Abstract. Introduction. There is a need to develop approaches to reduce chronic pain after total knee replacement. There is an established link between disturbed sleep and pain. We tested the feasibility of a trial evaluating the clinical and cost-effectiveness of a pre-operative sleep assessment and complex intervention package for improving long-term pain after TKR. Methodology. REST was a feasibility multi-centre randomised controlled trial with embedded qualitative study and health economics. Participants completed baseline measures and were randomised to usual care or the intervention, a tailored sleep assessment and behavioural intervention package delivered by an extended scope practitioner three months pre-operatively with a follow-up call up at four-weeks. Patient reported outcomes were assessed at baseline, one-week pre-surgery, and 3-months post-surgery. Results. 57 patients were randomised and 20 had surgery within the study timelines. All patients allocated the intervention attended an appointment and most engaged with treatment. The intervention group reported improvements in sleep (Sleep Conditions Indicator) and neuropathic pain (painDETECT) scores. Participants found the sleep treatments and study processes to be acceptable. The mean cost of the intervention was estimated at £134.45 per patient. Conclusion. The feasibility study has shown that patient recruitment is feasible, engagement with and adherence to the intervention is high, and the intervention is acceptable to patients and clinicians. Preliminary findings show that the intervention group had improved sleep quality and had reduced levels of pre-operative neuropathic pain. This study has demonstrated that a full RCT is feasible and identified areas for improvement to optimize the trial design

Total Hip Replacement (THR) is widely assumed to resolve sleep disturbance commonly experienced by individuals with hip osteoarthritis (OA). We report a study of 329 THRs with mean age of 71.9 years comparing pre-operative and one and two year post-operative patient reported outcomes for sleep disturbance to determine the veracity of this expectation. Data was collected from the validated Oxford Hip Patient Reported Questionnaire. Specifically, Question 12: “During the past four weeks, have you been troubled by pain from your hip in bed at night?” Answers to the question were multiple choice: No nights (4 points), Only 1 or 2 nights (3 points), Some nights (2 points), Most nights (1 point) and Every Night (0 points). Pre-operatively, the mean score for patients with hip OA was 1.2/4. This increased to 3.5 at one year and was also maintained at two years. The pre- to post-operative improvement was significant at both one and two years for THR with p <0.00001. Pre-operatively, only 6% of patients with arthritic hips reported that they were never woken from sleep because of their painful hip. One year after THR 72% always enjoyed pain free sleeping and at two years this had risen to 75%. When patients who only experienced disturbance one or two nights per month were included, the three figures increased from 13% to 83% and 83% respectively. The study confirms that sleep disturbance affects over 90% of patients with arthritic hip joints. Over 80% of THR patients will enjoy sleep that is seldom or never disturbed by their artificial hip. The improvement achieved by THR occurs within a year of surgery and is preserved at two years. In this regard, hip replacement is a highly effective intervention

Introduction:. Sleep disturbance is the one of major complaints associated with knee osteoarthritis, and sleep status is one factor that influences quality of life. The present study was designed to assess sleep status in patients undergoing total knee arthroplasty and to identify factors affecting sleep patterns. Methods:. We performed a prospective study of 112 patients undergoing total knee arthroplasty from June 2011 to February 2012. Data including demographic characteristics (age, gender, BMI, VAS pain scale score, SF 36, level of education, and psychologic comorbidities) and sleep profiles (Nottingham Health Profile – 0 to 100, with 0 indicating good sleep status; Sleep Satisfaction Scale – 0 to 10, with 10 indicating full satisfaction) was collected before and after (six days, two weeks, three months, and six months) total knee arthroplasty. Results:. There were 11 male and 101 female patients with an average age of 69.3 years (range: 49 to 85 years). The Nottingham Health Profile sleep scores were 30.3, 36.4, 21.0 and 16.7 before and two weeks, three months and six months after surgery, respectively. The corresponding sleep satisfaction scores were 6.6, 7.3, 7.3 and 7.7, respectively. A post-hoc analysis showed that the Nottingham Health Profile and sleep satisfaction scale scores had improved by three and six months after surgery, respectively. Patients with good sleep patterns six months after surgery did not differ from those with poor sleep patterns in terms of demographic characteristics, but a difference was detected in the preoperative sleep profiles between the two groups. Patients with good sleep patterns six months after surgery had better sleep profiles. Additionally, those undergoing unilateral TKA showed significantly better sleep patterns six months after surgery than those undergoing bilateral TKA. Conclusion:. These findings demonstrate that total knee arthroplasty improved sleep quality in patients with osteoarthritis. Sleep quality improvements were observed three months after surgery, and patients' sleep satisfaction increased six months after surgery. We also found that those with good sleep patterns preoperatively had better sleep patterns six months following surgery compared to those with poor preoperative sleep patterns. Patients undergoing unilateral TKA had a better sleep status than those undergoing bilateral TKA

