Rajpal Nandra

• FRCS (orth) MRes BSc MBBS MRCGP
• Consultant at Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust

A common question from patients undergoing hip arthroscopy for Femoroacetabular Impingement (FAI) is when they may return to driving. We aimed to perform a formal systematic review and meta-analysis to address this issue. A systematic review and meta-analysis followed PRISMA guidelines. Databases searched included OVID, EMBASE, and COCHRANE through...

Greater trochanteric pain syndrome (GTPS) is a common issue, affecting around 1.8–5.6 individuals per 1000 in the population. Treatments such as physiotherapy, anti-inflammatory drugs, corticosteroid injections, and surgery have been used, but with limited and temporary success. Focused extracorporeal shockwave therapy (f-ESWT) has been suggested a...

Despite the implementation of latex-free gloves, the issue of natural rubber latex hypersensitivity persists within medical practice, posing challenges for both patients and health care professionals. A comprehensive understanding of the demographic groups susceptible to this condition is essential, along with the establishment of robust perioperat...

Introduction: Surgeons allocate an indication(s) for revision surgery on NJR Minimum Data Set forms in the immediate perioperative period, when results from intraoperative histology and microbiology samples are not available. We evaluated to what extent the postoperative diagnostics obtained for patients undergoing metal-on-metal hip arthroplasty...

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditi...

Aims Periprosthetic joint infection (PJI) is a challenging complication of any arthroplasty procedure. We reviewed our use of static antibiotic-loaded cement spacers (ABLCSs) for staged management of PJI where segmental bone loss, ligamentous instability, or soft-tissue defects necessitate a static construct. We reviewed factors contributing to the...

Hip and knee arthroplasty are frequently associated with significant blood loss, often necessitating blood transfusions. A variety of methods are employed to minimise blood loss and consequently mitigate the necessity for transfusions. This review explores the incidence of blood loss in hip and knee arthroplasty alongside perioperative strategies a...

Von Willebrand disease stands as the most prevalent bleeding disorder seen in both medical and surgical practice. Due to recurrent bleeding episodes within the joints, many patients endure arthropathy, leading to substantial pain and restricted function. Total joint arthroplasty emerges as a final option for managing such cases. Nevertheless, the e...

Aims In metal-on-metal (MoM) hip arthroplasties and resurfacings, mechanically induced corrosion can lead to elevated serum metal ions, a local inflammatory response, and formation of pseudotumours, ultimately requiring revision. The size and diametral clearance of anatomical (ADM) and modular (MDM) dual-mobility polyethylene bearings match those o...

Aims The Birmingham Hip Resurfacing (BHR) was introduced in 1997 to address the needs of young active patients using a historically proven large-diameter metal-on-metal (MoM) bearing. A single designer surgeon’s consecutive series of 130 patients (144 hips) was previously reported at five and ten years, reporting three and ten failures, respectivel...

Aims: Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality. Methods: Using a multicentre study design, independent of registry data, we included adult patient...

Aims: Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in t...

Aims Most patients with advanced malignancy suffer bone metastases, which pose a significant challenge to orthopaedic services and burden to the health economy. This study aimed to assess adherence to the British Orthopaedic Oncology Society (BOOS)/British Orthopaedic Association (BOA) guidelines on patients with metastatic bone disease (MBD) in th...

Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Methods Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 centres with...

Aims: Periprosthetic fractures (PPFs) following hip arthroplasty are complex injuries. This study evaluates patient demographic characteristics, management, outcomes, and risk factors associated with PPF subtypes over a decade. Methods: Using a multicentre collaborative study design, independent of registry data, we identified adults from 29 cen...

In metal-on-metal (MoM) hip replacements or resurfacings, mechanical induced corrosion can lead to a local inflammatory response, pseudo tumours and elevated serum metal ions, requiring revision surgery. The size and diametral clearance of Anatomic (ADM) and Modular (MDM) Dual Mobility bearings matches that of certain MOM components. Presenting the...

