Research and Publications

May, 2015 This month, James presented his preliminary findings from his international, multi-center cohort study comparing Patient-Reported Outcomes Measures (PROMs) in normal, pathology-free individuals.

A Preliminary report of an International, Multi-Center Cohort Study Comparing Patient-Reported Outcomes Measures in a Normal, Pathology-Free Population Using an Electronic Data-Collection System

Objectives The aim is to assess whether commonly used Patient-Reported Outcomes Measures (PROM) are equivalent in normal, healthy, pathology-free individuals of different ethnicity, nationality, sex and age. The clinical scores under investigation include PROMs of the hip, shoulder, knee and wrist/hand. Hupothesis There is no difference in PROM clinical scores in a normal population when comparing sexes, age groups, ethnic groups and different nationalities. Methods American, Australian and Canadian citizens, free of pathology in the ipsilateral joint under investigation that corresponding to their dominant arm are invited to complete an electronic, web-based questionnaire on a mobile device or a laptop computer. The power calculation requires 600 participants in each hip, shoulder, knee and wrist/hand cohort.  The groups have been stratified to be sex and age matched. The questionnaires cover the subjective and objective components of the clinical scores under investigation. The PROM scores under investigation include:

• Hip PROMs - Harris, Oxford, HOOS shoulder scores, and EQ-5d scores
• Shoulder PROMs - ASES; CSS; OSS; UCLA; SPADI; and SPONSA shoulder scores
• Knee PROMs - Knee Society, Oxford Knee Score; and the KOOS knee scores
• Wrist/Hand PROMs - Mayo Wrist PRWE; and DASH wrist/hand scores

Progress

• Hip cohort - Canada : 310/300 Australia : 317/300
• Shoulder cohort - Canada : 220/300 Australia : 10/300
• Knee cohort - Canada : 250/300  Australia : 230/300
• Wrist/Hand cohort - Canada : 200/300  Australia : 10/300

Expected Conclusions An electronic, PROM data collection system can be used effectively to assess separate cohorts across different continents. Differences in sex, age, ethnicity and nationality must be taken into consideration when using PROM hip scores to assess patient outcomes. Studies using an electronic, pre-established control group for a comparative group, should be sourced from the same country of origin and be age- and sex-matched. This study has established an electronic, normal control group for future OBERD-derived studies using PROM outcome measures in Australia, Canada and the United States. Level of Evidence: Therapeutic Level II.

April, 2015  This month, a second group of two University of Adelaide Medical Students began their 6-week research electives under the supervision of Dr McLean and Dr Mandziak. The aim of this study is to assess whether Clinical Knee Scores are equivalent in normal, healthy, pathology-free individuals of different ethnicity, nationality, sex and age. The purpose of this study is to establish normal population values for Clinical Knee Scores using an Outcomes-Based Electronic Research Data collection system (www.oberd.com). Ultimately, this research will be published in an orthopaedic journal and used for future research initiatives.

March, 2015 A tear of the biceps tendon at the elbow can occur as the result of lifting a heavy object or from a traumatic accident. A biceps tear can cause significant pain and dysfunction for patients. The treatment of a biceps tear varies depending on the severity and type of tear, and a patient’s requirements and expectations. When operative management is indicated, Dr McLean performs a distal biceps repair using a modern endobutton technique. This technique can be performed safely with reproducible, excellent results. To learn more about the distal biceps repair technique that Dr McLean uses – Click Here.

February, 2015 This month, James received ethics approval to start a new study looking at iPhone applications that are available for the assessment of range of motion (ROM). The practicality of their use in the clinical setting has not been established. This study aims to compare several methods of ROM testing that are commonly used in clinical practice. This will help determine if iPhone applications can be utilised as a valid method of ROM assessment. This could be beneficial for patient’s who live remotely and require ROM assessment as part of their follow-up management. Overall, this will significantly enhance our ability to collect reliable, validated data and enhance our practice of evidence-based medicine. To read more about how iPhone technology is being used in orthopaedic practice – Click Here To see a video of iPhone applications are used in clinical practice– Click here.

December 2014

This month James was awarded an Arthritis Australia / Zimmer Orthopaedic Fellowship Scholarship. The funding is awarded to Australian orthopaedic surgeons who seek additional, non-compulsory, sub-specialty Fellowship training, either locally or abroad.