Standard protocol following total hip arthroplasty dictates that the hip is kept in a position of abduction until soft tissue healing is sufficient to provide stability. This is maintained by use of an abduction pillow while in bed, meaning that the patient must sleep on their back. Many patients find this position uncomfortable and have significant difficulty in sleeping. Aims: To assess the impact of sleep deprivation on recovery of the patient and quality of life in the peri-operative period. Methods: Patient cohort consisted of elective admissions for total hip replacement. All were assessed using the Epworth sleep scale, SF-36 as well as the Hospital Anxiety and depression score. Body mass index and history of insomnia or obstructive sleep apnoea were recorded. Baseline oxygen saturation was compared with postoperative overnight saturation and request for night sedation. Results: 64 consecutive patients undergoing total hip arthroplasty surgery were eligible for inclusion in the study. Mean age 68 (43 to 85), 42 females, 22 males, 62 patients were satisfied with the result of surgery, 1 patient with hip dysplasia had a persistent leg length inequality and one complained of back pain. All patients were nursed according to standard protocol with abduction pillow while in hospital and instructions to sleep on their back while at home. 18 patients did not fully comply with this instruction while at home. There were no early dislocations with a mean follow up of 5.4 months. Mean hospital anxiety and depression scores were significantly increased following surgery mean pre-operatively (5.2), to highest level (3.4) at two weeks, (8.5) at six weeks, returning to normal levels after three months (4.2). Epworth sleep scores were similarly increased with sleep patterns returning to normal at the three month stage. Increasingly, body mass index correlated significantly with poor scores and low oxygen saturation readings. This group of patients had a predisposition to obstructive sleep apnoea, which was predicated by sleeping on their backs, they require more night sedation and analgesia. Conclusions: Standard precautions following total hip arthroplasty are not without morbidity. Sleep deprivation leading to increased anxiety and decreased satisfaction. Increased demand for night sedation and analgesia with their resultant costs and dependence. Sleeping in the supine position may also precipitate obstructive sleep apnoea in at risk patients

Purpose: To measure quality and quantity of sleep in patients before and after hip arthroplasty. Methods: A prospective survey where 50 participants were sent a sleep diary, an acti-watch motion-logger, and a 32 item sleep questionnaire. These data were collected at least four weeks prior to and three months after surgery. Data analyses included descriptive statistics and within-subject pre and post surgery comparisons. For the subjective data, comparison was by the McNamar Test for the significance of changes. For the acti-graphy variables, comparison was by mixed model analysis of variance. Results: Preliminary results indicate that subjective measures of sleep quality improve significantly three months after hip arthroplasty, e.g. patients rated their sleep disturbance due to hip-pain on a scale from 1=never to 4=always. 75% of patients reported an improvement, and 25% reported no change in this variable, post surgery. Acti-graphy measures confirm the overall improvement in sleep quality (for sleep efficiency, (p(f)=0.05) and fragmentation index, (p(f)=0.05), and a reduction in mean activity during sleep (p(f)=0.04). Ongoing analyses are addressing the reliability of subjective measures compared to acti-graphy and why some patients show greater improvement in sleep than others, after hip arthroplasty. Conclusions: Findings suggest that sleep disturbance occurs as a result of painful osteoarthritis in the hip, and that this can be significantly ameliorated by hip arthroplasty surgery. The expected improvement in quality of life and level of day to day functioning that accompany improved sleep are perhaps an under-rated benefit of this procedure

