This study aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after total knee replacement (TKR) for patients with and without post-operative chronic knee pain. 83 adults participating in the PEP-TALK, a RCT testing the effectiveness of a behaviour change physiotherapy intervention versus usual rehabilitation post-primary TKR, were analysed. UCLA Activity Score and EQ-5D-5L values for participants with and without chronic knee pain (14 points or lower in the Oxford Knee Score Pain Subscale at six months post-TKR) were compared at six and 12 months post-TKR. We evaluated recovery trajectory those with or without chronic pain at these time points.Abstract
INTRODUCTION
METHODS
An increasing elderly population means joint replacement surgery numbers are projected to increase, with associated complications such as periprosthetic joint infections (PJI) also rising. PJI are particularly challenging due to antimicrobial resistant biofilm development on implant surfaces and surrounding tissues, with treatment typically involving invasive surgeries and systemic antibiotic delivery. Consequently, functionalisation of implant surfaces to prevent biofilm formation is a major research focus. This study characterises clinically relevant antimicrobials including gentamicin, clindamycin, daptomycin, vancomycin and caspofungin within a silica-based, biodegradable sol-gel coating for prosthetic devices. Antimicrobial activity of the coatings against clinically relevant microorganisms was assessed via disc diffusion assays, broth microdilution culture methods and the MBEC assay used to determine anti-biofilm activity. Human and bovine cells were cultured in presence of antimicrobial sol-gel to determine cytotoxicity using Alamar blue and antibiotic release was measured by LC-MS. Biodegradability in physiological conditions was assayed by FT-IR, ICP-MS and measuring mass change. Effect of degradation products on osteogenesis were studied by culturing mesenchymal stem cells in the presence of media in which sol-gel samples had been immersed. Antimicrobial-loaded coatings showed strong activity against a wide range of clinically relevant bacterial and fungal pathogens with no loss of activity from antibiotic alone. The sol-gel coating demonstrated controlled release of antimicrobials and initial sol-gel coatings showed no loss of viability on MSCs with gentamicin containing coatings. Current work is underway investigating cytotoxicity of sol-gel compositions against MG-63 cells and primary osteoblasts. This research forms part of an extended study into a promising antimicrobial delivery strategy to prevent PJI. The implant coating has potential to advance PJI infection prevention, reducing future burden upon healthcare costs and patient wellbeing.
We investigated the prevalence of late developmental dysplasia of the hip (DDH), abduction bracing treatment, and surgical procedures performed following the implementation of universal ultrasound screening versus selective ultrasound screening programmes. A systematic search of PubMed, Embase, The Cochrane Library, OrthoSearch, and Web of Science from the date of inception of each database until 27 March 2022 was performed. The primary outcome of interest was the prevalence of late detection of DDH, diagnosed after three months. Secondary outcomes of interest were the prevalence of abduction bracing treatment and surgical procedures performed in childhood for dysplasia. Only studies describing the primary outcome of interest were included.Aims
Methods
The preoperative diagnosis of periprosthetic joint infection (PJI) remains a challenge due to a lack of biomarkers that are both sensitive and specific. We investigated the performance characteristics of polymerase chain reaction (PCR), interleukin-6 (IL6), and calprotectin of synovial fluid in the diagnosis of PJI. We performed systematic search of PubMed, Embase, The Cochrane Library, Web of Science, and Science Direct from the date of inception of each database through to 31 May 2021. Studies which described the diagnostic accuracy of synovial fluid PCR, IL6, and calprotectin using the Musculoskeletal Infection Society criteria as the reference standard were identified.Aims
Methods
Alcohol has been associated with up to 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. This study aimed to quantify the effect of lockdown on trauma admissions specifically regarding alcohol-related trauma. All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N=316), and 1st April – 31st May 2020 (lockdown; N=191) had electronic patient records (EPR) analysed. Patients’ blood alcohol level (BAC) combined with records of intoxication were used to identify alcohol-related trauma. Multiple regression analyses were performed to compare pre- and post-lockdown alcohol-related trauma admissions.Abstract
Background
Methods
