BJJ Podcasts
BJJ Podcasts
The Bone & Joint Journal Festive Podcast 2025
Listen to Andrew Duckworth and Fares Haddad discuss maintaining methodological rigour in research, how the Society's journals and digital products continue to serve the orthopaedic community, as well as some of Prof Haddad's top article picks from 2025 and predictions for 2026.
Papers discussed:
Trends in day-case hip and knee replacement in England
Analysis of national real-world data on reoperations after medial unicompartmental knee arthroplasty
Find out as soon as the next episode is live by following us on X (Twitter), Instagram, LinkedIn, Tik Tok or Facebook!
[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 up our series for the year of 2025. I'd like to start by thanking all our listeners for their amazing support for our series. We do hope you've enjoyed the breadth of work we've discussed over the past year, which highlights some of the great studies published in the Journal each month, as well as some of the offerings of the Journal all told.
With that in mind, and to review the past year here at the BJJ today, I'm delighted to again be joined by our awesome Editor-in-Chief here at the Journal Professor Fares Haddad, who over the next 20 minutes or so will be giving us an overview of the past year. Highlighting some key papers we've published at the Journal, and finally what we might expect and hopefully look forward to in 2026.
Many thanks for joining us today Prof it's great, great to have you back with us. Andrew, great. Thank you for, for doing this, and as as we are coming to the end of the year, I, I think I should start by thanking you for doing a tremendous job on behalf of the Journal and the Editorial Society in spite of your busy schedule.
I don't know if our listeners know, but you've [00:01:00] been promoted to one of the most prestigious chairs in the UK in orthopaedics. There's all too few orthopaedic chairs in our country, and you know, as the chair in Edinburgh. Some big previous footsteps to follow from the dim and distant past and a lot of hard work and rebuilding to do, and you've done a wonderful job so far and I just personally want to congratulate you on behalf of everybody. That's very kind.
I really appreciate those words. It's very good of you. So Prof another year has passed and I think in many ways a, a positive year for the specialty as a whole. What do you feel have been the highlights over the past year? Yeah, it's been, it's been a fascinating year and a busy year, Andrew. It, it's, it's really interesting how the need for orthopaedic surgery for our services continues to increase wherever you are in the world.
And, you know, I've had the privilege of travelling around the globe again this year and seeing multiple healthcare systems at work. But what is without doubt that our services be that for elective surgery or trauma [00:02:00] are increasingly in need, and that our offerings continue to be refined and to continue to serve patients extremely well.
So I, I think it's, it's really important to recognise how important orthopaedic surgery is, not just within surgery. But within healthcare as a whole, and I think one area that probably came to my mind a lot more this year than previously is the fact that by keeping patients mobile, we're not just relieving them of pain, frankly, we are increasing their ability to live happy and healthy longer lives.
I think mobility correlates with longevity and I think that's a big, big plus for orthopaedics. From a, from a Journal perspective, that we've been, you know, unbelievably busy this year. The number of submissions continues to go up. And so you know, from a selfish perspective, it's great to see so much high quality research, although we are also seeing [00:03:00] some work that really should never see the light of day.
And I, I'm grateful to my specialty editors and to the editorial board and all of our reviewers. For helping turn everything around so, so efficiently. So that we've ended up with a, with a really nice offering what I believe is a nice offering that our readers have enjoyed throughout the year.
The first comment you made, I think it's really interesting isn't that about the frailty side of things, and I think we, we almost saw that, well, we did see that with COVID and the big long delays and how frail these patients got when they were waiting on the wait list.
And I think you make such a good point there is, it's just not about relieving pain in the hip or knee. This is about keeping people active. It's reducing that risk of, it's such an important thing actually, that isn't. We can't remember long ago, just post COVID. We coined this expression that elective surgery is not optional surgery, and I'm pleased to see the BOA and others have grasped this because we do tend to get pushed to one side when there are winter pressures.
