Our research
A clear mission: generating high impact research
Our focus is delivering research that can improve the effectiveness of clinical care. Our research is interdisciplinary and spans all areas of trauma and orthopaedic care. Working closely with the pragmatic clinical trials unit we develop clinical research studies that evaluate the effectiveness of current treatments in the NHS; we partner with industry to bring effective new treatments into everyday care and make use of health information that is routinely collected to help us answer key questions.
Our core research activities
Clinical trials
Working with our partners in the Pragmatic Clinical Trials Unit we are developing innovative clinical trials to answer key questions in bone and joint health. Our focus is on efficient trial design which means we can answer more questions quickly and therefore accelerate evidence-based changes in patient care.
Big data
We are maximising the opportunity to use routinely collected data to answer questions and evaluate patient outcomes. Through successfully joining the European Health Data & Evidence Network we are developing collaborations in big data research.
Systematic reviews
Xavier Griffin is the coordinating editor of the Cochrane Bone, Joint and Muscle Trauma Group. Cochrane produces high quality reviews of research so that decision making in healthcare is based on the best research evidence.
Co production of research
We understand that in order to deliver research excellence that has global impact, co-production is key. Working alongside patients and members of the public is at the core of every research project undertaken/overseen by us.
Interdisciplinary collaboration
With access to leading research methodologists, a life sciences campus, bio-engineers and world leaders in inflammation and osteoarthritis research, we are developing collaborations across the School of Medicine and Dentistry to tackle multiple issues affecting those with bone and joint conditions. We work with orthopaedic colleagues who are leaders in their fields across the UK and beyond.
Research training and education
We are committed to providing outstanding education in orthopaedic surgery at all levels – undergraduate and medical students, surgical residents, Masters and PhD students, fellows, young clinician scientists, and early career researchers. Our teaching programme for the two resident rotations (Percivall Pott and Royal London Hospital) takes place monthly.
A message from our chair Xavier Griffin
Welcome to Bone & Joint Health. Our mission is to improve the health and wellbeing of people with bone and joint disorders and injuries. Barts Health NHS Trust has a long and distinguished history dating back to the 12th Century and continues to grow. Barts and The London Charity funded the establishment of a new academic trauma and orthopaedic unit in August 2020. Starting something new is incredibly exciting and gives us a unique opportunity – to build a world-class team around our four core values.
"Transforming how we do research is central to our mission, we need to test treatments faster and more economically so that we can accelerate improvements in clinical care. Our emphasis on developing large scale studies and collaborations in bone and joint health will allow for bigger trials completed in a shorter time frame.
"More critical than any one of our studies is inspiring the next generation of clinical researchers who will keep our organisation and values at the forefront of research. Our home-grown mentoring program and initiatives to bring clinicians’ ideas to a reality will foster talent and inspire others to keep driving forward."
Professor Xavier Griffin – Chair of Bone and Joint Health
Current studies
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The NIHR Barts musculoskeletal BRC combines the second largest NHS Trust, serving ~7.5 million people from 97 nations, with the strengths of Queen Mary University of London partnered with St George’s University of London and St George’s University Hospitals NHS Foundation Trust.
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Globally, an estimated 4.5 million people will fracture their hip in 2050. Even with surgery, 30 per cent of patients die within a year. Among survivors, 25 per cent never walk again and 22 per cent change from living at home to a nursing home. Rehabilitation assists patients ‘to achieve and maintain optimal functioning’.
UK hospitals admit 70,000 older adults with hip fracture annually. Patients consider recovery as a return to prefracture activities often requiring outdoor mobility. Among 74 per cent of patients with outdoor mobility prefracture, only 9 per cent recovered this by 30 days post fracture, increasing to 26 per cent by 120 days post fracture.
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In the UK, around 70,000 people injure their leg and have to have wear a boot or a cast. These people are at higher risk of blood clots forming in their veins, a condition called venous thromboembolism (VTE). VTE can cause long-term problems in the legs, serious illnesses, and occasionally death if the clot migrates to other parts of the body such as the lungs.
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Back pain affects the majority of people at some point in their life, costing the United Kingdom approximately £12 billion per year. It worsens quality of life through loss of function, pain and its psychological effects. We do not currently know the outcomes of routine spinal surgery performed in the National Health Service to help relieve back pain. Most research has been poor with not enough patients to draw conclusions from.