Sub-specialty Fellowship training is an excellent opportunity for surgeons to travel abroad and train with internationally-renowned colleagues in world-class institutions. Often, an international Fellowship affords the opportunity to bring back new ideas, knowledge and equipment to Adelaide. These opportunities also allow a surgeon to attend international sub-specialty meetings and participate in a broader range of research and teaching.

James has sought additional training abroad, including two competitive, sub-specialty clinical fellowships:

1. Shoulder & Elbow Fellowship at Addenbrooke's Hospital / University of Cambridge (United Kingdom)
2. Upper Limb & Hand Fellowship at St Paul's Hospital / University of British Columbia (Canada).

To read more about the Arthritis Australia – Click here.

November, 2014 This month, James started the first stage of his international, multicenter cohort study. The study involves several Universities from the United States, Canada and Australia. The study uses an "Outcomes-based electronic research database" (OBERD: http://oberd.com/) to measure patient satisfaction and clinical scores on an iPad or tablet equivalent In an effort to improve evidence-based-medicine, OBERD has been developed to help clinicians collect important data on their surgical outcomes. The collection and interpretation of this data will enhance our ability to critically appraise surgical outcomes, which will ultimately improve patient care. OBERD has been adopted by several international, multi-practitioner orthopaedic practices, in an effort to enhance their patient care, increase their contributions to research and allow for a more streamlined commitment to multi-centre cohort studies. Some of the well-known international groups that have practitioners who have adopted OBERD include (Click Here):

• Depuy Synthes (World-wide Device Company)
• Hospital for Special Surgery (New York, USA)
• Midwest Orthopaedics at Rush (Chicago, USA)
• Missouri Orthopaedic Institute (Columbia, USA)
• Rothman Institute (Philadelphia, USA)

To find out more about OBERD – Click Here. To find out more about how Orthopaedics SA plans to use OBERD – Click Here.

October, 2014

This month, James attended an advanced shoulder course held by the Arthroscopy Association of North America (AANA). The course is world-renowned and attracted delegates from all over the world, including Australia; Brazil; Canada; China; Columbia; Costa Rica; Egypt; Ecuador; Hong Kong; India; Iran; Japan; Lebanon; New Zealand; Panama; the United Kingdom; the United States; Venezuela; and Vietnam. James used the opportunity to practice cutting-edge surgical techniques and work on the dexterity and skills that this specialized arthroscopic work requires. To learn more about arthroscopic shoulder surgery – Click Here.

October, 2014 This month, James visited Midwest Orthopaedics at Rush (MOR). The MOR Physicians are among the most highly trained, experienced and respected orthopaedic surgeons in the Midwest. They are also the Team Physicians for the Chicago White Sox and Chicago Bulls. Each MOR Physician holds an academic appointment at Rush Medical College, is on staff at Rush University Medical Center, and is active in research and education. While in Chicago, James spent time with Dr Greg Nicholson, a prominent shoulder & elbow surgeon at MOR. Dr Nicholson is involved in the design of an advanced shoulder replacement system and is a consultant to several orthopaedic companies. James and Greg took the opportunity to discuss the research programme at MOR. MOR, along with other leading orthopaedic groups in North America, use an electronic data collection system that utilises internet-based data entry collection tool to collect data for research. This is cutting-edge technology that utilises smartphones, android tablets and/or home computers to safely and securely collect valuable patient data. To learn more about "Outcomes-based electronic research database" (OBERD), Click Here.

August, 2014 This month, James helped the international Editorial Board of the Bone & Joint Journal prepare cases for the exam cornerTheBone & Joint Journal publishes interesting, topical cases. This helps surgeons remain up-to-date with rare conditions and their treatment. To read more – Click here.

James M McLean, Mark Clayer, Aaron W Stevenson, Anthony J Samson
Tech Hand Up Extrem Surg. 2014 Sep;18(3):135-42.
2014

Full article

July, 2014

This month James joined other international surgeons to trial specialized surgical equipment at the Arthrex Laboratory in Munich, Germany. James took the opportunity to discuss cutting-edge arthroscopic surgical techniques with Martin Jaeger, a prominent German Shoulder Surgeon and Head of Shoulder Surgery at Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, in Freiburg Germany. To learn more about the Arthrex Surgical Education Programme, Click Here.

