Aims. The aim of this study is to evaluate the change in incidence rate of shoulder arthroplasty, indications, and surgeon volume trends associated with these procedures between January 2003 and April 2021 in the province of Nova Scotia, Canada. Methods. A total of 1,545 patients between 2005 and 2021 were analyzed. Patients operated on between 2003 and 2004 were excluded due to a lack of electronic records. Overall, 84.1% of the surgeries (n = 1,299) were performed by two fellowship-trained upper limb surgeons, with the remainder performed by one of the 14 orthopaedic surgeons working in the province. Results. Total shoulder arthroplasty (TSA) was the most frequent procedure (32.17%; n = 497), followed by stemmed hemiarthroplasty (SHA) (27.7%; n = 428). The most frequent indication for primary shoulder arthroplasty was degenerative osteoarthritis (58.1%; n = 882), followed by acute proximal humerus fracture in 15.11% (n = 245), and rotator cuff arthropathy in 14.18% (n = 220). The overall rate of revision was 7.7% (2.8% to 11.2%). The number of TSAs and reverse shoulder arthroplasties (RSAs) has been increasing since 2016. The amount of revision cases is proportional to the number of operations performed in the same year throughout the study period. Conclusion. The incidence of shoulder arthroplasty in the Maritime Provinces has increased over the last 16 years. Revision rates are similar the those found in other large database registries. Reverse shoulder arthroplasty prevalence has increased since 2016. Cite this article: Bone Jt Open 2023;4(8):567–572

Introduction The value of collecting continuous prospective patient data, including operation records and outcome scores, is well known. In 1994, a systematic prospective patient data collection was initiated on all patients attending the Reading Shoulder Unit (RSU). Initially this was done with hand written records. In 1995 a Windows Access ® database was formulated on a portable laptop. This was used continuously through until September 2005 when an Internet web-based database was introduced. We present this collective data and trends in practice from a busy shoulder unit over this decade. Results Between 1995 and 2005, 10005 entries were made to the Reading Shoulder Unit database. 3233 patient visits to outpatient clinics were recorded. 6772 operations were recorded – this includes: arthroscopic decompressions (ASD) + AC joint excisions − 3514, MUA for frozen shoulder 842, shoulder arthroplasty 432, open stabilisation 356, arthroscopic stabilisation 192, arthroscopic rotator cuff repair (RCR) 402, open cuff repair 290, arthroscopic capsular release 78 and 248 trauma cases. Changes in the unit practice include the move from open to arthroscopic reconstructive surgery (RC and stabilisation), RCR rather than ASD alone in elderly patients with impingement and cuff weakness, and repairing partial rotator cuff tears when previously we did not. Conclusions With over 10000 continuous and prospective entries – the RSU database is invaluable for continuous audit of practice and assessment of outcomes of the different procedures. Several practices have changed through the decade; most notably from predominately open reconstructive surgery through to arthroscopic reconstructive surgery. We would recommend to every surgeon and unit to collect his own data prospectively to enable him to analyse and assess his results

Deep infection after THA is a devastating complication that implies major suffering for the patients and large costs for society. Reports from multiple national and regional registries show increasing incidence of deep infection. Is this a consequence of improved diagnostics, changed virulence of the causative organism, increased co-morbidity of the patients?. An open database will be setup and hosted by an existing, high quality registry. All possible variables including patient demographic, detailed surgical information, bacteria/fungus characteristics, antibiotic treatment, radiographic findings and follow-up for 3 years will be collected. The incoming data will be displayed on a dashboard with continuous analyses and statistics. Any individual surgeon or hospital can report data. A board with members from the International Hip Society and the International Society of Arthroplasty Registries will supervise the process and facilitate scientific analyses from collected data

