The Bone & Joint Journal Festive Podcast 2022

Listen to Mr Andrew Duckworth & Professor Fares Haddad discuss the challenges orthopaedic professionals have faced in the last year, their top picks from The Bone & Joint Journal in 2022, as well as celebrating progress made with Bone & Joint Open, OrthoSearch and OrthoMedia, and looking forward to research in 2023.

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Transcript

[00:00:00] Welcome everyone. I'm Andrew Duckworth and I'd like to thank you all for joining us for our special festive edition podcast to round off our series for the year of 2022 for what has been and continues to be a challenging and, and rather tumultuous year on many levels. Today I'm delighted to be again joined by our Editor-in-Chief here at the journal, Professor Fares Haddad, who over the next 20 to 30 minutes we'll be giving a hi his overview of the past year, highlighting some key papers we've published here at the Journal, and finally maybe what we can expect and hopefully can look forward to in 2023.

Many thanks for joining us Prof. It's always great to have you back. Andrew, thank you. Thank you so much for hosting this and for the wonderful job you've done with the podcasts again this year. They really are a, a great part of the offering from the, the Journal and the Society, and we're all very grateful to you.

Thanks very much, Prof, that's very kind. So, Prof, if we kick off, you know, another year has passed and sort of emerged from the pandemic now, but you know, further significant challenges have been presented to both the world, our, you know the, our, our, our nation and our healthcare system over the past year and continue to, [00:01:00] to do so.

What do you feel have been, I suppose, maybe a positive note, the biggest achievements of the past year for our specialty and, and what the challenges have been as well. No, no. I mean, it's been, you know, another really tricky year in, in that we are trying to recover. We are, we're trying to leave the pandemic behind, but we faced a number of huge challenges as a country along the way.

And, you know, nationally and internationally the pandemic has now been partly overcome, but we've still got a tricky situation with some wars going on. We've got economic challenges and frankly, we've still got a workforce that has had to bear the brunt of a really very challenging three years.

Yeah. And I, I think. We have to continue to be mindful of that workforce both in terms of the productivity and the work that we need to do for our patients who've been waiting for treatment, both in the UK and worldwide for such a long time, but also of the next workforce and o of the trainees and the others who are coming [00:02:00] through, for whom the last three has been very difficult and whose training may not have been what they wanted it to be.

Yeah, so, so I think it remains a, a, you know, a really challenging time for everybody. But within our profession in particular, I, I think there's still a a, a great deal of burnout. And, you know, there, there are a, a lot of people who are still not at peace with themselves and at peace with their work and, and probably are not able to enjoy their work as they did before.

No, absolutely Prof and I think it, it, it seems more common than ever that doesn't it. And, and I think it's, like you say, it was, it was hard during the pandemic and it, and there are just other challenges now, and it's just, it's, it's, it's hard to see that light at the end of the tunnel sometimes, isn't it really?

It is. But having said that, I think we have to admire the resilience. Of our profession and our colleagues and, you know, there has been a huge push against all the odds. Yeah. To, to meet the backlog, to restore scheduled and elective care across the country and to really [00:03:00] get going on this huge tsunami of patients who've been waiting.

You know, I think we've all now become accustomed to the fact that many of our patients have become very deconditioned. Many of our patients have deteriorated both physically and mentally with their arthritis and their allied conditions over the COVID time period. And so their care has become more tricky, and I think our profession, profession has risen to that task.

And we are working our way through this backlog. And, you know, we, we, we must always remember that we're blessed in trauma and orthopedics that we have some really highly effective procedures that change people's lives and we need to continue to fight. Yeah. To be able to deliver those. And I think, I think that's what the profession's going through and is about to go through for another winter.

No, I agree. I agree. And I think, like you say, you just hear from my, all my colleagues and both here in Edinburgh and throughout the UK, we all continue to advocate for our patients and, and, and for our specialty to try and provide those, [00:04:00] like you say, those very effective interventions that we, that we offer.

