Aims. The purpose of this study was to validate our hypothesis that centrifugation may eliminate false-positive leucocyte esterase (LE) strip test results caused by autoimmune diseases in the diagnosis of knee infection. Methods. Between January 2016 and May 2019, 83 cases, including 33 cases of septic arthritis and 50 cases of aseptic arthritis, were enrolled in this study. To further validate our hypothesis, another 34 cases of inflammatory arthritis from the Department of Rheumatology of our institution were also included. After aspiration, one drop of synovial fluid was applied to LE strips before and after centrifugation. The results were recorded after approximately three minutes according to the different colour grades on the colour chart. The differences of LE results between each cohort were analyzed. Results. Before centrifugation, 46% (23/50) of the LE strip tests in the aseptic arthritis group were false-positives. Most of the false-positive results were due to inflammatory arthritis; after centrifugation, 78.3% (18/23) of the tests yielded negative results. Similar results were observed in cases from the Department of Rheumatology. The sensitivity of the centrifuged LE strip test was 0.818 (0.639 to 0.924), which is still an acceptable level compared with the uncentrifuged results, which yielded a sensitivity of 0.909 (0.745 to 0.976). However, the specificity was increased from 0.540 (0.395 to 0.679) to 0.900 (0.774 to 0.963) after centrifugation. Conclusion. Although inflammatory arthritis can yield a false-positive LE strip test result in the diagnosis of knee infection, centrifugation may eliminate these false-positive results. Cite this article: Bone Joint Res. 2020;9(5):236–241

A hot swollen joint is a commonly encountered condition in clinical practice. With a broad range of differentials, septic arthritis (SA) is perhaps one of the most concerning. Treated by culture-specific antibiotics and arthroscopic lavage, some patients require multiple washouts. We aimed to determine:. (1) What are the risk factors for development of SA?. (2) What are the risk factors for repeat washout in SA patients?. (3) What are the important clinical differences between a periprosthetic joint infection (PJI) and SA cohort?. All patients presenting to the emergency department, orthopaedic, and rheumatology clinics between January 2020 to January 2021 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma on the ipsilateral joint, with data missing from their medical records in any of the variables required for analysis, <24 months follow-up were excluded. Variables of interest in the three-month period preceding the diagnosis of SA were compared between SA and non-SA patients. Factors with a p-value of p<0.100 in univariate analysis were included in a stepwise multivariate logistic regression model. Similar analyses were performed to compare SA patients with multiple washouts with those needing one washout. Demographical and clinical data for PJI patients were collected to delineate important differences with SA cohort. 211 patients were included (SA:28;PJI:24;pseudogout:32;gout:26;others:101). Multivariate analysis showed rheumatoid arthritis (RA), skin infection, and liver disease were risk factors for SA. Amongst patients with septic arthritis, multivariate analysis showed that WBC levels above normal limits (3.6-10.5×109 cells/L) and RA were risk factors for multiple washouts. Between the SA and PJI cohorts, BMI (p=0.002) was significantly lower in the former, whilst WBC level (p=0.023) and CRP (p<0.0001) was significantly higher in the former. Early diagnosis of septic arthritis requires understanding the risk factors, namely RA, skin infection, and liver disease. Considering PJI and septic arthritis as the same entity can lead to wrong clinical judgement, and clinicians should be aware of important differences. We believe that the models in this study are of prognostic value to clinicians who are presented with the common presenting compliant of a hot swollen joint