Abstract. Objectives. Biomechanics is an essential form of measurement in the understanding of the development and progression of osteoarthritis (OA). However, the number of participants in biomechanical studies are often small and there is limited ways to share or combine data from across institutions or studies. This is essential for applying modern machine learning methods, where large, complex datasets can be used to identify patterns in the data. Using these data-driven approaches, it could be possible to better predict the optimal interventions for patients at an early stage, potentially avoiding pain and inappropriate surgery or rehabilitation. In this project we developed a prototype database platform for combining and sharing biomechanics datasets. The database includes methods for importing and standardising data and associated variables, to create a seamless, searchable combined dataset of both healthy and knee OA biomechanics. Methods. Data was curated through calls to members of the OATech Network+ (. https://www.oatechnetwork.org/. ). The requirements were 3D motion capture data from previous studies that related to analysing the biomechanics of knee OA, including participants with OA at any stage of progression plus healthy controls. As a minimum we required kinematic data of the lower limbs, plus associated kinetic data (i.e. ground reaction forces). Any additional, complementary data such as EMG could also be provided. Relevant ethical approvals had to be in place that allowed re-use of the data for other research purposes. The datasets were uploaded to a University hosted cloud platform. The database platform was developed using Javascript and hosted on a Windows server, located and managed within the department. Results. Three independent datasets were curated following the call to OATech Network+ members. These originated from separate studies collected from biomechanics labs at Cardiff University, Keele University, and Imperial College London. Participants with knee OA were at various stages of progression and all datasets included healthy controls. The total sample size of the three datasets is n=244, split approximately equally between healthy and knee OA participants. Naming conventions and formatting of the exported data varied greatly across datasets. Datasets were therefore formatted into a common format prior to upload, with guidelines developed for future contributions. Uploading data at the marker set level was too complicated for combination at the prototype stage. Therefore, processed variables relating to joint angles and joint moments were used. The resulting prototype database included an import function to align and standardise variables. A a simple query tool was further developed to extract outputs from the database, along with a suitable user interface for basic data exploration. Conclusion. Combining biomechanics dataset presents a wide range of challenges from both a technical and data governance context. Here we have taken the first steps to demonstrate a proof-of-concept that can combine heterogenous data from independent OA-related biomechanics studies into a combined, searchable resource. Expanding this in the future to a fully open access database will create an essential resource that will facilitate the application of data-driven models and analyses for better understanding, stratification and prediction of OA progression. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Prosthetic joint infections (PJI) are one of the most devastating complications of joint replacement surgery. They are associated with significant patient morbidity and carry a significant economic cost to treat. The management of PJI varies from antibiotic suppression, debridement, antibiotics, and implant retention (DAIR) procedures through to single/multiple stage revision procedures. Concerns have been raised recently in relation to the rising number of revision arthroplasty procedures that are being undertaken in relation to infection. This database aims to collect data on all PJIs that have been managed in the Australian Capital Territory (ACT) region. This will allow us to investigate the microbial trends, outcomes of surgical intervention and patient outcomes within our local population. This database will incorporate diagnostic, demographic, microbiological and treatment information in relation to local PJI cases. The data will be collated from the local infectious diseases database, hospital medical records, and where available the Australian Orthopaedic Association National Joint Replacement Registry Data. The first 100 cases of PJI were assessed. 76% were defined as being acute. 56% of the patients received antibiotics prior to their diagnosis however only 3% were culture negative. 89% were monomicrobial and 11% polymicrobial. The intended management strategy was a DAIR in 38% of patients and a 2-stage revision in 12% of cases. The intended management strategy was successful in 46% of the patients. The ACT is uniquely placed to analyze and create a local PJI database. This will allow us to guide further treatment and local guidelines in terms of management of these complex patients

To create a comprehensive, user-friendly, database that facilitates selection of optimized animal models for fracture research. Preclinical testing using research animal models can expedite effective and safe interventions for clinical fracture patients but ethical considerations (e.g., adherence to 3R humane principles) and failure to meet critical review (e.g., clinical translation, reproducibility) currently complicate the model selection process. English language publications (1980-2021) were derived from PubMed® using the search-term ‘bone and fracture and animal’. Clinical cases, reviews, and cadaver studies were excluded. Qualifying papers reporting use of fracture models had the following data transcribed: Author, journal, abstract, summary data, animal data, bone, focus (e.g., allograft) and model (e.g., articular fracture). Publications were quantitatively scored (1 star [very poor] – 5 stars [excellent]) for reproducibility, clinical translation and animal welfare. 4602 papers were derived from 677 journals from 177 publishers. Number of annual publications progressively increased from 18 (1980), peaking in 2015 (250) before substantially declining in 2020 (121) and 2021 (51). Descriptors (low to high) included 15 species (frog [1]–rat [1586]), 24 bones (phalanx [1]–femur [1646]), 134 research foci (bioprinting [4]–fracture healing [3533]), and 37 fracture models (avulsion [4]–diaphyseal [2113]). Percent of total publications scoring 1 or more stars for reproducibility, clinical translation and animal welfare ranged from: 1.0–5.8% (1 star), 5.9–30.6% (2 star), 21.3–42.8% (3 star), 19.2–44.4% (4 stars), and 1.3–26.7% (5 stars). FRAMD provides a dedicated resource that enhances selection of animal models that pertain to researchers’ fracture focus while being clinically relevant, reproducible and humane. FRAMD will help improve scientific data, reduce unnecessary use of animals, heighten workplace efficiency, and reduce cost by avoiding ill-suited or outdated models. FRAMD may particularly benefit grant writers and organizations seeking ‘best-practice’ assurance (e.g., funding agencies, academic research societies, CROs)

