Navigated Total Knee Arthroplasty (TKA) is a new technique in our hospital. Any new procedure can be associated with both technical difficulties and difficulties due to patient and theatre staff expectations. The aim of this study was to demonstrate our learning curve and assess patient and staff acceptance. We highlight common technical problems unique to navigation and offer our solutions. A prospective study of 231 consecutive Emotion TKA were implanted over a 30 month period with Orthopilot version 4.2 Navigation system using soft tissue management (BBraun Aesculap, Tutlingen). They were done by a single knee surgeon previously experienced only in non-navigated TKA. Patient height and weight were measured preoperatively and the BMI calculated. Tourniquet times were recorded digitally with fixed timing criteria. Informed consent was obtained. Our results showed a significant decrease of tourniquet time with experience (p=< 0.0001) with other possible factors being preoperative deformity and BMI. There was full patient acceptance with the exception of the first patient. The surgical team had to modify patient positioning on the operating table, setup of the theatre and navigation equipment, placement of the scrub staff and delegation of tasks. Navigated Emotion TKA with Orthopilot software provided a comfortable learning curve. It was readily acceptable to patients and staff and has been adopted as our standard practice. The discussion of problems and the introduction of solutions had a positive effect on building our team. Further investigation is needed to elucidate other variables that affect the tourniquet time

Background and aims: The aim of this study is to investigate how people with chronic pain cope with everyday problems. Methods: Subjects (202 men and 323 women) were patients with chronic pain referred to a rehabilitation unit. The Utrecht Coping List (Dutch version of the WCC – ways of coping checklist) was used to measure their coping style at referral. It has 7 factors: approach and avoidance, palliative behaviour, social support, depressive/passive reaction, expressing emotion and comforting cognitions. Results: Men with chronic pain have lower scores on active problem solving behaviour, and higher scores on palliative behaviour and depressive reaction than men without pain (p< .001). Women with chronic pain have also lower scores on active problem solving behaviour than women without pain, but also on social support and expressing emotion. Like the men scores for women are higher on palliative behaviour (p< .001) and depressive reaction (p< .01), but also on avoidant behaviour (p< .01) and comforting cognitions (p< .001). Data shows that women with pain have higher scores than men with pain on all scales, except for expressing emotion. Differences on palliative behaviour, avoidant behaviour, social support and comforting cognitions are significant (p < .001). Conclusions: People – women as well as men – with chronic pain show less active coping behaviour, have a higher score on depressive reaction on problems and use more palliative behaviour in problem situations than people without somatic complaints. It is important to stress the differences between women and men with chronic pain in problem solving behaviour

Background and purpose of study:. Chronic back pain is a complex and poorly understood condition incorporating sensory, cognitive and emotional elements. Research demonstrates a strong association between chronic back pain and cognitive and non-cognitive factors such as anxiety, depression, fear-avoidance and self-efficacy. However, until very recently, the way in which chronic back pain sufferers process their emotions was largely unknown. To this end, we conducted two case-control studies using a between-groups correlational design to investigate the relationship between chronic back pain and emotional processing. Methods and results:. In study 1, 55 chronic back pain sufferers and 55 pain-free individuals were administered the Emotional Processing Scale (EPS) to determine whether chronic back pain sufferers process their emotions differently from pain-free individuals. In study 2, 32 CBP sufferers and 27 pain-free individuals were administered the EPS, PHQ-9 and the GAD-7 to further test if chronic back pain is associated with altered emotional process and whether anxiety and depression may play a role in this relationship. Conclusion:. Our studies demonstrate that altered emotional processing and regulation are strongly associated with chronic back pain. Prospective studies are necessary before it can be ascertained whether this relationship is causative or as a consequence of chronic back pain. However, our results are in line with a recent prospective neuroimaging study, which demonstrates that chronification of low back pain shifts brain representation from nociceptive to emotional circuits. It is therefore critical that clinicians in the field of musculoskeletal care consider the role of emotional processing in their patients' evaluation and management

