Paul Dieppe

• University of Exeter

Background Approximately 20% of people experience chronic pain after total knee replacement, but effective treatments are not available. We aimed to evaluate the clinical effectiveness and cost-effectiveness of a new care pathway for chronic pain after total knee replacement. Methods We did an unmasked, parallel group, pragmatic, superiority, rand...

One-stage and two-stage revision strategies are the two main options for treating established chronic peri-prosthetic joint infection (PJI) of the hip; however, there is uncertainty regarding which is the best treatment option. We aimed to compare the risk of re-infection between the two revision strategies using pooled individual participant data...

Background: Although arthritis in other affected major joints and back pain are known to lead to worse outcomes following total hip replacement, to our knowledge, these risk factors have not previously been operationalized as a musculoskeletal morbidity profile. The aim of this study was to measure the influence of other major joints and the spine...

Table S1. Demographic and clinical characteristics of patients undergoing total hip replacement (n = 90) and total knee replacement (n = 75) not included in the analysis because of missing data.

Table S2. Descriptive statistics for patients undergoing total hip replacement (n = 90) and total knee replacement (n = 75) not included in the analysis because of missing data.

Objective: Despite a health care system that is free at the point of delivery, ethnic minorities may not always get care equitable to that of White patients in England. We examined whether ethnic differences exist in joint replacement rates and surgical practice in England. Design: 373,613 hip and 428,936 knee National Joint Registry primary rep...

Introduction It is not always possible to use a combination of patient-reported outcome measures (PROMs), performance tests and clinician-administrated measures to assess physical function prior to hip surgery. We hypothesised that there would be low correlations between these three types of measure and that they would be associated with different...

Background: Discrepancies exist between osteoarthritic joint changes and pain severity before and after total hip (THR) and knee (TKR) replacement. This study investigated whether the interaction between pre-operative widespread hyperalgesia and severity of radiographic osteoarthritis (OA) was associated with pain severity before and after joint r...

The RESTORE programme provides important information to guide the development of interventions to improve long-term outcomes for patients with osteoarthritis receiving total hip replacement and total knee replacement. Abstract Background: Total hip replacements (THRs) and total knee replacements (TKRs) are common elective procedures. In the REsea...

This paper reviews some recent advances in our understanding of the effects of sham or dummy interventions on pain and other symptoms in osteoarthritis, and outlines two new approaches to the investigation of placebo and nocebo effects. We argue that the placebo effect provides us with a valuable way of investigating the nature of conditions like o...

Introduction: It is not always possible to use a combination of patient-reported outcome measures (PROMs), performance tests and clinician-administrated measures to assess physical function prior to hip surgery. We hypothesised that there would be low correlations between these three types of measure and that they would be associated with differen...

Background: Periprosthetic joint infection (PJI) is a serious complication of total knee arthroplasty. Twostage revision is the most widely used technique and considered as the most effective for treating periprosthetic knee infection. The one-stage revision strategy is an emerging alternative option, however, its performance in comparison to the t...

Background: Periprosthetic joint infection (PJI) affects approximately 1% of patients following total hip replacement (THR) and often results in severe physical and emotional suffering. Current surgical treatment options are debridement, antibiotics and implant retention; revision THR; excision of the joint and amputation. Revision surgery can be...

Background and purpose: Pain and function improve dramatically in the first three months after hip and knee arthroplasty but the trajectory after three months is less well described. It is also unclear how pre-operative pain and function influence short- and long-term recovery. We explored the trajectory of change in function and pain until and be...

Objective: To validate a new method to identify responders (relative effect per patient (REPP)>0.2) using the OMERACT-OARSI criteria as gold standard in a large multicentre sample. Method: The REPP ([score before - after treatment]/score before treatment) was calculated for 845 patients of a large multicenter European cohort study for THR. The p...

Objective There is limited information about the extent to which the association between pre-operative and chronic post-operative pain is mediated via pain-on-movement or pain-at-rest. We explored these associations in patients undergoing total hip (THR) and total knee (TKR) replacement. Methods 322 and 316 patients receiving THR and TKR respective...