Abstract. Introduction. Inter-prosthetic femoral fractures (IPFF) are fractures occurring between ipsilateral hip and knee implants or fixation devices. In 2020, the National Hip Fracture Database (NHFD) was extended to capture data from patients with peri-prosthetic femoral fractures (PPFF), including those specifically with IPFF. This study aims to describe the epidemiology and treatment of IPFF in England and Wales. Methodology. This population-based observational cohort study utilised open-access data available from the NHFD. Patients aged over 60, admitted to an acute hospital in England or Wales with an IPFF, within the period 1st January 2020 to 31st December 2020 were included. The primary outcome of this study was the incidence of IPFF in England and Wales. The secondary outcome was the treatment received. Results. Of 2606 patients admitted with PPFF, a total of 133 fractures occurred between ipsilateral hip and knee implants. Internal fixation was performed most frequently, in 87 cases. Revision arthroplasty was performed in 15 cases (hip n=10, knee n=5). A total of 20 patients were managed non-operatively, and three underwent primary arthroplasty (hip n=2, knee n=1). Conclusion. As the proportion of patients living with hip and knee implants continues to increase, it is expected that so too will the incidence of IPFF. This study is the first to estimate the incidence of IPFF in England and Wales. This is likely an underestimate of the true incidence and so we support calls for the prioritisation of further research into the epidemiology, prevention, and management of IPFF

The National Hip Fracture Database (NHFD) is a clinically led web based audit used to inform national policy guidelines. The aim of this audit was to establish the accuracy of completion of NHFD v13.0 theatre collection sheets, identify common pitfalls and areas of good practice, whilst raising awareness of the importance of accuracy of this data and the manner in which it reflects performance of CAH Trauma & Orthopaedic unit in relation to national guidelines. Our aim was to improve completion up to >80% by the operating surgeon and improve overall accuracy. The methodology within both cycles of the audit were identical. It involved reviewing the NHFD V13.0 completed by the operating surgeon and cross-checking their accuracy against clinical notes, operation notes, imaging, anaesthetic charts and A&E admission assessment. Following completion of cycle 1 these results were presented, and education surrounding V13.0 was provided, at the monthly trust audit meeting. At this point we introduced a sticker onto the pre-operative checklist for Hip fractures. This included time of admission and reason for delay. We then completed a re-audit. Cycle-1 included 25 operations, 56% (n=14) had a completed V13.0 form. Of these 21% (n=3) were deemed to be 100% accurate. Cycle-2 included 31 operations (between April – June 21) 81% (n=25) had a completed intra-operative from and showed an increase in accuracy to 56% (n=14). Through raising awareness, education and our interventions we have seen a significant improvement in the completion and accuracy of v13.0. Although 100% accuracy was not achieved its clear that education and intervention will improve compliance over time. Through the interventions that we have implemented we have shown that it is possible to improve completion and accuracy of the NHFD V13.0 theatre collection sheet locally and feel this could be implemented nationally

