Research

The Academic Surgical Unit (ASU) of South West London Elective Centre is led by the Director Research, Professor Richard Field.

Academic Consultant Orthopaedic Surgeon:
Professor Richard Field, Professor Deiary Kader, Professor Sochart and Mr Vipin Asopa.
Research and Outcomes Manager:
Miss Irrum Afzal
The Academic Surgical Unit is continually expanding its portfolio of Research, Outcome Service Evaluation Data Collection, Quality Improvements Projects and Audits. The Academic Surgical Units current research interests are Regenerative Medicine and Artificial Intelligence (AI).

Regenerative Medicine

Recent advances in regenerative medicine, particularly stem-cell therapy, hold promise for relieving symptoms of osteoarthritis by either replacing damaged cells and tissue or reducing inflammation.
Stem-cells are found in bone-marrow, peripheral blood and adipose (fat) tissue. Adipose tissue is a preferred source because it is thought to be a rich source of cells and easy to access using liposuction. Before considering the efficacy of stem-cell therapy, the exact nature of the intervention needs to be precisely defined. Several questions must be answered to define a consistent, high-quality, stem-cell based
therapeutic product. The Academic Surgical Unit would like to identify which site is the best source for obtaining adipose derived stem-cells (e.g. abdomen or buttock)? Can these cells be obtained using local anaesthetic?
Being able to use local anaesthetic without harming stem-cells may allow development of out-patient therapy. Are cells best separated from adipose tissue using mechanical means or the enzyme collagenase? Using collagenase may increase the number of stem-cells obtained but has the disadvantage of risking damage to the patient if residue remains when cells are re-injected back into the host patient.

Artificial Intelligence (AI)

Also known as Machine Learning (ML), AI is the empowerment of computer systems to be able to perform tasks requiring human intelligence. Examples of this include speech recognition, translation between languages and visual perception. From an orthopaedic perspective, the ability for a computer to recognise failing implants, such as total hip replacements, from x-ray’s could revolutionise the investigation and management of patients who have failing total hip replacements

Research Studies

We actively recruit patients onto studies at SWLEOC, including multi-centre, Orthopaedic Data Evaluation Panel (ODEP) Compliant surveillance studies of new implants, clinical trials and National Institute of Health Research Portfolio studies. The Academic Surgical Unit work to ensure the success of existing studies, initiation of new studies and maintain high-quality of collected data.

Outcome Service Evaluation data collection

The Academic Surgical Unit has been successful in building an outcomes database for patients who have hip, knee and shoulder surgery. This information has led to constant improvements in the services and treatments delivered to patients. To date, database has data collected from over 50,00 patients, and 40 surgeons. This data is regularly reviewed and analysed by surgeons, hospital management and researchers allowing for evaluation to devise new and improved measures to treat patients.
All the research staff are involved in ensuring that any research undertaken within the department safeguards the well-being of the patients and is conducted within ICH Good Clinical Practice Guidelines for Research.

We have promoted the sharing of ideas through publications in peer-reviewed journals and active participation in relevant national and international conferences such as the British Hip Society, British Society of Knee Surgery, British Orthopaedic Association and The European federation of Orthopaedic and traumatology.

The South West London and Surrey Complex Joint Network

Hip and Knee Surgery

The SWLEOC hospitals work closely with the Royal Surrey County Hospital in Guildford to provide a network of care to patients with complex hip and knee joint replacement problems. Colleagues supporting each other to improve outcomes for patients is the gold standard model of care across the world of Orthopaedics in 2021. The United Kingdom is divided up into a number of regions all of whom are working to deliver the model of care that SWLEOC has developed in our area.

The key features of our success are a weekly Multi-disciplinary Team meeting, strong outcomes research, excellent team working across the network and a close working relationship with our local teaching hospital – St George’s.

A multi-disciplinary team meeting (MDT) is a meeting where all surgeons come together with radiologists (X-Ray specialists), anaesthetists, infectious disease doctors, specialist nurses and any other specialists as required to discuss patients who present with complex/difficult problems. For the last three years at SWLEOC we have hosted the South West London MDT and are very pleased to have developed a close working relationship with Guildford and St Peter’s Chertsey. The team meet every Wednesday morning, some attending in person, some remotely. All patients having a revision hip or knee replacement in our network will be discussed. Their case is presented usually by the surgeon looking after the individual patient after which the x-rays and scans are presented by a radiologist. There then follows a team based discussion around personalising the optimum surgical and non-surgical care offered to each and every patient. Surgeons find this process hugely beneficial in terms of formalising their thoughts over what operation might be performed and how. We also address whether any further scans/tests might be needed. Patients benefit hugely because although they are not present, having their problems discussed by multiple experts leads to a far greater degree of sophistication in decision making and planning.

What stands us apart at SWLEOC is the contribution from our Research and Outcomes Department. Every patient who undergoes a revision hip or knee operation in our network will have their outcomes recorded and their X-Rays reviewed. This quality assurance process enables us to educate, reflect on our practice and ensure that the highest standards of care are being provided. The SWLEOC revision arthroplasty multidisciplinary meeting is where dedicated experts convene to discuss patients who may need re-do joint replacement surgery.

“The meeting covers all aspects of the patient pathway. This ensures that patients are appropriately investigated prior to surgery, the decision to proceed is in the patient’s best interest, a comprehensive surgical plan is made and tips to ensure the surgery is a success.

This provides me a wealth of experience, advice and guidance to make sure I can deliver the best care for my patients.”

Mr John Stammers

Consultant Hip and Knee Surgeon

St George’s Hospital

 

We are grateful to our Director Mary Richardson for providing funding for administrative support, which Yasmine George performs to an incredibly high standard. Effective communication is the essential foundation for our service of which we are extremely proud. We continue to strive to improve all aspects of care to all of our patients in an effective and sustainable way.

Philip Mitchell

Consultant Orthopaedic Surgeon

Network Lead for Complex Joint Replacement, South West London