Introduction. Chronic recurrent multifocal osteomyelitis (CRMO) is a rare condition characterised by bony pain and swelling which may be initially mistaken for bacterial osteomyelitis. The episodic course of the disease may confound the diagnosis and potentially be mistaken for a partial response to antimicrobial therapy. It is an orphan disease and consequently results in many unclear aspects of diagnosis, treatment and follow up for patients. The aim of this study is to evaluate a national tertiary centre's experience with the clinical condition and present one of the largest cohorts to date, emphasizing the vast array of clinical spectrum, course and response to treatment. Methods. We retrospectively evaluated all children identified with CRMO from the period 2000–2022 within Wales. Demographic data and clinical parameters were selectively identified through the utilisation of a national clinical platform (Welsh Clinical Portal). The diagnosis was based on clinical findings, radiological images, histopathological and microbiological studies. Results. A total of 21 patients were identified as suitable for inclusion. The mean age of diagnosis was 9.4 ±2 years. The age range of children being diagnosed was 6–14 years. Of the 21 patients, only 2 reported feeling unwell prior to their first presentation with generalized coryzal illness reported. The most common presenting site for CRMO was knee (33%) followed by back pain (28%). 19% of the included cases at initial presentation had localised warmth and had nocturnal pain. 4 of the patients went on to have dermatological conditions of which psoriasis was the most common (14%). Bilateral symptoms developed in 38% of the included patients. Biochemical investigations revealed only 19% of patients had a raised C-reactive protein level and erythrocyte sedimentation rate whilst 9/21 patients went on to have a bone biopsy to aid diagnosis. 100% of patients had MRI whilst whole body MRI was utilised in 8/21 patients. NSAID's were utilised for 81%, Pamidronate for 33% and methotrexate for 14%. Biologics were utilised for a further 24% of the total population in failed medical therapy. Surgical intervention was utilised for a single individual in this cohort of patients in the form of posterior spinal stabilisation. The most common referring speciality for these patients was Rheumatology (71%) followed by Orthopaedics (33%). Discussion. CRMO represents a challenging diagnosis to make with such varied clinical and biochemical presentations for this condition. The absence of diagnostic Radiological features on X-ray could argue over early MRI imaging. The utilisation of whole body-MRI can now identify multifocal disease burden which may facilitate a timely diagnosis and ensure that effective medical treatment is started promptly without delay. This study is the largest cohort of CRMO patients conducted in this country. Future work will serve to build upon a framework and national referral pathway so that these patients can be seen by the appropriate specialist in a timely manner

Introduction: Referrals for Low Back Pain (LBP) are common and many patients appear to see more than one specialist. In one acute trust, a dedicated Spinal Assessment Clinic (SAC) run by nurse practitioners was developed. Objective: To determine patterns of referral for LBP from primary to secondary care. Method: All new referrals to the hospital for LBP in an index period June–November 1998 were included. Consultations for these patients in the preceding six months and the subsequent two years were studied. Results: A total of 801 patients were referred in the audit period. The patients were seen in the SAC 75%, orthopaedics 5.5%, rheumatology 4.5%, neurosurgery 12% and the pain clinic 4%. Onward referrals made after the initial appointment from the SAC 4.9%, from orthopaedics 26.7%, from rheumatology 8.6%, from neurosurgery 33.7% and from the pain clinic 10.3%. Subsequent repeat referrals made by the GP occurred in 3.7%of patients initially seen in the SAC, 11.1% from orthopaedics, 2.9% from Rheumatology, 3.2% from Neurosurgery and 17.2% from the pain clinic. The average wait in days for a first appointment was SAC 42, orthopaedics 103, Rheumatology 82, Neurosurgery 78 and pain clinic 77. Conclusion: The SAC offers a shorter wait for patients and an extremely low “churn” rate, implying high rates of satisfaction in patients and GP’s. The wait for other specialities is longer, and in orthopaedics and neurosurgery the re-referral rate is almost one third. Referral procedures to secondary care might need to be streamlined for more efficiency

Background and purpose of the study. Axial Spondyloarthritis (axSpA) is commonly mistaken as chronic mechanical back pain. Delayed diagnosis averages 5- 8 years with impacts on effective and timely management, outcomes and quality of life. NICE Guidance (2017) highlights the importance of the recognition and referral of suspected axial spondyloarthritis. This study investigated the occurrence of physiotherapy care prior to diagnosis of axSpA within physiotherapy outpatient settings. Methods and results. A retrospective review was performed of all patients diagnosed with axSpA who had received physiotherapy care prior to their diagnosis from 1990–2016. Three or more episodes of care prior to diagnosis was taken as unrecognised axSpA. Information was obtained on diagnostic codes, number of episodes of care and contacts per episode from nine outpatient physiotherapy services. Analysis showed that 263 people (17–69 years) diagnosed with axSpAs had received physiotherapy care prior to diagnosis. Within this population, 103 (44%) had received ≥3 episodes of care. Number of contacts within each episode ranged from 3 (47 people) to 58 (1 person) [median=11 contacts-10 people]. Average time from initial physiotherapy episode to date of diagnosis was 6.4 years (range=0.3–12.8 years, median=8.8 years). The most common assigned diagnostic code was back pain (49.6%), followed by shoulder (11.1%), knee (8.5%), neck (7.7%), ankle/foot (4.3%), tendonitis (4.2%), joint pain (3.4%), osteoarthritis (3.4%) and sacroiliac joint (2%). Conclusion. Findings illustrate the extent of unrecognised axial spondyloarthritis referred to and missed in musculoskeletal physiotherapy practice. It is essential to improve screening and recognition of inflammatory back pain and possible axSpA in musculoskeletal assessments, supported by rheumatology referral guidance. No conflicts of interest. No funding obtained