Abstract. Introduction. In 2020, the National Hip Fracture Database (NHFD) was extended to capture data from patients with periprosthetic femoral fractures (PPFF) with plans to include these patients in Best Practice Tarif. We aimed to describe the epidemiology of PPFF in England and Wales, with a particular focus on fractures occurring around the femoral component of knee prostheses. Methodology. This population-based observational cohort study utilised open-access data available from the NHFD. Patients aged over 60, admitted to an acute hospital in England or Wales with a PPFF, within the period 1st January 2020 to 31st December 2020 were included. The primary outcome was the incidence of PPFF in England and Wales. The secondary outcome was the treatment received. Results. We identified 2606 patients with PPFF from 135 hospitals. Of these, a total of 578 fractures occurred around the femoral component of a knee implant. These were classified as Vancouver A (epicondylar, n=77), B (involving implant/cement, n=166) and C (proximal to implant/cement, n=335). Internal fixation was the most employed treatment, used in 352 cases. Revision arthroplasty was performed in 80 cases, and 100 were managed non-operatively. Only 28% of operated PPFF went to theatre within 36 hours but nearly 90% had orthogeriatrician review within 72 hours. Conclusion. Eighty six percent of patients with PPFF were treated with non-revision surgery and would not be recorded in the National Joint Registry. In response, we support calls for the prioritisation of further research into the prevention and management of PPFF around the knee

Septic Arthritis (SA) is considered a surgical urgency/ emergency by physicians around the world. As our understanding grows, and improved diagnostic algorithms are developed, it has become apparent that competing interests in terms of accurately diagnosing concurrent osteomyelitis may supercede rapid surgical intervention when the imaging is timely. Nevertheless, even in cases of isolated SA, many patients will require repeat surgery. We aimed to assess factors which could predict this. A multicenter retrospective redcap database was created involving 20 pediatric centers from the CORTICES study group with the goal of better understanding pediatric musculoskeletal infection (PMSKI). All patients who met inclusion for the database were considered, surgeons for each site determined through imaging and chart review which patients met the diagnosis of isolated SA. Patients with concomitant abscesses or osteomyelitis were expressly excluded. Appropriate non parametric statistics were used to assess univariate significance. Multivariable logistic regression was used to assess clinical factors associated with an increased likelihood of more than one surgery. Receiver characteristics operating curve (ROC) analysis was used to determine optimal cutoffs to discriminate between children who required more than one surgery compared to those who required only one surgery. A probability algorithm was developed for the number of clinical factors present and the likelihood requiring more than one surgery following SA diagnosis. “Four hundred and fifty-four patients with isolated SA were analyzed from 20 US hospitals. Patients were 5.4 +/− 4.8 years old at admission, and the cohort was 56% male. Of the 454 patients, 47 (10.4%) needed more than one surgery. Bivariate comparisons across surgery groups found significant differences in minimum platelet count (pplatelet, a patient has a 0.3% reduction in the odds of needing more than one surgery (OR=.997; p=0.04). For each additional ten units of CRP, a patient has a 0.1% increase in the odds of needing more than one surgery (OR=1.001; p<0.001). Our predictive algorithm found that children with both risk factors had a 64% chance of requiring multiple surgeries. Higher CRP values and lower platelet values indicate more severe disease in isolated SA with a greater likelihood of repeat surgery. Higher CRP and lower platelet counts may portend multiple surgeries and caregivers of children with isolated SA should be advised as such

The National Hip Fracture Database (NHFD) started collecting data on peri-prosthetic femoral fractures (PPFF) in December 2019. We reviewed the data from the first year of data collection to describe the patients being admitted with PPFF and the care they received according to established Key Performance Indicators (KPIs) used in hip fracture surgery. We performed a retrospective review of the NHFD between 1 January and 31 December 2020. Analyses consisted of the summary statistics used to generate the NHFD annual report. Of the KPIs used in hip fracture, data were available for PPFF on time to assessment by a geriatrician (KPI 1), time to theatre (if applicable) (KPI 2), and mobilisation the day after surgery (if applicable) (KPI 4). There were 2,411 PPFF fractures around a hip or knee replacement reported out of a total of 2,606 PPFF. Of the 171 hospitals reporting data to the NHFD, 135 reported at least one. The median number of fractures per hospital was 14 (IQR 8, 25, range 1 to 110). The median age of patients was 84 (range 60 to 104) and 1,604 (67%) patients were female. Of the 1,850 occasions a time to geriatrician review was documented, review within 72 hours was achieved on 89.2% of occasions. Of the 1,973 patients who underwent operative interventions, 546 patients went to theatre before the 36-hour target (28.4%). Of patients who had surgery 1,323 (67.4%) were mobilised the following day. In the first year collecting data on PPFF we can give the first idea of the incidence of these life changing injuries. Whilst geriatrician review with 72 hours was achieved in a high proportion of cases nationally, our data suggest fewer patients are mobilised the day after surgery. Notably, only 28.4% of patients who were managed operatively went to theatre within 36 hours of admission. We provide the first insight into the incidence and management of these injuries

