Aims

Deprivation underpins many societal and health inequalities. COVID-19 has exacerbated these disparities, with access to planned care falling greatest in the most deprived areas of the UK during 2020. This study aimed to identify the impact of deprivation on patients on growing waiting lists for planned care.

Aims

COVID-19 has compounded a growing waiting list problem, with over 4.5 million patients now waiting for planned elective care in the UK. Views of patients on waiting lists are rarely considered in prioritization. Our primary aim was to understand how to support patients on waiting lists by hearing their experiences, concerns, and expectations. The secondary aim was to capture objective change in disability and coping mechanisms.

Introduction

Both mobile bearing and fixed bearing unicompartmental knee arthroplasty (UKA) have demonstrated clinical success. However, much debate persists about the superiority of a single design. Currently most clinical data is based on high volume centers data, however to reduce bias, we undertook a through review of retrospective national joint registries. In this study, we aim to investigate UKA implant utilization and survivorship between 2000 and 2018.

Acetabular cup positioning remains a real challenge and component malpositioning after total hip arthroplasty (THA) can lead to increased rates of dislocation and wear. It is a common cause for revision THA. A novel 3D imageless mini-optical navigation system was used during THA to provide accurate, intraoperative, real-time, and non-fluoroscopic data including component positioning to the surgeon. This retrospective comparative single surgeon and single approach study examined acetabular component positioning between traditional mini-posterolateral THA and mini-posterolateral THA using the 3D mini-optical navigation system. A retrospective chart review was conducted of 157 consecutive (78 3D mini-optical navigation and 79 traditional non-navigation methods) THAs performed by the senior author using a mini-posterolateral approach at an ambulatory surgery center and hospital setting. Two independent reviewers analyzed postoperative radiographs in a standardized fashion to measure acetabular component positioning. Demographic, clinical, surgical, and radiographic data were analyzed.

These groups were found to have no statistical difference in age, gender, and BMI (Table I). There was no difference between groups in acetabular components in the Lewinnek safe zone, 31.2% vs 26.6% (p = 0.53). Cup anteversion within the safe zone did not differ, 35.1% vs 40.5% (p = 0.48); while cup inclination within the safe zone differed, with more in the navigation group, 77.9% vs 51.9% (p < 0.01). Change in leg length was significantly different with the navigation group's leg length at 1.9 ± 6.3, less than the traditional at 5.4 ± 7.0 (p < 0.01). There was no difference in mean change in offset between groups (4.5 ± 5.9 vs 6.2 ± 7.9, p = 0.12); navigation, traditional) (Table II). The 3D mini-optical navigation group did have significantly longer operative time (98.4 ± 17.5 vs 89.3 ± 15.5 p < 0.01). Use of the novel 3D Mini-optical Navigation System significantly improved cup inclination compared to traditional methods while increasing operative time.

For any figures or tables, please contact the authors directly.

INTRODUCTION

Component impingement in total hip arthroplasty (THA) can cause implant damage or dislocation. Dual mobility (DM) implants are thought to reduce dislocation risk, but impingement on metal acetabular bearings may cause femoral component notching. We studied the prevalence of (and risk factors for) femoral notching with DM across two institutions.

Background

80% of health data is recorded as free text and not easily accessible for use in research and QI. Natural Language Processing (NLP) could be used as a method to abstract data easier than manual methods. Our objectives were to investigate whether NLP can be used to abstract structured clinical data from notes for total joint arthroplasty (TJA).

OBJECTIVE

Post TKR manipulation under anesthesia is required when post operatively patients don't achieve desired range of motion. The rates quoted in various western literature ranges from 1 to 2 %. A knee is considered to be stiff when the patient fails to achieve 60 degrees of flexion. The objective of the study was to find out the differentiating factor responsible for low rate of MUA in Indian post TKR patients as compared to Anglo-Saxon population

Introduction and aim

TKR remains one of the most successful surgeries in orthopedics. Still a sizeable number of patients remain dissatisfied reaching to a level of 30%. Our aim was to examine the excised synovium from the suprapatellar region in all osteoarthritic knees and evaluate the histopathological report to know if in a few cases the unrelenting pain and discomfort could be due to some undiagnosed pathology within the joint.