Purpose. Previous studies have demonstrated pronounced reduction of sleep quality following major surgery, which may affect postoperative pain and early recovery. This prospective, randomized, controlled trial was designed to evaluate the effect of zolpidem on sleep quality in fast-track total knee arthroplasty (TKA). Methods. 180 patients who underwent primary TKA were enrolled in this study and randomized 1:1 to receive either zolpidem (Group A) or placebo (Group B) for 6 days. VAS pain scores (rest, ambulation, flexion, and night), range of motion (ROM), opioid analgesics use, postoperative nausea and vomiting (PONV) and other complication, sleep efficacy and patients VAS satisfaction were recorded postoperatively and at 1, 3, 5 after surgery. Sleep quality was measured using the polysomnography (PSG) and Epworth Sleepiness Scale. Results. Sleep efficiency was decreased on all three postoperative nights but returned to pre-admission levels on the fifth postoperative night in Group A. Compared to Group B, Group A showed better sleep quality in early period. It was found that patients taking zolpidem showed greater improvement in quality of life, better patient VAS satisfaction, lower pain VAS score, and less opioid analgesics use. Conclusion. In conclusion, sleep quality is impaired after total knee arthroplasty and zolpidem could improve postoperative sleep or pain and be beneficial to patients' post-TKA early recovery

Introduction: Only few studies have investigated the role of sleep disturbances in adolescents’ musculoskeletal pains. Methods: A two-year follow-up by postal questionnaires was made for the Northern Finland Birth Cohort 1986 at the ages of 16 and 18 years (n=1773). The outcome measures were six-month period prevalences of self-reported neck pain (NP) and low back pain (LBP) (“Reporting Pain” and “Consultation for Pain”). Sleep disturbances were categorised into three groups (major, minor and no sleep disturbances) based on average hours spent sleeping, and whether or not the subject suffered from nightmares, tiredness and sleeping problems. The odds ratios (OR) and 95% confidence intervals (CI) for were obtained from logistic regression and adjusted for all previously suggested risk factors. Results: Sleep disturbances at 16 years predicted NP and LBP at the age of 18. Among the adolescents initially without LBP, major sleep disturbances at 16 predicted LBP at 18 in both girls (OR 2.6; 95% CI 1.2 to 5.5) and boys (2.7; 1.1 to 6.7). Similarly, among those initially without NP, major sleep disturbances at 16 years predicted NP at 18 years in girls (3.9; 1.6 to 9.4) but not in boys. Discussion: Sleep disturbances were an independent risk factor for LBP and NP in adolescence. Possible mechanisms may include decreased time for muscle relaxation during disturbed sleep, co-morbidity with psychological distress, or activation of inflammatory mediators. Perhaps some musculoskeletal pains could be prevented – at least partially – by ensuring that adolescents have sufficient quality and quantity of sleep

Subjective outcomes used in THA show outstanding improvements in patient-reported outcomes. However, recent evidence suggests that there may be a disconnect between patient-reported and objectively measured function. The aim of this study was to investigate if physical activity and sleep patterns change from pre- to six months post primary THA. 54 patients scheduled for THA were recruited. Patients were given a wrist-worn accelerometer (GeneActiv, UK) to wear continuously for one week pre-operatively and six weeks, three months and six months post-operatively. The device was also fitted to the patient immediately following surgery to capture data for the first two post-operative weeks. The following parameters were calculated: (1) sleep efficiency; (2) the amount of time (and length of each bout and fragmentation of the activity) spent in sedentary activity; and (3) time spent in light, moderate and vigorous physical activity. Sedentary activities showed no change in the number, duration or fragmentation (p= 0.382, 0.288, 0.382, respectively). Patients were sedentary for 5–6 bouts/day with each bout lasting 50–76 minutes/day. A significant main effect was identified for time spent in light intensity activities (p=0.049). Prior to surgery, patients spent 201 minutes/day in light intensity activity. This decreased significantly to 133 minutes/day (p=0.025) in the first two postoperative weeks before returning close to pre-operative levels (192 minutes/day) at six weeks (p=0.025). No further changes were observed in light intensity activities. A significant main effect was identified for time spent in moderate intensity activities (p=0.003). Prior to surgery, patients spent 45 minutes/day in moderate intensity activities. This dropped to 18 minutes/day in the first two postoperative weeks (p=0.190). By three months this had increased to 66 minutes/day (p=0.049). No further changes were seen. There were no significant differences in time spent in vigorous intensity activities (p=0.244). Patients spent <1minute/day in vigorous intensity activities. Sleep efficiency did not change significantly from pre- (82%) to six months post-operative (75%) (p=0.067) − 85% is typically considered good sleep efficiency. Patients discharged to a regional hospital had significantly poorer sleep efficiency than those discharged home (mean difference=14%, p=<0.001) or to a rehabilitation centre (mean difference=15%, p=0.001). This patient cohort didn't demonstrate an overall improvement in objectively measured physical activity patterns from pre- to six months post-operative. Sleep efficiency, did not improve and remained sub-optimal