This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery. This will be a mixed-methods feasibility RCT, recruiting 60 patients following hip fracture surgery and their informal caregivers. Patients will be randomized to usual NHS care, versus usual NHS care plus a caregiver-patient dyad training programme (HIP HELPER). This programme will comprise of three, one-hour, one-to-one training sessions for the patient and caregiver, delivered by a nurse, physiotherapist, or occupational therapist. Training will be delivered in the hospital setting pre-patient discharge. It will include practical skills for rehabilitation such as: transfers and walking; recovery goal setting and expectations; pacing and stress management techniques; and introduction to the HIP HELPER Caregiver Workbook, which provides information on recovery, exercises, worksheets, and goal-setting plans to facilitate a ‘good’ recovery. After discharge, patients and caregivers will be supported in delivering rehabilitation through three telephone coaching sessions. Data, collected at baseline and four months post-randomization, will include: screening logs, intervention logs, fidelity checklists, quality assurance monitoring visit data, and clinical outcomes assessing quality of life, physical, emotional, adverse events, and resource use outcomes. The acceptability of the study intervention and RCT design will be explored through qualitative methods with 20 participants (patients and informal caregivers) and 12 health professionals.Aims
Methods
Kinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. A primary search was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials.Introduction and Objective
Materials and Methods
Urinary catheter use in the peri-operative and post-operative phase following arthroplasty may be associated with increased risk of urinary tract infection (UTI) and deep prosthetic joint infection (PJI). These can be catastrophic complications in joint arthroplasty. We performed a systematic review of the evidence on routine use of antibiotics for urinary catheter insertion and removal following arthroplasty. Electronic databases were searched using the HDAS interface. Grey literature was also searched. From 219 citations, six studies were deemed eligible for review. Due to study heterogeneity a narrative approach was adopted. Methodological quality of each study was assessed using the CASP appraisal tool. Included studies were found to have moderate to good methodological quality.Aims
Methods
Tantalum trabecular metal components are increasingly used to reconstruct major bone defects in revision arthroplasty surgery. It is known that some metals such as silver have antibacterial properties. Recent reports have raised the question as to whether Tantalum components are protective against infection in revision surgery. This is based on a retrospective, single institution review, of revision cases comparing tantalum with titanium acetabular implants, which reported a lower incidence of subsequent infection in the tantalum group. This laboratory study aimed to establish if tantalum had any intrinsic antibacterial properties against planktonic bacteria or ability to inhibit biofilm formation. Equal sized pieces of tantalum (Trabecular metal, Zimmer UK) and titanium (Trilogy, Zimmer UK) were sterilised and then incubated with a low dose inoculum of either Staphylococcus aureus or Staphylococcus epidermidis for 24 hours. After serial dilution, colony forming units were quantified on MH agar plates. To establish the ability to inhibit biofilm formation these tantalum and titanium pieces were then washed twice, sonicated and washed again to remove loosely adhered planktonic bacteria. They were then re-incubated for 24 hours prior to quantifying colony forming units. All experiments were performed in triplicateIntroduction
Materials and methods
Previous systematic reviews have shown that patients experience low physical activity levels following total hip replacement (THR). However no previous systematic reviews have examined the changes between pre- and post-operative physical activity levels. AMED, MEDLINE, EMBASE, CENTRAL, CINHAL, openSIGLE, Introduction
Methods
Vancomycin is commonly added to acrylic bone cement during revision arthroplasty surgery. Proprietary cement preparations containing vancomycin are available but significantly more expensive. We investigated whether the antibiotic elution and mechanical strength of ‘home-made’ vancomycin containing bone cement was comparable to commercial vancomycin-impregnated cement. A total of 18 cement discs of constant size, containing either proprietary CopalG+V®; or ‘home-made’ CopalR+G® with vancomycin added by hand, were made. Each disc contained the same antibiotic quantities (0.5g gentamycin, 2g vancomycin) and was immersed in ammonium acetate buffer in a sealed container. Fluid from each container was sampled at eight time points over a two week period. The concentration of gentamicin and vancomycin in the fluid was analysed using high performance liquid chromatography mass spectrometry. The impact strength of each PMMA cement preparation was measured using a Charpy-type impact tester.Introduction
