Price Group | Knee Research Group
We focus on research that can directly improve the outcome for patients who undergo surgery for degenerative osteoarthritis of the knee.
Osteoarthritis of the knee is the commonest problem seen in our clinics, with patients either presenting with the primary condition or problems after previous surgery used to treat it.
The patient care pathway can be broken down into four key steps:
- Referral from primary care;
- The decision to undergo surgery or not
- The delivery of the surgery itself; and
- How patients are followed-up after surgery.
Our research aims to improve care at each of these points to enhance patients experience and outcome following knee surgery.
Research in detail
The Knee Research Group is led by Professor Andrew Price working in close collaboration with Professor David Beard. Our research can be considered to be in the following areas sitting across a number of different themes in NDORMS.
Exploring the aetiology, progression and response to treatment for patients with early knee osteoarthritis.
Through the Arthritis Research UK Experimental Osteoarthritis Treatment Centre (Andrew Price is Director) we are developing improved surgical care for patients with early knee arthritis.
Osteotomy around the knee offers a possible way of reducing patient's symptoms. Using finite element modeling and 3-D printing technology we are developing a new way of performing the procedure that improves outcome for patients and potentially reduces progression of OA.
In parallel we have created new outcome tools including a novel biomarker, which will enable us to perform a clinical trial of the procedure and establish its efficacy.
Improving the delivery of care for patients who undergo primary or revision knee replacement
The Arthroplasty Candidacy Help Engine (ACHE) study is an NIHR HTA funded programme grant. Its aim is to create a tool for use in primary care that helps identify patients who are candidates for knee/hip joint replacement and therefore support the referral process.
We are developing personalised decision support for patients who attend secondary care clinics, based on research aimed at identifying the optimum time for patients to undergo surgery (the PROMPt Study).
For patients who undergo surgery we are developing novel new surgical techniques to improve the outcome of knee replacement (Ligament Referenced Knee Replacement). The JAVLIN project is exploring new cost effective ways to follow-up patients after surgery. At the centre of this programme of work is the extended use of patient related outcome scores across the entire pathway.
In collaboration with Fr3dom Health we are developing PROMAPP an electronic web-based application translate ACHE, PROMPt and JAVLIN into the pathway integrating with the National PROMs collection programme. In addition Grant funding is currently being sort to extend his programme of work to enhance the treatment of patients who require revision joint replacement.
Enhancing the pathway for patients undergoing arthroscopic knee surgery
The Knee Research Group is also focused on research focused on improving the delivery of arthroscopic surgery. The group is exploring a number of aspects of this pathway; the variation in arthroscopic practice that occurs in the NHS, the adverse effects of menisectomy on the knee, developing a trial of knee arthroscopy in patients with mechanical symptoms and defining how to measure the outcome of arthroscopic surgery.
In addition, the Group collaborates closely with Professor Jonathan Rees in research aimed at improving training in arthroscopic surgery.
Developing the measurement of outcome in orthopaedic surgery
To support the programs of work outlined above the group has developed considerable expertise in the development of patient reported outcome measures. This includes creating/testing new scores and exploring new uses of established scores.
The Musculoskeletal Health Questionnaire (MSK-HQ) project is collaboration with NHS England and AR-UK to develop a new generic MSK outcome tool for use across the NHS.
In addition, the group is in the early development phase of a new method to incorporate established PROMs measurement into a multidimensional outcome tool to study and compare surgical interventions in the knee.
Developing and delivering clinical trials in knee surgery
Working closely with the RCS Surgical Interventional Trials Unit (SITU) in the Botnar, directed by Professor David Beard, at present we are closely involved in the delivery of three large randomised controlled trials of knee surgery:
- TOPKAT - NIHR HTA funded trial of partial vs. total knee replacement for patients with knee OA
- SNAPP - NIHR HTA funded trial of early ACL reconstruction vs. a non-operative strategy
- ALLIKAT - Industry funded trial of Bi-cruciate retailing TKA vs. standard TKA
- Professor David Beard
- Professor Sion Glyn-Jones
- Professor Jonathan Rees
- Professor David Murray
- Professor Hemant Pandit
- Professor Andy Carr
- Professor Philippa Hulley
- Professor Kassim Javaid
- Professor Andrew Judge
- Professor Nigel Arden
- Professor Tonia Vincent
- Professor Chris Murphy
- Professor Jonathan Cook
- Dr Fiona Watt
University of Oxford
- Professor Ray Fitzpatrick (Nuffield Department of Population Health)
- Professor Alistair Gray (Health Economic Research Centre, Nuffield Dept. of Population Health)
- Professor Irene Tracey (FMRIB)
- Professor Louise Locock (Nuffield Department of Primary Care Health Science)
- Professor Sue Zeibland (Nuffield Department of Primary Care Health Science)
- Professor Amy Zavatsky (Department of Engineering Science)
- Professor Ashley Blom (University of Bristol)
- Dr. Jonathan Hill (University of Keele)
- Professor Tony Day (University of Manchester)
- Professor Anders Troelsen (University of Copenhagen)
- Professor David Beverland (Belfast)
- Professor Mike Nevitt (SF USA)