From the Executive Editor

Deborah Eastwood

The image on the front cover represents a stark view of what 2020 meant for us and for our patients. We were essentially closed for business. The figures in terms of lost opportunities to fix people and lost opportunities to train our colleagues are huge and there has been a significant impact on the quality of life of those we care for, those we support and ourselves. The full cost has yet to be counted.

Our ‘Restart’ and ‘Recovery’ plans seem to involve asking teams to work harder and longer – not necessarily recognised strategies for efficient and effective healthcare delivery with a tired workforce. Certainly there is some evidence to support the use of hot/cold sites and the BOAST Providing a Continuous Safe Elective Orthopaedic Environment may help us protect a resourced bed base in the future and to utilise it well. The article from the NJR (page 38) highlights figures from 2020 showing both a sharp drop and significant variation in elective activity. Northern Ireland and Wales were particularly badly affected and significant variation is seen across England with, for example, one region managing only 33% of their ‘usual’ TKR activity. Some of the variation may be explained by the availability of hot/ cold sites. The overall reduction, whichever way you look at it, is immense and recovery will not be instantaneous – the politicians and the public must not be fooled by the offer of a ‘quick fix’; there is none.

Now is the time for innovative thinking and to ensure that we challenge for change to improve MSK health for all. We are being asked to define areas for improvement rapidly without, I fear, the realisation that it takes time to develop a good and workable idea. We must ensure that change is not enacted just for change’s sake.

If we want to think about change, then the articles on sham/placebo surgery (page 54) are entertaining and informative in equal measure and certainly do challenge the way we think about our surgical equipoise and how we deliver surgical research. We do have to question.

All those of us who train are also going to have to get to grips with the new curriculum (page 26) – please do not leave it too late to learn about the MCRs, CiPs and the GPS – as our President says in his editorial, acronyms are on the up and we must be up with them.

The contribution from the medico-legal team (page 50) regarding the management of our patients who are Jehovah’s Witnesses may make you consider ideas that you have previously taken for granted and reminds us that informed consent is a two way process - the surgeon must be informed, and this article does inform.

Another contribution that perhaps challenges our practice is the article on the use of tourniquets in total knee replacement surgery (page 42). Our trauma colleagues might feel that this is just the tip of the iceberg in asking us to challenge our views on tourniquet use more generally. Why not join the debate and submit your views to the Transient Journal?

Thank you to the 1,300 people who responded to our Burnout Survey in January – the wellbeing of you and your team is important, so please take care and be kind to yourself and those around you (page 20).