Methods
This analysis determined whether the type and level of physical activity changes during the initial 24 months post-total hip (THR) or total knee replacement (TKR) compared to pre-operative levels, and how this change compares to people without arthroplasty or osteoarthritis. Data from a prospective cohort dataset (Osteoarthritis Initiative dataset) of community-dwelling individuals who had undergone a primary THR or TKR were identified. These were compared to people who had not undergone an arthroplasty and who did not have a diagnosis of hip or knee osteoarthritis during the follow-up period (control). Data were analysed comparing between-group and within-group differences for physical activity (gardening, domestic activities, sports, employment, walking) within the first 24 months post-arthroplasty.Introduction
Patients/Materials & Methods
We investigated whether the indentation of bone
cement spacers used in revision of infected joint arthroplasty with a
MacDonald dissector increased the elution of antibiotic The fluid sampled at 72 hours from the indented discs containing
0.17 g gentamicin (0.88% w/w) contained a mean of 113 mcg/ml (90.12
to 143.5) compared with 44.5 mcg/ml (44.02 to 44.90) in the fluid
sampled from the plain discs (p = 0.012). In discs containing 0.33
g gentamicin (1.75% w/w), the concentration eluted from the indented discs
at 72 hours was a mean of 316 mcg/ml (223 to 421) compared with
a mean of 118 mcg/ml (100 to 140) from the plain discs (p <
0.001). At two weeks, these significant differences persisted. At nine
weeks the indented discs eluted a greater concentration for all
gentamicin doses, but the difference was only significant for the
discs containing 0.17 g (0.88% w/w, p = 0.006). However if the area
under the curve is taken as a measure of the total antibiotic eluted,
the indented discs eluted more gentamicin than the plain discs for
the 0.17 g (0.88% w/w, p = 0.031), the 0.25 g (1.41% w/w, p <
0.001) and the 0.33 g (1.75% w/w, p <
0.001) discs. When preparing antibiotic spacers for use in staged revision
arthroplasty surgery we recommend indenting the spacer with a MacDonald
dissector to increase the elution of antibiotic. Cite this article:
Obesity is a global epidemic of 2.1 billion people and a well known cause of osteoarthritis. Joint replacement in the obese attracts more complications, poorer outcomes and higher revision rates. It is a reversible condition and the fundamental principles of dealing with reversible medical conditions prior to elective total joint replacement should apply to obesity. The dilemma for orthopaedic surgeons is when to offer surgery in the face of a reversible condition, which if treated may obviate joint replacement and reduce the risk and severity of obesity related disease in both the medical arena and the field of orthopaedics.
Enhanced recovery programmes have improved outcomes following elective arthroplasty surgery. Most studies assess whole advanced recovery programmes. There are few studies assessing the role of patient education. We therefore assessed our outcomes. As part of our enhanced recovery programme at Wrexham Maelor Hospital, all patients are offered the chance to attend ‘joint school’, a preoperative education class. Not all patients attend these sessions allowing comparison of outcomes in these two groups using our prospectively collected database of outcome measures. Between April 2009 and March 2013, 915 patients underwent elective hip or knee arthroplasty. Revision cases were excluded, leaving 567 knee replacements, 315 hip replacements and 27 unicompartmental knee replacements. In patients undergoing knee replacement, those attending joint school had shorter length of stay (4.38 vs 4.85 days, p=0.145) and better Oxford Knee Score at 6 months (p=0.026) and two years (p=0.035). Patients undergoing total hip arthroplasty had a statistically significantly shorter length of stay (3.64 vs 4.54 days, p=0.011); increased frequency of mobilising on the day of surgery (28.1% vs 22.6%, p=0.203) and higher Oxford Hip Scores (non-significant) if they attended joint school. Our retrospective analysis demonstrates that preoperative education for patients undergoing elective total hip arthroplasty produces significantly shorter lengths of stay. There are also effects on mobilisation and outcome scores. These effects are also seen in knee arthroplasty. These results will have clinical and financial implications. Assessing cost of saved bed days alone, joint school saves the trust over £10,000 per year.