Background and purpose. Sleep disturbance is frequently reported by people with chronic low back pain (CLBP >12 weeks), but there is limited knowledge of their sleep quality compared to healthy people. While disturbed sleep influences patients' mood, quality of life and recovery, few studies have comprehensively investigated sleep in CLBP. This study investigated differences in sleep profiles of people with CLBP, compared to age- and gender matched controls over seven consecutive nights. Methods. Thirty-two consenting subjects (n=16 with CLBP, n=16 matched controls), aged 24-65 years (43.8% male) underwent an interview regarding sleep influencing variables (e.g. mattress firmness, caffeine consumption), completed the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), Pittsburgh Sleep Diary, SF36-v2, Hospital Anxiety and Depression Scale, and CLBP measures (i.e. Oswestry Disability Index and Numerical Pain Scales), recorded seven consecutive nights of sleep in their home using actigraphy, and completed a Devices Utility Questionnaire. Results. Compared to controls, people with CLBP had significantly disturbed sleep on self-report measures (PSQI mean (SD) 10.9 (4.2); ISI mean 13.7 (7.6); Sleep Diary; p<0.001), but no significant differences on objective actigraphy (p>0.05). Actigraphy was found to be a user friendly sleep measure for use in the home environment (84.6%, n=11 CLBP; 73.3%, n=11 control). Conclusions. Self-rated sleep using a valid instrument should be routinely measured in LBP research and clinical practice. Further investigation of the relationship between patients' perception of their sleep quality and its objective measurement is warranted before actigraphy could be recommended as an objective outcome measure for the evaluation of sleep in this population

The association between obesity and sleep apnea syndrome (SAS) is well known, as is the fact that TJR patients are often obese. Based on review of 5819 primary TJR patients at our institution, 53% of patients presenting for TJR were obese (mean BMI 31), and of those obese patients 61.3% were female. The potential impact of SAS, diagnosed and undiagnosed, on TJR outcomes has not been well described. In the literature it has been suggested that such patients may be at increased risk of prolonged hospital length of stay (LOS), increased risk of postoperative MI, and risk of postoperative respiratory compromise requiring unplanned transfer to a special care unit (SCU). At our institution, unless deemed required for preoperatively identified co-morbidities, all TJR patients are managed acutely on an orthopaedic ward with no formal step down unit available for enhanced monitoring, even when receiving PCA or epidural for postoperative pain control. We undertook a prospective non-randomised survey of 1927 primary TJR patients over a fifteen-month period to screen for a preoperative diagnosis of SAS, or symptoms suggestive of SAS using the self-report Epworth Sleep Apnea Questionnaire. In addition, we evaluated impact of SAS on LOS, risk of postoperative MI, risk of postoperative respiratory compromise and unplanned transfer to SCU. Of our sample, 88/1927 patients (4.6%) had a confirmed preoperative diagnosis of SAS. An additional 74/1927 patients (3.8%) had 3/3 symptoms suggestive of undiagnosed SAS. SAS patients were younger; mean sixty-six years, p=0.005, and predominantly male; 58%, p< 0.0001, as compared to non-SAS patients comprised of 60% females and mean age sixty-nine years. Mean BMI was higher in the SAS group; 32.3 versus 30, p< 0.0001. There was no correlation between SAS and risk of postoperative MI, LOS (mean 5.2 days, both groups), nor unplanned SCU admission. Despite concerns expressed in the literature, we found that SAS, both diagnosed and suspected, was not associated with prolonged LOS, increased risk of postoperative MI, postoperative respiratory compromise, or unplanned postoperative transfer to a SCU