When there are strikes when there's any you know, limitation on the system. Elective [00:04:00] orthopaedics sadly takes a hit and I think we have to keep fighting as a profession for our patients. You know, we are their advocates. I totally agree. And with regards to the Journal, I think I totally agree. In terms of that large volume of submissions that we are seeing now, I mean, what do you think has been the real key in terms of maintaining that, that high quality that we now see in the Journal in terms of that particularly that you always talk about, that methodological rigour.
What's been the key to that, do you think? Yeah, so I think we remain strict and that's the prime driver of what we publish. It's, it's got to be answering a question that's relevant to patients and relevant to clinicians, and it's got to be done in a methodologically sound reproducible way that we can understand, we can replicate it needed, that can then help surgeons and allied health professionals advise and treat their patients.
Yeah, and that's the central tenet of what we do. We are fortunate to have by our side, Bone & Joint Research to take the more basic science type of work. We're fortunate to have [00:05:00] Bone & Joint Open to take more of the if you like, the protocols, the pilot studies, the review type articles but for The Bone & Joint Journal, the methodology is fundamentally at the heart
of what we look at. And that's becoming, in some areas that's quite tricky. I think you, you and our readers will be aware of the increasing impact of AI on everything that we do. And in, in, in reality AI's going to contribute greatly to our knowledge and to our practice moving forward. But any AI innovation needs to be studied in the same way
as any other change in our practice, it's got to be looked at critically. It's gotta be transparent, it's got to be generalisable, and we have to understand it before we use it. So I think that's, that's going to be one of the challenges moving forward. It's interesting bringing up AI Prof 'cause very much it's, we almost feel like we're on Scott's parabola with it really, aren't we?
And everybody's starting to use it for absolutely everything. And I just hope with time we will refine that and it will have [00:06:00] a very, very important but very sort of, you know, refined place in what we do. Yeah. And in some places it's going to gain traction very quickly. Yeah. In others, it's going to take a very long time and, and, you know, and it'll take a while to unpick the real experts from those who are just jumping on the bandwagon to, you know, to to to, to the things that are really going to contribute on a day-to-day basis to patient care.
Whether that's, you know, predicting osteoporosis from one simple set of images to predicting the, the lifetime of a joint. From an x-ray or a joint shape early on. So I think there's lots of really exciting stuff that will come. Absolutely. And Prof sort of led into like, you know, sort of the other, other products that we sort of offer.
Obviously we have, like you say, Bone & Joint Research. There's Bone & Joint Open, which obviously has a very, very strong, strong impact factor, you know, considering how, you know, it's still relatively in its infancy in many ways. But, you know, I just wanted to talk briefly about, you know, first of all, the amazing team we have at the Journal that,
they back everything up and, and [00:07:00] also all these amazing digital products that we've developed over the past years and how they really are building that orthopaedic community, that global orthopaedic community that you've always, we've always wanted to strive for. Yeah no no. Look, it's, it's, it's a great question.
Lots of facets to this that are worth stressing. Look, the first one, which I don't think everybody realises, is the Editorial Society, The Bone & Joint Journal is a, is an independent publisher. It's a charity, and that is run by phenomenal group of staff. We often talk of Emma Vodden and her publishing team, but there's a, there's a big team there that are all working together to create all these products and actually to move the, the, the, the, the sort of if you like, the direction of the Society
to where it needs to go. And that's very different to our direct competitors, which are, you know, the, the big, big heavy hitting publishers that we are competing with. So I think the team has done an amazing job over the last ten, 15 years. We've got a, an impact factor that's up there easily in the [00:08:00] top
five or ten orthopaedic and musculoskeletal journals and, and we've stayed there for a few years. This is no accident. We're there on the basis of quality, on the basis of citations, on the basis of the quality of our authors, editorial board and reviewers. But that's also allowed us to think
beyond what is a traditional publishing model. So we've got our standard journals, we've got, if you like, a little digest journal in 360. But now we've really pushed into the use of digital products and how they are going to help our community because at the end of the day, what, what I see for the Editorial Society and for BJJ isn't just a product that helps a single clinician.
