Total hip replacement (THR) for end-stage osteoarthritis is a commonly performed cost-effective procedure, which provides patients with significant clinical improvement. Estimating the future demand for joint replacement is important to identify the healthcare resources needed. We estimated the number of primary THRs that will need to be performed up to the year 2060.

We used data from The National Joint Registry for England, Wales, Northern Ireland and the Isle of Man on the current volume of primary THR (n=94,936) performed in 2018. We projected future numbers of THR using a static estimated rate from 2018 applied to population growth forecast data from the UK Office for National Statistics up to 2060.

By 2060, primary THR volume would increase from 2018 levels by an estimated 37.7% (n=130,766). For both males and females demand for surgery was also higher for patients aged 70 and over, with older patients having the biggest relative increase in volume over time: 70–79 years (144.6% males, 141.2% females); 80–89 years (212.4% males, 185.6% females); 90 years and older (448.0% males, 298.2% females).

By 2060 demand for THR is estimated to increase by almost 40%. Demand will be greatest in older patients (70 years+), which will have significant implications for the health service that requires forward planning given morbidity and resource use is higher in this population. There is a backlog of current demand with cancellation of elective surgery due to seasonal flu pressures in 2017 and now Covid-19 in 2020. Orthopaedics already has the largest waiting list of any speciality. These issues will negatively impact the health services ability to deliver timely joint replacement to many patients for a number of years and require urgent planning.

In order to achieve a true AP and lateral radiograph of the wrist, there must be no movement at the radio-ulnar joint. Projections taken with only pronation and supination at the wrist provide two views of the radius but a single view of the ulna. True radiographs are achieved by rotating the humerus through 90 degrees and extending at the elbow between the two views. Our aim was to look at whether true lateral and AP radiographs are taken by our radiology department. Between April 2009 to November 2010, we identified all patients with ulna shortening osteotomies. This was because the plate and screws placed only in ulna making it easy to identify if two projections of the ulna have been achieved. Radiograph at first follow up were reviewed using PACS. Of the 29 patients identified, 5 patients were excluded. Only 6 out of 24 patients had TRUE wrist projections. Most radiographs taken were inadequate and this has to be communicated with the radiology department. Two different views are needed to accurately comment on radiographs. Patients have to be sent back to radiology department. This causes an increase in clinic time, radiation to the patient and inconvenience

A key challenge for healthcare delivery in OECD countries is the projected significant increases in populations over the age of 65 years. Australia for example will experience an increase of 16.4% by 2015 while Canada will experience an increase of 16%, UK an increase of 17.9% and US an increase of 14.3% during the same time period (Australian Bureau of Statistics, 2010). Increases of such magnitude will have significant and far reaching implications for healthcare delivery, labour force participation, housing and demand for skilled labour (Australian Bureau of Statistics, 2010). Given the impending economic impact of providing healthcare services to this projected increase of seniors, examination of technology solutions that serve to provide effective and efficient healthcare delivery during the peri and postoperative care process are highly desired and help those desiring to age in place. Recent studies have demonstrated rapid growth in the number of seniors using computers in the US and other developed countries and is projected to increase further (Jimison et al., 2006). This technology adoption leads to further growth in the potential for health monitoring technologies (Clifford and Clifton, 2012) with the key aim being the maintenance of a seniors' autonomy through understanding how he or she can manage his or her individual health problem and what necessary actions should be taken and when (Ludwig et al., 2012). Projections by the Congressional Budget Office for Social Security, Medicare, and Medicaid transfers as a percentage of GDP show the share of output spent on seniors' care programs in US rising from 7.6% in 2000 to 13.9% in 2030 to 21.1% in 2075 (Zhang et al., 2009, Falls, 2008). Despite the increased number of home monitoring technologies in age care contexts, there are several challenges that have to be met before integrating such services into the practice, as a real-life application (Ludwig et al., 2012). As the incidence of arthroplasty surgery is projected to increase over six fold between 2010 and 2030 in the US (Kurtz, Ong, Lau, Mowat, & Halpern, 2007), the post arthroplasty period represents a challenging environment for the adoption of new monitoring technologies to optimize the rehabilitative and recovery process. This study develops a framework for post-arthroplasty monitoring through the application of the intelligence continuum (Wickramasinghe and Schaffer, 2006) to the post-arthroplasty care process including an analysis of the risks and complications. The benefits, barriers and critical elements of designing the theory based framework for home-monitoring technologies provides the structural framework for clinical application of the monitoring modalities. The entire arthroplasty process is included in order to provide appropriate management governance (figure 1) with the following metrics:. Improving post-operative quality by continuous monitoring of risk factors at home. Reducing the number of unplanned emergency room visits and readmissions. Optimizing rehabilitation costs by developing / expanding alternative home care delivery methodologies. Increasing post arthroplasty value and decreasing hospital post-operative costs

Aims

This work aimed at answering the following research questions: 1) What is the rate of mechanical complications, nonunion and infection for head/neck femoral fractures, intertrochanteric fractures, and subtrochanteric fractures in the elderly USA population? and 2) Which factors influence adverse outcomes?