Orthopaedics research

Nottingham University Hospitals boasts a depth of expertise in investigating diseases that affect people’s skeletons, joints and muscles, as well as conducting research into areas including trauma surgery and fractures. 

Our research teams also work in partnership with the NIHR Nottingham Biomedical Research Centre (BRC) to translate research about common musculoskeletal diseases such as arthritis into breakthrough treatments that benefit millions of patients living in Nottingham, nationally and internationally.

Exercise and rehabilitation interventions

Knee osteoarthritis causes the cartilage in the knee to grow thin. This means patients’ knees don’t move smoothly, becoming painful and stiff.  Severe osteoarthritis makes the knee unstable and painful. Current treatment options for osteoarthritis pain include - for very severe cases surgery - meaning total knee replacement. Less invasive options recommended by NICE are:

• Education (learning how to cope with the disease)
• Weight loss. This is a good idea for overweight people to reduce also other diseases but is difficult to achieve
• Over-the-counter pain killers such as Paracetamol or Ibuprofen, which can have some side effects, and are not very effective
• Prescription pain killers such as opioids, which may have serious side effects and induce addiction
• Exercises to strengthen muscles and relieve pain, which are safe and effective

The problem with exercise programmes is motivating people to keep performing the exercises several times per week. 

The Nottingham BRC has used an exercise intervention initially developed in Sweden in face-to-face visits in >70,000 people. This was then adapted into an app, with videos taking the patient through the exercises step-by-step and helping the patient track progress. Recruitment started in Oct 2018 and the research was published in the JAMA Open Network.

We found that substantial improvements are seen within six weeks of exercise delivered via a smartphone or tablet computer.

People in the exercise group were able to get up from a chair and walk faster, increased the number of “chair stands” they could do in 30 seconds, and then increased the strength of their leg muscles.

Digital health exercise

• Is an effective way to significantly reduce/manage pain in people with knee osteoarthritis
• Increases the muscle strength of hamstrings and quadriceps
• Improves functional abilities (such as walking, getting up from a chair)
• Improves the self-satisfaction of patients with their daily living activities
• The improvement in functional ability is correlated with increased leg muscle strength

Our researchers are currently exploring how to deliver the same type of exercise for people recovering from surgery.

Surgery and fractures

The Nottingham Surgical team is working closely with the British Orthopaedic Association on a mechanistic translational study called OPERA (Orif Procedure mEchanisms of Rib fixation).

Broken ribs are a serious injury affecting both young and older people and usually caused by a serious accident, such as a car crash. They cause pain and difficulties in breathing. 

Both pain and loss of oxygen (hypoxia) cause a response in the body which results excessive  inflammation. When patients can’t breathe deeply or cough, they are more likely to get a chest infection. 

Our bodies normally release chemicals into our blood to fight infection or heal injuries. When the levels of these chemicals are too high, it can cause organ failure or death. This is called “systemic inflammatory response syndrome” (SIRS) and is common in severely injured patients. Some patients also lose a large amount of muscle and these people seem more likely to perish. 

However, people with broken ribs can receive surgery and our study aims to show that this group of patients are less likely to die. A key question is: is that because they get less of the inflammatory chemical imbalance? 

The ORiF research study is studying the potential benefit of performing surgery for broken ribs. As part of a new project called the OPERA Study, researchers are collecting blood and stool samples from 108 injured patients from the ORiF Study.

We will use these samples to measure the levels of chemical imbalances after broken ribs and see if the effect of reducing pain and hypoxia from surgery reduces inflammation as well. 

Research aims 

We will understand what molecules are altered when surgery is performed to repair a person’s broken ribs, so they don’t become seriously unwell or die. 

We will identify who develops a chemical imbalance after broken ribs, and who does better after surgery. We want to answer four questions that will help us treat patients in future: 

1) Does surgery reduce the inflammatory chemical imbalances?

2) Do some people benefit from surgery more than others? 

3) Where should we focus future research to develop new related treatments to increase the benefit of surgery? 

4) How well do biological and patient characteristics predict recovery after surgery? 

Study design 

This embedded study will use biological data, data from the ORiF trial and a large national dataset of injuries. We are measuring substances produced by blood cells during healing and muscle loss and looking at scans performed during the care of these patients to assess their muscles.

We will also measure the types of bacteria present within the gut and a substance produced by harmful bacteria to measure leakiness so we discover if bacteria are moving from the gut. We will make comparisons between people with rib fractures who receive an operation, and those who don’t. 

Statistical modelling will also show us which of the things we have measured are important, and how they may affect patients’ recovery. This will allow us to better understand where we can target new treatments to go with surgery. 

Clinical Physiology

We have state-of-the-art facilities to research human health and performance in the group led by Professor Philip Atherton, Dr Beth Philips and Dr Dan Wilkinson. Coupling researchers in physiological/exercise (cardiovascular, metabolic, functional and motor), nutritional (appetite, energy, balance and obesity), psychological (behaviour and motivation) and physical (MRI) sciences:

This multidisciplinary group is currently using Mass Spectrometry to investigate the molecular basis of musculoskeletal ageing as part of the metabolism research area.