![Antony Johansen](https://profiles-cardiff.imgix.net/attachments/2469?w=200&h=200&auto=format&crop=faces&fit=crop&q=90")
Professor Antony Johansen
Honorary Professor. Consultant Orthogeriatrician in the University Hospital of Wales
Overview
Every year 80,000 people break their hip in the UK. Most are aged over 80 with multiple social, medical and psychiatric comorbidities. Despite the success of modern surgery and anaesthesia these lead to prolonged hospital stays, and the resulting dependency means this one condition incurs health and social care costs of over £1 billion each year in the UK.
I’ve helped to develop two key resources to help people in the UK and other countries understand and improve the care of these patients.
National Hip Fracture Database (NHFD)
- https://youtu.be/DrkbQ4nQxhc - a discussion of the most recent report of the national clinical audit of hip fracture care in England, Wales and Northern Ireland, and of how clinical teams can use the nhfd website www.nhfd.co.uk to identify aspects of care that need to be the focus for local quality improvement work
Fragility Fracture Network (FFN)
- https://youtu.be/lldJ7ML21Og - a 10 minute YouTube explanation of how health services in different countries can learn from each other if existing and new national hip fracture audits collect the same core set of data to describe patients, care and outcome https://docs.google.com/spreadsheets/d/1XO7WDR2EhX6JAc9Sdqb-F94YeCOAFa4E/edit?usp=sharing&ouid=103906954655955907104&rtpof=true&sd=true
Publication
2023
- Zhang, X. et al. 2023. Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry. Osteoporosis International 34, pp. 1763-1770. (10.1007/s00198-023-06832-5)
- Johansen, A. et al. 2023. Call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture. Age and Ageing 52(9) (10.1093/ageing/afad172)
- Almilaji, O. et al. 2023. Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility. Physiotherapy 120, pp. 47—59. (10.1016/j.physio.2023.03.002)
- Baji, P. et al. 2023. Organisational factors associated with hospital costs and patient mortality in the 365 days following hip fracture in England and Wales (REDUCE): a record-linkage cohort study. The Lancet Healthy Longevity 4(8), pp. e386-e398. (10.1016/S2666-7568(23)00086-7)
- Patel, R. et al. 2023. Patients’ recovery of mobility and return to original residence after hip fracture are associated with multiple modifiable components of hospital service organisation: the REDUCE record-linkage cohort study in England and Wales. BMC Geriatrics 23(1), article number: 459. (10.1186/s12877-023-04038-2)
- Mohsin, Z., Javaid, M. K. and Johansen, A. 2023. Current approaches to secondary prevention after hip fracture in England and Wales - an analysis of trends between 2016 and 2020 using the National Hip Fracture Database (NHFD). Archives of Osteoporosis 18(1), article number: 93. (10.1007/s11657-023-01282-2)
- Grimm, F., Johansen, A., Knight, H., Brine, R. and Deeny, S. R. 2023. Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data. BMJ Quality & Safety 32(5), pp. 264-273. (10.1136/bmjqs-2022-014896)
- Hawley, S., Inman, D., Gregson, C., Whitehouse, M., Johansen, A. and Judge, A. 2023. Risk factors and 120-day functional outcomes of delirium after hip fracture surgery: a prospective cohort study using the UK National Hip Fracture Database (NHFD). Journal of the American Medical Directors Association 24(5), pp. 694-701. (10.1016/j.jamda.2023.02.008)
- Jones, C. S., Eardley, W. G. P., Johansen, A., Inman, D. S. and Evans, J. T. 2023. Caring for patients with periprosthetic femoral fractures across England and Wales in 2021. Bone & Joint Open 4(5), pp. 378-384. (10.1302/2633-1462.45.bjo-2023-0011.r1)
- Janjua, S. S., Boardman, H. F., Sami, A., Johansen, A., Toh, L. S. and Javaid, K. M. 2023. Anti‐osteoporosis medication dispensing by clinical commissioning groups in England: an ecological study of variability in practice and of the effect of the Covid‐19 pandemic. Pharmacoepidemiology & Drug Safety 32, pp. 248-255. (10.1002/pds.5544)
- Fox, F. et al. 2023. Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery. BMC Musculoskeletal Disorders 24(1), article number: 128. (10.1186/s12891-023-06164-9)
2022
- Matharu, G. S. et al. 2022. The influence of mode of anaesthesia on perioperative outcomes in people with hip fracture: a prospective cohort study from the National Hip Fracture Database for England, Wales and Northern Ireland. BMC Medicine 20, article number: 319. (10.1186/s12916-022-02517-8)
- Patel, R. et al. 2022. Multiple hospital organisational factors are associated with adverse patient outcomes post-hip fracture in England and Wales: the REDUCE record-linkage cohort study. Age and Ageing 51(8), article number: afac183. (10.1093/ageing/afac183)