At least 10% of consultations in General Practice are for musculoskeletal problems. It would seem appropriate that the diagnosis and management of common musculoskeletal problems should form an important part of the “core” curriculum of any undergraduate medical training. Time is always short in an undergraduate teaching program and the pressures not to overload the curriculum are constant. The planned increased in student numbers is likely to stretch the ability of most teaching departments to provide a high level of undergraduate training in musculoskeletal disease. A postal survey of the provision of undergraduate teaching in T& O was performed in the UK. All 23 medical schools in England, Scotland, Wales and Northern Ireland were. To gain further insight into non-specialist general training in T& O after qualification a survey of the Vocational Training Schemes (VTS) for General practitioners in the Northern Deanery was performed. Ninety-one percent of Medical Schools replied. The average length of the orthopaedic attachments (all years combined) was five weeks. However, all but two programs were combined with other clinical subjects. The dilutional effect of these other subjects resulted in the average duration of the T& O attachment being reduced to 2.7 weeks (range 1.5 – 6). All the modules in orthopaedic surgery except one included trauma within the curriculum. There are four VTSs in the Northern Deanery. All of these had schemes that included A& E but not for every trainee. No scheme had either a rheumatology or orthopaedic surgery placement, although some exposure to rheumatology occurred during attachments in general medicine. This study shows that there is a significant discrepancy between the amount of time, within the curriculum (4%), devoted to musculoskeletal/orthopaedic teaching and the number of consultations in General Practice (10%); this discrepancy is not made up during VTS placements. In addition, such short exposure to a large subject may encourage superficial learning which medical education is specifically trying to avoid

The purpose of our presentation is to propose a asimple and reliable method which does not expose the doctor and the patient to radiation for hip arthrocentesis and to be used by inexperienced doctors as well as for studies. Hip Arthrocentesis (HA) on every day practice is performed by the anatomic knowledge and experience. But as a study has shown there is a high failure rate as it concerns the correct position of the needle in the joint, even in joints as the knee and shoulder where the intraarticular injections as usual. According to the American College of Rheumatology hip arthrocentesis should be performed by experienced Rheumatologists, Orthopaedic Surgeons and Radiologists, and always under radiological control. HA at first has been performed for diagnostic purposes, mainly infections, for fluid aspiration. Later for therapeutic reasons (corticosteroids), and for the differential diagnosis between abdominal and osteoarthritic pain of the hip with the intraarticular injection of local anaesthetic. HA under ultrasound control was initially performed in 1989 for diagnostic reasons and later in 2001 has been used for intraarticular injections of Hyalouronic Acid for the treatment of hip osteoarthritis. In the international literature publications about the help that Ultrasonography provides at hip arthrocentesis are sporadic (sparse). Since 2000 we performed 50 intraarticular injections at the hip joint in our out -patient department under ultrasonographic control for the confirmation of the correct position of the needle in the articulation. All patients suffered from hip osteoarthritis according to the criteria of the American College of Rheumatology, and all were female, 50 – 75 years old. 30 injections were performed with simple head (Convex) of 6 MHz and 20 with linear head of 9 MHz. There was no difference concerning the accuracy of needle placement, but a more clear picture had the linear head. There was no complication. In the Hellenic area, to our knowledge, this method is applied and announced for the first time. In conclusion we believe that it is an accurate and safe method which does not expose neither the patient nor the doctor to radiation and is much less time – consuming than CT. it can be recommended for inexperienced collegues, for studies that need confirmation, as well as for control of the correct placement of the needle intraarticular for therapeutic purposes. In general it can be used for every hip arthrocentesis

