Ravi Patel (NIHR ACF Orthopaedic Trainee) from Robert Jones and Agnes Hunt Orthopaedic Hospital used Ignition funding to conduct PPIE, collaborate with international hip replacement registries, and complete a literature search of existing evidence. He tells us about it here:
The Academy Ignition funding was truly transformative for our research programme. Before this award, we had limited capacity to engage meaningfully with the oldest patients undergoing elective total hip replacement. This is a group frequently overlooked in research due to sensory, mobility, and digital barriers. The funding enabled us to recruit eight public contributors aged 90–96, including patients and carers, through thoughtfully adapted one-to-one telephone conversations that prioritised rapport-building and active listening for initial PPIE work.
Invaluable insights
The insights we gained were invaluable. Our contributors taught us that they view mortality risk pragmatically as an acceptable ‘chance you take.’ Their decision-making is driven overwhelmingly by quality of life; mobility, independence, and optimism, rather than longevity alone.
They called for clear, respectful, multi-modal communication and firmly rejected ageist or paternalistic framing. These findings fundamentally reshaped our research, leading to the co-design of new patient information leaflets and an infographic. Also, a complete reorientation of our interview topic guides to prioritise quality-of-life concerns before discussing mortality.
Academic impact
The work established through this award has had tangible academic impact. It directly contributed to two peer-reviewed publications:
- The methodology paper arising directly from this PPIE work: Patel R, Woodhouse B, Selim A, Banerjee R, Steele N, Dickenson E, Nandra R, Whitehouse SL, Higginbottom A, Evans JT, Thomas G. Patient and Public involvement to understand and inform the co-design of how we communicate mortality risk for patients aged 90 and over considering elective total hip replacement (THR). Research Involvement and Engagement. 2026 May 4;12(1):99. doi: 10.1186/s40900-026-00900-w. PMID: 42083000; PMCID: PMC13285189.
- A systematic review and meta-analysis, “90-day Mortality in Octogenarians & Nonagenarians Undergoing Elective Total Hip Arthroplasty,” accepted for publication in JBJS Open Access.
International collaboration
The credibility and relationships built through this PPIE work have opened doors to international collaboration that would otherwise not have been possible. We have now secured collaborative access to hip replacement registries in Sweden, the Netherlands and New Zealand, enabling us to examine mortality outcomes and communication practices across different healthcare systems.
This funding is now being used to support our ongoing registry-based data research in collaboration with these international partners. Our shared goal is to improve how we support healthy ageing and surgical decision-making for the oldest patients. We have continued to embed PPIE principles throughout this work, ensuring that patient and public perspectives remain central to our research as it expands globally.
The Ignition funding provided the essential infrastructure – honoraria for public contributors, facilitator time, and materials development – that enabled genuine inclusion of an underserved group. It continues to underpin our work as we build upon this foundation through international collaboration and sustained public involvement. We are immensely grateful to the Vivensa Foundation for making this possible.
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Thank you to my supervisors and collaborators who were instrumental to this work:
Supervisors:
– Dr. Dahai Yu (Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Staffordshire, UK)
– Mr. Johnathan T. Evans (Princess Elizabeth Orthopaedic Centre, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK)
– Professor Geraint Thomas (The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK)
Collaborators:
– Mr. Ben Woodhouse (Centre for Science and Technology in Medicine, School of Life Sciences, Keele University, Keele, Staffordshire, UK)
– Mr. Rajpal Nandra (Robert Jones and Agnes Hunt Orthopaedic Hospital Foundation Trust, Oswestry, Shropshire, UK)