This project determines the numbers of UK service personnel with sports related injuries requiring physiotherapy or admission to Bastion Role 3 facility. We identified the trend of the injuries and how they were sustained during. The outcomes were recorded to determine the cost to the mission. Data was collected from April to September 2013. Results included 123 (29% of the deployed contingent in BSN catchment) were unfit for role whilst receiving treatment and 27 personnel (6%) were unable to return to their role in theatre due to their injury. 19 personnel were evacuated to UK, 7 to RCDM and 12 DAH to RRU. The mean length of hospital stay was 2.5 days, the total number of overnight stays was 58. The cost of an overnight stay in a Role 3 hospital bed is £200 and the cost of an escorted Aeromed £8,020. Incidence of sports injuries of UK personnel during H18, requiring role 1 or role 3 interventions was 6.3%. Individual PT accounted for 84% of injuries and 16% due to duty PT. 50% were lower limb injuries (UL – 25%, spine – 25%). Following treatment 94% patients remained in BSN in role, 4% Aeromed to UK. The potential cost was estimated at a minimum of £163,980.
We aim to create a set of reference data of commonly used scoring systems in the normal population, and to compare these results with published postoperative scores for commonly performed knee operations. This was a questionnaire-based study and a total of 744 questionnaires were sent out, of which 494 replies were received. Six scoring systems were addressed: Lysholm and Oxford Knee Scores, Tegner and UCLA activity scales and Visual Analogue Scales (VAS) for both pain and function. Data was collected into groups based on age (20–29, 30–39, 40–49, 50–59, 60–69, 70–79, 80–89 years). The reference data obtained was then compared to published postoperative scores for knee arthroplasty and ACL reconstruction, to assess whether these patients did indeed return to “normal”. The mean scores for sequential age groups (described above) were as follows: Oxford Knee Score – 13, 13, 14, 14, 17, 15, 17; Lysholm Knee Score – 96, 95, 92, 89, 89, 89, 79; Tegener Activity Scale – 6, 5, 5, 4, 4, 3, 3; UCLA Activity Scale – 8, 7, 7, 7, 6, 6, 5; VAS pain – 5, 8, 10, 9, 14, 12, 20; VAS function 96, 95, 90, 90, 86, 84, 84. Symptom based scoring systems (Oxford Knee Score, Lysholm) were independent of age whereas activity scores (Tegner, UCLA) decreased with age. There was no significant difference detected between scores in different sexes in the same age group. Compared to published scores in an age-matched population following TKR, the data obtained showed that patients do not return to normal scores following arthroplasty. Following ACL reconstructive surgery, activity scores were higher than compared to the data obtained from our population. Data generated from this study can be used as reference data and can play an important role in interpreting post-intervention scores following knee surgery.
Complex primary total knee replacements have been poorly reported in the literature We review all complex primary total knee replacement procedures at Stepping Hill Hospital. Patients underwent knee examination, knee scores, notes review and pre- and post-operative radiograph review. There were 29 patients with 36 knees that had a complex primary total knee replacement. Most frequent indications for surgery were osteoarthritis, rheumatoid arthritis or following trauma. Mean age at surgery 70 years. The prosthesis used were : 3 Stryker Kinemax; 32 De Puy PFC and one rotating hinge. Complex Primary Oxford knee score; preoperative mean 45 (range 33 to 57); postoperative mean 26 (range 14 to 53). NJR Total Knee Replacement Oxford knee score postoperative mean 30. Mean visual analogue scores; pain in the knee, mean 19; knee function, mean 77; outcome of the operation 76; satisfaction with the surgery 87. Mean length of hospital stay 13 days. Using the Knee Society Radiographic Scoring System, there were no signs that need to be monitored or signify failure. Seven patients were transfused postoperatively, four patients had minor wound problems, three required further surgery, two to washout the knee and exchange the polyethylene liner, one femoral plating to stabilise an osteotomy site. Long term complications : one above knee amputation for infection, one foot drop. Revision implants can be used in complex primary knee replacements, and pose technical difficulties but address various pathologies. The surgery is associated with an increased risk of complications and transfusion. Clinical scores at least match scores for routine total knee replacements, patient satisfaction is excellent.
Patients are offered a choice of 4 hospitals and time and date of outpatient appointment on referral from their GP practice. Research revealed that people want choice. Can popular centres still provide a service for the local population? What are the priorities of the local population when choosing a healthcare provider?
94% would not change hospitals if offered a shorter waiting time 78% would wait longer than the government targets to be treated in the hospital of their choice 67% of patients did not want to be able to choose the time and date of their clinic appointment 61% thought the clinical quality of an institution was more important than the waiting time.
The government state patients want to choose the time and date of their first clinic appointment, however the majority of our population don’t. The current ‘Choose and Book’ system does not fulfil patient’s priorities.