Introduction. Patients with rheumatoid arthritis (RA) have a higher risk of surgical site infection (PJI) than patients with osteoarthritis (OA). Disease modifying therapy is in widespread use in RA patients, and biologic medications may increase Staphylococcus aureus colonization rates. Because S. aureus colonization likely increases risk of surgical infection, perioperative assessments and therapies to decrease the risk of invasive S.aureus infections may be warranted. The objective of this study was to determine if there was a difference in S. aureus carriage among patients with RA, OA, and RA on biologics (RA+B). Methods. An a priori power analysis determined 123 participants per group were needed to detect a relative difference of 20% among groups with 80% power. After IRB approval, patients were screened; included patients met American College of Rheumatology classification criteria. Patients were approached between April 2017 and May 2018 and asked to perform a nasal swab while on site using the Center for Disease Control's swabbing protocol; questionnaires pertaining to their current health status were collected. Swabs were inoculated onto ChromAgar/ChromID MRSA plates for detection of S. aureus. Mann-Whitney U and Chi-square tests were used to evaluate baseline differences between groups. Logistic regression evaluated the associations between groups and S. aureus carriage. All statistical analyses were performed using SAS Software version 9.3 (SAS Institute, Cary, NC); statistical significance was defined as p<0.05. Results. Overall the patient cohort evaluated had a mean age of 66 (+/-13.7), BMI of 29 (+/-28.2), and were predominantly female (78%) .28% of the cohort was on antibiotics within three months prior to the nasal swab, 18% were currently on steroids, and 24% had been hospitalized within the last year. We found differences in age (p<0.001), BMI (p<0.001), sex (p<0.001), diabetes (p=0.04), steroid use (p=0.02), antibiotic use (p<0.001), and hospitalizations within the last year (p<0.001). S. aureus carriage was most prevalent in RA+B37%, followed by RA (24%), and OA (20%). After multivariate adjustment, RA+B was found to have increased odds of S. aureus (OR=1.80, 95% CI 1.00–3.22); p=0.047) compared to RA group. Use of glucocorticoids, hospitalization, or diabetes did not increase the odds of S. aureus carriage. The OA group had decreased odds of S. aureus growth when compared to the RA group; however, this was not found to be statistically significant (p=0.987). Conclusion. RA patients treated with biologics have an increased prevalence of S. aureus colonization. Since nasal S. aureus carriage may play a role in the pathogenesis of surgical infections, S. aureus decolonization should be considered in RA patients on biologics prior to elective surgery

Adipose derived mesenchymal stromal cells (ASC) are adult stem cells exhibiting functional properties that have open the way for cell-based clinical therapies. Primarily, their capacity of multilineage differentiation has been explored in a number of strategies for skeletal tissue regeneration. More recently, MSCs have been reported to exhibit immunosuppressive as well as healing capacities, to improve angiogenesis and prevent apoptosis or fibrosis through the secretion of paracrine mediators. Among the degenerative diseases associated with aging, osteoarthritis is the most common pathology and affects 16% of the female population over 65 years. Up to now, no therapeutic option exists to obtain a sustainable improvement of joint function beside knee arthroplasty. This prompted us to propose adipose derived stem cells as a possible cell therapy. We performed pre-clinical models of osteoarthritis and showed that a local injection of ASC showed a reduction of synovitis, reduction of osteophytes, joint stabilization, reducing the score of cartilage lesions. This work was completed by toxicology data showing the excellent tolerance of the local injection of ADSC and biodistribution showing the persistence of cells after 6 months in murine models. The aim of the ADIPOA trial is to demonstrate the efficacy of adipose derived stem cells therapy in knee osteoarthritis (OA) in a phase 2/3 controlled multicenter study controlled against standard of care. Safety and feasibility as well as dose response was previously assessed in the ADIPOA FP7 project. The bi-centric phase I clinical trial in Montpellier (France) and Würzburg (Germany) included 18 patients with moderate to severe knee OA, each patient received a single injection of autologous ADSC, in a open scale up dose trial, starting form 2 10 6 cells to 50 106 cells. The 107 dose appears to be well tolerated and showed preliminary response in terms of decreasing local inflammation. This first study confirmed the feasibility and safety of local injection of ADSC in knee OA and suggested the most effective dose (107 autologous ADSC). This work constituted a significant step forward treating this disease with ADSC to demonstrate safety of the procedure. we conduct a prospective multicenter randomized Phase 2/3 study with 86 patients with moderate to severe knee OA to demonstrate superiority of stem cell-based therapy compared to standard of care (SOC) in terms in reduction in clinical symptoms (WOMAC score) and structural benefit (assessed by T1rhoMRI that allow quantification of cartilage proteoglycan content). This project will offer EU a unique leadership in OA with strong positions in EU and US due to patents and quality of the methodology to demonstrate efficiency of ADSC. ADIPOA brings together a unique combination of expertises and leaders in clinical rheumatology, MRI specialists, Stem cell Institutes, national GMP grade adipose derived stem cell production platform (ECELLFRANCE) and SME specialized in cell therapy trials in the EU. The production of the cells will be granted to EFS through ECELLFRANCE national platform, which have the GMP facility and will work as a contracting manufacturing organization. The expertise, leadership and critical mass achieved by this Consortium should enable breakthroughs in ASC engineering directly amenable for clinical applications in OA

