Some of my research and Development activities:

Intubation of patients infected with Covid 19

This YouTube video gives guidance of the safe intubation of patients who may be infected with C0vid 19. It shows the impact of some of our work on Ultra Clean Air Operating Theatres.


Ventilation of Healthcare facilities dealing with Covid-19

This guidance was produced early during the Covid-19 outbreak, I contributed to the section on the use of operating theatres.


Basic science research in Rhematoid arthritis

For many years I have had a productive relationship with researchers in the field of rheumatoid arthritis at Birmingham University. Many of my patients have been involved in activities such as clinical trials at the University Hospital Birmingham. Many of the patients have donated samples of diseased tissue removed during joint replacement surgery.


The research team, led by Professor Chris Buckley and Professor Andrew Filer, have produced a steady stream of publications in the literature describing our work.


The latest publication compared the fibroblast cells in diseased rheumatoid joints to normal cells in tiny samples of muscle and skin obtained from joint replacement patients.


I, and the rest of the team, am very grateful to all of the patients who donated tissue samples for the work.


Read the lastest publication here:



Laser imaging of airflow in the Howorth Exflow Ultra clean air operating canopy


This picture shows the movie images which can be obtained when testing an operating theatre using laser imaging.


This work was carried out in co-operation with the optical engineering unit of Cranfield University.


The method uses a very thin curtain of smoke which is dropped from the top of an operating theatre.  The smoke is illuminated by a sheet of powerful laser light.  Movie images are obtained and computer processed. 


The computer processing removes surplus background and colourises the images to fully demonstrate the flow of air in the enclosure as in the illustration below:

The technique is useful to demonstrate the flow of ultra clean air in the enclosure and allows testing of the effects of obstructions such as X-Ray equipment, microscopes etc.


The enclosure tested was made by Howorth Airtech of Bolton,  UK. 


Scanning Electron Microscopy of PMMA Bone Cement


This picture is a scanning electron micrograph showing the surface of some orthopaedic polymethylmethacrylate bone cement magnified around 100x.  


The cement is made up from beads of a plastic called methylmethacrylate, which you can see on the surface, which are mixed with a monomer and a catalyst and which set to produce the solid cement.  The cement grouts into the bone surface and is used to fix joint replacements.


In this experiment the cement has been vibrated into a bone sample and the bone was later removed to show the cement surface.


The technique was never used clinically due to the risk of cavitation in the cement.

Computer based systems for spinal history taking and pre-operative assessment:

At The Royal Orthopaedic Hospital we developed a new computer based interview system to talk to patients with back pain and sciatica, and published it back in 1989


We also devised an early computer based system which takes a medical history from patients who are to be admitted to hospital for orthopaedic surgery.


The system uses branching logic to take comprehensive medical details and prints them out in narrative English, using an algorithm designed by Dr Paul Pynsent.


The system will record data to safely manage patients and measure the outcomes of surgery. It can do medical and nursing clerical tasks like taking consent for property and use of medical imaging.



This picture shows one of the screens on the pre-operative assessment system:


Research on the growth of children of Pakistani heritage in Birmingham in the 1990s:


In the 1980s I designed a paper based growth chart, to monitor the growth of children, particularly with orthopaedic problems, such as leg length inequality.


One problem with this was the possibility that children of different ethnic backgrounds might have different growth patterns.  We therefore undertook a large study measuring children of Pakistani heritage at a school in Birmingham. The study clearly showed that the children had the same growth patterns as the white English children, who had been measured for the original charts, see: 


Ulnar Cutting Jig for the Souter-Strathclyde Total Elbow Replacement:


During an unlinked Total Elbow Replacement it is a key point to cut the Ulna precisely aligned to the component that has already been fitted to the humerus on a trial basis.



The jig seen in the picture was designed by me to enable this to be done.


It was included in the surgical instruments which were supplied by the original manufacturer, Stryker Howmedica. This type of Total Elbow Replacement was discontinued by the manufacturer, in spite of good clinical results.



Some great people from the history of Orthopaedics:

The anatomical studies of Leonardo da Vinci, from around 1510, are one of the great achievements of the Italian renaissance.  His work helped to lay the foundations of modern scientific medicine, and orthopaedics in particular


Pioneering Orthopaedic Surgeon Professor Sir John Charnley using the lathe in his workshop at home. John Charnley radically changed the treatment of hip arthritis with his total hip replacement designed in the early 1960s. 


Mr Mike Freeman of The London Hospital sitting with Dr John Insall  (right) of The Hospital for Special Surgery, New York in Mike Freeman's garden in about 1980.  These two individuals were responsible for working out questions of design, balance and alignment which are the basis of all good modern Total Knee Replacements.