Purpose. of this study is to analyze the results of a modular reconstructive tumor prosthesis for the lower limb (GMRS. (r). ) with a comparative statistical analysis of primary and secondary implants. Material and methods. From October 2003 to September 2007 at Rizzoli 161 GMRS. (r). prostheses were implanted, most after resection of osteosarcoma (94 cases, 58%). It is a modular system with a rotating hinge mechanism for the knee, cemented and uncemented stems, in titanium and chromium-cobalt-molybdenum, curved and straight-fluted, with or without hydroxyapatite coating. Moreover adaptors are available to revise HMRS. (r). implants. This series includes 88 males and 73 females ranging in age from 9 to 80 years. Sites of reconstruction were 109 distal femurs, 19 proximal femurs, 1 total femur and 32 proximal tibias. There were 149 oncologic and 12 non oncologic diagnoses, including 96 primary reconstructions and 65 revisions after failure of previous implant. A retrospective analysis of imaging and complications was performed and functional results assessed according to MSTS system. Statistical analysis with Kaplan-Meier curves was used to study implant survival. Results. At a mean follow up of 2 yrs. 106 patients are continuously NED, 31 are NED after treatment of one or more local recurrence or metastasis, 7 AWD, 5 DWD. There were 10 major complications: 8 infections (4,7%) (5 in primary and 3 in secondary implants, 2 previously infected) and 2 aseptic loosening (1,2%) (1 each). There were 9 minor complications (4 wound sloughs, 1 stiff joint, 3 disrupted extensor apparatus,1 patellar instability) requiring revision. Comparative statistical analysis of primary and secondary implants survival at major complications shows no statistically significant difference. Functional results were good or excellent in 95% of the evaluated patients, without any poor. Conclusions. Middle term results are promising: good function, very low incidence of major complications, no breakage of implant components. This prosthetic reconstruction is indicated in oncological cases as well as in selected in some non oncological settings, such as challenging revisions of prosthetic failures with massive bone loss or post-radiation non unions or allografts failures. Although a higher incidence of complications was expected in secondary implants, statistical analysis shows similar survival

Purpose of this study is to analyze the results of a modular reconstructive tumor prosthesis for the lower limb (GMRS. ®. ) with a comparative statistical analysis of primary and secondary implants. Material and methods: From October 2003 to September 2007 at Rizzoli 161 GMRS. ®. prostheses were implanted, most after resection of osteosarcoma (94 cases, 58%). It is a modular system with a rotating hinge mechanism for the knee, cemented and uncemented stems, in titanium and chromium-cobalt-molybdenum, curved and straight-fluted, with or without hydroxyapatite coating. Moreover adaptors are available to revise HMRS. ®. implants. This series includes 88 males and 73 females ranging in age from 9 to 80 years. Sites of reconstruction were 109 distal femurs, 19 proximal femurs, 1 total femur and 32 proximal tibias. There were 149 oncologic and 12 non oncologic diagnoses, including 96 primary reconstructions and 65 revisions after failure of previous implant. A retrospective analysis of imaging and complications was performed and functional results assessed according to MSTS system. Statistical analysis with Kaplan-Meier curves was used to study implant survival. Results: At a mean follow up of 2 yrs. 106 patients are continuously NED, 31 are NED after treatment of one or more local recurrence or metastasis, 7 AWD, 5 DWD. There were 10 major complications: 8 infections (4,7%) (5 in primary and 3 in secondary implants, 2 previously infected) and 2 aseptic loosening (1,2%) (1 each). There were 9 minor complications (4 wound sloughs, 1 stiff joint, 3 disrupted extensor apparatus,1 patellar instability) requiring revision. Comparative statistical analysis of primary and secondary implants survival at major complications shows no statistically significant difference. Functional results were good or excellent in 95% of the evaluated patients, without any poor. Conclusions: Middle term results are promising: good function, very low incidence of major complications, no breakage of implant components. This prosthetic reconstruction is indicated in oncological cases as well as in selected in some non oncological settings, such as challenging revisions of prosthetic failures with massive bone loss or post-radiation non unions or allografts failures. Although a higher incidence of complications was expected in secondary implants, statistical analysis shows similar survival

Aim: To review the study size and requirements of studies looking at factors affecting outcome following total hip arthroplasty.