Background and purpose. Sleep disturbance is a prevalent symptom in people with chronic low back pain (CLBP >12 weeks), but there is currently no knowledge of the effectiveness of physiotherapy for this problem. This study evaluated the feasibility of a randomised controlled trial (RCT) exploring the effects of physiotherapy on sleep disturbance in CLBP [Current controlled trial ISRCTN 54009836]. Methods. A sample of 60 consenting patients with CLBP [23 M, 37 F; mean (SD) age = 44.93 (13.41) years] were recruited in Beaumont Hospital, Dublin and randomly allocated to one of three groups [supervised exercise class (SEC), walking programme (WP) and usual physiotherapy (UP)] in a concealed manner. The main outcomes were sleep quality, functional disability, pain, and quality of life at baseline, 3 and 6 months. Results. The majority of participants reported sleep disturbance (95%, n=57) and related it to their LBP (81%, n=46). At 3 months compared with the WP and SEC, participants in the UP group displayed greater reductions in average low back pain VAS (WP d=.97, SEC d=.86) and greater improvements in sleep disturbance (Pittsburgh Sleep Quality Index WP d=.59, SEC d=.29; Insomnia Severity Index WP d= .56, SEC d= .24). However, compared to UP there were greater improvements in functional disability (SF-36 PCS) in the WP (d= .32) and the SEC (d= .21). Conclusions. The results provide preliminary evidence of the effects of physiotherapy on sleep disturbance in CLBP, demonstrate the feasibility of undertaking a RCT in this field and inform refinement of the study protocol for a fully powered trial

We analysed factors affecting the rate of recovery from ankle fractures. Delays in return to normal functioning may relate to poorer quality and duration of sleep during recovery. This prospective study investigates the relationship between the rate of recovery from ankle fracture and sleep disturbance, comparing ankle fractures classified using AO-Danis-Weber Classification – types A, B & C treated at Wellington Hospital, aged between 18 and 55 years. From June 2003 to October 2004 participants completed an ankle fracture questionnaire, and a general health profile at three, six and twelve months post-injury. A randomly selected subgroup was interviewed to identify specific recovery issues. Six percent were Weber A, 56% B and 39%, C. Mean (and standard deviation) for return to normal functioning was; 5 (2); 8 (3) and 8 (7) weeks respectively, overall range – 2 to 24 weeks. Those who returned in 2 weeks had sedentary jobs, worked from home or were students, all with a high level of support by ACC. Physically demanding occupations delayed return to work. After one year, (93%) scored 85 – 90% satisfaction with their ankle performance. 97% scored highly on the SF 36, indicating positive life attitudes. 98% reported no change from their pre-fracture sleep patterns. Rate of recovery is less predictable and sometimes more prolonged for Weber C than for A and B ankle fractures. Earlier return to work is a function of practical support in the workplace and positive health attitudes including balanced sleep patterns. Work planning and workplace assessment are significant factors