We have a national UK database for hip fracture outcome. It has been developed synchronously with an agreed care pathway that is multi-disciplinary, including surgeons, anaesthetists, geriatricians, osteoporosis experts, healthcare managers and lay charities. Care has been improved and audit established for future evolution. The database started in 2007 and now includes 85 units. The synchronous care pathway deals with falls and osteoporosis prevention, perioperative multi-disciplinary care, rehabilitation and outcome results. Key issues are avoidance of delay and cancellation of surgery and how we deal with patients with medical co-morbidities. Outcome is analysed prospectively to take account of co-morbidities and variations in surgical techniques. The care pathway and data base are now universally accepted as a national priority with advice for all UK trauma units to participate. Of the 121 registered units, only 85 actively contribute data. The cost and staff needs for data input are now accepted. To date, 12,983 clinical cases have been entered. Variation of trauma theatre list operating time per head of population and other related resource has been highlighted. This has been accepted by politicians and health managers. The NHS Institute of Improvement has started a rapid improvement plan to support units with poor resource/audit outcome. It is early days in terms of validity of outcome data for technical variations in treatment eg. fixation/replacement/use of bone cement. We have a national increase in resouce for hip fractures. We now have some logic to interaction between surgeons and medics/managers. Objectively struggling units get active support. We accept the possible lack of validity of some outcome data. Some units who look bad on paper should not be disadvantaged

Introduction. In 2015, the healthcare system transitioned from International Classification of Diseases, Ninth Revision (ICD-9) coding to the Tenth Revision (ICD-10). Given that administrative claims are used for quality initiatives, risk adjustment models and clinical research, we sought to determine the effect of new, more detailed coding on the incidence of complications following primary total knee arthroplasty (TKA). Methods. The Humana administrative claims database was queried from 2-years prior to October 1, 2015 (ICD-9 cohort) and for 1-year after this date (ICD-10 cohort) to identify all primary TKA procedures. Each TKA was then tracked for occurrence of an arthroplasty specific post-operative complication within 6 months of surgery using the respective coding systems. Laterality and joint specific codes were utilized for the ICD-10 cohort to ensure complications occurred on the same side and joint as the index procedure. Incidence of each complication was compared between cohorts using risk ratios (RR) and 95% confidence intervals. Results. There were 19,009 TKAs in the ICD-10 cohort and 38,172 TKAs in the ICD-9 cohort. The incidence of each post-operative complication analyzed was significantly higher in the ICD-9 cohort relative to the ICD-10 cohort (Figure 1). Comparing ICD-9 cohort to ICD-10 cohort, PJI occurred in 1.9% vs 1.3% (RR 1.5), loosening in 0.3% vs 0.1% (RR 2.7), periprosthetic fracture in 0.3% vs 0.1% (RR 3.0) and other mechanical complications in 0.7% vs 0.4% (RR 2.0), respectively (p < 0.05 for all). These findings remained significant when subgroup analyses were performed to control for seasonal variation between groups. Conclusion. The transition from ICD-9 to ICD-10 coding has dramatically altered the reported incidence of complications following TKA. These results are likely due to the added complexity of ICD-10 which is joint and laterality specific. It is important to quantify and understand the differences between coding systems as this data is used for quality initiatives, risk adjustment models and clinical research. Thoughtful methodology will be necessary for future research if both ICD-9 and ICD-10 data are being analyzed simultaneously. Furthermore, additional studies are needed to compare the hospital billing data for complex diagnoses or revision procedures to coding performed by skilled researchers in the field. For figures, tables, or references, please contact authors directly