It is a set of products for our orthopaedic and musculoskeletal community to help everybody be that in their day-to-day practice, be that in their research, be that in their education, whether they are sitting an exam or just majoring in a topic. I want everybody to feel, feel comfortable, and know where the material they trust is [00:09:00] and the material they trust should be in the BJJ and with the Editorial Society.
Yeah, no, I, I, I completely echo those words, and I think, like you say. All these amazing, amazing products that have been developed over the past couple of years and really in a relatively short time span. You know, things like OrthoMedia, OrthoSearch, and now obviously re recently OrthoPublish and BJJ LIFE.
And we obviously did our podcast last month about BJJ LIFE and the benefit it's having, and I had a few of my trainees come up to me this weekend. They said they did UKITE and the most representative thing was BJJ LIFE, you know, in terms of that testing. And I think it really is amazing how that has just all come together and, like you say, covered the breadth of their training and their orthopaedic life in many ways.
That's true and it, you know, these products have all been designed to help our people you know, our community you know, OrthoSearch to kind of clear the mud that you might get with PubMed and other search engines. OrthoMedia to be a repository. For our key material, for guidelines, for things that you normally would struggle to find or not necessarily trust where you find [00:10:00] them.
And then I think OrthoPublish is a bit of a gem. You know, any of us who've spent a weekend having to reformat a paper, you know, that should hopefully be a distant memory for the next generation. Absolutely. But you know, you and I, you and I have lived through that and then, you know, BJJ LIFE, you know, I think BJJ LIFE has been really well received and actually it shows how well we work
with the BOA, it's very different from UKITE. You know, UKITE is the exam that all our trainees will continue to sit, it will help them as, as they go through their training. But BJJ LIFE is going to help people prepare for that. It's going to help them prepare for their exams and quite frankly, it'll help them prepare for their specialty and for ultimately for lifelong learning because it is reflecting what is in the literature and can take them
to what is in the literature right now. I think that's an important point, isn't it? 'cause BJJ LIFE is so much more than the questions of everything that goes with it and actually the learning that goes with it. I couldn't agree more. And I, I say a, a, a, as you always say, a big shout out to Emma and her team on an amazing amount of work that has gone into that and an incredible, incredible product.[00:11:00]
So, Prof, if you move you know, now just briefly to talk about a few of the highlight papers from the past year. And as I'm, I'm sure some people know Prof sent me quite a few and we sort of narrow them down 'cause there were so, such good quality out there. And you know, it really does emphasise, again, I think the level of evidence, the level of methodology and the quality of work being published in the Journal.
And also, as you said in our open access journal, BJO and the first of these papers, highlights know that's, you know, increasingly relevant to our colleagues. And there's a few papers here that I have a theme really to it, and that is the work from Mike Whitehouse's group in Bristol looking at trends in day case, hip and knee replacement, using data from the NJR and a, a really topical, topical study this.
Yeah, no. Look, I, I, I enjoyed this and, and, and for a number of reasons. I think the first thing to say is that I was the biggest critic of registry data when I took over the Journal. There was a lot of poor quality analysis, a lot of flawed interpretation, a misconception of what is association and what is causation and yeah, frankly, [00:12:00] we were doing ourselves disservice in the way we were using big data.
Yeah. You know, the guys have stepped up and they've stepped up, particularly in the UK and Mike Whitehouse has led a team of statisticians and data and analysts who've done a phenomenal job with the National Joint Registry. So everyone needs to be really proud and recognize what Mike has done because he may not be the face at the front of it.
You know, you, you see other great people sitting as the medical director and the chair and the, you know, the voice of the NJR. But actually the real engine is Mike and the group in Bristol who've done the data and frankly raised the bar because the quality of what you see coming out there is, is very, very sound.