And in terms of, you know, moving to the journal, how, what's the past year been like for, for the team here at the Journal and all the amazing work that they do. No, it's been a, a really impressive year. I think people have really adapted to working differently and now have found a hybrid model whereby, you know, we have a wonderful base in London, as you know, but people are in the office less than they used to be, and we're now considering quite how we use the office space.

But we've, we've kind of managed to come back in. We've come together. We've had face-to-face editorial board meetings. Again, we've had face-to-face council meetings. So we've had the, the opportunity to reset the strategy and look to the direction for the journal and for the overall society as to what we are doing now, how well we can progress in future, and what the future vision's going to look like.

I mean, ult, ultimately the, the journal. It's a close-knit family at the center. We've, we, you know, we've got, we celebrated 20 [00:05:00] years of Emma Vodden at the Journal this year, which is remarkable. And those who come and meet us at the stand at meetings or come to our receptions will know she's very much the face of the, of the journal on the publishing side.

And, you know, 20 years supporting, growing these products is, is phenomenal. And around Emma is, is, is a very close-knit family and beyond that is, is the community of the journal. Yes. And, and I think we've seen, in spite of the the challenges of the pandemic and sort of hybrid working, we've seen the journal really progress this year.

Yes. It's, it's been a fascinating year in the sense that research has rather changed a little. I think people have been catching up with studies, you know, lots of our studies failed to recruit or recruited very slowly during the COVID pandemic. So whilst we saw a sharp upsurge in submissions during COVID, when people were catching up on previous work, reporting their cohorts, their series, searching their databases quite frankly, now people are getting back stuck into their clinical work.

And the studies that should have been producing data [00:06:00] during COVID often haven't. So I think we've seen fewer submissions. But we've still seen some really good quality publications. On the other hand that's given us the time and the energy to focus on other products, other in initiatives.

And if you like, our digital offerings at the journal. Absolutely. Er no, and I echo those comments particularly like you say regarding Emma and her 20 years here at the Journal. And you sort of, what you just mentioned perhaps sort of leads me into my, something I just wanted talk about, just two things on our digital offering, which we'll come onto, but just to, just to highlight, you know, the, the really exceptional growth that the Bone & Joint Open has had, you know, our gold open access journal and how that has really just gone from strength, to strength and, and very soon will have its own impact factor.

Yeah. I mean, this is remarkable. It, it is. As you know, I, I edit BJO with, with the help of Alex Liddle as well as the BJJ. And, and this started just in January, 2020. It has been a phenomenal growth so that we've now published over 300 papers over, over the [00:07:00] past three years. BJO's now really well recognized by our community.

It's got a growing base of registrants, of supporters and of, of people on social media. And it's fully accessible on PubMed Central and in the directory of open access journals. And as you mentioned, from 2023, it's going to have a, an, an impact factor. And by our predictions, that's going to be a really, very good

impact factor that people will be surprised by. And that, and that's a testament to, to the quality of the publications that have gone in there. I think it, it's probably worth stressing. To our, to our listeners that BJO is a journal that people can submit to directly, but also if a paper is submitted to The Bone & Joint Journal

and it's reviewed by our, our excellent group of reviewers. So this paper's already been looked at. It's been digested by our reviewers, by our associate editors. That paper may come [00:08:00] back and we may think this is methodologically sound or this is interesting work, but it doesn't quite fit into the BJJ in terms of its impact or, or, or, or its quality, but it nevertheless is above the bar.

Then we offer those authors the opportunity to publish in BJO and, and an increasing number of authors are taking that Bone & Joint Open option because they recognize its quality. And, and it's reach and it's, it's probably worth briefly giving you one, one good example. If you've, you know, been in, looked in the news for orthopedic news in the last couple of weeks, you'll have seen the storm that's arisen over over knee replacements and where the, the media's unfortunately taken the, the, the failure of a small subset of the next gen knee replacement and

amplified that and scared many of our patients. Now, the reassuring thing is that this is, you know, a couple of femoral designs, designs with one tibial design. But actually the, one of the first reports on this, in fact I think [00:09:00] probably the first report was in Bone & Joint Open for Eric Masterson and his group this year.

