From the Executive Editor

Amar Rangan

As I take up the reins as Executive Editor, I am reminded of what Benjamin Franklin once said, “Either write something worth reading or do something worth writing.” In many ways, JTO embodies that quote and is helping disseminate important news stories, interesting articles, and key opinion pieces to a wide readership. I would like to start my work in this role by thanking Deborah Eastwood for her stewardship and the editorial team for ensuring the growing popularity of JTO.

This issue does not disappoint. There is something in it for everyone in the T&O community. Did you know that the risk of noise induced hearing loss is nearly 50% in senior T&O surgeons? I wonder how many of us speak louder as we get older! Jerry Sam and Hiro Tanaka present the occupational hazard of noise induced hearing loss affecting orthopaedic surgeons and suggest measures we can take to mitigate that risk (p24). Lucky Jayaseelan and Cronan Kerin provide an update on the current selection process to T&O ST3 posts (p20). Ashley Scrimshire and colleagues propose a hub-and-spoke regional network model to cope with the growing problem of metastatic bone disease (p32). Ali Ridha and Aditya Vijay highlight areas where the all-pervasive AI and Computer Vision have found their place in T&O (p36). Richard Power explains how the fulfilling work by orthopaedic surgeons in Leicester helped the Gondar University Hospital in Ethiopia set up their own trauma theatre and training programme (p48).

Theatres are said to be three- to six-times more carbon intense than the hospital as a whole, which has brought into sharp focus the need for sustainable surgical practices. Patient experience should of course be central in implementing safe and sustainable service improvements. Ashita Paul and her co-authors present their experience in using WALANT in hand surgery, which has now become more established in some centres post-COVID (p28). This is a good example of improved patient experience by avoiding general anaesthesia and a tourniquet, alongside surgical sustainability and benefits to the health economy. Scaling up such initiatives should bring wider benefits. Oliver Townsend and Karen Chui share their thoughts on how trainees can get involved at various levels in driving sustainable practices in surgery (p44).

The subspecialty section is shoulder and elbow with Deborah Higgs as guest editor (p52-62). A major growth in shoulder replacement volumes is anticipated over the next decade. Features in this section include innovation and use of technology in shoulder arthroplasty, initiatives to centralise the provision of low-volume procedures, and the use of large language models to aid clinical practice.

In addition to our upper limb subspecialty section, Jaime Candal-Couto et al. provide highlights of shoulder data analyses from the NJR. In particular, the link between surgeon volumes and outcomes in shoulder arthroplasty provides food for thought (p40).

I hope you enjoy reading this issue. I would like to take this opportunity to extend my very best wishes to you all for the festive season and the New Year.