Diffuse noxious inhibitory control (DNIC) works through the “pain-inhibits-pain” principle in which an additional painful (conditioned) stimulus can suppress the initial experienced pain through the descending and inhibiting pathways. Painful stimulation produced less pain inhibition in patients with knee osteoarthritis patients (KOA) than in controls, suggesting an impaired DNIC function and a loss of endogenous pain modulation. Electroacupuncture (EA) is widely used to treat acute pain associated with KOA, but the available evidence of its benefit on chronification of acute pain is scarce. This is a single-arm clinical study aims to evaluate the effect of EA on the chronification of pain associated with KOA and provide a profile of various cytokines underlying the pathogenesis of KOA. Participants are recruited through hospital-based recruitment and advertisements, diagnosis was based upon the criteria formulated by the American College of Rheumatology. Each participant was administered with EA (2 mA < current < 5 mA) at the ipsilateral EX-LE5, ST35, ST34 and SP10 for two weeks (once a day, 30 minutes per session, in 5 sessions per week). Visual Analog Scale (VAS), DNIC function, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Numerical Rating Scale (NRS), Emotional Scale (ES) and Present Pain Intensity (PPI) are evaluated before treatment and after 5 to 10 sessions of treatment. Cytokines including GRO, TNF-α, VEGF, IP-10, IL-1β, IL-17, IL-8, MCP-1 and IL-10 levels in plasma were measured using a Human Cytokine/Chemokine Magnetic Bead Panel on MAGPIX instrument before and after two weeks of treatment. A total of 39 patients with KOA were enrolled in our study (age: 63.46±9.89 years; height: 1.63±0.07 m; BMI: 22.83±2.89), all of them completed the trial. After 5 sessions of EA treatment, a significant decrease of VAS, WOMAC scores, NRS, ES and PPI was detected, but no significant difference in DNIC was observed. After two weeks' treatment, all clinical parameters (VAS, DNIC, WOMAC, NRS, ES, PPI) reduced significantly when compared with baseline; GRO, IL-17A, IL-1b, IL-8, MCP-1, TNF-a, VEGF levels in plasma reduced significantly while IL-10 and IP-10 concentrations were elevated. This study appeared to provide evidence that EA was effective in improving chronic pain associated with KOA through repairing the impaired DNIC function and down-regulation of OA detrimental cytokines. A randomized controlled prospective study with large sample size is required to clarify the effect of EA in reversing the chronification of pain in KOA

Aims

To explore the synovial expression of mucin 1 (MUC1) and its role in rheumatoid arthritis (RA), as well as the possible downstream mechanisms.

Aims

Hand trauma, consisting of injuries to both the hand and the wrist, are a common injury seen worldwide. The global age-standardized incidence of hand trauma exceeds 179 per 100,000. Hand trauma may require surgical management and therefore result in significant costs to both healthcare systems and society. Surgical site infections (SSIs) are common following all surgical interventions, and within hand surgery the risk of SSI is at least 5%. SSI following hand trauma surgery results in significant costs to healthcare systems with estimations of over £450 per patient. The World Health Organization (WHO) have produced international guidelines to help prevent SSIs. However, it is unclear what variability exists in the adherence to these guidelines within hand trauma. The aim is to assess compliance to the WHO global guidelines in prevention of SSI in hand trauma.

Aims

To investigate the correlations among cytokines and regulatory T cells (T-regs) in ankylosing spondylitis (AS) patients, and their changes after anti-tumour necrosis factor-α (TNF-α) treatment.

Aims

Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients’ decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research.

