Faheem Bhatti

Aims: It is known that survival of primary total shoulder arthroplasty at 10 years is excellent; however, evidence beyond this time-point is limited. We aimed to evaluate the long-term survival of anatomic total shoulder arthroplasty (aTSA) and reverse total shoulder arthroplasty (rTSA) implants, at ≥13 years follow-up, using case series and international joint registry data. Methods: CENTRAL, Embase, and MEDLINE databases were searched for studies reporting TSA survival data at ≥13 years follow-up. National joint registries were contacted for implant data. Pooled survival at 13, 15, and 20 years was calculated for case series and registry data using a random-effects model. Results: Data from four national joint registries and seven studies were analysed. Pooled aTSA registry data showed survival of 91.50% (89.36–93.64) at 13-years and 90.82% (88.25–93.38) at 15-years. Pooled rTSA registry data showed survival of 93.19% (91.78–94.60) at 13-years and 90.74% (85.73–95.74) at 15-years. Data from case series gave pooled aTSA survival estimates of 88.69% (76.97–100.42), 90.23% (85.87–94.58) and 82.08% (70.30–93.88) at 13, 15 and 20 years, respectively. Conclusion: Our analysis suggests approximately 90% of shoulder replacements last up to 15 years without revision. Variation between individual implants highlights the need for granular implant-level data to guide patient and clinician decision making.

Background: Despite reverse shoulder replacement (RSR) being the predominant form of shoulder arthroplasty in the United Kingdom, substantial variation exists in implant selection and surgical technique. This study aims to capture current RSR practice among members of the British Elbow and Shoulder Society (BESS). Methods: A 24-question online survey was sent to BESS surgeon members in December 2024, assessing routine practice in both trauma and elective RSR. Descriptive statistical analysis was performed. Results: In total, 127 surgeons responded. Over half performed at least 20 RSRs annually (54.3%). The most common glenosphere sizes were 42 mm and 36 mm for male and female patients, respectively. Glenoid onlay components were used by 87.9% of respondents, and humeral inlay components by 55.6%. Most surgeons used symmetric liners (69.2%), a standard (50.0%) or short (48.4%) humeral stem, 10°–20° of humeral version (56.7%), and 135° (45.4%) or 145° neck-shaft angles (36.1%). Intraoperatively, 79.5% of surgeons routinely repaired the subscapularis, and metallic augments (70.9%) were the most used method of building offset. Preoperative planning was used by 67.7% of surgeons, while 7.9% used computer navigation. Discussion: This survey highlights variation in implant selection, operative technique, and technology use among UK surgeons, underscoring the need for evidence-based standardisation.

Background: Isocitrate dehydrogenase (IDH) mutation and chromosome 1p19q genotyping have become fundamental to the prognostic grouping of adult diffuse gliomas. Apparent diffusion coefficient (ADC) values may enable non-invasive prediction of glioma molecular status. The purpose of this systematic review and meta-analysis was to investigate the diagnostic accuracy of ADC for IDH and 1p19q genotyping, considering measurement techniques and tumour grade. Methods: A systematic search of PubMed and Cochrane Library databases was performed in December 2024. Studies were grouped according to the ADC parameter measured and the measurement techniques used. A meta-analysis was performed, supplemented by Egger’s regression testing. The quality of studies was assessed with the QUADAS-2 tool. Results: Thirty-three studies including a total of 4297 patients fulfilled the inclusion criteria. IDH mutation and 1p19q deletion status were assessed by 30 and 14 studies respectively. Pooled area under the curve (AUC) values for the prediction of an IDH mutation and 1p19q codeletion ranged from 0.743 (0.680-0.805) to 0.804 (0.689-0.919), and 0.678 (0.614-0.741) to 0.692 (0.600-0.783). No significant differences were identified between regional and volumetric measurements, between ADCmean and ADCmin values, or comparing normalised and raw ADC data. Conclusion: This meta-analysis supports ADC as an imaging biomarker in untreated gliomas, specifically to predict IDH status. ROI measurement, particularly by a single ADCmean, is rapid, reproducible and appears statistically equivalent to volumetric read outs. We found no evidence for superior diagnostic accuracy by ADC normalisation. Published ADC thresholds have been summarised for consideration of prospective testing across institutions.