July, 2014

This month James attended the Bone & Joint Journal Reviewers Course in London, United Kingdom. This journal has a long and prestigious history, being formerly known as the Journal of Bone & Joint Surgery – British (JBJS-Br). Surgeons and researchers submit their manuscripts to the journal for peer review and consideration for publication. The BJJ receives over 1200 submissions per year, of which less than 14% are accepted for publication. To learn more about the BJJ – Click here.

June, 2014 This month, James joined other sub-specialised orthopaedic shoulder surgeons from all over the United Kingdom at the British Elbow & Shoulder Society annual scientific meeting in Nottingham. This scientific meeting provides the opportunity for surgeons to meet and discuss current research outcomes, cutting edge techniques and surgical advances. The meeting combines lectures, case discussions, surgical workshops, cadaveric workshops and live surgical demonstrations. The meeting aims to keep surgeons up-to-date and enable them to learn new skills. Click here to find out more about the British Elbow & Shoulder Society Since there are often only a few sub-specialised shoulder surgeons in practice per city (or even per country in some cases), surgeons often have to travel internationally to keep up-to-date with advances in surgical techniques and equipment. Meetings that include live surgical demonstrations are one way that surgeons remain up-to-date and learn new skills. Surgeries are performed in a normal operating theatre where audiovisual equipment is used to project the operation live to a lecture theatre. In this way, hundreds of interested surgeons can watch a single surgery at one time, without having to crowd into a small operating theatre and risk decontamination of the sterile operating field. To see an example of a live shoulder surgery seminar - click here.

June, 2014

This month, James joined other sub-specialised orthopaedic shoulder surgeons from all over the world at ArthoParis Convention. This meeting is a large multi-national shoulder meeting that is held every 2 years. It provides the opportunity for surgeons to meet and discuss interesting cases, cutting edge techniques and surgical advances. The meeting combines lectures, case discussions, surgical workshops and live surgical demonstrations. The meeting aims to keep surgeons up-to-date and enable them to learn new skills.

July, 2014 This month, James helped the international Editorial Board of the Bone & Joint Journal prepare cases for the Bone & Joint Journal - Exam Corner. To read more - Click here. To become a fully-qualified Orthopaedic Surgeon, surgeons-in-training must pass a final examination that is administered by the Royal (Australasian) College of Surgeons. Prior to presenting for examination, most trainee surgeons have completed 6 years of medical school; a 1-year internship; 3-6 years of Basic Surgical Training (or unaccredited surgical training); and 5-6 years of Advanced Surgical Training in Orthopaedic Surgery (or Surgical Education & Training). A further 1-2 years of sub-specialty training (i.e. an international Fellowship) is highly-regarded and worthwhile, but optional. The final examination for FRCS / FRACS is the culmination of this training and has three components: a written component, a clinical examination and a series of oral vivas. Surgeons are examined on real patient cases to ensure they meet the standards required to practice in their respective countries. The Bone & Joint Journal helps trainee surgeons prepare for these final examination by publishing interesting, topical cases, that are similar to those seen in normal clinical practice. To read the exam questions - Click Here

June, 2014 To become a fully-qualified Orthopaedic Surgeon, surgeons-in-training must pass a final examination that is administered by the Royal (Australasian) College of Surgeons. Prior to presenting for examination, most trainee surgeons have completed 6 years of medical school; a 1-year internship; 3-6 years of Basic Surgical Training (or unaccredited surgical training); and 5-6 years of Advanced Surgical Training in Orthopaedic Surgery (or Surgical Education & Training). A further 1-2 years of sub-specialty training (i.e. an international Fellowship) is highly-regarded and worthwhile, but optional. The final examination for FRCS / FRACS is the culmination of this training and has three components: a written component, a clinical examination and a series of oral vivas. Surgeons are examined on real patient cases to ensure they meet the standards required to practice in their respective countries. The Bone & Joint Journal helps trainee surgeons prepare for these final examination by publishing interesting, topical cases, that are similar to those seen in normal clinical practice. This month, James helped the international Editorial Board of the Bone & Joint Journal prepare cases for the Bone & Joint Journal - Exam Corner.