INTRODUCTION

This study is to determine the response of CRP after TKR surgery, both unilateral and simultaneous bilateral TKR. According to the previously published literature from North America and Europe CRP value peaks on the 1^st and 2^nd post-operative day and then gradually comes down to normal by 6–8 weeks post-operatively.

Introduction

Forgotten knee is the terminology which is used to describe a post TKR patient who is completely unaware of his knee implant. Various factors like age, sex, BMI, pre operative pain, pre operative patella symptoms have been studied to see their cause effect relationship on the achievement of forgotten knee status by the patient. All the published data till to date shows no relationship between thetwo

Tibial shaft fractures co-existing with osteoarthritis can increase the challenges for the orthopedic surgeon. The novel Londhe-Shah technique manages both the problems using one-stage total knee arthroplasty with a long stemmed tibial component which has a good diaphyseal fit. Three osteoarthritis patients with fractures of tibial shaft were treated with this technique and were followed up at 6-weeks, 12-weeks and 1-year (figure 1–3). A complete union of the fractured segment was achieved at follow-up without any adverse events such as infection, damage to the implant, and soft-tissue injury during and after surgery. The American Knee Society Score (AKSS) improved and WOMAC pain and stiffness scores reduced at follow-ups suggesting excellent improvement in functionality and patient satisfaction. One-stage TKR with a long-stem extension of the tibial component to bypass the fracture site mends and stabilises the fracture along with the adverse biomechanics at the fracture site while also correcting the arthritis. The single stage procedure allows early ambulation in six weeks.

For any figures or tables, please contact the authors directly.

Summary Statement

Pulmonary embolism (PE) after total knee arthroplasty can have a significant impact on patient outcomes and healthcare costs. Efforts to prevent or minimise PE over the last 10 years have not had a significant impact on its occurrence at the national level.

A number of studies suggest revision of unicompartmental knee replacement (UKR) to total knee replacement (TKR) is straightforward. We hypothesise that this is not always the case in terms of complexity, cost and clinical outcome.

We identified 23 consecutive patients revised from UKR to TKR by 2 consultant surgeons (2005–2008). These were matched by age, sex and comorbidity to a cohort of primary TKRs (42 patients) performed during the same period. Data were collected regarding demographics, cost (surgical time & implants) and 1 & 5-year follow-up of clinical outcome (OKS) and outpatients attended.

There was no statistically significant difference in cost of implants for revision UKR to TKR vs. primary TKR (p=0.08), however operative time was significantly higher in the revision group. One year mean OKS was significantly higher in the primary TKR group (mean 30 vs. 23 p=0.03), but 5-year follow up showed no significant difference (mean OKS 27 vs. 32 p=0.20). The revision group had statistically significantly greater number of follow-up appointments (mean 6 Vs. 2 p<0.0001).

Revision of UKR to TKR is not a universally straightforward procedure, carrying significant overall cost implications. Clinical outcomes, although significantly different at 1 year are almost the same at 5 years.

Computer assisted total knee arthroplasty has been demonstrated to provide reproducible limb mechanical alignment within three degrees from the neutral mechanical axis. However, restoring proper implant and extremity alignment remains a significant challenge with proximal tibial deficiencies. In this prospective study, we describe the use of computer navigation to quantify the amount of bone loss on the medial or lateral tibial plateau and the use of this data to assess the need for augmentation with metallic tibial wedges.

In this study, we demonstrate that CAS TKR in patients with significant tibial deformities can accurately measure severe tibial deformities, predict tibial augment thickness, and provide excellent mechanical alignment and restore the joint line without excessive bony resection, repeated osteotomies, and repeated augment trialing.

Back pain is extremely common in soldiers undergoing training¹. There is no data worldwide with regards to incidence, prevalence and impact of back pain in a deployed military population. This study was undertaken to evaluate these issues.

1000 back pain questionnaire were distributed over a period of four days at the main military base in Basrah in February 2009 in different locations. The filling out was anonymous and completely voluntary.