Background: Research methodology is insufficiently featured in undergraduate medical curricula. Student-selected components are designed to offer some research opportunities but frequently fail to meet student or supervisor expectations, such as completion or publication. We hypothesized that a collaborative, educational approach to a systematic review (SR), whereby medical students worked together, may improve student experience and increase success. Objective: This study aimed to establish whether offering a small team of students the opportunity to take part in the screening phase of SRs led by an experienced postgraduate team could enhance the learning experience of students, overcome the barriers to successful research engagement, and deliver published output. Methods: Postgraduate researchers from the University of Cambridge led a team of 14 medical students to work on 2 neurosurgical SRs. One student was appointed as the lead for each SR. All students were provided with training on SR methodology and participated in title and abstract screening using Rayyan software. Students completed prepilot, midscreening, and postscreening questionnaires on their research background, perceptions, knowledge, confidence, and experience. Questions were scored on a Likert scale of 1 (strongly disagree) to 10 (strongly agree). Results: Of the 14 students involved, 29% (n=4) reported that they had received sufficient training in research methodology at medical school. Positive trends in student knowledge, confidence, and experience of SR methodology were noted across the 3 questionnaire time points. Mean responses to “I am satisfied with the level of guidance I am receiving,” “I am enjoying being involved in the SR process,” and “I could not gain this understanding of research from passive learning e.g., textbook or lecture” were greater than 8.0 at all time points. Students reported “being involved in this research has made me more likely to do research in the future” (mean 8.57, SD 1.50) and that “this collaborative SR improved my research experience” (mean 8.50, SD 1.56). Conclusions: This collaborative approach appears to be a potentially useful method of providing students with research experience; however, it requires further evaluation.

BACKGROUND Research methodology is insufficiently featured in undergraduate medical curricula. Student-selected components are designed to offer some research opportunities but frequently fail to meet student or supervisor expectations, such as completion or publication. We hypothesized that a collaborative, educational approach to a systematic review (SR), whereby medical students worked together, may improve student experience and increase success. OBJECTIVE This study aimed to establish whether offering a small team of students the opportunity to take part in the screening phase of SRs led by an experienced postgraduate team could enhance the learning experience of students, overcome the barriers to successful research engagement, and deliver published output. METHODS Postgraduate researchers from the University of Cambridge led a team of 14 medical students to work on 2 neurosurgical SRs. One student was appointed as the lead for each SR. All students were provided with training on SR methodology and participated in title and abstract screening using Rayyan software. Students completed prepilot, midscreening, and postscreening questionnaires on their research background, perceptions, knowledge, confidence, and experience. Questions were scored on a Likert scale of 1 (strongly disagree) to 10 (strongly agree). RESULTS Of the 14 students involved, 29% (n=4) reported that they had received sufficient training in research methodology at medical school. Positive trends in student knowledge, confidence, and experience of SR methodology were noted across the 3 questionnaire time points. Mean responses to “I am satisfied with the level of guidance I am receiving,” “I am enjoying being involved in the SR process,” and “I could not gain this understanding of research from passive learning e.g., textbook or lecture” were greater than 8.0 at all time points. Students reported “being involved in this research has made me more likely to do research in the future” (mean 8.57, SD 1.50) and that “this collaborative SR improved my research experience” (mean 8.50, SD 1.56). CONCLUSIONS This collaborative approach appears to be a potentially useful method of providing students with research experience; however, it requires further evaluation.