Purpose of the study and background. Healthcare practitioners' (HCPs) attitudes and beliefs about MSK pain influence their practice behaviour. The Pain Attitudes and Beliefs Scale (PABS), developed for use in the context of LBP, consists of two subscales (biomedical and biopsychosocial) is the most widely used measure. However, poor performance of the biopsychosocial orientation scale is attributed, in part, to inadequate conceptualisation of the orientation. Purpose. To develop a new biopsychosocial scale and adapt the PABS to assess HCPs' attitudes and beliefs about common MSK pain. Methods and results. A grounded conceptualisation process was conducted with 40 MSK HCPs and/or researchers using concept mapping methodology. The resultant conceptual framework consisted of six primary domains of biopsychosocial clinical orientation (bio-clinical, therapeutic relationship, individual patient aspects, emotions, social and work) and informed development of new scale items. These items were included with existing PABS items in a national survey of UK-based HCPs, and analysis was conducted on 587 responses. Exploratory and confirmatory factor analyses identified and confirmed a new 10-item biopsychosocial scale (Cronbach's alpha of 0.83). The new biopsychosocial and existing biomedical scales demonstrated good test-retest reliability (ICC(2,1) 0.77 and 0.74 respectively). Standard error of measurement and smallest detectable change were also established. Conclusion. The new generic MSK version of the PABS biopsychosocial scale shows promising structural validity and test-retest reliability. The existing PABS biomedical scale's structure and performance was upheld. The new conceptual framework provides a contemporary, comprehensive understanding of the biopsychosocial clinical approach to common MSK pain, with potential value for the development, delivery and evaluation of biopsychosocial clinical practice. No conflicts of interest. Sources of funding:. Kirsty Duncan was the holder of an ACORN PhD studentship from Keele University. Part of the conceptualisation component of this work was also supported by a Chartered Society of Physiotherapy Charitable Trust International Lecture Fund Award. Annette Bishop and Nadine Foster were supported through an NIHR Research Professorship for Nadine Foster (NIHR-RP-011-015). NEF is an NIHR Senior Investigator. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR, NHS or the Department of Health

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The aim of this study was to explore parents’ experience of their child’s recovery, and their thoughts about their decision to enrol their child in a randomized controlled trial (RCT) of surgery versus non-surgical casting for a displaced distal radius fracture.

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Periprosthetic proximal femoral fractures (PFFs) are a major complication after total hip arthroplasty (THA). Health status after PFF is not specifically investigated. The aim of this study is to evaluate the health status pattern over two years after sustaining a PFF.

Valgus knees present a surgically demanding challenge. Dissimilar bone and soft-tissue deformities compared to varus knees complicate restoration of proper alignment, positioning of components, and attainment of joint stability. Our study examined the relationship between tourniquet time and valgus deformity. A prospective study of all valgus knees were implanted over a 30 month period with Emotion Ortho-pilot version 4.2 Navigation system (BBraun Aesculap, Tutlingen). They were done by a single knee surgeon. Tourniquet times (TT) were recorded digitally with fixed timing criteria. The software recorded all pre- and post-operative deformities. We performed the lateral parapatella approach for all valgus knees. No patella resurfacing was done but all tibiae were cemented. There were a total of 56 valgus knees (1° to 22°, Mean 5.9°, SD 4.9). The TT varied from 42 min to 121 min (mean 72 min, SD 17.4). There was a statistically significant relationship between TT and Valgus deformity. Tourniquet Time = 59.6 + 2.1 * Pre-operative Valgus (p= < 0.0001, R. 2. = 36.4%). Thirty six percent of the observations were explained by this analysis. Other factors will need to be considered in future studies. This equation can be used as a guide in the allocation of theatre time. It applies to a specific surgical team and we would expect different teams to have different coefficients. This may be useful in comparisons of different teams