Context effects are described as effects of a given treatment, not directly caused by the treatment itself, but rather caused by the context in which treatment is delivered. Exercise is a recommended core treatment in clinical guidelines for musculoskeletal disorders. Although moderately effective overall, variation is seen in size of response to e...

Total hip replacement (THR) and total knee replacement (TKR) are usually effective at relieving pain; however, 7-23% of patients experience chronic post-surgical pain. These trials aimed to investigate the effect of local anaesthetic wound infiltration on pain severity at 12 months after primary THR or TKR for osteoarthritis. Between November 2009...

Osteoarthritis (OA) is a common and disabling joint disorder affecting millions of people worldwide. In OA, pathological changes are seen in all of the joint tissues including bone. Although both cross-sectional and longitudinal epidemiological studies have consistently demonstrated an association between higher bone mineral density (BMD) and OA, s...

Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether pr...

Knee pain is associated with radiographic knee osteoarthritis, but the relationships between physical examination, pain and radiographic features are unclear. To examine whether deficits in knee extension or flexion were associated with radiographic severity and pain during clinical examination in persons with knee pain or radiographic features of...

We previously reported an association between high bone mass (HBM) and a bone-forming phenotype of radiographic hip osteoarthritis (OA). As knee and hip OA have distinct risk factors, in this study we aimed to determine (i) whether HBM is also associated with knee OA, and (ii) whether the HBM knee OA phenotype demonstrates a similar pattern of radi...

Total hip replacement (THR) is an effective procedure for alleviating pain and improving function in majority of patients with end-stage osteoarthritis (OA). Clinically, meaningful improvement in pain and function after surgery is not universal, and the reasons for this are unclear. We investigated whether radiographic OA severity was a determinant...

Background Understanding the risk factors for early death after knee replacement could help to reduce the risk of mortality after this procedure. We assessed secular trends in death within 45 days of knee replacement for osteoarthritis in England and Wales, with the aim of investigating whether any change that we recorded could be explained by alte...

The 2013/14 year marks the 10th anniversary of the National Joint Registry. By 31 March 2013 the NJR held more than 1.4 million records and nearly 200,000 submissions were received on hip, knee, ankle, shoulder, and elbow replacements. The in-year compliance is over 90% and the overall compliance, since 2003, is 86.8%. It was interesting to note th...

n affluent Western countries today, in spite of massive improvements in healthcare and the control of disease, many people feel unfulfilled, unhappy or un-well 1 . They often look for non-medical interventions that might improve their wellbeing, and they do not have to look hard for advice. There are many books, websites, apps and practitioners who...

This critical reflection is based on the belief that creative practitioners should be using their own well-established approaches to trouble dominant paradigms in health and care provision to both form and inform the future of healing provision and well-being creation. It describes work by a transdisciplinary team (drama and medicine) that is devel...

Objective Epidemiological studies have shown an association between increased bone mineral density (BMD) and osteoarthritis (OA), but whether this represents cause or effect remains unclear. In this study, we used a novel approach to investigate this question, determining whether individuals with High Bone Mass (HBM) have a higher prevalence of rad...

Three academic/practitioners from different disciplines (performance, medicine and psychology) describe the ways in which observing, and importantly, participating in the healing rituals of the French pilgrimage site of Lourdes challenged their ways of thinking about both their discipline's research approaches and their understandings of community,...

OBJECTIVE: Previous studies of skeletal remains have suggested that both enthesophytes and osteophytes are manifestations of an underlying bone-forming tendency. A greater prevalence of osteophytes has been observed among individuals with high bone mass (HBM) compared with controls. This study was undertaken to examine the possible interrelationshi...

Three academic/practitioners from different disciplines (performance, medicine and psychology) describe the ways in which observing, and importantly, participating in the healing rituals of the French pilgrimage site of Lourdes challenged their ways of thinking about both their discipline ' s research approaches and their understandings of communit...

Background and hypothesis Range of motion (ROM) is a core component of some commonly used measures of disability, such as the American Knee Society Score and Harris Hip Score. However, the relationship between ROM and function is contested. The aim of this cross-sectional analysis was to investigate the relationship between pre-operative range of m...