Purpose and Background. Back pain impinges upon all aspects of life, has a reported UK lifetime prevalence as high as 84% and considering approximately a third of our lives are spent asleep the paucity of research into the effect a mattress has on back pain and sleep is surprising. Mood changes, effecting an increase in pain perception, due to sleep loss may also lead to a downward spiral of increasing back pain and greater sleep loss. A controllable factor in this spiral, affecting both aspects, is the mattress but to the authors' knowledge none currently available on the market have any robust, published research to objectively support any claims made and at best being ‘endorsed’ by experts. This may lead to possible misinterpretation of efficacy and leave professionals at a loss with what to advise when questioned. Methods and Data collection. Method:. A three month, randomised, controlled, double blind crossover field study is proposed to take place in the participants own homes, ensuring the most natural sleep environment. Data collection:. Three 28 day phases. 1 - Baseline data, participants sleeping on their own mattress. 2 - Random allocation of mattresses, half allocated test and half control. 3 - Crossover of test and control mattress. Subjective measures of back pain and sleep quality will be collected utilising a daily sleep diary and visual analogue scales. Objective measures of sleep quality using activity monitors during sleep. Conclusion. Minimal evidence is available suggesting the optimal sleep surface for people with back pain. This research hopes to generate evidence to help this group with mattress selection. To confirm: this abstract has not previously been published in whole or part nor has it been presented previously at a national meeting. Conflicts of interest: All mattresses will be designed in conjunction with and provided by Innovative Health Organisation Caerphilly. Sources of funding: This work is part-funded by the European Social Fund (ESF) through the European Union's Convergence programme administered by the Welsh Government and is in conjunction with the Knowledge Economy Skills Scholarship (KESS) project

Aims. Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care. Methods. This was a cross-sectional study of patients from Duke University Department of Orthopaedic Surgery clinics (14 ambulatory and four hospital-based). There were two separate cohorts recruited by convenience sampling (i.e. patients were included in the analysis only if they completed PROMIS measures during a new patient visit). Cohort #1 (n = 12,141; December 2017 to December 2018,) included PROMIS short forms for eight domains (Physical Function, Pain Interference, Pain Intensity, Depression, Anxiety, Sleep Quality, Participation in Social Roles, and Fatigue) and Cohort #2 (n = 4,638; January 2019 to August 2019) included PROMIS Computer Adaptive Testing instruments for four domains (Physical Function, Pain Interference, Depression, and Sleep Quality). Cluster analysis (K-means method) empirically derived subgroups and subgroup differences in clinical and sociodemographic factors were identified with one-way analysis of variance. Results. Cluster analysis yielded four subgroups with similar clinical characteristics in Cohort #1 and #2. The subgroups were: 1) Normal Function: within normal limits in Physical Function, Pain Interference, Depression, and Sleep Quality; 2) Mild Impairment: mild deficits in Physical Function, Pain Interference, and Sleep Quality but with Depression within normal limits; 3) Impaired Function, Not Distressed: moderate deficits in Physical Function and Pain Interference, but within normal limits for Depression and Sleep Quality; and 4) Impaired Function, Distressed: moderate (Physical Function, Pain Interference, and Sleep Quality) and mild (Depression) deficits. Conclusion. These findings suggest orthopaedic patient subgroups differing in physical function, pain, and psychosocial distress can be created from as few as four different PROMIS measures. Longitudinal research is necessary to determine whether these subgroups have prognostic validity. Cite this article: Bone Jt Open 2021;2(7):493–502

Aims. Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of ‘full-time bracing’ versus ‘night-time bracing’ in adolescent idiopathic scoliosis (AIS). Methods. UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. Discussion. The primary outcome is ‘treatment failure’ (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or ‘treatment success’ (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry. Cite this article: Bone Jt Open 2023;4(11):873–880