Introduction This study aimed to assess the relationship between immediate post-operative imaging and the risk of revision surgery for mechanical failure, as well as to determine the effect of routine peer review of post-operative imaging on the rate of unsatisfactory radiological outcomes and revision surgery. Methods Two trauma fellowship-traine...

Background Prosthetic joint infection (PJI) is associated with poor outcomes and catastrophic complications. The aim of this study was to present the outcomes of re-revision surgery for PJI of the knee following previous failed two-stage exchange arthroplasty. Materials and methods A retrospective analysis was performed of 32 patients who underwen...

Purpose The study proposed a simple classification system that aimed at predicting the labral procedure during hip arthroscopy using images from unenhanced 3T MRI scans. Patents and methods Forty patients undergoing hip arthroscopy had their MRI scans reviewed pre-operatively by one of two senior radiologists and classified into: type 1: stable la...

The multi-centre trainee-led collaborative research model improves the generalizability of results, efficiency of data collection, quality of data and sample size. Although an enormous amount of effort and resources are sometimes required, the final results lead to a standard that is unachievable by conventional studies. In this article, we summari...

Background Bone sarcomas often present late with advanced stage at diagnosis and an according, varying short-term survival. In 2016, Nandra et al. generated a Bayesian belief network model for 1-year survival in patients with bone sarcomas. The purpose of this study is: (1) to externally validate the prior 1-year Bayesian belief network prediction...

Introduction The incidence of femoral periprosthetic fractures (PPFs) in the UK is on the rise. This rising incidence presents a clinical and an economic burden on the national health care services. There is also uncertainty about the most effective treatment modality for femoral PPFs, as well as a lack of evidence for a standardized management app...

Metastatic bone disease (MBD) is a frequently encountered condition in trauma and orthopaedic practice, and delayed or inappropriate management may lead to worse oncological outcomes, dysfunction and reoperation. Updated guidance from the British Orthopaedic Oncology Society (BOOS) and British Orthopaedic Association (BOA), in 2015, aimed to raise...

Aims It is imperative to understand the risks of operating on urgent cases during the COVID-19 (SARS-Cov-2 virus) pandemic for clinical decision-making and medical resource planning. The primary aim was to determine the mortality risk and associated variables when operating on urgent cases during the COVID-19 pandemic. The secondary objective was t...

Introduction Uncemented unicompartmental knee replacement offers a minimally invasive approach, faster rehabilitation and good levels of function, supported by evidence reporting low intra-operative fracture rate and mid-term stability with no implant migration at 5-years. Our aim was to examine the clinical outcomes in 289 consecutive Oxford unico...

PurposeSurgical treatment of Early Onset Scoliosis (EOS) is challenging. Stable and robust foundations are vital. We have assessed a small cohort of patients with a rib-based proximal fixation and a pedicle screw-based distal foundation for a distraction based growing rod system.Method This is a single center study in a tertiary spinal deformity un...

Background Many worldwide regulatory authorities recommend regular surveillance of metal-on-metal hip arthroplasty patients given high failure rates. However, concerns have been raised about whether such regular surveillance, which includes asymptomatic patients, is evidence-based and cost-effective. We determined: (1) the cost of implementing the...

Aims: There are reports of a marked increase in perioperative mortality in patients admitted to hospital with a fractured hip during the COVID-19 pandemic in the UK, USA, Spain, and Ita-ly. Our study aims to describe the risk of mortality among patients with a fractured neck of femur in England during the early stages of the COVID-19 pandemic. Meth...

Introduction: The fracture burden of the UK utilises a vast proportion of National Health Service (NHS) resources. Subsequent complications in healing result in poor patient outcomes (indirect costs) and increased demand on healthcare services (direct costs). Inadequate education regarding risk factors for poor outcomes provides a target for interv...

Human error or systematic failures can cause harm to patients and both direct and indirect costs to healthcare trusts. In response, surgical safety has become a vital component of modern healthcare worldwide. Safe execution of surgery is even more important as an increasing number of surgical interventions are occurring annually. The World Health O...