- Johansen, A., Ojeda-Thies, C., Poacher, A. T., Hall, A. J., Brent, L., Ahern, E. C. and Costa, M. L. 2022. Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone and Joint Journal 104-B(6), pp. 721–728. (10.1302/0301-620X.104B6.BJJ-2022-0080.R1)
- Poacher, A. T., Hoskins, H. C., Protty, M. B., Pettit, R. and Johansen, A. 2022. The impact of adopting low-molecular-weight heparin in place of aspirin as routine thromboprophylaxis for patients with hip fracture. Postgraduate Medical Journal, article number: 141628. (10.1136/postgradmedj-2022-141628)
2021
- Shah, A., Hawley, S., Inman, D. S., Cooper, C., Fagan, E., Johansen, A. and Judge, A. 2021. Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD). Osteoporosis International 32(10), pp. 1989–1998. (10.1007/s00198-021-05922-6)
1999
- Johansen, A., Evans, W. and Stone, M. 1999. Bone assessment in elderly women: what does a low bone ultrasound result tell us about bone mineral density?. Archives of Gerontology and Geriatrics 28(3), pp. 239-246. (10.1016/s0167-4943(99)00010-2)
Articles
- Zhang, X. et al. 2023. Establishing a Chinese older hip fracture registry for older patients: a Delphi study to define the focus and key variables for this registry. Osteoporosis International 34, pp. 1763-1770. (10.1007/s00198-023-06832-5)
- Johansen, A. et al. 2023. Call to action: a five nations consensus on the use of intravenous zoledronate after hip fracture. Age and Ageing 52(9) (10.1093/ageing/afad172)
- Almilaji, O. et al. 2023. Frequency, duration, and type of physiotherapy in the week after hip fracture surgery - analysis of implications for discharge home, readmission, survival, and recovery of mobility. Physiotherapy 120, pp. 47—59. (10.1016/j.physio.2023.03.002)
- Baji, P. et al. 2023. Organisational factors associated with hospital costs and patient mortality in the 365 days following hip fracture in England and Wales (REDUCE): a record-linkage cohort study. The Lancet Healthy Longevity 4(8), pp. e386-e398. (10.1016/S2666-7568(23)00086-7)
- Patel, R. et al. 2023. Patients’ recovery of mobility and return to original residence after hip fracture are associated with multiple modifiable components of hospital service organisation: the REDUCE record-linkage cohort study in England and Wales. BMC Geriatrics 23(1), article number: 459. (10.1186/s12877-023-04038-2)
- Mohsin, Z., Javaid, M. K. and Johansen, A. 2023. Current approaches to secondary prevention after hip fracture in England and Wales - an analysis of trends between 2016 and 2020 using the National Hip Fracture Database (NHFD). Archives of Osteoporosis 18(1), article number: 93. (10.1007/s11657-023-01282-2)
- Grimm, F., Johansen, A., Knight, H., Brine, R. and Deeny, S. R. 2023. Indirect effect of the COVID-19 pandemic on hospital mortality in patients with hip fracture: a competing risk survival analysis using linked administrative data. BMJ Quality & Safety 32(5), pp. 264-273. (10.1136/bmjqs-2022-014896)
- Hawley, S., Inman, D., Gregson, C., Whitehouse, M., Johansen, A. and Judge, A. 2023. Risk factors and 120-day functional outcomes of delirium after hip fracture surgery: a prospective cohort study using the UK National Hip Fracture Database (NHFD). Journal of the American Medical Directors Association 24(5), pp. 694-701. (10.1016/j.jamda.2023.02.008)
- Jones, C. S., Eardley, W. G. P., Johansen, A., Inman, D. S. and Evans, J. T. 2023. Caring for patients with periprosthetic femoral fractures across England and Wales in 2021. Bone & Joint Open 4(5), pp. 378-384. (10.1302/2633-1462.45.bjo-2023-0011.r1)
- Janjua, S. S., Boardman, H. F., Sami, A., Johansen, A., Toh, L. S. and Javaid, K. M. 2023. Anti‐osteoporosis medication dispensing by clinical commissioning groups in England: an ecological study of variability in practice and of the effect of the Covid‐19 pandemic. Pharmacoepidemiology & Drug Safety 32, pp. 248-255. (10.1002/pds.5544)
- Fox, F. et al. 2023. Complex organisational factors influence multidisciplinary care for patients with hip fractures: a qualitative study of barriers and facilitators to service delivery. BMC Musculoskeletal Disorders 24(1), article number: 128. (10.1186/s12891-023-06164-9)
- Matharu, G. S. et al. 2022. The influence of mode of anaesthesia on perioperative outcomes in people with hip fracture: a prospective cohort study from the National Hip Fracture Database for England, Wales and Northern Ireland. BMC Medicine 20, article number: 319. (10.1186/s12916-022-02517-8)
- Patel, R. et al. 2022. Multiple hospital organisational factors are associated with adverse patient outcomes post-hip fracture in England and Wales: the REDUCE record-linkage cohort study. Age and Ageing 51(8), article number: afac183. (10.1093/ageing/afac183)
