Analysing health data on MSK patients, particularly those with long-term knee problems, to find out the period of time from knee surgery to total joint replacement

Dr Nikki Kuiper

We recently announced the first winner of our three-year joint fellowship with The Daphne Jackson Trust, Dr Nikki Kuiper. She is a highly qualified academic with a biomedical PhD and a long-standing career in the musculoskeletal (MSK) field based at Keele Medical School and the Robert Jones & Agnes Hunt Orthopaedic Hospital in Oswestry (RJAH), who is returning to research after an illness-enforced career break.

The Daphne Jackson Trust, through their fellowships, are dedicated to supporting individuals returning to research after a 2 year career break due to illness, caring or family responsibilities. As well as financial support, the fellowship offers retraining and mentoring which helps the recipient to develop the skills and the confidence necessary to pursue a successful and valuable career in research.

Dr Kuiper’s story will hopefully serve as an inspiration for others who are considering a return to research after an enforced absence. For many of us the 2020 Covid pandemic threw our lives – both personal and professional – into disarray. But for Dr Kuiper it coincided with her recovery from two years of serious health problems and led to her having to reassess a successful established academic career track in the field of musculoskeletal (MSK) health. In 2018 Dr Kuiper developed invasive Group A streptococcal (iGAS) disease which was then complicated by a bout of life-threatening severe sepsis. Months in hospital, during some of which she was in a coma needing an emergency tracheostomy, left her with limited mobility and suffering with long-term fatigue.

Much of her rehabilitation took place at the RJAH where she trained as an undergraduate and has had a long association as a MSK researcher. Several months following her discharge from hospital, Dr Kuiper realised she would have to re-evaluate her career options as a full schedule of teaching at Keele Medical School would be too physically demanding, especially with tracheal scarring (a long-term complication of her emergency tracheotomy). She was keen to use her years of experience in MSK health, but also needed to take into account her physical needs. She was already considering a return to MSK research when she found out about the Daphne Jackson Trust Fellowship scheme in association with Orthopaedic Research UK (ORUK).

Her fellowship will focus on analysing health data on MSK patients, particularly those with long-term knee problems, to find out the period of time from knee surgery to total joint replacement.  She wants to help clinicians predict when and to whom cartilage repair may be successfully applied by developing an algorithm and ultimately a digital app to be used in outpatient clinics. The fellowship would offer her the chance to use her existing biomedical and MSK strengths for cross-domain re-training in health data analysis. She is keen to conduct valuable research into knee osteoarthritis , a problem which affects one in five adults over the age of 45. Dr Kuiper was aware that no significant long term (>10 years) research has been done in this country to analyse the journey of patients from first reporting knee problems to having a repair, to developing severe osteoarthritis, and then potentially needinga complete knee replacement.

‘I felt I could put together a fellowship that fitted with ORUK’s strategy, which is to expand orthopaedic knowledge and to improve patient outcomes. The whole project is to work out the true effects of having cartilage surgery by studying health records and linking those to two long-standing national joint registries and, ultimately, to ease the burden on the NHS,’ she explains.

She was delighted and excited when she found out that she had been awarded the fellowship. She will be based in Dr Karina Wright’s regenerative medicine lab at the RJAH where she started her career, and the project will be hosted by the University of Keele’s School of Pharmacy and Bioengineering. At Keele, Dr Kuiper will be supported by Dr Martin Frisher (Reader in Health Services Research) and Professor Kelvin Jordan (Professor of Biostatistics).

The project will require her to learn new skills, something she is looking forward to: ‘I’m going to be doing new training in health statistics, predictive modelling and learning technical programming languages,’ she explains. ‘I will be working with huge volumes of data (known as “big data”) from RJAH clinical trials and national registries and combining that with my knowledge of musculoskeletal biology.’

As well as the National Joint Registry, established in 2002 to record every patient who has had a joint replacement, she will have access to the UK Biobank which tracks risk factors for the major diseases of middle and old age such as genetic predisposition to osteoarthritis. At the RJAH there are also a unique database of detailed patient records going back over 20 years which were started by the late Professor James Richardson, a pioneer in cell therapies for cartilage repair, making it possible to track the time lapse between having knee cartilage repair, possibly developing severe osteoarthritis and subsequently needing a knee replacement. This information will be invaluable in helping Dr Kuiper to understand all the factors involved in a cartilage problem, the timeline involved and the consequences for patients.

 ‘The aim of the project is to work out the true effects of having knee cartilage surgery by studying health records and linking them to national joint registries. It will be possible to combine a whole range of independent variables including patient demographics such as age, BMI, cartilage defect, type of cartilage surgery and genetic risk factors into a predictive model and a digital app so that clinicians can decide on the best course of treatment when they first encounter a patient with knee cartilage issues and potentially avoid unnecessary procedures for their patients.’