Background. Shoulder impingement syndrome (SIS) is a common debilitating condition, treated across multiple health disciplines including Orthopaedics, Physiotherapy, and Rheumatology. There is little consistency in diagnostic criteria with ‘Shoulder impingement syndrome’ being used for a broad spectrum of complex pathologies. We assessed patterns in diagnostic procedures for SIS across multiple disciplines. Methods. This is a systematic review of electronic databases MEDLINE, PubMed, The Cochrane Library, Embase, Scopus and CINAHL five years of publications, January 2009 - January 2014. Search terms for SIS included subacromial impingement syndrome, subacromial bursitis. Searches were delimited to articles written in English. The PRISMA guidelines were followed. Two reviewers independently screened all articles, data was then extracted by one reviewer and twenty percent of the extraction was independently assessed by the co-reviewer. Studies included were intervention studies examining individuals diagnosed with SIS and we were interested in the process and method used for the diagnosis. Results. The search strategy yielded 3339 articles of which 1931 were duplicates. A further 1260 were excluded based on relevance obtained from title/abstract. A total of 148 articles were identified investigating SIS across thirty different journals internationally. Fourteen different health disciplines have investigated twenty-five different surgical and conservative treatments. Studies document their diagnostic approach, reporting on duration of symptoms, medical history, physical examination tests and radiological investigations. Duration of symptoms for inclusion ranged from a minimum of 2 weeks to 18 months where the median duration of symptoms is 3 months observed in 46 percent of the studies. Commonly used physical tests were Neer's test, Hawkins-Kennedy test, Jobe and Yocum, and a further eight tests identified. Neer's test or Hawkins-Kennedy tests were individually used in 72 percent of studies. Thirty of the studies used more than one and up to six physical tests per study to determine the presence of impingement. Radiological investigations were reported in twenty-eight studies, sixteen of these required more than one radiological investigation to confirm the diagnosis of SIS. Comparisons between disciplines identify important differences in diagnostic criteria used by different health professionals. Conclusions. This study highlights the variety of diagnostic methods which are currently used between health disciplines and will be a useful comparative tool for clinicians. Diagnostic transparency is pertinent for shoulder impingement syndrome to ensure all disciplines are treating the same pathology and importantly to contribute to our understanding of the common pathology

Aims

Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic training in the UK.

Purpose of the study. To take a snapshot opinion of General Practitioner understanding of the prevalence, diagnosis and management of coccydynia. Methodology. We designed a simple 5 question survey to administer to our local GPs. The survey was sent to 107 GP practices in Devon whose details were provided by The Devon Access Referral Team. We received 128 electronic replies. We also submitted the survey to 50 GPs who attended a study day at our institution – and ensured they had not already completed the electronic format of the same work. Thus we received 178 replies which we believe to be a highly representative sample of our local GPs opinion. Results. 53% correctly identified the prevalence of the condition. 42% believed the condition to be associated with an underlying psychological disorder. 58% believed there was no proven treatment for the condition. Less than 18% would consider referring the patient to any secondary care service that dealt with chronic spinal pain (Pain clinic, rheumatology or spinal surgery) even if the symptoms persisted beyond 3 months duration. 73% believed surgery was madness or had a less than 20% chance of relieving symptoms. Conclusion. Coccydynia is a painful condition, causing significant distress for those suffering with the condition. Primary care physicians seem reluctant to recognise the problem as significant and reluctant to refer patients for treatment that may offer significant symptomatic relief. Education about the condition is required

Background: Musculo-skeletal conditions account for at least 10% of General Practice consultations yet the average time spent by UK medical students in orthopaedic and trauma surgery is only 2.7 weeks. Aim: This study assessed whether a seven-week undergraduate musculoskeletal teaching program introduced in 2006 improved performance. Methods: This seven week program combined Orthopaedic and Trauma Surgery with Rheumatology and allied specialities. Its main elements were weekly plenary sessions, specialist clinics, a task-based workbook, regular assessments and traditional firm based teaching. The performance of 139 students who attended the new curriculum in its first year of introduction was assessed using multiple choice questions just before their final examinations in 2008 and was compared to that of a control group of students assessed in 2005 prior to program introduction. Results: The 2008 students showed a 6% improvement in MCQ scores (p< 0.001) over the 2005 graduates. There was no difference between the 2005 students and a second control group of 46 students from 2008, who did not attend the new teaching program. Conclusion: The program improved performance by providing more focused musculoskeletal training using available resources and by increasing the program duration

Aims

Therapeutic agents that prevent chondrocyte loss, extracellular matrix (ECM) degradation, and osteoarthritis (OA) progression are required. The expression level of epidermal growth factor (EGF)-like repeats and discoidin I-like domains-containing protein 3 (EDIL3) in damaged human cartilage is significantly higher than in undamaged cartilage. However, the effect of EDIL3 on cartilage is still unknown.

Aims

To assess the cost-effectiveness of a two-layer compression bandage versus a standard wool and crepe bandage following total knee arthroplasty, using patient-level data from the Knee Replacement Bandage Study (KReBS).