So, the cellular level is all very well. But, what about the evidence for people... and populations of people.

What makes the biggest difference in our quest to do more with less pain?

Well, the clue is in the title of this newsletter. But my way into this- my 'aha' moment'- came 15 years ago...


My Eye Opening Vancouver Experience 

I was working with the hip and knee team at the University of British Columbia in Vancouver. A group who do joint replacements. A group who do a lot of them. And who do them very well.

What they also do well is… measurement. Measurement of everything they do (well, everything hip and knee related anyway).

I was beginning to see and understand the power of measurement to improve patient care, when the opportunity to look at people returning to sport after joint replacement.

I jumped at the chance to combine my passion for sport and joint replacement. 
 

So, what did we do?

We took a group of 736 patients who'd undergone 1st- or 2nd- time hip or knee replacement over a 2-year period between 2005 and 2007.

We listed out at all of the pre-operative factors before surgery that could make a difference. And then looked at which ones statistically correlated with a return to sport at 1-year following joint replacement.

What factors actually make a difference?


The results from our paper (see below) were as straightforward as they were clear cut…

Only age, male sex, body mass and activity level predicted a return to sport 1-year following joint replacement.

That was it.
 
Young patients are more likely to return to sport than older patients.
 
Male patients are more likely to return to sport than female patients.
 
Patients with a lower body mass are more likely to return to sport.
 
More active, compared to less active patients are more likely to return to sport afterwards.

All fairly common sense. So what?


Patient factors made all the difference.

Surgeon, type of operation or type of implant, of any kind, did NOT make a difference.

Whether patients returned to sport after joint replacement depended on the patient themselves.

And as a potential patient, that is good to know.

Particularly as you and I can do something about two out of those four things: body mass and activity.

That straightforward finding opened my eyes to what really makes a difference to people considering joint replacement.

And it's influenced my treatment philosophy ever since.

Over the coming newsletters I'll take a look at the evidence across even larger groups of patients; across 1000s of people. Evidence that combines studies like this one, with many others to give a super powerful result.

Spoiler alert: it's people that make the biggest difference in their own treatment. 

Help me to reach and help 1000 people...  

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