UK military personnel

Information was obtained about age, BMI, length of service, rank, incidence, prevalence, onset, admission rate, treatment, aero-medical evacuation, operational effectiveness, pain killers and VAS.

768 (77%, 26% of population at risk) questionnaires were returned Prevalence of back pain was 33.4% (257). A greater prevalence occurred in the combat arms (41.7%, p=0.01) and those of over 12 years service (44%, p=0.004). No statistical difference was found with rank, or BMI. 74 people (9.6%) had developed new onset back pain since deploying. Recurrent pain occurred in 38.9% of the whole sample. VAS showed a normal distribution. 35% of those affected were discharging their duty with mild difficulty but around 6% were having great difficulty. 25% were on regular analgesics. Back pain constituted 23% (137/583) of the physiotherapy dept caseload, 6.6%, (25/378) of ward admissions and 0.04% (5/119) of aero-med patients.

Back pain is a major problem among deployed personnel. However with adequate resources the vast majority can be managed in the field thus reducing attrition rates² and maintaining operational effectiveness. Further studies should be undertaken to assess if back pain persists after deployment.

Introduction

Displaced distal radius fractures in children have been treated in above elbow plaster casts since the last century. Cast index has been calculated previously, which is a measure of the sagittal cast width divided by the coronal cast width measurement at the fracture site. This indicates how well the cast was moulded to the contours of the forearm. We retrospectively analysed the cast index in post manipulation radiographs to evaluate its relevance in redisplacement or reangulation of distal forearm fractures.

Computer Assisted Total Knee Arthroplasty (CAS TKR) has been shown to provide excellent and reproducible limb mechanical alignment. CAS TKR has also been demonstrated to reduce limb alignment variance and outliers. Previous studies have shown improved mechanical alignment both radiographically and clinically. Specifically, CAS TKR has been shown to result in alignment deviations less than 3 degrees from neutral mechanical femoral and tibial axes. Furthermore, CAS TKR also permits any significant pre-operative tibial deformity to be quantified prior to performing tibial osteotomies. In this study, we describe the use of computer navigation to quantify the amount of bone loss on the medial or lateral tibial plateau and the subsequent use of this data to assess the need for augmentation with tibial wedges.

Two hundred and thirty consecutive primary computer assisted total knee arthroplasties were performed by one senior surgeon (L.P.) at Northwestern Memorial Hospital. In all cases, the tibial deformity was quantified and recorded intraoperatively using computer navigation software. The deformity was recorded in the navigation software by inputting the lowest point on the deformed tibial plateau and the mid point on the non-deformed tibial plateau using navigation markers. After Institutional Review Board approval was obtained, a retrospective review of the patient operative reports and patient charts was performed. Operative reports were reviewed to identify cases with the difference between the values of medial and lateral tibial plateaus exceeded thirteen millimeters and cases when tibial augmentation was performed. In cases utilising medial or lateral tibial augmentation, pre operative and post operative anterior posterior and lateral knee radiographs and long leg standing anterior posterior radiographs were reviewed to measure the joint line restoration and final mechanical limb alignment.

All two hundred and thirty operative dictations and patient charts were reviewed. In seven cases, the difference between the values of the medial and lateral tibial plateaus was greater than thirteen millimeters. In all seven cases, tibial augmentation was utilized in order to prevent resection of tibial bone in excess of fourteen millimeters. In cases with a difference of medial and lateral tibial plateau values of less than thirteen millimeters, no tibial augmentation was utilised. For the seven cases using tibial augmentation, preoperative and post-operative knee and long standing radiographs were reviewed to examine joint line restoration and final limb alignment. In all seven patients, joint line restoration was successful within 4 millimeters and long standing radiographs revealed excellent limb alignment.

Computer Assisted Total Knee Arthroplasty has already been shown to provide excellent limb alignment and reduce variance and outliers. We demonstrate that Computer Assisted Total Knee Arthroplasty in patients with significant tibial deformities can help assess and the amount of bone loss on the medial or lateral tibial plateaus. Excessive tibial resection to restore the mechanical axis and joint line can be avoided by quantifying the amount of tibial bone loss prior to osteotomy. Thus, Computer Assisted Total Knee Arthroplasty can successfully restore the joint line and overall limb alignment with conservative bone resection in patients with significant pre-operative tibial deformities.