So we're, we're, we are publishing some really good quality material and material that would be looked at and referenced in Bone & Joint. Yeah, no, absolutely Prof. Like you say, it started off for, you know, with having a lot of COVID work in it, didn't it initially, and really the growth that was started with that.

But the quality of the work and the breadth of the work in now is, is really, really impressive. And also it does publish things as well, like you say, like protocols for trials and things like that, that it covers and all, all I would say, and I think a lot of people would know at a very reasonable open access charge compared to a lot of the journals that are out.

No, no. I mean, it, it is extremely affordable. Yeah. Absolutely com compared to most APCs. And and so we would encourage people to look at that. Absolutely. And, and just before we move on to the highlight papers Prof, just very briefly, sort of, you know, we've talked about these before, but you know, the, the, the digital products that are being developed by the team at the journal, really, really amazing.

And particularly things like OrthoMedia and OrthoSearch. They are really [00:10:00] growing rapidly and are really impressive. They are. And it's a testament to, to, to our team and their hard work. And as I was saying earlier, the attention's been directed, if you like, a away from the core work because we've got the core work under control at the moment.

And the society sees its mission as helping and educating orthopedic surgeons. And so both those offerings are directed at our trauma and orthopedic community to basically allow searches to occur. We all do them. We do them in different ways on different platforms to occur in a, in a bespoke way that's designed for orthopedic surgeons to deliver what they need.

And so I think people will find OrthoSearch extremely helpful. It isn't centered in any way on the journal. It, it is neutral. It is really just designed to give you access to the best material, but it is designed, if you like, by orthopedic surgeons and their teams and their publishing teams [00:11:00] for the orthopedic community.

So I think people will, will enjoy that and it will become their search engine of choice. They'll, they'll find it incredibly useful. Lots of ways of downloading PDFs, ways of linking, ways of sighting that make life much easier than many of the standard platforms. And OrthoMedia is a phenomenal repository for

the good quality material that is presented and created all around in various meetings. It's just great to bring it all together for our community to be able to access it in in one place. You know, in increasing, increasingly we're finding different ways to learn. Snippets of a video there, a presentation there, a lecture there.

We want to be able to do it on the move. The podcasts are one way that we're delivering that. But if you look at OrthoMedia, it is a wonderful resource that the Journal and the society are providing for our members. No, I totally agree. And like you say, it is a real way that it's serving the community in a really large way.

Throughout, not only the UK, but the world. And I think Emma and her team would be happy for us to say, you know, it is [00:12:00] something that's evolving and you know, we, we, we need people to go and use it. And if you, there's feedback you have that can be helpful, we will, we'd always welcome it, wouldn't we? Absolutely. You know, it is work in progress, but it is already tremendously useful.

Absolutely. And, you know, we will evolve it and progress it with our community. Definitely. So Prof, if we sort of move on briefly to a few highlight papers from the past year, which you've published, which we've published, here at the BJJ and you've kindly picked for us, I can say there were, it, was it there, there were several ones that you sent through to me and, you know, we could, we could have picked any, any of, of that, of that group, but just, just to, I thought we'd highlight a few, which I think these papers highlight the quality of the work

that now is being published in the journal. The level of evidence now that is becoming common place in the journal. And the first is sort of very topical looking at biologics, PRP and is from the group in Australia was a double-blind, randomized placebo controlled trial, comparing three groups of patients with early stage symptomatic knee OA.

And they received either a placebo injection with some saline, a one PRP injection followed by two placebos or three PRP injections. A really interesting study [00:13:00] Prof, isn't it? And it's sort of, there's a lot of nuances around the literature in this area as we know. Yeah. No, this, I mean, this is, this was outstanding, as you know, I, I keep talking and writing about the importance of level one data and, and the importance of us raising the bar Yeah.

