James started practising as an orthopaedic consultant in Bristol in 2007. He holds an elective NHS Consultant post at The Avon Orthopaedic Centre, Southmead Hospital where he is the Specialty Director for Elective Orthopaedics since 2017, previously having been Director for Trauma from 2008-2012. James is an Honorary Lecturer at the University of Bristol, School of Translational Health Sciences.

James graduated from Cambridge University, underwent basic surgical training in Oxford before working in knee and hip research in Newcastle. He then entered orthopaedic specialist training in the Wessex Deanery and won the EndoPlus Knee Prize in 2005. In 2006, he spent a Fellowship year in Sydney, Australia at the internationally renowned Australian Institute of Musculoskeletal Surgery, gaining valuable experience in sports injuries and joint replacement surgery under the supervision of Merv Cross. That same year he was awarded the British Association of Surgery for the Knee travelling fellowship.  

James has a keen research and training interest having written numerous published peer-reviewed papers and his first book, A to Z of Musculoskeletal and Trauma Radiology, which was published in June 2008. He also reviews for scientific journals, including the Bone and Joint Journal, The Knee, Injury, Acta Orthopaedica and Clinical Orthopaedics and Related Research. James leads on a number of trials and contributes to others as a co-investigator; he works closely with his colleagues as a member of the Bristol Knee Group which carries out research and teaching related to knee surgery both in the UK and internationally. He is a member of both national and international collaborative consensus groups.

His extensive experience has enabled him to offer a comprehensive knee service from ligament reconstruction, meniscal and cartilage surgery, osteotomy, partial, total and revision knee replacement. He is able to solve even the most complex of knee problems, including prosthetic knee joint infection, the management of which is coordinated by a multidisciplinary team at Southmead Hospital where James leads the service. He is well-known to encourage early post-operative mobility using techniques such as minimally-invasive muscle-sparing joint replacement and avoidance of tourniquets.

James has a keen sporting interest, previously playing competitive squash, athletics and rugby, but now he tends to be more of a spectator, but still coaches rugby and still plays recreational squash and loves skiing! He is also a keen pianist, playing anything from Blues to Classical.  He is married to a local GP at Bristol University Students' Health Service and together they have three children.