Background and hypothesis Range of motion (ROM) is a core component of some commonly used measures of disability, such as the American Knee Society Score and Harris Hip Score. However, the relationship between ROM and function is contested. The aim of this cross-sectional analysis was to investigate the relationship between pre-operative range of m...

Objective Epidemiological studies have shown an association between increased bone mineral density (BMD) and osteoarthritis (OA), but whether this represents cause or effect remains unclear. In this study, we used a novel approach to investigate this question, determining whether individuals with High Bone Mass (HBM) have a higher prevalence of rad...

Patients and policy makers advocate that drug treatments should be individualised. However, the term is used in a variety of ways. We set out to identify the range of related terminology and concepts in the general field of individualisation, map out the relationships between these concepts and explore how patients' perspectives are considered. We...

To describe whether body mass index (BMI) is a clinically meaningful predictor of patient reported outcomes following primary total hip replacement (THR) surgery DESIGN: Combined data from prospective cohort studies. We obtained information from four cohorts of patients receiving primary THR for osteoarthritis: Exeter Primary Outcomes Study (n=1431...

Death within 90 days after total hip replacement is rare but might be avoidable dependent on patient and treatment factors. We assessed whether a secular decrease in death caused by hip replacement has occurred in England and Wales and whether modifiable perioperative factors exist that could reduce deaths. We took data about hip replacements done...

/st>Trust is important for patients and may be used as an indicator and potential 'marker' for how patients evaluate the quality of health care. The review aimed to classify the current evidence base on trust in the patient-provider relationship in order to identify strengths and weaknesses and to point towards areas for future research. /st>Nine e...

Chronic pain after total knee replacement (TKR) is a prevalent condition, affecting about 20% of patients. The aim of this study was to explore the relationship between pre-operative pain thresholds and chronic pain after TKR. Patients listed for a TKR because of osteoarthritis participated in a Quantitative Sensory Testing (QST) session prior to s...

To explore doctors' understanding of individualisation of drug treatments, and identify the methods used to achieve individualisation. In this exploratory study, we used in-depth qualitative interviews with doctors to gain insight into their understanding of the term 'individualised treatments' and the methods that they use to achieve it. 16 genera...

The 'placebo response' is a concept derived from the use of dummy (sham) interventions as 'controls' for active interventions within the context of a randomised controlled trial (RCT). Clearly if there is nothing in the sham treatment it can have no effect, so the response must be dictated by other contextual or incidental factors. However, the ass...

Objective. Epidemiological studies have shown an association between OA and increased BMD. To explore the nature of this relationship, we examined whether the risk of OA is increased in individuals with high bone mass (HBM), in whom BMD is assumed to be elevated due to a primary genetic cause. Methods. A total of 335 115 DXA scans were screened to...

Background Joint replacement is an effective intervention for people with advanced arthritis, although there is an important minority of patients who do not improve post-operatively. There is a need for robust evidence on outcomes after surgery, but there are a number of measures that assess function after joint replacement, many of which lack any...

Previous debate has explored whether medical education research should become more like health services research in terms of frameworks, collaborations and methodologies. Notable recent changes in health services research include an increasing emphasis on complex interventions, defined as interventions that involve more than one component. The purp...

Background: Implant survival after conventional total hip replacement (THR) is often poor in younger patients, so alternatives such as hip resurfacing, with various sizes to fit over the femoral head, have been explored. We assessed the survival of different sizes of metal-on-metal resurfacing in men and women, and compared this survival with thos...

To assess the influence of pre-operative X-ray changes on the response to total knee joint replacement (TKR). We included patients from one centre who underwent primary TKR (n = 478) for osteoarthritis in 2006 and 2007. The International Knee Society score (IKSS) and short form health survey were collected pre-operatively and at 1 and 2 years after...

To develop a clinical risk prediction tool to identify patients most likely to experience long-term clinically meaningful functional improvement following total hip arthroplasty (THA). We studied 282 patients from 2 health districts in England (Portsmouth and North Staffordshire) who were ≥45 years of age and undergoing THA for primary osteoarthrit...