Introduction. The Center for Medicare Services (CMS) recently proposed its phase 3 “Quality metrics” which include a section on patient engagement. CMS uses a fitness monitor as an example of an acceptable way for patients to contribute to the health record. Wearable technology allows measurement of activity, blood glucose, heart rate, sleep, and other health metrics, all of which can be useful in the management of patients in the orthopaedic practice. The purpose of this study is to thoroughly review existing fitness devices; and evaluate their potential uses in orthopaedic practice. Methods. Several fitness devices exist; we focused on the top 27 based on popularity mentioned in reputable tech review articles. Features of each device were reviewed including type, specifications, interfaces, measurable outcomes (HR, steps, distance, sleep, weight, calorie intake), cost to the patient, barriers to compliance and strengths. Ultimately all these factors were taken into consideration to look into potential uses for orthopaedic surgery. The orthopedic applications of these devices were reviewed. Nonsurgical management applications were: compliance with physiotherapy, distance walked and stairs completed, and compliance with activity restrictions. Preoperative optimization included detection of sleep apnea, blood glucose monitoring, preoperative weight, and preoperative activity level. Postoperative outcomes included postoperative activity level, stairs, and distance walked. Results. Twenty-seven devices were reviewed of which 26% were targeted for the beginner, 33% for runners and 41% were multipurpose fitness trackers. Most were designed as either a wrist band (26%) or watch (30%). Several used a smartphone as an interface (33%) while the majority (52%) synced automatically via Bluetooth to either the online, mobile device, smartphone or pc application. The majority (37%) had excellent battery life, over 7 days; all were either waterproof (26%) or water resistant (74%), and some (41%) had GPS tracking. A pedometer was included in 85% of devices, 63% monitored HR of which 26% required a separate chest strap or forearm strap, 7% measured respiratory rate and 7% devices measured temperature. Sleep was recorded in 63% of devices, mostly as length of sleep and quality of sleep based on wrist movement. One device was able to differentiate between sleep phases allowing the application of sleep apnea assessment for preoperative testing. Twenty devices monitored weight, twenty two monitored calorie intake, three could monitor glucose readings, seventeen measured distance walked, whereas five measured both stairs and distance walked. A few devices (15%) are already linked to electronic medical records (EMR), the majority allowed for sharing (67%) and 19% are linked to insurance companies which provide incentivized reimbursement rates. Conclusion. The fitness device technology has yet to be explored or implemented widely in orthopaedic surgery. We demonstrated how fitness devices can assist the orthopaedic surgeon in measurement of basic outcomes and can also assist with preoperative, perioperative and postoperative care. Further research is warranted as the use of these devices increases. Patient privacy issues may come into play as more practices employ these devices for their patients

The purpose of our study is to examine the outcome of patients undergoing outpatient total hip arthroplasty with a BMI >35. Case-control matching on age, gender (46% female;54%male), and ASA (mean 2.8) with 51 outpatients BMI≥35 kg/m. 2. (mean of 40 (35–55)), mean age of 61 (38–78) matched to 51 outpatients BMI<35 kg/m. 2. (mean of 27 (17–34)) mean age 61 (33–78). Subsequently 47 inpatients BMI≥35 kg/m. 2. (mean of 40 (35–55)) mean age 62 (34–77) were matched outpatients BMI≥35 kg/m. 2. For each cohort, adverse events, readmission in 90 days, reoperations were recorded. Rate of adverse events was significantly higher in BMI ≥35: 15.69% verus 1.96% (p=0.039) with 5 reoperations in the BMI≥35 cohort vs 0 in the BMI<35 kg/m. 2. (p= 0.063). Readmissions did not differ between groups (p=0.125). No significant difference for all studied outcomes between the outpatient and inpatients cohorts with BMI≥35 kg/m. 2. The most complications requiring surgery/medical intervention (3B) were in the inpatient cohort of patients >35. The prevalence of Diabetes and Obstructive Sleep apnea was 21.6% and 29.4% for BMI>35 compared to 9.8% and 11.8%, for BMI <35, respectively. Severely obese patients have an overall higher rate of adverse events and reoperations however it should not be used a sole variable for deciding if the patient should be admitted or not

Introduction. Introduction: Pre-operative counselling to prepare patients for frame surgery is important to ensure expectations of recovery and rehabilitation are realistic and anxiety is reduced. The aim of the study was to ascertain whether the current clinical nurse specialist frames counselling session (CNS FCS) prepared patients adequately for life with a frame as well as to explore information patients felt was missing. Materials & Methods. Materials and Method: Patient reported questions were used to assess frames patient views on the CNS FCS. Thirty frames patients were asked about the CNS FCS information, involvement in decision making, factors influencing frames surgery decision and patient experience. Results. Results: There were 27 patients who received CNS frames counselling and 82% of those (N=22) said they definitely received enough information to make a decision when faced with a choice of surgical plans. 85% (N=23) reported definitely feeling involved in the decision making process with factors contributing to choosing frame treatment being lower risk of deep infection, quicker / safer recovery and advice from the limb reconstruction team. 48% (N=13) definitely felt the CNS FCS gave them a realistic idea of what it's like to live with a frame and 52% (N=14) answered yes to some extent. Feedback on providing more information around sleeping with a frame was provided which has been added to future CNS FCS. Conclusions. Conclusion: The current CNS FCS does prepare patients for frames surgery and life with a circular frame and important points raised by patients in this study have been added to future patient information sessions. Regular patient satisfaction audits should be carried out to ensure information remains useful and current patient needs and concerns are met