So now we're pleased when we see good data from them and. Often just reading the reports is, is useful in its own right. And I think other registries have had to step up and match that and they all haven't done it to the same level, but everything's moving in the right direction. But this paper's interesting because outpatient [00:13:00] hip and knee replacement or day case, hip and knee replacement, as we call it in the UK, has become such a topical, big subject worldwide.
And yet here's a real world analysis saying, you know, we're down to less than 10% for unis, and down to sort of 1% for total knees and total hips. Which, which makes you think, you know, what are the drivers here? What are we doing right, what are we doing wrong? You know? Is, is the US model, is that a patient centred model or is it a surgeon centred model?
Is it, is it about the money for the surgeon? Is it about actually patient welfare? Do patients really want to be day surgery candidates for joint arthroplasty? They had no choice during COVID, which is when we had that spike in the UK. But it hasn't kicked on dramatically since then. I'm sure it's going to continue to increase, but this data is, is impressive.
'cause it shows us if that is the way to go. We've got a long way to go in the UK. Yeah. Yeah. There's certainly, the numbers are not where you really, potentially expect them to be, would you, in terms of, it's [00:14:00] not the astronomical rise that one would potentially anticipate from that data. And like you say, it's, it's going that way, but it's certainly not the massive frame shift that we're some, maybe, maybe would have a suggest.
And that sort of leads us on a bit, a bit to the next paper Prof. You know, looking into, and this is from our colleagues in Argentina. And they were looking at a you a slightly related thing looking predicting the necessity of routine postoperative lab test after primary total hip arthroplasty and whether they're sort of required or not.
And it's got, it's quite an interesting data set this. Look, it's fascinating. First of all, look, this is a nice paper from Argentina and that's really important 'cause that shows the international nature of what we do. And you know, they've, they've not only got a good quality database, but they're asking actually quite an important question in terms of health resource utilisation.
You know, not everybody needs a full blood count using these LFTs, et cetera. On the day post surgery, frankly, not everybody needs a test the day post surgery 'cause some patients are fit and well and [00:15:00] have, you know, low complexity surgery and it can be perfectly fine. But then they've used some really nice methods to if, if you like, analyse and model
that data. And so there's a lot to learn from that. So I, you know, I really value work coming from all over the world, how we all teach each other. So I really like this paper. But, you know, the message here is that we can probably predict which patients can have short stay surgery, which patients can be done in a day surgery unit.
You know, the, the ASC model, ambulatory surgery centre model in the US will inevitably in some sectors follow in the UK. And we will do more patients. Yeah. As day case or overnight or short stay. But beyond that, if we can save on investigations that will just facilitate that journey, absolutely. That will make it much easier.
And actually, as you say, this is just another piece of that puzzle of trying to tell us which are the ones that might be suitable for that and not, which is, like you say, it's just building all that together to knowing that it's, like you say, not a full frame shift, but actually for some people this is [00:16:00] very appropriate.
And you sort of mentioned about, you know, data from, from elsewhere. And I think the next paper is another good example of that, you know, out with the UK and that's from the Danish Knee Arthroplasty Register. And that looked at almost two and a half thousand medial unis and the indications and the number of operations following this, again, some really interesting and, and, and strong data from a, a good registry.
Absolutely. So, you know, Anders Troelsen has done an unbelievable job in Denmark. You know, both in terms of a culture of doing randomised studies as well as good quality registry work, as well as an evidence-based approach to unis that has really made them a big uni country. So, and you know, the uni literature's been dominated by one implant, one set of authors for so long, particularly in the UK.
And here we've got real world data at a population level. It's really powerful from a country looking at complications and at the risks and actually the profile looks really good. [00:17:00] The Danes have moved towards more unis and their data looks very compelling. You know, the complication rates are low and they're even learning from this data in terms of, you know, if you have a fracture, quite frankly, think hard about a revision.
