NJR Research Fellows
The NJR runs a rolling Research Fellowship programme delivered in partnership with the Royal College of Surgeons of England.
We welcome applications from orthopaedic trainees who wish to contribute to the analysis of data from the NJR and undertake a period of independent research into arthroplasty.
One Fellowship is available with the successful candidate to be appointed in early 2021, for a start of 2021/22. The fellowship is worth up to £60,000 per annum for a maximum two-year period.
Chairman of the NJR Research Committee, Professor Mark Wilkinson said: "We look forward to welcoming new fellows who can help to maximise the value of the data in the NJR and use it in new ways to help drive improvement and quality in orthopaedics" .
Fellowship Applications for 2021/22
- must be members, affiliates or ad eundem of RCS, or you may have an ad eundem application in progress;
- must have an identified host institution with a recognised orthopaedic centre;
- must have the written support of an orthopaedics-orientated mentor;
- must propose a project that is aligned with the broad strategic objectives of the NJR and based upon NJR data.
Please note the second year of the Fellowship is subject to satisfactory performance in the first year.
NJR/RCS Fellows will remain employed by their host institution, remunerated by the RCS.
No indirect or directly incurred costs are allowed. There will be a £500 a year allocation for travel and up to £ 3,000 for consumables.
To apply for the fellowship, please visit https://www.rcseng.ac.uk/standards-and-research/research/fellowships-awards-grants/fellowships/joint-rcs-njr-research-fellowships/
In May 2019, the NJR's Fellowship programme recruited for a seventh time, supported in partnership with the Royal College of Surgeons of England. As the NJR/RCS Clinical Research Fellow from November 2019, Mr Toby Jennison has been exploring the 5 year survivorship of total ankle replacements. His work will be showcased here when complete.
About Toby Jennison – Joint NJR/RCSEng Research Fellow
“I am delighted to be given this opportunity to undertake research on ankle replacements by undertaking the NJR/RCSEng fellowship for 2019. I am currently a Specialty Registrar in the Peninsula Deanery and will be undertaking my research at the Royal Devon and Exeter Hospital.
“I will be undertaking an exploratory descriptive analysis of the 5 year survivorship of total ankle replacements compared with equivalent rates in administrative datasets. As the number of ankle replacements being performed is increasing, the need for research into the results of these is becoming more important. There are over 900 ankle replacements performed a year in England and Wales. Data from all ankle replacements and those that fail is collected by the National Joint Registry. Many ankle replacements that fail will undergo an ankle fusion rather that a revision ankle replacement and this data is often not currently collected by the National Joint Registry. Therefore we don’t know the number of ankle replacements that fail and undergo either a revision ankle replacement or ankle fusion.
“The aim of this study is to analyse data from the National Joint Registry and from NHS Digital to find out how many ankle replacements fail within 5 years of the primary surgery.
"This will be the largest study looking at outcomes of these operations. By analysing this data it will give both surgeons and patients more information on the expected outcomes and risks of complications following ankle replacements. The aim is that this will improve knowledge of ankle replacements that will improve future patient outcomes.”
In May 2018, the NJR's Fellowship programme recruited for a sixth time, supported in partnership with the Royal College of Surgeons of England. As the NJR/RCS Clinical Research Fellow from November 2018, Mr Rob Middleton has been exploring the associations between patient frailty and primary knee replacement outcomes.
About Rob Middleton – Joint NJR/RCSEng Research Fellow
"I am currently reading for a DPhil in Musculoskeletal Sciences at the University of Oxford, having completed my early surgical training in the Thames Valley Deanery. It is a privilege to have been awarded the 2018/19 Joint NJR/RCSEng Research Fellowship, a position with a strong history of high-quality orthopaedic evidence output. The 2018/19 Fellowship will support the investigation of associations between patient frailty and primary knee replacement outcomes.
"The demand for primary knee replacement is high, with over 100,000 performed each year in the United Kingdom alone. This demand is predicted to increase globally over the next 20 years. It is therefore vital that we continue to advance our understanding of what factors influence outcomes after surgery. Patient health is one such factor and is increasingly important given ageing populations with increasing levels of multimorbidity. The concept of frailty recognizes the potential for declining health in different ways (such as physical, psychological and social). Measures of frailty have shown value in identifying individuals with greater health care needs (higher levels of hospital admission, poorer quality of life and higher mortality). As a consequence, frailty is now routinely assessed in primary care in England. Patients identified as living with higher levels of frailty are then provided with additional support. An improved understanding of a role for patient frailty in predicting outcome after knee replacement is therefore timely.
