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SCOT Statement on COViD-19

As Scotland enters the next phase of the COVID-19 response the orthopaedic community has been active in playing its part. We are all now implementing plans to postpone our elective services for all but the most urgent cases and reorganising to ensure we can continue to provide a safe trauma service for the duration of the crisis. 

SCOT has formed communication groups to ensure effective communication between CDs and leads across the country. Through this there has already been very useful sharing of ideas and updates on local situations. The following is a summary of the picture for T&O at the moment:

  • There are discussions about possible regionalisation for vital trauma surgery such as hip fractures but at present health boards need to plan for managing these patients within their own facilities. It is important for us in T&O to ensure that Boards appreciate the vital nature of preserving trauma surgery which provides quick and effective treatment and minimises in-patient stay. 
  • Some centres are reporting difficulty having their T&O teams fitted for protective equipment. There has been an issue with central supply and some delays encountered. Any activity involving an intubated patient who is positive for coronavirus is considered high risk and orthopaedic surgical teams must be given sufficient priority for fitting and supply of protective equipment. The BMA has issued a statement offering support where problems are being encountered. SCOT would also like to hear about these issues.
  • With the postponement of most elective care some teams are looking at providing a clinic service from previously unused sites remote from the main hospitals. For example, NHS Lanarkshire are tasking the ESP workforce to plan and deliver what they can to ensure that urgent referrals and returns can be seen. 
  • Many T&O teams have been asked to plan and provide a minor injuries service to remove this burden from the Emergency Departments. This requires a fair amount of planning and will be a particularly useful area for us all to share information such as protocols for certain conditions or safe use of sedation. 
  • Another useful development adopted by some centres has been planning rotas to cover in-patients and ambulatory trauma but also build in time for teams to work from home for a few days at a time to reduce fatigue and exposure to infection. 

This is a rapidly evolving situation to which orthopaedic services need to respond urgently. Sharing of concerns, problems and above all solutions to the challenges we face will be vital in supporting each other and tackling this unprecedented situation in the best way we can. 

Al Murray

Chairman, on behalf of SCOT


SCOT Zimmer Biomet Travelling Fellowship

We are pleased to announce that following competitive application and interview, three current Scottish Registrars have been awarded the SCOT Zimmer Biomet Travelling Fellowship. For further details see this page. We hope to make this an annual fellowship, with the next round of applications opening in July 2020, for interview at the Summer SCOT meeting.

Dates for the Diary

Please note the following upcoming dates:

Winter SCOT Meeting (Crieff Hydro Hotel) 31/1/20 to 1/2/20

STOTS Meeting (Dunblane Hydro Hotel) 27/8/20

Summer SCOT Meeting (Dunblane Hydro Hotel) 28/8/20

Further information will be posted as it becomes available.

Position Statement Regarding Hip Resurfacing for Patients in NHS Scotland

Metal Resurfacing of Hips

There remains concerns in the press and scientific literature about metal on metal total hip joint replacement bearing surfaces.  Hip replacements/ hip resurfacing with metal-on-metal hip bearings became very popular in the late 1990’s and early 2000’s with implant companies, the popular press, patients and some surgeons being a driving force. In the late 2000’s, however, it became  apparent there was a much higher failure rate (5-6x that of standard hip replacements in some patient groups) with these bearing surfaces. There were also incidences of significant soft tissue damage being caused by metal wear debris, so called pseudo-tumours. NHSScotland is aware of these concerns and takes patient safety seriously.  There are currently no total hip joint replacements using metal on metal bearings being performed in NHSScotland.  Hip resurfacing procedures are not routinely offered in the majority of health boards in Scotland and there are only a small number of specialist centres performing the procedure under close follow up. However, there may be a limited place for metal resurfacings procedures.  The belief that it is easier to revise a hip resurfacing than a hip replacement is misplaced.

This note sets out NHSScotland  position with regard to hip resurfacing with metal bearings. 


Patients should have the option to consider a range of choices to improve their quality of life when they have significant pain or lack of mobility due to damage to a hip joint.


The group of patients to whom a metal hip resurfacing procedure is a potential option tend to be male, young, with good bone quality and with large diameter hips


There must be additional informed and recorded consent agreed with the patient that currently a resurfacing procedure does involve the use of a metal bearing and that there may be a risk of early failure and soft tissue damage due to metallosis.  The patient must agree, and the surgeon must ensure that more intensive follow-up is in place than is routine following standard total hip replacement surgery so any development of metallosis will be found early and managed properly in line with current guidelines for metal hip bearings from the MHRA. This follow up may involve yearly review and x-rays together with blood tests to monitor metal levels that can become elevated.


The surgeon must have significant experience in hip resurfacing procedures, record specific consent for the procedure and ensure follow up according to MHRA guidance


The device chosen must be one with a minimum 10A Orthopaedic Data Evaluation Panel (ODEP) rating Bor be part of a registered research trial.

Patients and surgeons should ensure that the advice from the British Orthopaedic Association and British Hip Society is followed.

Mr Edward Dunstan
Consultant Orthopaedic Surgeon
Chair – Scottish Committee for Orthopaedics & Trauma

Summer SCOT Meeting 2018

A quick reminder of the dates of the Summer SCOT Meeting:

Date: Friday 7 September 2018

Location: Dunblane Hydro Hotel

Draft Programme: Download

The STOTS (Trainee) Day will take place on Thursday 6 September 2018 with a dinner in the evening.

STOTS Main Sponsor:

SCOT Meeting Sponsors:

Other Educational Support: