Trauma and Orthopaedics

The relationship between contracture and function in patients with Dupuytren’s disease – further analysis of the DISC (Dupytrens Interventions: Surgery versus Collagenase) trial

Supervisors: Mr Nick Johnson (nj94@le.ac.uk) , Professor Joe Dias (jd96@le.ac.uk)

Dupuytren’s contracture is caused by nodules and cords which pull the fingers towards the palm of the hand. The DISC trial recruited 672 patients who were randomised to surgery (limited fasciectomy) or collagenase injection, and showed that collagenase delivered in an outpatient setting is less effective but more cost-saving than limited fasciectomy. Those treated with collagenase considered the outcome to be acceptable, though not perfect. It is not understood what amount of finger deformity is acceptable to patients with Dupuytrens contracture and what factors influence this.

All patients in the trial had PROMS, clinical photographs and goniometric joint measurements taken at regular intervals. The ACF will join this project to use the large data set from the DISC study to investigate the relationship between deformity, function and other patient factors (ie age, gender, occupation). In addition, they will carry out work using a visual classification system (from clinical photographs) to assess recurrence and progression rates.

Experience from these projects would allow the ACF to apply for future grants to assess longer term follow up of patients in the DISC study, and to provide useful information to clinicians and patients about disease progression, recurrence rates and when intervention is likely to be required.

Development of Phage Therapy for the Treatment of Prosthetic Joint Infections

Supervisors: Dr Melissa Haines(mh508@leicester.ac.uk) and Mr Daniel Howard

Prosthetic Joint Infections (PJIs) are costly to the NHS – approximately £36,000 per infection, and they are difficult-to-treat in the long-term. A new collaboration between the University Hospitals of Leicester Orthopaedics Department and the Leicester Centre for Phage Research aims to support the development of promising alternative treatment options.  

Bacteriophages (phages) are a potential alternative treatment for infections caused by bacteria. The clinical use of phages to treat infections is known as phage therapy. Phages are currently being explored globally and the demand for phage therapy is increasing, in countries such as Australia, Belgium, France, Georgia, Poland and the USA. This project aims to bridge the gap between laboratory research/compassionate use and use within the NHS.

The Leicester Centre for Phage Centre has successfully built clinical collections for urinary tract infections, COPD, and C. diff infection. This project will involve building a collection of clinical bacterial strains taken from PJIs, laboratory experiments to find and assess the phages for effective killing of the PJIs from clinical isolate collection, and analysis of implant-associated biofilm breakdown. The resultant phage collection will have to potential to be used clinically.

Dynamic measurement of range, rhythm and rate of shoulder motion for evaluating shoulder diseases

Supervisor: Dr Harvinder Pal Singh (hps9@le.ac.uk)

Objective measurement of the shoulder range of movement (ROM) is an important element of assessment for diagnosing shoulder pathology. Measurement of only extremes of movements of the shoulder joint provides a limited picture of the static ability of the joint to move in the orthogonal planes. Exploring alternate, feasible methods to measure the range of movement during the activity can provide greater insight into the total capacity of shoulder function, which can translate into improved recovery from shoulder impairments.

Any mobile phone/ computer camera using Kemtai software has been developed to provide high resolution 3D imaging for a variety of industrial applications. It uses any camera as sensor’s depth camera that generates a speckle pattern and detects the reflections from objects. The accuracy of the software which does not require the attachment of markers to determine limb position has been validated in comparison with marker-based systems. It is therefore possible to develop it further to provide immediate, in-clinic visual feedback to patients on shoulder mechanics pre- and post-surgical intervention. We have conducted a feasibility study on 10 patients with the physiotherapy department to look at the compliance with prescribed physiotherapy and results are encouraging.

The ACF will join this project where we intend to develop a simple yet effective motion detection approach using the mobile phone/ computer camera using Kemtai software, which would enable us to distinguish the movement of a normal shoulder with that of a shoulder with pathology such as arthritis, adhesive capsulitis (also known as frozen shoulder) and impingement syndrome. We will be studying patients and normal volunteers(matched for age and gender) with no previous history of any upper limb disease or pain affecting the shoulder joint. After gaining consent, each participant in the study would have their shoulder movements measured using mobile phone or computer camera virtually using Kemtai software. Statistical analysis would then be carried out to determine if the measurements obtained from the mobile phone or computer camera with Kemtai software can be used to identify and differentiate shoulder diseases, and be used to develop a targeted treatment approach to expedite recovery after shoulder surgery.