"I will be using a large national dataset comprised of joint registry, hospital and patient reported outcome records. This data will be used to describe the distribution of frailty among patients that have undergone primary knee replacement, and subsequently investigate associations between level of patient frailty and post-operative outcomes (including changes in quality of life, medical complications and implant survival). A greater understanding of how frailty may influence outcome after primary knee replacement will contribute to the shared decision-making process around surgery and to perioperative planning."
In May 2017, the NJR’s fellowship programme recruited for the fifth time in partnership with the Royal College of Surgeons of England. Mr Jonathan T Evans from the South West (Peninsula) deanery was appointed to investigate the feasibility of long term benchmarking following total hip replacement. He was based in the Musculoskeletal Research Unit at the University of Bristol under the supervision of Mr Michael Whitehouse and former NJR Honorary Research Fellow Mr Adrian Sayers.
About Jonathan T Evans – Joint NJR/RCSEng Research Fellow
During his fellowship, Jonathan published two landmark articles in The Lancet attempting to answer the questions: How long does a hip replacement last? and How long does a knee replacement last?. These important meta-analyses received both national and international media coverage and provide important information to patients considering whether to undergo a hip or knee replacement. A short video explaining this work and its importance is available on the following link. He subsequently went on to publish an important article in the journal PLOS Medicine using NJR data to suggest that the superior survival results seen in one unit in the NJR are associated with the implants they use and not down to local factors such as surgical skill. This important article suggests that if other units within the remit of the NJR make changes to which implants are used, they could also mirror the better survival results improving outcomes for patients. This is a concept that Jonathan is following up with a subsequent research project. The final part of Jonathan’s Fellowship saw him undertake an extensive collaboration with the Exeter Hip Unit to create a predictive algorithm using their 30 year database that could then be applied to the NJR dataset to predict long term survival of total hip replacements in the NJR. This currently unpublished work suggests that the current 10 year NICE benchmark may be too high and also provides evidence to potentially support 15 year benchmarks.
Work completed in the fellowship led Jonathan to be awarded the prizes for Best Presentation at both the 2018 and 2019 International Society of Arthroplasty Registers (ISAR) conferences as well as at the British Hip Society meeting in 2019. He has also recently been awarded the Apothecaries Prize by the Worshipful Society of Apothecaries for his article “How long does a hip replacement last?).
The NJR/RCS(Eng) Fellowship was the perfect springboard into research for Jonathan and on completion of his MD he was appointed as an NIHR Academic Clinical Lecturer at the University of Bristol, where he is now the Programme Director of the MSc in Orthopaedic Research Methods and Evidence-Based Medicine. He has also recently been appointed as Honorary Clinical Fellow of the National Hip Fracture Database and is preparing an application for an NIHR Advanced Fellowship later this year
In May 2016, the NJR's Fellowship programme recruited for a fourth time, supported in partnership with the Royal College of Surgeons of England. Mr Richard Craig is the first NJR/RCS Clinical Research Fellow appointment who will look at one of the NJR upper limb datasets. His work will be showcased here when complete.
About Richard Craig – Joint NJR/RCSEng Research Fellow
"I am a Specialty Registrar in Trauma and Orthopaedic Surgery on the Oxford rotation. The award of the Joint NJR/RCSEng fellowship has enabled me to take time out of clinical training to study towards a DPhil at the Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford.
"My project title is “Improving Outcomes of Shoulder Joint Replacement Surgery”. This is the first time that an NJR fellow has been appointed to look at one of the upper limb datasets. In recent years, there has been a rapid expansion in the overall number of shoulder replacements performed in the UK together with an unregulated expansion in the different shoulder implants available. This has occurred against a background of limited supporting high-quality evidence.
"Choice of procedure and patient selection for shoulder arthritis surgery have been identified amongst the top ten research priorities in shoulder surgery by a 2015 James Lind Alliance Priority Setting Partnership. I will be performing a detailed assessment of current UK practice and performing an outcomes analysis focussed heavily on Patient Reported Outcome Measures (PROMs). Poor PROMs may be an early marker for failure following shoulder arthroplasty surgery and PROMs, together with other factors, will be built into revision risk prediction models based on current UK data. Using this data, I aim to inform surgeons better regarding which patients will do well with shoulder replacement surgery and to inform future NJR strategy."
In Spring 2015, the NJR's Fellowship programme recruited for a third time, supported in partnership with the Royal College of Surgeons of England. Mr Tanvir Khan was appointed in August 2015 as NJR/RCS Clinical Research Fellow and his work will be showcased here when complete.
