regenerative capacity of allograft include both the addition of skeletal stem cells and the investigation of novel biomaterials to reduce and ultimately obviate the need for allograft altogether. Use of bone cement is a common method of stabilizing implants in conju...

Given the demographic challenges of an ageing population combined with rising patient expectation and the growing emphasis placed on cost containment by healthcare providers, economic regenerative medicine approaches for regeneration of damaged and diseased organs and tissues are a major clinical and socio-economic need. The scope of this chapter i...

Background & purpose Skeletal stem cells (SSCs) and impaction bone grafting (IBG) can be combined to produce a mechanically stable living bone composite. This novel strategy has been translated to the treatment of avascular necrosis of the femoral head. Surgical technique, clinical follow-up and retrieval analysis data of this translational case se...

Background: Recent approaches have sought to harness the potential of stem cells to regenerate bone that is lost as a consequence of trauma or disease. Bone marrow aspirate (BMA) provides an autologous source of osteoprogenitors for such applications. However, previous studies indicated that the concentration of osteoprogenitors present in BMA is...

Impaction bone grafting (IBG) with human allograft remains the preferred approach for replacement of lost bone stock during revision hip surgery. Associated problems include cost, disease transmission, and stem subsidence. Synthetic grafts are therefore appealing, and ideally display similar mechanical characteristics as allograft, but with enhance...

The pathogenesis of unicameral bone cysts (UBCs) remains largely unknown. Osteoclasts have been implicated, but the role of osteoblastic cells has, to date, not been explored. This study investigated the pathophysiology of UBCs by examining the interactions between the cyst fluid and human bone marrow stromal cells (hBMSCs) and the effect of the fl...

When transferring tissue regenerative strategies involving skeletal stem cells to human application, consideration needs to be given to factors that may affect the function of the cells that are transferred. Local anaesthetics are frequently used during surgical procedures, either administered directly into the operative site or infiltrated subcuta...

Disease transmission, availability and cost of allografts have resulted in significant efforts to find an alternative for use in impaction bone grafting (IBG). Recent studies identified two polymers with both structural strength and biocompatibility characteristics as potential replacements. The aim of this study was to assess whether increasing th...

Bone tissue engineering seeks to develop strategies for the regeneration of diseased or damaged bone. Broadly, the approach seeks to harness the regenerative capacity of local or implanted stem or progenitor cell populations through the application of biodegradable and osteoconductive three-dimensional structures (or scaffolds) together with the te...

Tissue engineering has enormous potential for the regeneration of bone defects. Approximately 4 years ago we reported on a 62 year old patient who underwent treatment of a benign cyst in the proximal femur by impaction bone grafting supplemented with autologous bone marrow. The cyst and symptoms subsequently recurred and this patient has now requir...

Loss of skeletal tissue as a consequence of trauma, injury, or disease is a significant cause of morbidity with often wide-ranging socioeconomic impacts. Current approaches to replace or restore significant quantities of lost bone come with substantial limitations and inherent disadvantages that may in themselves cause further disability. In additi...

Bone tissue engineering seeks to develop strategies for the regeneration of diseased or damaged bone. Broadly, the approach seeks to harness the regenerative capacity of local or implanted stem or progenitor cell populations through the application of biodegradable and osteoconductive three-dimensional structures (or scaffolds) together with the te...

Avascularity is important for the unique biomechanical properties of articular cartilage, and normal cartilage actively repels vascular invasion. This study investigated whether the antiangiogenic properties changed in the presence of osteoarthritis (OA) by culturing explants of human articular cartilage on the chorioallantoic membrane (CAM) of chi...