Aims Base of thumb osteoarthritis (BTOA) is a common age-related disease which has a significant negative impact upon quality of life. Our aim was to assess current UK practice in secondary care with regard to the nature of non-surgical treatments, the surgical procedures most commonly performed, and factors influencing the surgical decision-making...

A vulnerable participant in research lacks capacity to consent or may be exposed to coercion to participate. Capacity may be temporarily impaired due to loss of consciousness, hypoxia, pain and the consumption of alcohol or elicit substances. To advance emergency care, providing life-threatening measures in life-threatening circumstances, vulnerabl...

Aims The aim of this study was to investigate the local recurrence rate at an extended follow-up in patients following navigated resection of primary pelvic and sacral tumours. Patients and Methods This prospective cohort study comprised 23 consecutive patients (nine female, 14 male) who underwent resection of a primary pelvic or sacral tumour, usi...

Aims The aim of this study was to investigate the local recurrence rate at an extended follow-up in patients following navigated resection of primary pelvic and sacral tumours. Patients and Methods This prospective cohort study comprised 23 consecutive patients (nine female, 14 male) who underwent resection of a primary pelvic or sacral tumour, us...

Military medical innovation has significantly improved battlefield casualty survival. In recent warfare, we observed higher rates of survival than expected. In fact, a quarter of those severely injured were not expected to survive at all. In Afghanistan and Iraq medical teams had to adapt to changing mechanisms of injury, notably the improvised exp...

Introduction. Bone is a complex heterogeneous composite, constantly remodelling under the influence of hormones and local loading forces. The inorganic component of bone consists primarily of hydroxyapatite, containing a variety of trace elements. Bone is one of the few human tissues that heals without scarring and is able to regenerate. Objective....

The development of new materials for clinical use is limited by an onerous regulatory framework, which means that taking a completely new material into the clinic can make translation economically unfeasible. One way to get around this issue is to structure materials that are already approved by the regulator, such that they exhibit very distinct p...

There are concerns regarding early years' training for junior doctors in Trauma & Orthopaedic Surgery (T&O) in the United Kingdom. Our primary objective was to audit the clinical activities undertaken by junior doctors working in Trauma & Orthopaedic (T&O) surgery in the National Health Service (NHS) in a typical workweek. A secondary objective was...

Introduction: The management of displaced fractures of the distal clavicle remains controversial, particularly in younger patients where there is no consensus as to which surgical intervention is best. Each surgical method has unique surgical complications and rates of persistent pain and post-traumatic arthritis. We report an innovative surgical...

Aims To determine ten-year failure rates following 36 mm metal-on-metal (MoM) Pinnacle total hip arthroplasty (THA), and identify predictors of failure. Patients and Methods We retrospectively assessed a single-centre cohort of 569 primary 36 mm MoM Pinnacle THAs (all Corail stems) followed up since 2012 according to Medicines and Healthcare Produ...

Proximal femoral fractures are a major public health concern with estimated annual direct and social costs amounting to £2 billion and average 30-day mortality risk of 7.5%. In response to the recent debate over out-of-hours hospital provision we investigated the ‘weekend effect’ at a major trauma centre, caring for acute injuries. A single centre,...

Background: Extremity sarcoma has a preponderance to present late with advanced stage at diagnosis. It is important to know why these patients die early from sarcoma and to predict those at high risk. Currently we have mid- to long-term outcome data on which to counsel patients and support treatment decisions, but in contrast to other cancer group...

Aims: Following the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union. Patients an...

The management of ankle fractures in octogenarian and nonagenarians. What is the optimum mode of treatment? Author(s): James Holton Abstract: Introduction: The rapidly growing elderly population is living longer, active lifestyles with significant comorbidities. Modern literature challenges the conservative approach to elderly ankle fractures. Our...

Aims Following the introduction of national standards in 2009, most major paediatric trauma is now triaged to specialist units offering combined orthopaedic and plastic surgical expertise. We investigated the management of open tibia fractures at a paediatric trauma centre, primarily reporting the risk of infection and rate of union. Patients and M...