Total hip replacements (THRs) provide pain relief and improved function to thousands of patients suffering from end-stage osteoarthritis, every year. Over 800 different THR constructs were implanted in the UK in 2017. To ensure reliable implants are used, a NICE revision benchmark of 5% after 10 years exists. Given the 10-year cumulative mortality of patients under 55 years of age receiving THRs is only 5% and that a recent study suggests 25-year THR survival of 58%, we aim to produce revision estimates out to 30 years that may guide future long-term benchmarks. The local database of the Princess Elizabeth Orthopaedic Centre (PEOC), Exeter, holds data on over 20,000 patients with nearly 30-years follow-up with contemporary prostheses. A previous study suggests that the results of this centre are generalisable if comparisons restricted to the same prostheses. Via flexible parametric survival analysis, we created an algorithm using this database, for revision of any part of the construct for any reason, controlling for age and gender. This algorithm was applied to 664,761 patients in the NJR who have undergone THR, producing a revision prediction for patients with the same prostheses as those used at this centre. Using our algorithm, the 10-year predicted revision rate of THRs in the NJR was 2.2% (95% CI 1.8, 2.7) based on a 68-year-old female patient; well below the current NICE benchmark. Our predictions were validated by comparison to the maximum observed survival in the NJR (14.2 years) using restricted mean survival time (P=0.32). Our predicted cumulative revision estimate after 30 years is 6.5% (95% CI 4.5, 9.4). The low observed and predicted revision rate with the prosthesis combinations studied, suggest current benchmarks may be lowered and new ones introduced at 15 and 20 years to encourage the use of prostheses with high survival

Background. Since it's establishment in 2007, the National Hip Fracture Database [NHFD] has been the key driving force in improving care for hip fracture patients across the UK. It has facilitated the setting of standards to which all musculoskeletal units are held, and guides service development to optimise outcomes in this group of patients. As with any audit, the ability to draw conclusions and make recommendations for changes in practise relies on the accuracy of data collection. This project aimed to scrutinise the data submitted to the NHFD from a Major Trauma Centre [MTC], focusing on procedure coding, and discuss the implications of any inaccuracies. Method. The authors performed a retrospective analysis of all procedure coding data entered into the NHFD from July 2009 to July 2014 at Cambridge University Hospitals NHS Foundation Trust. We examined 1978 cases for discrepancies, comparing procedure codes entered into the NHFD with post-procedure imaging and operative notes. Results. The procedure coding data submitted to the NHFD was highly inaccurate, with incorrect procedure codes in 24% of the 1978 cases reviewed. In particular, coding of cemented total arthroplasty and cemented bipolar hemiarthroplasty, with coding errors in registry data of 42% and 39% respectively. Of the 67 THRs performed only 52% were correctly coded for, and only 626 of the 915 hemiarthroplasties (68%). 16% of cannulated hip screws actually underwent primary arthroplasty. Conclusions. This study highlights the inaccuracy of coding data entered into the NHFD from a Major Trauma Centre, with data on arthroplasty being particularly inadequate. The unreliability of procedure data leaves us unable to evaluate surgical treatment strategies using the NHFD. This has worrying implications for standard setting, service development and, consequently, patient care. Level of evidence. 2c

The rate of Metastatic Spinal Cord Compression (MSCC) has been increasing over recent years with increased patient survival from improved cancer treatment. MSCC presents an increasing demand for spinal surgical resources. NICE guidance was issued in 2008 to improve diagnosis and management and to prevent unnecessary delays which may result in disability. The recent advances in management of cancers coupled with improved spinal surgical approaches have improved the outcome in MSCC. Early surgery has been shown to improve restoration of function. A recent systematic review found that surgery produced superior results to radiotherapy alone for the management of MSCC. However, the quality of evidence so far is mostly from observational studies. We would like to use Bluespier to create a database of MSCC patients referred to our tertiary centre. Our database would include all adult patients referred to the spinal surgical service with MSCC. Information recorded would be the diagnosis, time of onset and imaging, comorbidities, previous interventions, clinical findings, ASIA score, mobility status, sphincteric status, Karnofsky, Tokuhashi, Tomita and Bauer scores. These scores have been shown by numerous studies to have the best predictive value for outcome following MSCC. The SINS and Boriani MSCC protocols will be collected and externally validated. Time to surgery, operative data and intra operative complications will be recorded. PROMs will include the Oswestry / Neck disability index, VAS and SF36 scores. Post operative complications, morbidity and mortality will be collected and the details of any other therapy received. We would score the patients on admission and at 3 months, 6 months and one year post operatively (if survival allows). This will be done in out patients and via postal and telephone questionnaires. The database will flag the time intervals. This database will enable us to improve the quality of care given to patients with MSCC, provide evidence to highlight the importance of prompt referral and surgical intervention, audit our care against the standards set out by NICE and establish the risks, complications and outcomes of surgical intervention in this high risk group. It will be the first study to externally validate and compare several different scoring systems and protocols (above) in the same cohort. Finally, the data can be used to perform a costing analysis for the treatment of MSCC in the NHS