Rather than fixation. 'cause the data is not so good from that point of view. Yeah. If you have an infection, let's learn. Sometimes DAIR work, sometimes DAIR doesn't work. But in reality, this is a hugely supportive data set for unis and suggest that the direction they've taken is one that others may yet wish to follow
in terms of increasing the proportion of unis, we've talked about it, we've done it in some centres in the UK there are other countries. Notably North America where the rate of unis is still very low and where frankly they probably still have much to gain from this kind of experience. Absolutely, absolutely.
And Prof that sort of takes us nicely onto the, the last study, which I, I thought was really interesting. And again, you know, I think very [00:18:00] topical and looking at the role of PROMs and, and when and if they're acquired after total hip and knee arthroplasty. And, you know, this was again, another example of a different methodology, systematic review with meta-analysis, but one that, you know, uses really robust data.
And this was 24 studies all RCTs from memory that had baseline PROMs and PROMs at more than five years and, and some really important take home messages from it I think. Yeah. Absolutely. I think we we're in an era where we're tussling with that balance between innovation and regulation.
Yeah. And my sense is regulation and control are starting to dominate a little bit and that desire. For more data, for more evidence has penalised us already in certain areas. In in Europe with EUMDR and UKCA, we're lagging several years behind with new techniques, new implants. That is going to hurt some of our patients the need for long-term data.
It's particularly been mandated in the US [00:19:00] but actually, quite frankly, the need for data here has taken away a large number of oncology implants of hand implants of foot implants. So even though those are rarely used, it doesn't mean they're unimportant. And so this has really penalised patients. So suddenly doing a piece of work to try and reduce that burden and possibly challenge the the need for collecting PROMs for ten years, when in reality.
The data you get year one, year two is probably the most compelling and most important data. Beyond that, the drift is probably not related to your intervention, but is related to other things and, and the cost of finding those patients and getting their PROMs later on. So this is an important paper 'cause it's a key challenge to, if you like, a regulatory demand and sometimes.
We as a community 'cause we don't really have a voice. Yeah. In the EU or, or, you know, in, in, in, in the US mandates that, that we've gotta be able to use our research to lobby [00:20:00] from that point of view. So I thought that was a really important paper from that perspective. No, like, say, it's like it's using that data and good data to actually argue the point.
And I think I totally agree. It was a very compelling, I thought that. So Prof those are our studies, you know, and just to sort of wrap up, you know, you know, looking forward to the year ahead, what do you think 2026 holds for both, I suppose our specialty and, and for us at the Journal. Well, I mean, hopefully it's going be another good year.
I suspect it's gonna be a busy one. I think, you know, hopefully all colleagues will get the to refresh, recharge over the holidays and then go again in the new year. I'm very optimistic that we're seeing more and more good quality research in our specialty and I think, you know, I would urge everybody to come together, think of the important questions that we need to answer for our specialty, for our patients, and, and frankly, to work together to get answers to those 'cause that's
actually what we need to do to, and as a specialty, you know, we are unique. We, we can continue to innovate, we can continue to do [00:21:00] things to improve the quality of life of our patients. And you know, I think every day, every time, you know, I rather unusually for an Editor-in-Chief, I still operate three days a week and I really enjoy doing it.
I enjoy seeing my patients, I enjoy treating them, but actually the impact that we have through innovating, through research is actually much greater than the impact on an individual patient. We can impact on a much larger scale nationally and internationally. So I think people should continue to think of important questions and do good research.
Yeah, no, that's a I think that's a really nice point to finish on Prof. And so, you know, thank you so much for an excellent overview and you know, what has been a, I think agree a very overall positive year for both our specialty and certainly for our Journal. And as ever, it's been great to talk to you Prof.
Andrew, thank you as ever. You've done an amazing job. And finally, we'd like to wish all our listeners and our wider orthopaedic global community a very happy, festive period and on all the very best for 2026. We at the Journal, thank you so much for your continued support. Stay safe and well. And thanks as always for [00:22:00] listening.
Take care everyone.