Objectives: The PROximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial has recently demonstrated that surgery is non-superior to non-operative treatment in the management of displaced proximal humeral fractures. The objective of this study was to assess current surgical practice in the context of the PROFHER trial in terms o...

Follow-up series of the Copeland resurfacing hemiarthroplasty have reported few postoperative fractures around the prosthesis. We report three cases of periprosthetic fracture around a Copeland resurfacing arthroplasty. Due to prosthetic loosening and tuberosity comminution, all cases were managed with revision shoulder arthroplasty. All patients h...

Introduction: For many cancers, one-year mortality following diagnosis is a reflection of either advanced stage at diagnosis, multiple co-morbidities and/or complications of treatment. One-year mortality has not been reported for soft tissue or bone sarcomas. This study reports 1-year sarcoma mortality data over a 25-year period, investigates prog...

Fracture non-union remains a clinical problem despite advances in the understanding of basic science and technology. Each fracture has a unique personality as does the patient suffering the injury. Thus, each case must be treated on an individual basis. This article defines the problem of fracture non-union and reports recent epidemiological studie...

Only 1 in 100 of primary care consultations regarding new soft tissue lumps (STL) are malignant and are susceptible to a delay in diagnosis. We aimed to generate a Bayesian Belief Network to estimate the likelihood of malignancy in patients to facilitate the initial evaluation of a STL and improve timing and quality of referrals to specialist treat...

We hypothesised that the use of computer navigation-assisted surgery for pelvic and sacral tumours would reduce the risk of an intralesional margin. We reviewed 31 patients (18 men and 13 women) with a mean age of 52.9 years (13.5 to 77.2) in whom computer navigation-assisted surgery had been carried out for a bone tumour of the pelvis or sacrum. T...

Surgery remains the main treatment of bone metastases due to renal cell carcinoma (RCC). We reviewed 135 patients treated with resection and endoprosthetic replacement (EPR) and examined clinico-pathological factors predicting survival. Surgical and oncological outcomes were examined using a prospectively maintained database between 1976 and 2012....

Acute avulsions of the tibial tubercle apophysis are uncommon, with reported incidence of 0.4-2.7% of all physeal injuries. In our case the extent of the injury was not realised at first presentation and initial internal fixation was attempted. At first outpatient follow-up, repeat radiographs indicated the fracture was not reduced and further CT i...

The reduction in one-year mortality over the last 20 years in major cancer groups has not been seen in Sarcoma patients. There has been little improvement since the introduction of neo-adjunctive chemotherapy. It is generally considered that death within one year of cancer diagnosis is related to advanced stage at diagnosis, multiple comorbidities...

Traumatic injuries of the elbow in children pose a diagnostic challenge. They demand precise knowledge of radiographic anatomy, growth characteristics of healthy and injured bones as well as specific fracture dynamics in this age group. Dislocation of the elbow is rare in children, accounting for 3-6% of all childhood elbow injuries. Fractures at t...

Anterior cruciate ligament rupture is a common soft tissue knee injury, often affecting young athletic individuals keen to return to pre-injury levels of function. Increasing sporting activity is reflected by an increasing incidence of anterior cruciate ligament rupture. Although treatment has advanced considerably over the years, there are still a...

The aims of treatment of anterior cruciate ligament rupture are to eliminate pain, restore stability and allow early return to activity while preventing early degeneration. Ruptures can be treated conservatively, which requires careful patient selection and avoidance of high-risk activity. Each patient must be treated on an individual basis with co...

Achilles tendon rupture is a common sports-related injury, with the incidence of acute ruptures continuing to increase. Achilles ruptures can be missed, or presentation may be delayed. Clinical tests assist diagnosis, with the Thompson and Matles tests being the most sensitive and specific. Ultrasound provides a valuable adjunct for diagnosing acut...

Anterior dislocation of the shoulder is a common injury which is often reduced in the emergency department, without specialist orthopedic input. We report a case of an irreducible locked anterior glenohumeral dislocation with impaction of the humeral head onto the antero-inferior glenoid rim and subsequent generation of a Hill-Sachs lesion. To our...