Purpose. The purpose of this study was to investigate the difference in the level of pre- and 6 months post-operative objective and subjective measures of disability between patients with full-thickness rotator cuff tears and those with impingement syndrome/low grade partial thickness rotator cuff tears. Impact of age, gender, and job demands was taken into consideration. Methods. Standardised pre- and post-operative data were collected on consecutive patients who had undergone surgery related to rotator cuff pathology. A disease-specific disability measure, the Western Ontario Rotator Cuff (WORC) Index which explores five domains of physical symptoms – life style, work, sports, and emotions – was the primary outcome. Paired and independent non-parametric statistics and multivariable regression analysis were performed. Results. Three hundred and thirty patients (140 women and 190 men) with a mean age of 58 years (range, 21-82) met the inclusion criteria. Two hundred and fifteen (65%) patients had full-thickness rotator cuff tears and 115 (35%) had impingement or partial thickness rotator cuff tears. Patients with full-thickness tears complained of greater weakness and had a higher prevalence of a fall on an outstretched hand. They were significantly weaker in elevation both pre- (p=0.0002) and post-operatively (< 0.0001). Patients with impingement syndrome expressed more emotional disability both prior to (0.007) and after surgery (0.004). Both groups showed a statistically significant improvement in overall pain, disability and strength 6 months following surgery (p< 0.0001). Factors that affected emotional disability at both time points were job demands and age. Females were more emotionally disabled before surgery. Conclusion. Patients with impingement syndrome and less extensive tears tend to be more emotionally disabled due to their gender, age and work status/job demands. This needs to be considered when planning for return to work and other activities and when assessing treatment outcomes

Study Design: To design and test a new questionnaire to assess depression and other mood states. Summary of Background Data: Measurement of depression and of other mood states in pain patients has been criticised in recent years on the grounds that most questionnaires were not developed in pain populations and suffer from criterion contamination by somatic items. In addition, there is no accepted measurement for positive emotions which are more than the absence of depression. Objective: To develop a reliable and brief tool to assess mood in pain patients. Method: Non-somatic items concerning depression, anxiety and positive outlook were extracted using exploratory factor analysis from commonly used instruments (Beck Depression Inventory and Hospital Anxiety and Depression Scale) completed by over 900 chronic pain patients. Confirmatory factor analysis was used to test the internal structure of the final item set. Items were then reworded and presented as a new questionnaire (the Depression, Anxiety and Positive Outlook Scale: DAPOS) to two new samples: patients attending pain management and patients attending osteopathy. The new questionnaire was compared with several well-known questionnaires (SF-36, BDI, PCS). The structure was calibrated and tested using confirmatory factor analysis on both samples. Finally, a sub-set of patients carried out a sorting task to test for face validity. Results and conclusion: The DAPOS performed well, indicating that it is a reliable measure of the three mood states with good initial evidence of validity in these samples

i. Measurement of depression and of other mood states in pain patients has been criticised in recent years on the grounds that most questionnaires were not developed in pain populations and suffer from criterion contamination by somatic items. In addition, there is no accepted measurement for positive emotions which are more than the absence of depression. The aim of this study was to develop a reliable and brief tool to assess mood in pain patients. ii. Nonsomatic items concerning depression, anxiety and positive outlook were extracted using exploratory factor analysis from commonly used instruments (the Beck Depression Inventory and the Hospital Anxiety and Depression Scale) completed by over 900 chronic pain patients. Confirmatory factor analysis was used to test the internal structure of the final item set. Items were then reworded and presented as a new questionnaire(the Depression, Anxiety and Positive Outlook Scale: DAPOS) to two new samples: patients attending pain management and patients attending osteopathy. The new questionnaire was compared with several well-known questionnaires (SF36, BDI, PCS). The structure was calibrated and tested using confirmatory factor analysis on both samples. Finally, a sub-set of patients carried out a sorting task to test for face validity. iii. The DAPOS performed well, indicating that it is a reliable measure of the three mood states with good initial evidence of validity in these samples

Aim: Examine how individuals on Teesside, diagnosed with mechanical back pain, socially construct the beliefs they hold about their back problem. The Spinal Assessment Clinic, at Middlesbrough General Hospital, uses a comprehensive and co-ordinated approach when assessing and treating individuals. More information demonstrating how people suffering with mechanical back pain are influenced by their psychosocial and cultural beliefs would enable the team to enhance the process. This research, is an anthropological examination of individual’s thoughts and beliefs as they absorb the information extended to them. This will be valuable in enhancing clinicians, sufferers and academics understanding of back pain. The research is still in the recruitment phase. Method: This is an ethnographic study using a phenomenological framework to interpret the narrative and pictorial accounts given by individuals suffering with mechanical back pain as they proceed through their treatment at Spinal Assessment Clinic. Interviews are informal, the intention being to listen to each individuals life story and explore the way in which the narratives evolve, as they explain the lived experience of their pain. Individuals are being recruited from the Spinal Assessment Clinic. One of the research methods utilised is that of pain imagery, with volunteers providing a drawing, representing their back pain. Results: The drawings demonstrate that physical pain is not always viewed by individuals as a biological problem, it may be externalised or expressed as an emotion. The images are filled with vivid metaphors symbolising each individuals unique interpretation of their pain. Conclusion: Initial results demonstrate there is a gap between the patients’ visualisation in their drawing and the narrative accounts provided