Background: Surgical treatment of spinal deformities is complex and is performed by a limited number of spine surgeons. To obtain adequate radiological and clinical correction, a large amount of clinical experience is required when planning corrective surgery because of the enormous amount of patient related variables, and the many surgical techniques (e.g. rod rotation vs translation, pedicle screws vs hooks, anterior vs posterior). The widely used classification systems (King and Lenke) are useful for documentation of the deformities. Unfortunately explicit guidelines for surgery are not clear. A multi-centre database with pre and postoperative patient data including photographic images and x-rays will be very useful in decision making. It will allow surgeons to find similar cases in the database that will help them in their decision making for surgical planning and execution. Furthermore it will provide extensive data to perform outcome studies, and to develop general treatment guidelines. Surgery for spinal deformities will become more evidence based and less dependent on the individual surgeons judgement. Methods: A modern web-based database system, Scolisoft was developed for documenting patient data and curve characteristics. The system contains patient data (demographics etc), radiological data (AP, Lat, bending films), classification of curve patterns according to the often-used classification systems and information about the surgical procedure. It includes pre and postoperative radiological data and clinical photographs. The patient data can also be stored and printed as a PDF-file, so that it can be used as a patient chart and for patient information purposes. Scolisoft allows the user to select patients based on all the individual characteristics, e.g. curve classification. For pre-operative planning of a specific deformity, a cohort of patients with the same deformity (patient demographics, curve pattern, bending films etc) can be selected and the postoperative results viewed. With the same selection tool, cohorts of patients can be selected for outcome studies. Furthermore Scolisoft provides the possibility of discussing difficult cases with other spine surgeons using the system. Finally, complications are registered according to the existing Scoliosis Research Society complication registry system. Experiences: Data of more than 200 patients have been entered into the former PC application system. The current web based system has 60 cases that have been entered during its trial phase. Most cases have been adolescent or adult idiopathic scoliosis. Forty two surgeons have used the software and eight surgeons have participated in entering cases. The web-based version has shown to be very user friendly. Submitting the radiological and clinical images is easy (but takes some time). All data input is possible by a simple click of the mouse. Therefore it is relatively easy to learn. The system already has the possibility for documenting other spine pathology such as sagittal plane deformities, fractures and spondylolisthesis. Conclusion: Scolisoft is a powerful, user-friendly web-based registry for spinal deformities. It is a very useful tool in planning spinal deformity surgery and research. In this time of evidence-based medicine, it is time to take the planning of scoliosis surgery out of the realm of myth, and this database is a strong step in that direction

Computer assisted surgery (CAS) has gained popularity in orthopaedics for both total knee (TKA) and total hip arthroplasty (THA) in the past decades as a stereotactic device that provides the surgeon with real-time feedback on implant position based on electromagnetic or infrared based instruments. The purpose of this study was to assess the effect of CAS on 30-day complication rates following THA and TKA. The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database was used to identify all patients that underwent THA and TKA from 2011 to 2013, as well as any complication they had within 30-days of their surgery. Univariate and multivariate regression analysis was used to compare the post-operative complications in patients whose surgery involved the use of CAS with those by conventional surgical techniques. We identified 104,550 patients who had THA (42,275 patients) and TKA (62,275 patients) procedures in the database between 2011 and 2013. Computer Assisted Surgery was used in 1,120 THA and 2,173 TKA procedures. There were higher overall adverse events (OR 1.40, CI: 1.22–1.59) in the Conventional group when compared to CAS for TKA. The rate of overall minor events (OR 1.38, CI: 1.21–1.58) and requirements for blood transfusion (OR 1.44, CI: 1.25–1.67) were higher in the Conventional group compared to the CAS group for TKA. However, rate of re-operation was significantly higher in the CAS group for TKA (OR 1.60, CI: 1.15–2.25). The results also showed higher overall adverse events (OR 2.61, CI: 2.09–3.26) in the Conventional group when compared to CAS for THA. The rate of overall minor events (OR 2.72, CI: 2.16–3.42) and requirements for blood transfusion (OR 3.27, CI: 2.52–4.25) was higher in the Conventional group whereas superficial wound infections (OR 0.46, CI: 0.46–0.81) were shown to be higher in the CAS group. The result also showed slightly longer operative times in CAS for both THA and TKA. This study analysed a large patient database involving multiple institutions and surgeons and found that, overall, the use off CAS in primary total hip and total knee arthroplasty reduced the number of adverse events in the first 30-days postoperatively, compared to conventional surgical techniques. However, CAS was associated with an increased number of reoperations, superficial infections and operating time. The clinical benefits and disadvantages of CAS should be considered by arthroplasty surgeons when determining the potential benefit-cost ratio of this technology