- Johansen, A., Ojeda-Thies, C., Poacher, A. T., Hall, A. J., Brent, L., Ahern, E. C. and Costa, M. L. 2022. Developing a minimum common dataset for hip fracture audit to help countries set up national audits that can support international comparisons. Bone and Joint Journal 104-B(6), pp. 721–728. (10.1302/0301-620X.104B6.BJJ-2022-0080.R1)
- Poacher, A. T., Hoskins, H. C., Protty, M. B., Pettit, R. and Johansen, A. 2022. The impact of adopting low-molecular-weight heparin in place of aspirin as routine thromboprophylaxis for patients with hip fracture. Postgraduate Medical Journal, article number: 141628. (10.1136/postgradmedj-2022-141628)
- Shah, A., Hawley, S., Inman, D. S., Cooper, C., Fagan, E., Johansen, A. and Judge, A. 2021. Geographical variation in surgical care and mortality following hip fracture in England: a cohort study using the National Hip Fracture Database (NHFD). Osteoporosis International 32(10), pp. 1989–1998. (10.1007/s00198-021-05922-6)
- Johansen, A., Evans, W. and Stone, M. 1999. Bone assessment in elderly women: what does a low bone ultrasound result tell us about bone mineral density?. Archives of Gerontology and Geriatrics 28(3), pp. 239-246. (10.1016/s0167-4943(99)00010-2)
Research
Teaching
I have used lectures and interactive teaching to spearhead the development of the specialty of orthogeriatrics within my hospital, within wales, and across the uk. I have pioneered new approaches to the care of frail and older trauma patients, using hip fracture as a model with which to study and understand their needs, and so improve how health services respond to them.
I teach students, surgical and medical juniors and the multidisciplinary team within my hospital and my national and international lecturing aim to support the adoption of hip fracture audit and orthopaedic-geriatric collaboration in other countries.
Protocols for the assessment and management of patients are key to improving care and outcome. Much of my work has focused on the development of a clerking and 'care bundle' protocol for the initial care of my own patients with hip and other femoral fractures:
Hip fracture proforma https://drive.google.com/file/d/1fduxcpd2thhu_ovrba27f5zpbj7mscap/view?usp=sharing
The following series of youtube talks is designed as a resource for students, nurses, therapists and juniors joining my department and explains the approach taken in this cardiff clerking proforma. My talks are a free resource for people developing hip fracture service in countries where the incidence of this injury is rising, but where the specialties of orthogeriatrics and geriatric medicine are less well developed.
Hip fracture made simple
A quick introduction to key aspects of acute hip fracture care https://youtu.be/qbn50gg5uug (15 minutes)
Orthogeriatrics talks
Using hip fracture to help us understand Frailty https://youtu.be/cvpns2msiau (28 minutes)
Using hip fracture to help us understand Peri-operative care https://youtu.be/u0xbgtk_sfo (35 minutes)
Using hip fracture to help us understand Delirium https://youtu.be/ri78onbt_gw (27 minutes)
Using hip fracture to help us understand Nutrition https://youtu.be/1bntlipqdbi (19 minutes)
Using hip fracture to help us understand Falls https://youtu.be/gzzdpzte-7i (22 minutes)
Using hip fracture to help us understand Osteoporosis https://youtu.be/otiibxkehfc (19 minutes)
Biography
In the 1990s Professors Woodhouse and Bayer pioneered acute geriatrician support for the Cardiff Trauma Unit. Since 1994 I have developed this concept; working as a full-time NHS consultant since 1997.
I was the world’s first consultant ‘orthogeriatrician’ to work full time in the acute orthopaedic wards, and went on to establish this new specialty by co-authoring the key British Orthopaedic Association ‘Blue Book’ on care of people with fragility fractures, and the 2011 NICE guidelines on hip fracture.
Since 2013 I have led our national clinical audit of hip fracture – the National Hip Fracture Database (NHFD), and its national sprint audits of hip fracture in collaboration with the Association of Anaesthesia and with the Chartered Society of Physiotherapy.
The NHFD's innovative website www.nhfd.co.uk makes a vast array of real time patient and service data freely available to those leading local and national quality improvement and research work in this area. The most recent NHFD report focuses on 2022 and is available at: https://www.nhfd.co.uk/20/hipfractureR.nsf/docs/2023Report and I discuss what the report and the NHFD website tell us in this YouTube talk: https://youtu.be/DrkbQ4nQxhc (27 minutes).