Back pain is common, with quotes of lifetime prevalence ranging from 50% to 80% and point prevalence of 15% to 30%. There is scarce data within the British Military.

A prospective observational study evaluated the prevalence of back pain and its impact on work in a deployed population on OP TELIC 13. 1000 questionnaires were distributed over 4 days, 768 were returned. Additionally, clinical data was collected from the ward, aero-medical, and physiotherapy dept for the period September 2008- February 2009.

Overall prevalence of back pain was 33.4% (257). A greater prevalence occurred in the combat arms (41.7%, p=0.01) and those of over 12 years service (44%, p=0.004). No statistical difference was found with rank, or BMI. 74 people (9.6%) had developed new onset back pain since deploying. Within the new pain group 10/74, (13%) were experiencing either ‘some’ or ‘great’ difficulty at work. Recurrent pain occurred in 38.9% of the whole sample, with an increased prevalence in those of over 12 years service (58% p< 0.001). Back pain constituted 23% (137/583) of the physiotherapy dept case-load, 6.6%, (25/378) of ward admissions and 0.04% (5/119) of aero-medical patients.

This study shows that back pain is a major problem among deployed personnel, but can be managed with timely medical input, and is rarely the indication for aero-medical evacuation. Adequate resources are required to maintain operational effectiveness. Further studies should be undertaken to assess if back pain persists after deployment.

Introduction The aim of this study was to assess the comparability of telephone questionnaire interviews with outpatient attendance for assessing hip function after Total Hip Replacement (THR).

Materials and Methods 100 patients attending the orthopaedic clinic for follow-up after undergoing THR were recruited to this study. A modified Harris Hip Score (HHS) was used as the questionnaire. This modified score assessed pain and function with 8 variables and had a maximum score of 91. The score thus obtained was multiplied by a factor of 1.1 to derive a score out of 100. Patients attending follow-up clinics were contacted by telephone between 1–2 weeks prior to their scheduled appointment and the questionnaire was completed. The questionnaires thus completed were compared to those completed in the clinic.

Results The mean HHS obtained with the telephone interview was 85.22 as compared to 86.11 obtained at direct interview with a Pearson’s correlation coefficient of (0.906) and p-value for the difference of (0.111). Out of a total of 800 variables assessed 725 (90.37%) had the same scores by the two methods and only 75 (9.67%) showed a discrepancy. Only 3 patients had a significant difference (more than 20 points) between the two methods.

Conclusion The study shows that there is no significant difference between scores obtained by telephone interview or direct interview using a modified HHS. Telephone interview is an important adjuvant tool for patient follow-up after THR and a useful adjunct to lifelong review.

Introduction: The aim of this study was to assess the feasibility of telephone questionnaire interviews for assessing hip function after Total Hip Replacement (THR).

Methods: 100 patients attending the orthopaedic clinic for follow-up after undergoing THR were recruited to this study. A modified Harris Hip Score (HHS) was used as the questionnaire. This modified score assessed pain and function with 8 variables and had a maximum score of 91. The score thus obtained was multiplied by a factor of 1.1 to derive a score out of 100. Patients attending follow-up clinics were contacted by telephone between 1–2 weeks prior to their scheduled appointment and the questionnaire was completed. The questionnaires thus completed were compared to those completed in the clinic.

Results: The mean HHS obtained with the telephone interview was 85.22 as compared to 86.11 obtained at direct interview with a Pearson’s correlation coefficient of (0.906) and p-value for the difference of (0.111). Out of a total of 800 variables assessed 725 (90.37%) had the same scores by the two methods and only 75 (9.67%) showed a discrepancy. Only 3 patients had a difference of > 20 points between the two methods.

Conclusion: The study shows that there is no significant difference between scores obtained by telephone interview or direct interview using a modified HHS.

Telephone interview is an important tool for patient follow-up after THR and a useful adjunct to life-long review.