In our specialty as to how we do research, how we answer questions. And, and, you know, this is an area that is of great interests to our patients and to our community, to industry that, you know, the holy grail, this sort of regenerative biologic area. Where we can treat osteoarthritis without metal and plastic and improve patients symptoms.

So, but sadly, this area is also dominated by bias studies generally with conflicts or industry drivers behind them, or poor reporting. And as you know, Iain Murray and I and others and Scott Rodeo have written in the journal in the past about the, the, the importance of high quality studies in this area of avoiding conflicts [00:14:00] and of appropriate reporting.

So this I really enjoyed reading and was delighted we could publish from this excellent group. Yeah. You know, th they've managed to show the power of placebo, and in this study with this particular PRP, not really show a benefit for patients. And I think studies like this and there are others are, are very important for us to be really pragmatic.

Absolutely. In, in our interpretation. We must continue this regenerative drive, but we need to do it in a you know, clinically robust way that is unconflicted. No, absolutely Prof. I think, like you say, until you actually delve into these studies a little bit more in terms of, like you say about the, the bias or the conflict that's in there, but also things like, you know, the standard standardization of the type of PRP that you're using.

I mean, people think PRP is one thing. It's such a range out there and actually often not reported in a, in a proper way. In some studies you don't even know what they're actually using or how you would recreate it. So I think it's a real, a real good highlight paper of and, and, really, I suppose in some ways a good starting point to [00:15:00] continue to build from, isn't it. A absolutely key study,

key messages. Let's not raise false hopes in our patients. Let's, you know, let, let's recruit patients of all studies rather than offer them unproven treatments. You know, just on, on the basis. And remember, these things are expensive. Absolutely there's a mustn't forget that. But I think we have like many other areas, we've published criteria for what we like to see in these studies in terms of reporting and you know, we would commend people to see those, read them and use them to plan their studies.

Absolutely. Absolutely. So Prof, that takes on to our next study which was reporting on data from the Sweden spinal stenosis study. And again, you know, a prospective randomized trial, over 200 patients with central lumbar spinal stenosis at one or two adjacent levels. And they were randomized into two groups of decompression alone and decompression with fusion.

And again, a large RC T you know interesting primary outcome in many ways. But again, you know, actually, a study that is actually answering a, a, a really important clinical question, but in the right way. Yeah. I mean the, the [00:16:00] ability of our Scandinavian colleagues to do these randomized studies Yeah.

Is, is, is, you know, second to none. Yeah. They are, they, they are extremely impressive. And, you know, this is answering a, a, an important question, I think for many orthopedic surgeons. Remember the spinal world has, orthopedic surgeons, neurosurgeons, there are often divides over what people like to do.

I, you know, the, the, the, the bias of the orthopedic spinal surgeon would be towards adding in a bit of stability on top of the decompression. And yet here we've got a study, a high quality randomized study that is giving us an opposite, opposite signal. Yes. So I think that's, that's really important.

Now, I, I spend a lot of time, as I'm sure you do, and other colleagues on the board do trying to focus our randomized studies towards you know, PROMs and pa patient specific outcomes as, as the direction of travel. And, you know, in an NIHR, as you know yeah, look, looks at that as an absolutely necessary thing

at the heart of our big randomized studies here, they've [00:17:00] got a, a radiographic outcome study, but they've looked at clinical outcomes. But I think it's a valid radiographic outcome. It's, it's, they've done it extremely well. Agreed. Really good methodology. It looks like, you know, very robust reporting. Yeah, so it, it's, it's, it's, I, I'm excited by the fact that people are doing these studies.

I'm really excited by the fact they're being published in the journal. Absolutely. Absolutely. And, and finally, Prof, just going on to the sort of, maybe not one paper, but just highlighting a type of paper that we've, we've published more at the Journal in the past year or so, and that was to highlight the COMPOSE and OPEN studies, which are ex excellent examples of UK trainee, collaborative projects and, and how

they really have been really a, a successful, but actually are really used at providing large baseline epidemiological and management data. You know what, in the COMPOSE study, it was periprosthetic fractures per prosthetic fractures and in the OPEN study, open fractures, but really valuable data not only just to have in the literature, but also to build from and build our, our trials from as well.

