The TARVA video produced at UCL and the Royal National Orthopaedic Hospital aimed at encouraging participation in clinical trials has won a prestigious national award.
The film was directed by film maker Jan Letocha and features Hollywood actor Sylvester McCoy, as well as other patients discussing their experiences with ankle replacement and ankle arthrodesis.
The TARVA trial is the first randomised clinical trial comparing total ankle replacement against ankle arthrodesis for patients aged between 50 and 85 with ankle arthritis.
Full details on the TARVA trail can be found at the project website. You can also follow the trial on Twitter@TARVA_Trial.
Everything that you want to know about ankle arthritis in one concise booklet.
Ankle arthritis can affect your quality of life as much as end stage heart failure and end stage hip arthritis.
Every patient deserves access to relevant, high-quality information to help inform them of their disease and support to help them understand their treatment options and most importantly make informed decisions about their health and wellbeing choices.
The TARVA patient information booklet on ankle arthritis is a comprehensive source of information on ankle replacement and ankle arthrodesis (fusion) which are the two main treatments available on the NHS.
The free information bookley has been written by some of the leading specialists who are experts in treating ankle arthritis
The free booklet can be downloaded here.
The MOBILITY™ Total Ankle System (Depuy Synthes) implant has been withdrawn from sales for commercial reasons as of June 2014. The Mobility Ankle Replacement System was the highest volume implanted ankle replacement in the UK.
The Daily Mail features an article on ankle replacements and ankle fusion but implied that a rise in middle aged runners is responsible for an increased incidence in ankle replacements. The TARVA team are quick to respond that exercise is good for you and it is NOT exercise that is the issue, it is INJURY that is bad for you and sadly as you age you are at increased risk of injury. Full details of the Daily Mail article can be read here.
More and more people are taking up running. It’s great for your cardiovascular and mental health, it lowers your risk of diabetes and obesity and keeps you alert and fit.
It’s logical to think that pounding your joints causes them to wear but actually the scientific evidence suggests this is not the case.
There are plenty of long-term studies of runners to show that, as long as your joints are healthy to start with, running does not substantially increase the risk of developing arthritis, even if someone jogs into middle age and beyond.
So if exercise is good for you, then why do the press knock it? Well lets be absolutely clear, it’s not exercise that is bad for you, it is INJURY that is bad for you and sadly as you age you are at increased risk of injury.
Why are you at increased risk of injury as you age?
Well, as you age your ligaments become less elastic or less stretchy. This means that they are less adaptable to changes in foot position and so ligament injury is common. In fact a million people a year attend A&E with an ankle sprain so its one of the commonest injuries people suffer.
What is an overuse injury?
An overuse injury occurs where the forces put on the body exceed the ability of the body to handle them and soft tissues such as tendons, ligaments or bones can fail. This presents with conditions such as tendon problems (tendinopathy or tendon tears), ligament sprains, and even stress fractures.
What tips could you give to someone looking to take up jogging?
- Make sure you have a Good Pair of trainers that must be well fitting and comfortable
- Build up gradually and slowly. DON’T overdo it or you will get an overuse injury
- If you are not used to running and are starting afresh, get a personal trainer or physiotherapist to assess your running style and give you advice on injury avoidance.
And if you are very overweight or have pre-existing arthritis you may wish to consider different or modified activities such as walking in water, cycling or cross training which put much less strain across your joints but can give you an equally good cardiovascular work out.
The UK National Health Service (NHS) has adopted a philosophy of “no decision about me, without me,” moving away from a paternalistic model of decision-making towards a shared decision-making (SDM) process between the patient and the clinician. This ideal is the foundation of high-quality healthcare and is especially important in the context of long-term conditions and chronic illness, such as osteoarthritis.
The patient and doctor interactions are underpinned by three main decision-making models, these being paternalistic, informed and shared.
The paternalistic model assumes that the doctor knows best. It is characterised by the passive compliance of the patient to the authority of the surgeon, who is the custodian of the patient’s best interest. As a result, decisions may not take account of a patient’s values and preferences, as long as the patient is perceived to benefit. This approach is less desirable in the setting of elective surgery, but still has its applications in trauma and life-threatening situations, where patients may present acutely with altered conscious or mental state.
At the other end of the spectrum is the informed model, where all decisions are made by the patient. The role of the doctor is to deliver to the patient information on all relevant treatment options including their benefits and risks. Communication in this model is largely one way.
Shared Decision Making is a two-way interaction where the doctor and the patient share all stages of the decision-making process simultaneously and reach a decision together. This is the ideal held by the NHS and affords many advantages in the orthopaedic setting. SDM increases the patient’s knowledge and understanding, and creates more accurate expectations. It allows for better tailoring of treatment to the patient’s values and has been shown to result in higher satisfaction.
Decision-making has been examined in orthopaedic surgery mainly in the context of hip and knee joint replacement. The majority of the work has centred on the decision of whether to undergo surgery or not. Our aim was to address a different question namely as to how patients that have decided to undergo surgery decide between different treatment options. The model we have used pertains to patients with end-stage ankle osteoarthritis.
Osteoarthritis of the ankle is a major cause of disability with an impact on quality of life similar to end-stage heart failure and hip arthritis. Its demand incidence in the UK has recently been estimated to be 47.7/100,00. The majority of cases are secondary to trauma or other diseases such as inflammatory arthritis.10 We believe that ankle osteoarthritis is a good model to study because there are two accepted surgical treatments, ankle fusion and total ankle replacement (TAR). Both have been shown to be valid and cost-effective treatments with a degree of clinical equipoise between them. Click to read the full article.