Objectives To evaluate the measurement properties of outcome measures currently used in the assessment of degenerative cervical myelopathy (DCM) for clinical research. Design Systematic review Data sources MEDLINE and EMBASE were searched through 4 August 2020. Eligibility criteria Primary clinical research published in English and whose primary purpose was to evaluate the measurement properties or clinically important differences of instruments used in DCM. Data extraction and synthesis Psychometric properties and clinically important differences were both extracted from each study, assessed for risk of bias and presented in accordance with the Consensus-based Standards for the selection of health Measurement Instruments criteria. Results Twenty-nine outcome instruments were identified from 52 studies published between 1999 and 2020. They measured neuromuscular function (16 instruments), life impact (five instruments), pain (five instruments) and radiological scoring (five instruments). No instrument had evaluations for all 10 measurement properties and Conclusions This review aggregates studies evaluating outcome measures used to assess patients with DCM. Overall, there is a need for a set of agreed tools to measure outcomes in DCM. These findings will be used to inform the development of a core measurement set as part of AO Spine RECODE-DCM.

Study design: Systematic review.Objectives: To evaluate the impact of cannabinoids on neurobehavioral outcomes in preclinical models of nontraumatic and traumatic spinal cord injury (SCI), with the aim of determining suitability for clinical trials involving SCI patients.Methods: A systematic search was performed in MEDLINE and Embase databases, following registration with PROPSERO (CRD42019149671). Studies evaluating the impact of cannabinoids (agonists or antagonists) on neurobehavioral outcomes in preclinical models of nontraumatic and traumatic SCI were included. Data extracted from relevant studies, included sample characteristics, injury model, neurobehavioural outcomes assessed and study results. PRISMA guidelines were followed and the SYRCLE checklist was used to assess risk of bias.Results: The search returned 8714 studies, 19 of which met our inclusion criteria. Sample sizes ranged from 23 to 390 animals. WIN 55,212-2 (n = 6) and AM 630 (n = 8) were the most used cannabinoid receptor agonist and antagonist respectively. Acute SCI models included traumatic injury (n = 16), ischaemia/reperfusion injury (n = 2), spinal cord cryoinjury (n = 1) and spinal cord ischaemia (n = 1). Assessment tools used assessed locomotor function, pain and anxiety. Cannabinoid receptor agonists resulted in statistically significant improvement in locomotor function in 9 out of 10 studies and pain outcomes in 6 out of 6 studies.Conclusion: Modulation of the endo-cannabinoid system has demonstrated significant improvement in both pain and locomotor function in pre-clinical SCI models; however, the risk of bias is unclear in all studies. These results may help to contextualise future translational clinical trials investigating whether cannabinoids can improve pain and locomotor function in SCI patients.

Introduction: Degenerative cervical myelopathy (DCM) is the commonest cause of adult spinal cord impairment worldwide, encompassing chronic compression of the spinal cord, neurological disability and diminished quality of life. Evidence on the contribution of environmental factors is sparse; in particular, the role of nutrition in DCM is unknown. The objective of this review was to assess the effect of nutrition on DCM susceptibility, severity and surgical outcome. Methods: A systematic review in MEDLINE and Embase was conducted following PRISMA guidelines. Full-text papers in English papers, focussing on cervical myelopathy and nutrition, published before January 2020 were considered eligible. Quality assessments were performed using the GRADE assessment tool. Patient demographics, nutritional factor and DCM outcomes measures were recorded. Relationships between nutritional factors, interventions and disease prognosis were assessed. Results: In total, 5835 papers were identified of which 44 were included in the final analysis. DCM patients with pathological weight pre-operatively were more likely to see poorer improvements post-surgically. These patients experienced poorer physical and mental health improvements from surgery compared to normal weight patients and were more likely to suffer from post-operative complications such as infection, DVT, PE and hospital readmissions. Two trials reporting benefits of nutritional supplements were identified, with 1 suggesting Cerebrolysin to be significant in functional improvement. An unbalanced diet, history of alcohol abuse and malnourishment were associated with poorer post-operative outcome. Conclusion: Although the overall strength of recommendation is low, current evidence suggests nutrition may have a significant role in optimising surgical outcome in DCM patients. Although it may have a role in onset and severity of DCM, this is a preliminary suggestion. Further work needs to be done on how nutrition is defined and measured, however, the beneficial results from studies with nutritional interventions suggest nutrition could be a treatment target in DCM.