The Orthopaedic Department is a team of highly experienced Consultant Orthopaedic surgeons, Associate Specialists and Specialty Doctors who offer specialist treatments for a wide range of acute and chronic musculoskeletal conditions.
We provide a comprehensive, friendly and professional consultation where we can take a full history, perform an examination and arrange specialist investigations such as X-rays, ultrasound scan, blood tests, nerve conduction studies, CT scan, bone scan and MRI scan. We have access to physiotherapy in the community and are also able to carry out injection treatments in the clinic where appropriate.
In the operating theatres we are able to offer the very latest surgical techniques and implants so that every patient receives the highest standard of individually tailored care.
Services we provide include
- Hip, knee, foot/ankle, shoulder, elbow and hand chronic conditions-arthroplasty, arthroscopy, fusion, injection etc
- Specialist treatment of sports injuries (knee, hip and shoulder)
- Management of acute trauma and Orthopaedic treatment of acute Emergency Department referrals.
The department is supported by enthusiastic junior doctors, experienced nursing and support staff, and we are contactable via our courteous and efficient Orthopaedic secretaries.
Currently we have two full-time and one part-time Physiotherapists, two full-time and one part-time Occupational Therapists and one full-time Therapy Assistant Practitioner (TAP). We work closely together as a multi-disciplinary team.
We cover Ward 6 which is a busy 32 bed trauma ward, plus any other patients around the hospital who are under the care of an Orthopaedic Consultant.
We are also referred patients from fracture clinic. This involves seeing outpatients who have come back into fracture clinic to be reviewed by a Consultant, and now need to be taught how to walk with a walking aid or a different weight-bearing status.
The majority of our caseload is patients who have fractured bones; however, we do also see back pain and spinal cord injuries. Most of the patients we see are people who have fractured their neck of femur (hips), and we have a structured management plan for these patients as per national guidelines and best practice. We also see polytrauma patients, i.e. those who have sustained multiple injuries; as well as patients with spinal fractures, pelvic fractures, upper limb fractures and peripheral injuries.
Physiotherapists use clinical assessment of functional movements, gait assessment where appropriate, and outcome measures such as the Tinetti scale and the Rockwood Frailty Score. We also use other outcome measures such as the Berg Balance and elderly mobility scale where appropriate. This information is then used to work with patients to set clear rehabilitation goals, and to work on transfers, walking, functional strength, balance and falls prevention as appropriate.
Occupational Therapists (OT’s) use initial clinical assessment to identify rehabilitation goals, equipment needs and care needs for discharge planning. This may include assessment of wash and dress, functional movements such as transfers, and other assessments such as kitchen assessments or cognitive assessments where appropriate. OT’s will also assess home environment via access or home visits as needed to ensure a clear and safe discharge plan.
Currently there are various team projects underway. We are involved in a three-year national PROFHER-2 study which is investigating the best practice management of patients who have fractured their proximal humerus. We will be responsible for working with the Trust’s research department to collect and collate data, and collaborate with our community therapy colleagues to ensure that this process continues as per the research protocol.
Additionally, we are piloting an orthopaedic supported discharge process as part of an NHS improvement collaborative to try and ensure a more streamlined management of fractured neck of femur patients in the acute setting, and a service which can continue their rehabilitation once discharged home, prior to community therapy involvement.
We also work closely with wider networks, such as Sheffield Teaching Hospital for Spinal Cord Injury management, Addenbrooke’s for major trauma patients, and more locally with our community therapy teams to continue to streamline patients’ journeys from hospital to home.
Orthopaedic Trauma at the James Paget University Hospital has been recognised as being within the top Trusts in the country for acute therapy management of fractured neck of femur patients. Ward 6 has also being nominated for the Trust’s Ward of the Year award 2018, in recognition of its close multidisciplinary working with trauma rounds, and its incorporation of the SAFER patient flow bundle.
Links: hip sprint audit https://www.fffap.org.uk/FFFAP/landing.nsf/phfsa.html , NICE guidelines https://www.nice.org.uk/Guidance/CG124, safer flow bundle https://improvement.nhs.uk/resources/safer-patient-flow-bundle-implement/
Currently we have two full-time Physiotherapists, and the Trauma Occupational Therapists (OT) and Therapy Assistant Practitioner (TAP) cover any additional OT needs for elective patients once admitted.
We cover Ward 22 which is a busy 22 bed elective ward, plus Charnwood which is a ward for Private elective surgical patients, as well as a range of orthopaedic day case procedures who need to be reviewed prior to discharge that same day from the Day Care unit.
We also run an Elective Joint Replacement Education Group (aka ‘Joint School’) which is a group presentation for outpatients on the waiting list for total hip or knee replacements. This is run by a senior physiotherapist and covers the pathway for pre-operative and post-operative enhanced recovery for patients who are having a total hip or knee replacements.
The majority of our patients have had total knee replacements or total hip replacements; however, we also see patients who have had a range of different orthopaedic surgeries including but not limited to:
rotator cuff repair
meniscal or ACL repair
Achilles tendon repair
shoulder capsular release or subacrominal decompression
Physiotherapists use clinical assessment of functional movements, walking and step/stair assessments where appropriate. This is then used to work with patients to set clear rehabilitation goals for a discharge, and to teach post-operative exercises which are also provided in patient information booklets. Physiotherapists also work on transfers, walking, and functional strength to ensure safe and timely discharges.
Patients who are having elective surgery have their OT needs assessed and addressed pre-operatively. For patients having total knee or hip replacements, this is done in a clinic by Therapy Assistant Practitioners (TAPs) prior to patients coming into the hospital for surgery. This ensure that all equipment needed is in place beforehand, and therefore patients can be discharged back home sooner.
Orthopaedic Elective patients at the James Paget University Hospital are part of a well-established enhanced recovery programme, which has been shown to improve patient experience and recovery, as well as reduce length of stay. This has been developed in collaboration with anaesthetists, theatre staff, consultants, nurses and therapists. To continue improving this service, we will be reviewing the pathway for frailer patients awaiting joint replacement.
We now have two surgeons who are adopting innovative surgical techniques which have been proven to have quicker recovery post-operatively. We are also one of the pioneering Trusts in the country to demonstrate that there is no longer a need to have hip precautions (restricting hip movements) post-operatively for first-time total hip replacements. This has significantly reduced patient anxiety, and increased function and independence. This is now a model which is being adopted by more Trusts around the country.
Links: NHS enhanced recovery https://www.nhs.uk/conditions/enhanced-recovery/