A reliable and valid measurement tool, The Western Ontario Meniscal Evaluation Tool (WOMET) was developed to assess the benefit of conservative and surgical interventions for meniscal pathology. A methodologic protocol designed by Guyatt was used for the development. This measurement tool can be used as the primary outcome tool in clinical trials evaluating the outcome of patients in this population. It can also be used to monitor a patients’ progress in private practice. The purpose of this study was to develop a measure of quality of life, which is reliable and valid, to assess the benefit of conservative and surgical interventions for meniscal pathology. Health-related quality-of-life measurement tool development. A modified methodologic protocol designed by Guyatt was used to develop the Western Ontario Meniscal Evaluation Tool (WOMET) a disease-specific quality of life measurement tool for patients with meniscal pathology. The stages were: 1) item generation, 3) item selection, 4) pretesting. Evaluation of the WOMET included testing reliability, responsiveness and validity. The final instrument, the Western Ontario Meniscal Evaluation Tool has sixteen items representing the domains of physical symptoms (nine items), sports, recreation/work/lifestyle (four items), and emotions (three items). The instrument proved to be valid by demonstrating predicted correlations with previously published knee measurement tools. Reliability at two weeks was high with an intraclass correlation coefficient of 0.833. The new instrument was also more responsive than other knee measurement tools. Since the patients own perception of changes in their health status is the most important indicator for success of a treatment, this measurement tool can be used as the primary outcome tool in clinical trials evaluating the outcome of patients in this population. It can also be used to monitor a patients’ progress in private practice

Previous attempts to assess the comfort and protection afforded by surgical gowns have been extremely simplistic and limited in their nature relying on a single and subjective linear scoring system. We have performed a comfort assessment comparison between the Charnley exhaust suit, disposable gown plus visor and the Stryker Steri-Shield system using a newly developed objective multi-dimensional validated ergonomic tool. A prospective, comparative study was conducted using a modification of the Comfort Rating Scales (CRS) designed to measure wearable comfort of computer devices during physical activity across 6 dimensions. These dimensions are emotion, attachment, harm, perceived change, movement and anxiety. 10 theatre staff were recruited to the study and completed modified CRS scores on three separate occasions after having worn a disposable surgical gown plus mask with visor, a Charnley exhaust suit and a Stryker Steri-Shield system. The total mean CRS for a disposable gown plus visor was 16.1 with a mean dimensional score of 2.7 (range: 0.2 – 8.4), for the Charnley system the values were 51.4 and 8.6 (range: 5.9 – 12.8) respectively and for the Stryker Steri-Shield 15.4 and 2.6 (range: 0.8–5.6). Although disposable, impermeable gown plus visor or the Steri-Shield system provide a similar level of comfort, the modified CRS has demonstrated that over 6 dimensions of measurable comfort the Steri-Shield system provides the least variation in comfort and as such may offer the best combination of comfort, protective qualities and form or style of personal protection systems for lower limb arthroplasty operations

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The aim of this study was to develop a core outcome set of what to measure in all future clinical research on hand fractures and joint injuries in adults.

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The evidence base within trauma and orthopaedics has traditionally favoured quantitative research methodologies. Qualitative research can provide unique insights which illuminate patient experiences and perceptions of care. Qualitative methods reveal the subjective narratives of patients that are not captured by quantitative data, providing a more comprehensive understanding of patient-centred care. The aim of this study is to quantify the level of qualitative research within the orthopaedic literature.