Patellar instability is a complex, multi-factorial disorder. Radiological assessment is regarded as an important part of the management of this population. The purpose of this study was to determine the intra- and inter-rater reliability of common radiological measurements used to evaluate patellar instability. One hundred and fifty x-rays from 51 individuals were reviewed by five reviewers: two orthopaedic trainees, a radiological trainee, a consultant radiologist and an orthopaedic physiotherapist. Radiological measurements assessed included patellar shape, sulcus angle, congruence angle, lateral patellofemoral angle (LPA), lateral patellar displacement (LPD), lateral displacement measurement (LDM), boss height, and patellar height ratios (Caton-Deschamps, Blackburne-Peel, Insall-Salvati). All assessors were provided with a summary document outlining the method of assessing each measurement. Bland-Altman analyses were adopted to assess intra- and inter-rater reliability.Background
Methods
Injectable collagenase clostridium histolyticum (CCH) is a minimally invasive non-surgical therapy with efficacy in correcting Dupuytren's contracture (DC). In the concurrently run JOINT I and JOINT II studies, designed to follow clinical practice, we evaluated the efficacy of ?5 CCH injections in patients with DC. JOINT I and II were multicenter, 9-month, open-label studies in which DC patients with primary flexion deformities ?20° received ?3 CCH (0.58 mg) injections/joint (?5 injections/patient) at 30-day intervals into joints prioritized by extent of contracture. After the first injection, patients could opt to receive up to 2 additional injections in same cord or other cords regardless of outcome for the first joint. The primary endpoint was reduction in contracture to ?5° 30 days after the last injection. Data from JOINT I and II were pooled.Introduction
Methods
Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulna sided wrist pain and resultant functional disability. Diagnosis is based on history, clinical examination and radiological evidence of a TFCC central perforation or radial/ulna tear. The purpose of this study is therefore to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the detection of TFCC injury in the adult population. Published and unpublished literature databases were systematically review independently by two researchers. Two-by-two tables were constructed to calculate the sensitivity and specificity of MRI or MRA investigations against arthroscopic outcomes. Pooled sensitivity and specificity values and summary Receiver Operating Characteristic curve (sROC) evaluations were performed. Methodological quality of each study was assessed using the QUADAS (Quality Assessment of Diagnostic Accuracy Studies) tool.Background and Objectives
Methods
Using Altman’s nomogram, the sample size was calculated to be 85 for a power of 90%, with an α significance level of 0.05. Using this database, digital radiographs were assessed using the institution’s PACS system. Pre-operative and follow-up skyline radiographs following Jones et al’s (1993) patellofemoral scoring system were examined by four assessors utilising Jones’ patellofemoral scoring system. In addition, in cases where patellofemoral joint changes were evident, each assessor acknowledged whether this involved the medial, lateral or bilateral aspects of the patellofemoral joint. Intra-observer reliability was made comparing the four assessors. Statistical analysis was performed, using the Statistical Package for the Social Sciences (SPSS) 16.0 for Windows (SPSS Inc, Chicago, Illinois). In order to determine whether changes in patellofemoral joint status related to patients function or quality of life, the difference in OKS and SF-12 from pre-operative to the follow-up period was assessed.