Abstract. Background. Daycase pathways which aim to discharge patients the same day following Unicompartmental Knee Replacement have been introduced in some centres, though most continue with Standard pathways. While Daycase pathways have cost savings, recovery data comparing pathways is limited. This study aims to compare patient-reported early recovery between Daycase and Standard pathways following UKR. Method. This study was carried out in two centres that originally used the same Standard recovery pathway for UKR. In one centre, the Standard pathway was modified into a Daycase pathway. 26 Daycase-Outpatient, 11 Daycase-Inpatient, and 18 Standard patients were recruited. Patients completed the Oxford Arthroplasty Early Recovery Score (OARS) and SF-36 (Acute) measure between Days 1–42. Results. Standard patients had significantly better Day-1 scores than Daycase patients, but this difference rapidly diminished, and from Day-3 onwards both groups had near-identical scores (OARS Day-1, 59 vs 37, p=0.002, stemming from differences in Pain, Nausea/Feeling-Unwell, Function/Mobility subscores p=0.003,0.014,0.011. OARS Day-3 48 vs 49, p=0.790). Daycase-Outpatients had a higher overall OARS (p=0.002), recovering 1–2 weeks faster than Daycase-Inpatients. OARS subscores demonstrated that Daycase-Outpatients had better Pain, Nausea/Feeling-Unwell, Fatigue/Sleep scores (p=0.020,0.0004,0.019 respectively). SF-36 scores corroborate OARS scores. Conclusion. The Standard cohort had better Day-1 scores than the Daycase cohort, likely due to later mobilisation and stronger inpatient analgesia; these differences diminished by Day-3. Daycase-Outpatients recovered substantially faster than Daycase-Inpatients – likely due to the factors that delayed their discharge. The convergence of scores at 6 weeks demonstrates that both pathways have similar early recovery outcomes

This study investigates the relationships between Intervertebral Disc (IVD) morphology and biomechanics using patient-specific (PS) finite element (FE) models and poromechanical simulations. 169 3D lumbar IVD shapes from the European project MySpine (FP7-269909), spanning healthy to Pfirrmann grade 4 degeneration, were obtained from MRIs. A Bayesian Coherent Point Drift algorithm aligned meshes to a previously validated structural FE mesh of the IVD. After mesh quality analyses and Hausdorff distance measurements, mechanical simulations were performed: 8 and 16 hours of sleep and daytime, respectively, applying 0.11 and 0.54 MPa of pressure on the upper cartilage endplate (CEP). Simulation results were extracted from the anterior (ATZ) and posterior regions (PTZ) and the center of the nucleus pulposus (CNP). Data mining was performed using Linear Regression, Support Vector Machine, and eXtreme Gradient Boosting techniques. Mechanical variables of interest in DD, such as pore fluid velocity (FLVEL), water content, and swelling pressure, were examined. The morphological variables of the simulated discs were used as input features. Local morphological variables significantly impacted the local mechanical response. The local disc heights, respectively in the mid (mh), anterior (ah), and posterior (ph) regions, were key factors in general. Additionally, fluid transport, reflected by FLVEL, was greatly influenced (r2 0.69) by the shape of the upper and lower cartilage endplates (CEPs). This study suggests that disc morphology affects Mechanical variables of interest in DD. Attention should be paid to the antero-posterior distribution and local effects of disc heights. Surprisingly, the CEP morphology remotely affected the fluid transport in NP volumes around mid-height, and mechanobiological implications shall be explored. In conclusion, patient-specific IVD modeling has strong potential to unravel important correlations between IVD phenotypes and local tissue regulation. Acknowledgments: European Commission: Disc4All-MSCA-2020-ITN-ETN GA: 955735; O-Health-ERC-CoG-2021-101044828