Aims: Traditionally in surgery, and this is especially true in orthopaedic foot surgery, is not paid much attention to patient’s emotions, not considering how specific personality traits could affect pre and post surgical management. Following the guidelines of WHO about the treatment of pain and in order to optimize the clinical management of patients who complain of painful foot disorders such as hallux valgus, we studied the relation between level of anxiety, perception of pain and memory pain before and after the surgical procedure. Methods: In the period 2000 and 2004 we studied 88 patients who were treated with distal metatarsal osteotomy for correction of hallux valgus. In order to evaluate anxiety trait level we selected one of the most frequently employed tests in clinical medicine (S.T.A.I. Y2). To quantify the amount of pain, due to such pathology in the pre and post surgical period, FFI test (visual analogous) and a questionnaire on pain memory, were employed. Pain was studied longitudinally, in the following steps: presurgery, immediately postsurgery, daily in the first four days, and at one and two weeks interval after the procedure. The use of analgesic drugs in the first two weeks was recorded. Two years later the same patient were recalled in order to collect data related to the clinical outcome and pain memory persistence. Results: A subgroup of 33 patients showed an high anxiety trait level (score > 43), the remaining 50 patients had a score in the normal range. The statistical analysis of the data shows a direct correlation between anxiety level and pain perception in the pre surgical period. Furthermore, patients with higher level of anxiety showed an increased use of analgesic drugs in the post surgical period (the higher dosage prescribed on demand). The unpleasant memory persistence is however mitigated in the same group, possibly due to much drug assumption. Conclusions: A correct management of patients with painful diseases candidated to surgical procedures should include a comprehensive psychological evaluation in order to identify their emotional state. Especially in clinical situations requiring bilateral surgical approaches is mandatory to avoid that pain could become a traumatic experience

Purpose: The purpose of this study was to investigate the difference in the level of pre and 6 months post operative objective and subjective measures of disability between patients with full-thickness rotator cuff tears and those with impingement syndrome/partial thickness rotator cuff tears. Method: This study involved a review of prospectively collected data from a consecutive series of patients who had undergone surgery related to rotator cuff pathology (acromioplasty with or without resection of clavicle for impingement syndrome/partial thickness rotator cuff tears or repair for full-thickness rotator cuff tears). Exclusion criteria included previous surgery, concomitant pathologies, and work-related injuries with an active compensation claim related to the shoulder. Standardized pre and post-operative data (history and clinical examination, including strength assessment) were collected. To measure symptoms and functional levels, all patients completed a disease-specific outcome measure, the Western Ontario Rotator Cuff (WORC) Index which explores five domains of physical symptoms, life style, work, sports, and emotions. Paired and independent non-parametric (Wilcoxon two sample tests, and Wilcoxon signed rank tests) statistics were used where normality of data were violated. Results: Three hundred and five patients (130 women and 175 men) with a mean age of 58 years (range, 21–82) met inclusion criteria. One hundred and ninety eight (65%) patients had full-thickness rotator cuff tears and 107(35%) had impingement [59 (55%)] or partial thickness rotator cuff tears [48 (45%)]. Patients with full-thickness tears complained of greater weakness, had a higher prevalence of a specific injury such as fall on an outstretched hand, and reported a higher frequency of insidious onset of pain. The full-thickness tear group was significantly weaker in elevation both pre and post-operatively. Patients with impingement syndrome expressed more severe symptoms and more emotional disability prior to surgery and had more physical disability related to lifting and performing activities of daily living and more emotional disability 6 months after surgery. Both groups showed a statistically significant improvement in overall pain, WORC score, and strength 6 months following surgery. Conclusion: Our results indicate that the extent of rotator cuff pathology and level of physical and emotional disability do not necessarily correlate positively in the early phase of recovery. Patients with less severe rotator cuff pathology tend to be more disabled both before and after surgery. This needs to be considered when planning for return to work and other activities and when assessing treatment outcomes

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To systematically review qualitative studies of patients with distal tibia or ankle fracture, and explore their experience of injury and recovery.

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One of the main causes of tibial revision surgery for total knee arthroplasty is aseptic loosening. Therefore, stable fixation between the tibial component and the cement, and between the tibial component and the bone, is essential. A factor that could influence the implant stability is the implant design, with its different variations. In an existing implant system, the tibial component was modified by adding cement pockets. The aim of this experimental in vitro study was to investigate whether additional cement pockets on the underside of the tibial component could improve implant stability. The relative motion between implant and bone, the maximum pull-out force, the tibial cement mantle, and a possible path from the bone marrow to the metal-cement interface were determined.

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The aim of this study was to explore parents and young people’s experience of having a medial epicondyle fracture, and their thoughts about the uncertainty regarding the optimal treatment.