Objective Co-morbidities may influence the clinical response to total hip replacement (THR); however, limited information is available for specific or multiple co-morbidities. We aimed to analyse this association in a large population-based setting. Methods Patients of the Dresden Hip Surgery Registry were recruited. Pre- and postoperative (6 mont...

Objective: To identify pre-operative predictors of patient-reported outcomes of primary total knee replacement (TKR) surgery. Methods: The Elective Orthopaedic Centre database is a large prospective cohort of 1991 patients receiving primary TKR in south-west London from 2005 to 2008. The primary outcome is the 6-month post-operative Oxford Knee...

To determine whether use of metal-on-metal bearing surfaces is associated with an increased risk of a diagnosis of cancer in the early years after total hip replacement and specifically with an increase in malignant melanoma and haematological, prostate, and renal tract cancers. Linkage study with multivariable competing risks flexible parametric s...

Conclusions: This study provides evidence that measurements of hip morphology characteristic of FAI or previously undiagnosed mild dysplasia are predictive of OA development at 19 years follow-up. Cam type deformity may be identified by an alpha angle of more than 65 on an anteroposterior pelvis radiograph. Dysplasia may be identified by measuremen...

Objective: To determine the association between radiographic osteoarthritis (OA) and pre-operative function in patients undergoing primary knee replacement. Methods: Single centre study examining pre-operative outcomes in a consecutive series of 525 patients who underwent primary knee replacement for OA between January 2006 and December 2007. Pr...

Total hip replacement (THR) is extremely common. Some prostheses fail, particularly in younger patients, and need to be revised, most commonly for loosening secondary to wear or dislocation. Surgeons have tried to address these problems by implanting large diameter metal-on-metal bearing surfaces. Our aim was to assess if metal-on-metal bearing sur...

Approximately 12% of postmenopausal women have osteoporotic vertebral fractures (VFs); these are associated with excess morbidity and mortality and a high risk of future osteoporotic fractures. Despite this, less than one-third come to clinical attention, partly due to lack of clear clinical triggers for referral for spinal radiographs. The aim of...

Total hip or knee replacement is highly successful when judged by prosthesis-related outcomes. However, some people experience long-term pain. To review published studies in representative populations with total hip or knee replacement for the treatment of osteoarthritis reporting proportions of people by pain intensity. MEDLINE and EMBASE database...

This study used 'think aloud' to explore issues around using a standardised questionnaire to assess persistent pain after joint replacement. Twenty participants with moderate-extreme persistent pain in their replaced hip or knee completed the Chronic Pain Grade (CPG) while 'thinking aloud'. The interviews were audio-recorded, transcribed and analys...

The aim of this study was to use quantitative sensory testing (QST) to explore the range and prevalence of somatosensory abnormalities demonstrated by patients with advanced knee OA. One hundred and seven knee OA patients and 50 age- and sex-matched healthy participants attended a 1-h QST session. Testing was performed on the medial side of the kne...

Patient expectations have been identified as a factor that may account for individual differences in recovery after total hip replacement (THR) surgery. However, patient expectations have not been studied within a valid theoretical framework. This study employed the World Health Organization's model of health, the International Classification of Fu...

Dr Juliet Rogers (Fig. 1), who died in 2001, aged 61, devoted her working life to the study of ancient human skeletons to aid our understanding of disease – the science of ‘skeletal paleopathology’ (1, 2). She made many important contributions to rheumatology. Here we celebrate her work through a brief resume of some of the things her work has taug...

Deriving statistically separable I, A and P measures from the Ab-IAP. Details of the derivation and validation of statistically separable I, A and P measures from the Ab-IAP.

The measurement model: CFA. Details of the measurement model using CFA including comparisons of the three factor model with alternative one and two factor models.

The International Classification of Functioning, Disability and Health (ICF) proposes three main constructs, impairment (I), activity limitation (A) and participation restriction (P). The ICF model allows for all paths between the constructs to be explored, with significant paths likely to vary for different conditions. The relationships between I,...

Knee joint replacement is an effective and cost-effective intervention for severe symptomatic osteoarthritis of the knee joint. However, utilisation rates vary hugely, there are no indications, it is difficult to know when (in the course of arthritis) it is best to operate, and some 10-20% of people who have this surgery are unhappy with the outcom...