Background. In a number of disciplines, positive correlations have been reported between volume and clinical outcome. This has helped drive the evolution of specialist centres to deal with complex or high risk medical conditions. Hip fractures are a common injury associated with high morbidity and mortality. Aim. To assess whether volume of hip fracture cases attended to by individual hospitals is associated with the quality of care provided and clinical outcomes. Methods. Utilising 19 quality of care measures espoused by NICE and available on the National Hip Fracture Database website, we examined whether there was a correlation between Volume of hip fractures per institution and each outcome measure for 2016 and 2018. Outcomes were assessed for normality of distribution and correlated using either Spearman rank or Pearson Correlation as appropriate. Results. Over 170 institutions were available for analysis. The average number of procedures per institution was 371 (sd 154) in 2016 and 378 (sd 158) in 2018. 9 units attended to in excess of 700 cases per annum. There was a positive correlation between volume of cases and a number of quality of care indices; notably survivorship, length of stay, ortho-geriatric consultation, pressure ulcer prevention, post-operative mobilisation, delirium prevention, bone health assessment and the proportion of patients satisfying the Best Practice Tariff (BPT) criteria. 5 of the measures had no correlation. The worst performances were observed for measures that were not financially incentivised. Discussion. Our analysis of a large synchronous national dataset show weak but favourable correlations with unit volume and important outcomes including mortality and length of stay. Our results do not invariably justify the centralisation of hip fracture services. Hip fracture care may be more convincingly improved by promoting compliance to the guidance that already exists via financial incentivisation or otherwise

Purpose: To subjectively assess and present the outcome after ACL reconstruction with minimum follow-up of 24 months. Methods: Our knee injury database was established in June 2001. Data were collected prospectively for all knee ligament reconstructions carried out by a single surgeon. The database has a prospectively studied consecutive series where all the patients surveyed completed the Lysholm, KOOS and IKDC 2000 questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively. Our knee injury database comprises of 163 patients who had ACL reconstruction in which Hamstrings were used in 120 cases and Bone Patella-Tendon Bone (BPTB) grafts in 43. This includes 27 complex reconstructions and 12 revisions (11 from other centres). Results: Fifty-six of the 79 patients (70.8%) who were at least 2 years post ACL reconstruction attended for their 2 year review. Majority were male patients(90%) and both attendees and non- attendees were of a similar age (30.5 /30 respectively) and did not exhibit a statistically significant difference in their pre op or early post op scores. In the non-attendee group 2 were students, 1 emigrated, 1 registered as unemployed, 7 no employment status and 3 did not consent to such follow-up. The mechanism of injury was, 62 as sporting injury (24 contact/38 non-contact sport), 3 road traffic accidents and 8 activities of daily living and 2 not recorded. The mean scores were, IKDC – 77.14, Lysholm – 83.96 and KOOS symptom – 81.6. Conclusions: All subjective evaluation questionnaires (KOOS, Lysholm and IKDC) revealed a progressive trend in our patients. We found that in the KOOS, a multidimensional patient completed aggregated score, the Quality of Life (QoL) dimension exhibited results which were interestingly not correlating with the other dimensions of the questionnaire, with patients who scored < 50% occupying manual or non-administrative positions at work