About Tanvir Khan – Joint NJR/RCSEng Research Fellow
"I am a Specialty Registrar in Trauma & Orthopaedic Surgery based in Nottingham. Having completed a NIHR Academic Clinical Fellowship, I have taken time out from my clinical training program to undertake a PhD within the Department of Academic Orthopaedic & Trauma Surgery at The University of Nottingham.
"I am delighted to have been awarded the 2-year joint NJR/Royal College of Surgeons of England Fellowship which will enable me to perform a national epidemiological analysis of revision surgery for periprosthetic fractures. As the number of hip and knee replacements performed is rising annually, fractures around prosthetic joints are a growing problem. Fractures are one of the most common reasons for undertaking revision surgery. They can lead to significant morbidity and poor function. Treatment is challenging and surgical decision-making is critical in preventing catastrophic outcomes. This project will identify which patients are at higher risk of fracture and investigate results of treatment. Thus, the ultimate aim is to reduce the prevalence of fractures and determine the best approaches to treatment for better patient outcome."
In August 2014, the NJR's Research Sub-committee offered Adrian Sayers the honourary position of 'NJR Research Fellow' for the duration of his Medical Research Council (MRC) Fellowship. The honourary position recognises that Mr Sayer's research uses substantial NJR data and his objectives are aligned to the ongoing research priorities of the registry.
About Adrian Sayers - Honourary NJR Research Fellow
"I have worked in health related research since 2004 following a MSc in Nutrition, Physical Activity & Public Health at the University of Bristol. I received a scholarship in 2006 to undertake a MSc in medical statistics at the London School of Hygiene and Tropical Medicine and since 2007, have worked in musculoskeletal research at the University of Bristol. I have recently been awarded a three-year MRC Population Health Science Fellowship as well as the honorary position of NJR Research Fellow."
"My MRC fellowship title is Factors affecting mortality, morbidity and patient outcomes after joint replacement surgery (femoral). The NJR is an early warning system which highlights issues relating to patient safety and strives to improve patient outcomes. However, it is currently unclear what the optimal statistical methods are for achieving those aims. Using data from the NJR of England, Wales, and Northern Ireland I hope to apply novel statistical procedures which will provide new and unique insights into patient safety and hopefully improve patient outcomes."
In 2012, the Fellowship programme recruited for a second time and Mr Jeya Palan was appointed in February 2013 and his work will be showcased here when complete.
About Jeya Palan - NJR Research Fellow
"I am a trauma and orthopaedic specialty registrar, based in Leicester and am currently undertaking a PhD based at the University of Leicester. As part of this, I have been looking into why a small minority of patients continue to be dissatisfied with the results of their hip or knee replacement. This clinical study will provide information to help identify these patients before surgery, so that more focused work can be done to improve their satisfaction rate after surgery. I became interested in the NJR Fellowship because I believe the work undertaken by the NJR is vital in helping to monitor the results of joint replacement surgery, in order to improve patient outcomes after surgery.
"My NJR Fellowship research will cover two main projects. The first is the reasons why unicompartmental or ‘partial’ knee replacements have a wide range of revision rates. I will be undertaking a radiographic analysis of the Oxford brand of partial knee implants in order to try and answer this question. I hope that by assessing the radiographs of patients who have had partial replacements, the reasons for revision after the initial operation can be identified.
"The second is concentrating on analysing revision hip and knee replacements and how well revision implants do. The number of hip and knee replacements being performed is increasing all the time and patients are also having hip and knee replacements at a younger age. This means that in the future, there will be an increasing number of revision hip and knee replacements and the performance of revision implants will need to be reviewed. I am also interested in looking at the potential risks to the patient of having revision surgery, which for patients and surgeons, is a significant undertaking."
Working with the NJR’s Research Sub-committee, the first two Fellows - Mr Paul Baker and Mr Simon Jameson - completed a period of 12 and 16 months respectively. They have both made significant contributions to the NJR research strategy and outputs in terms of published papers and poster presentations including:
- More than twenty published papers in journals including the Journal of Bone and Joint Surgery (Britain, America), Clinical Orthopaedics and Related Research (CORR), Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) and The Knee
- Open the portfolio of published papers from Simon Jameson (pdf) >
- More than 30 poster and podium presentations at national and international orthopaedic meetings including the American Association of Orthopaedic Surgeons, British Association for Surgery of the Knee, British Hip Society, International Society of Arthroplasty Registers, European Federation of National Associations of Orthopaedics and Traumatology (EFORT) and the British Orthopaedic Association
- Please see below for a link to Simon Jameson’s doctoral thesis: Jameson, Simon (2015) Rationalisation of primary hip replacement using evidence from linked national databases. Doctoral thesis, Durham University