You know absolutely. I [00:18:00] was really pleased that we were able to publish both of these papers. You know, both are trainee collaboratives, but they're trainee collaboratives that I think are well guided Yeah. And well led. And, and that's really quite important. And I think they'll, they'll, they'll give us baseline data to inform future data collection, future studies and to really build on as a community.

I think it's, it's always been challenging and as you know, there's, there's been this desire to have trainees publish. Yeah, in order to progress with their careers. And I still think that's very important, but how you publish and where you publish and what you get from it is really, really critical. Yeah.

And you know, publishing a. You know, a case report in the journal of what you had for breakfast is not, it's not that valuable to me in terms of what people can do to interpret the literature and to interpret what's happening around them during their career, but getting trainees involved. In these high quality collaborations and getting them to meet the, the, the [00:19:00] leading researchers in our field and getting them to understand what are important questions, how to collect data, how to analyze it.

I think that sets us up very well for the future of academic orthopedics and trauma. And the, there'll be the, the future leaders of research and I'm hoping future reviewers, future board members, and hopefully one of these people will step up and eventually allow you and I to have a rest and take over.

No abs. Absolutely. And like you say, I think it's given those really important building blocks for good methodology from an early stage, isn't it? And it's so vital and like you say, a really good way to, a really good way to do it. But I think they're two, two really good studies and, and provide such important data.

So, so Prof, just sort of finishing up just conscious of time, what, what do you think, you know, looking ahead for the year ahead, you know, what do you think are the challenges or maybe things to look forward to for our specialty and for the. Yeah, no, I think it, it is great. I'm optimistic. I'm, I'm, I'm always optimistic.

I'm, I'm looking forward to 2023. I, I think we're getting back on our feet. And so from a [00:20:00] research perspective, I think we're going to see more high quality studies, more high quality research. I hope the economic turn down and, you know, the cut in funding for the BRCs and so on isn't going to see a reduction in good quality orthopedic studies.

So I think we must continue, we must continue to develop, grow, and fund the next generation of academic surgeons. But so I'm optimistic from a research perspective, I'm hoping that we can continue to lobby for standalone orthopedic facilities to treat our patients. All year round so that the winters aren't too tough.

So I think we've got a massive backlog and a, a huge need to deliver our surgery. So I hope the orthopedic community's gonna be busy in in 2023. I, my feeling as a trauma community has been pretty busy anyway, in 2022 and slightly to continue to be busy. But I think we, we've got a lot to do. Yeah. We should keep doing it both on a clinical and research and a training and education level.

And at the journal, you know, we're gonna continue doing what we're doing. We're I [00:21:00] think we are continuing to set the bar high. And I think my, my solution to the fact that we're setting the bar high is, is, is, is going to be just to accept that there are some studies that are likable and that are potentially plausible, but that we are not going to publish in the journal because they're not going to change clinical practice.

So we are going to focus on practice changing high quality methodology in the journal. We're going to invite more expert matter and systematic reviews to be put in the journal as well. And we're going to continue with the digital products. I think you'll see, OrthoMedia and OrthoSearch expand and improve. And we've got other offerings on the way, including an improved website. So I think our, our, our readers have a lot to look forward to. Absolutely prof. Well, I think that's a really nice place to finish and, and all we have time for, but thank you so much. As always, excellent overview of what has been another, you know, good but challenging year for everyone. And as ever, it's, it's been really informative and always great to talk to you.

Thanks Prof. Andrew, thank you. And Merry Christmas and Happy New Year to you, your family, and all our [00:22:00] community. Absolutely, I'd like to echo that as well. And finally, as ever, we, we'd like to wish all of our listeners and the wider community a very hap happy and festive period and all the very best for 2023. We at the Journal, thank you so much for your support.

And stay safe, stay safe everyone, and thanks for listening.