By: 1 July 2021
Surgeon in focus – Matthew Costa

Professor Matthew Costa was appointed Professor of Orthopaedic Trauma, University of Oxford in 2015. He was previously Professor of Trauma and Orthopaedics at University of Warwick. Matt is also Honorary Consultant Trauma Surgeon at the John Radcliffe Hospital, Oxford.

Matt’s research interest is in clinical and cost effectiveness of musculoskeletal interventions and he is Chief Investigator for a series of randomised trials and associated studies supported by grants from the UK National Institute of Health Research. His work has been cited widely, and informs many guidelines from the National Institute for Health and Care Excellence (NICE).


OPN: What drove you to choose surgery as a career – and orthopaedic surgery in particular?

MC: Surgery offers a huge variety of activities from emergency department through wards and clinics and, of course, into the operating theatre – it was that variety of work that attracted me to surgery. In terms of specialty, the practical mechanics of T&O surgery was a big draw.


OPN: It is clear that the healthcare industry has been greatly impacted by the Covid-19 pandemic, what has been the greatest impact within the orthopaedic industry?

MC: As an orthopaedic trauma surgeon, I consider myself lucky to have been able to carry on my ‘day job’ at a time when many of my colleagues in planned orthopaedics were redeployed into unfamiliar environments, including COVID wards. I think the biggest challenge for the healthcare industry is how to cope with and support the backlog of planned surgery that has built up during the pandemic.


OPN: As a surgeon, how do you embrace new technologies to ensure the best patient experience, management strategies and surgical outcomes?

MC: I’m very interested in testing new technologies against the best existing solutions. This is the reason why we run a lot of studies such as the World Hip Trauma Evaluation, which allows us to assess new interventions for patients in formal randomised clinical trials. New technology has the power to improve outcomes for patients, but also the potential to cause harm if it is not properly evaluated before being introduced across whole healthcare systems.


OPN: Tell us more about the results recently published concerning the world hip trauma evaluation study at NDORMS?

MC: The UK National Health Service, and many other health systems around the world, set standards for high-quality care and sometimes link financial payments to institutions which deliver against these standards.

In the UK, the NHS set seven quality standards for the delivery of care to patients with hip fracture and gave hospitals extra money if they met these quality indicators. By delivering care which met these standards it was hoped that patients would have better outcomes, but evidence that this was the case was limited.

Using data from the World Hip Trauma Evaluation [WHiTE] project we were able to show that tariff payments linked to the delivery of recommendations for best care led to better quality of life for patients.


OPN: How could this effect patient experience and outcomes? What did you find were the most important indicators of care to improve patient recovery?

MC: Trauma and orthopaedic units which can meet all seven standards of care will provide the best outcomes for patients with this serious injury. However, achieving just three of these quality standards – “joint care by surgeon and orthogeriatrician,” “assessment of falls risk and bone health” and “preoperative and postoperative cognitive assessments” – will lead to a measurable improvement in patients’ quality of life at 120 days after their hip fracture. Early, expert surgery is important. However, it seems that multi-disciplinary care for older, frail patients with fragility fractures really is the key to improving their recovery.


OPN: What’s the best part of your job?

MC: Still the days when I am in the operating theatre. As I spend more and more of my time on research, I enjoy the days with my trainees in the operating theatre more than ever.


OPN: … and the worst?

MC: At the moment, the endless meetings on video conference – I’m all zoomed out…


OPN: What has been the highlight of your career so far?

MC: There have been many highlights (and quite a few low moments) but I think the one that stands out was the first time that we identified that surgeons were changing their clinical practice in response to a clinical trial that we had published. Finishing a research project and publishing the results is one thing, but the research only really matters if surgeons and healthcare systems use that research to inform the way that they treat patients.


OPN: If you weren’t an orthopaedic surgeon what would you be?

MC: I always wanted to be a footballer. I was very enthusiastic, but it turns out that you also need to be a talented player! I’d still answer the call if Jurgen Klopp asked me to play for Liverpool FC


OPN: What would you tell your 21-year-old self?

MC: Choose the career option that you think you’ll enjoy the most. It’s easy to work hard in a job which you enjoy.


OPN: If you were Health Minister for the day what changes would you implement?

MC: Increase pay for nurses.


OPN: Are you attending any orthopaedic events this year?

MC: Yes, I’m attending the Orthopaedic Trauma Society meeting in the UK, which is part in person and part online, and hoping to participate in person at the British Orthopaedic Association meeting. No trips abroad unfortunately.


OPN: Away from the clinic and operating theatre – what do you do to relax?

MC: My children still keep me busy at weekends but, as they get older, I’m trying to do more cycling (but only because I can no longer play football).


OPN: How do you think the future looks in the field of orthopaedic surgery and what are your predictions for the decade ahead?

MC: I still think Trauma and Orthopaedic surgery is the best specialty in medicine. I can’t see a ‘cure’ for arthritis appearing in my lifetime and people will still find ways to break themselves so there will be no lack of work, that’s for sure.

I would like to think that formal trials of new techniques and devices, as they are introduced into clinical practice, will become the norm in the next ten years.