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Shoulder pain accounts for 3 per cent of all visits to a GP, with frozen shoulder being the most common cause of pain. Prevalence of frozen shoulder is estimated to be 10 per cent of working age adults, having a significant impact on function and the ability to work.
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Worldwide there are 1.3 million hip fractures with more than 70,000 hip fractures in the UK every year; projected to rise to more than 100,000 by 2020 in the UK.
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Hip fracture is one of the biggest challenges facing patients and healthcare systems. Worldwide there are 1.3 million hip fractures with more than 70,000 hip fractures in the UK every year. These figures are projected to rise to more than 100,000 by 2020 in the UK and more than 6 million by 2050 worldwide. The global cost of this clinical problem is estimated at 1.75 million disability adjusted life years lost and represents 1.4% of the total healthcare burden in established market economies.
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NIHR has several streams from which commissioning inputs can be generated – NICE research recommendations, researcher inputs and priority setting exercises. The flagship amongst these is the James Lind Alliance. This has been enormously successful in generating commissioned trial calls and is one of the ways that the community have together driven a transformation in the culture of bone and joint health research. We are delivering a prioritisation partnership with multiply injured patients, those sustaining major trauma.
The Tendon Seed Network will spatially define the transcriptome of extracellular matrix-rich tissues such as tendon across multiple anatomic and micro-anatomic sites. To enable this, the project will develop clinical, laboratory, bioinformatics, and mathematical modelling tools and platforms. This group will also pilot a patient engagement strategy in order to increase recruitment of ethnically underrepresented donors by developing and growing partnerships with clinical research teams in London and Birmingham.
Worldwide there are 1.3 million hip fractures with more than 70,000 hip fractures in the UK every year; projected to rise to more than 100,000 by 2020 in the UK. The global cost of this clinical problem is estimated at 1.75 million disability adjusted life years lost and represents 1.4 per cent of the total healthcare burden in established market economies. People suffering hip fracture have a 30 day mortality of 7 per cent and experience a persistent reduction in their health-related quality-of-life similar to that of a major stroke.
There is evidence from many countries that patients with severe injuries should be treated in specialist hospitals. In 2012, trauma services across England underwent a major re-organisation; 22 hospitals were designated as ‘Major Trauma Centres’ (MTCs) that would treat the most severely injured adult patients, even if this meant ambulances by passing other hospitals. Although this restructuring required considerable financial investment, it is unknown whether it has improved care for these severely injured patients.
Ankle fracture is one of the most common musculoskeletal injuries sustained in the UK. Many of these patients experience ongoing pain and physical impairment with the consequences of the fracture and its management lasting for several months or even years. The broad aim of ankle fracture treatment is to maintain the alignment of the joint whilst the fracture heals. More severe injuries to the ankle, those which require realignment or are expected to be unstable, are routinely treated surgically.
There are around 170 ankle fractures each day in the UK. Many of these injuries heal with support in a plaster cast or splint, but some require surgery to restore the natural alignment of the bones and fix them in place with screws and plates. This promotes good ankle function once the fracture has healed. Following surgery for an ankle fracture, patients are commonly told not to walk on the affected leg for six weeks in order to allow the bones to heal.
Every year 65,000 people in England, Wales and Northern Ireland break their hip and undergo surgery. This is a devastating injury for these typically elderly, frail and anaemic patients. As a result of the break and the surgery, 30 per cent of patients require a transfusion of someone else’s donated blood. This can lead to complications, increase the risk of infections (e.g. pneumonia or a wound infection) and increases the length of the hospital stay.
Fractures of the proximal femur (hip fractures) are one of the greatest challenges facing the medical community. In 1990, a global incidence of 1.31 million was reported and was associated with 740,000 deaths. Hip fractures constitute a heavy socioeconomic burden worldwide. The cost of this clinical problem is estimated at 1.75 million disability adjusted life years lost, 1.4% of the total healthcare burden in established market economies.
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The European Health Data and Evidence Network (EHDEN), an IMI 2 consortium with 23 partners, is a multi-stakeholder, interdisciplinary, open-science collaborative maximising the value of health data through large-scale analytics.
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The EHDEN public private project was set up under the framework of IMI2, with twenty-two partners, including academia, SMEs, patient associations, regulatory authorities and pharmaceutical companies, led by Erasmus Medical Centre, The Netherlands, and Janssen Pharmaceutica N.V., Belgium.
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