Aspects of orthopaedic surgical research with emphasis on surgery in haemophiia and immunocompromised patients

  • W. J. Ribbans

    Student thesis: Doctoral Thesis


    Ninety-three publications have been presented from the last 22 years.This body of work represents an opus of publications from the author's own medical qualification, in 1980, until the present day. They vary from short abstracts representing research presentations at scientific meetings through to major multi-centre international studies and significant contributions to medical texts. They are accompanied by an overview, which details original contributions to medical knowledge and superior methodology, reinforced by calculation of a citations index, which demonstrates the impact of such research on the medical community.

    The overview has chosen to collate the output into four main clusters of which Haemophilia represents the largest numerically, with forty-seven contributions, and the most significant scientifically. The other three groups represent Infection,
    including HIV and Hepatitis, Trauma and its sequelae, and General Surgery and Orthopaedics.

    Contributions on the issues of surgery on HIV positive Haemophilic patients, the more general problems surrounding surgical intervention in Haemophilia, and the natural history of Orthopaedic pathology in these patients has been the area where it is felt the most significant contribution has been made.

    Papers have been published demonstrating the generally positive clinical and economic outcomes following different forms of joint replacement in Haemophilia. However, the markedly increased infection risks following joint replacement in HIV positive Haemophilic patients has been highlighted in the largest paper published on the subject, combining the results from many different countries. In contrast, by access to historical laboratory specimens, it has been shown that Orthopaedic surgical interventions have not adversely affected the natural history of HIV in terms of immune competence.

    A number of papers have been published on the subject of the natural history of ankle arthropathy in Haemophilia - an area under investigated in the past. A critical review of accepted scoring systems in Haemophilia has been published with a more scientifically evaluated system suggested in its stead.

    The Infection section has developed from the initial interests in the problems encountered in Haemophilia. Further work has been undertaken evaluating protective gloves designed to minimise injury to staff during high risk procedures and the more general exposure to HIV and Hepatitis in general Orthopaedic practice.

    The Trauma section presents a number of varied papers in terms of publication type and subject matter. The randomised prospective paper on intertrochanteric fractures of the hip, demonstrating no advantage in outcome following a more
    technically difficult surgical procedure, is an important contribution to the iterature. The first paper published on the pathology demonstrated by CT following an initial shoulder dislocation has been a similarly influential publication - as demonstrated by its citation count.

    The final section on General Surgery and Orthopaedics provides a catholic collection of publications reflecting a number of surgical interests and career appointments. One paper from this group was particularly influential. It evaluated the outcomes of knee arthroscopy as a day case procedure and it was an mportant contribution at its time, as witnessed by its widespread acceptance as normal practice sixteen years later.
    Date of Award2003
    Original languageEnglish
    SupervisorDanny Saunders (Supervisor), Peter McCarthy (Supervisor) & Maggie Kirk (Supervisor)


    • Orthopedic surgery
    • Research

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