Background: The orthopaedic literature is full of claims that new products out-perform older ones, cemented and un-cemented components are equal, cementing grades and mantles are all important and that component orientation is vital to longevity. We are also aware of patients who have performed well despite having numerous adverse features to their joint replacements.

We have searched the available literature for factors that have been implicated in the survival of hip replacements. We have used these to determine the likely study sizes required to provide meaningful data.

Method: We identified over 50 variables that have been implicated in the survival of hip replacements. Assuming all of them to be of equal relevance the study size required for multivariate analysis to be possible would be in excess of 50000. Some of these variables are less likely to be of great significance and this number could potentially be reduced to 25–30000.

Discussion: Because total hip replacement has a greater than 90% success rate at 10 years in nearly all series this makes the numbers required for multivariate analysis much larger. Individual factors affecting survival will be difficult to identify unless large series are considered.

Conclusion: The only way to reduce the numbers required for meaningful studies is to increase the matching of as many variables as possible to ensure that investigators conclusions are valid in the majority of small series orthopaedic studies.

The use of Joint Registers is likely to be the only way of obtaining the volume of data required to detect individual factors affecting survival. Care will still need to be taken interpreting this data as there are still numerous variables which are not accounted for in the Joint Register.

Statistics of the clinical activities of an academic training unit was compiled from 1 January 2005 until 31 December 2005. The statistical study had three purposes. Firstly to determine the pathological profile of the patient population and to determine the distribution of patients who needed acute management versus elective surgery. Secondly to determine the needed staff establishment especially with the future anticipated expanding role of the public health sector in the management of orthopaedic patients. The last aim was to create a model of the clinical activities of a junior orthopaedic surgeon during one year of orthopaedic trauma training.

Detailed statistics were compiled of all the clinical activities at the two hospitals. The one is a tertiary trauma centre, but also functions at a secondary trauma care level. The second hospital is a referral tertiary care orthopaedic hospital where elective surgery takes place. Furthermore the statistics were also compiled in such a way that detailed doctor activities could be processed from it.

There were 181 spinal admissions of which 77 were treated surgically. 106 were treated conservatively. Elective spinal surgery consisted of 20 cases who needed reconstructive surgery and we managed 56 spinal infections. 1263 cases were admitted for orthopaedic trauma management of which 259 had surgery for femur fractures. A total of 250 tibia fractures were treated surgically and a total of 216 radius and ulna fractures. 117 arthroscopic knee procedures were done. A total of 168 arthroplasty cases were treated of which 47 were problem cases.

Pathological profile was determined and gave guidance to clinical studies that should be undertaken. The numbers of some types of injuries that were managed are large. Staff establishment assessment can be done and the expansion of it can be motivated for. A model can be compiled for clinical activities of orthopaedic surgeons in training. Extracted from this statistical analysis an activity list was compiled for an orthopaedic surgeon in training. Amongst other minor cases and excluding Paediatric orthopaedic cases – Femur neck fractures 18, Femur fractures 29, Ankle fractures 53, Humerus fractures 12 and adult Supracondylar humerus fractures 9 and Radius Ulna fractures 34 were done.

Alumina ceramic has been used in total hip arthoplasty since the 70’s and, in the last 30 years, a considerable evolution has occurred in designing the microstructural features of this material, taking advantage of improved processing techniques, as the hot isostatic pressing. As a result, a high degree of densification (> 99.5) has been achieved in materials with a high degree of purity and, especially, with a fine grain size ( 2 microns). The surface stress field acting on a femoral head inoperation is not only due to working conditions, but also to unexpected factors, as local impacts on the surface as a result of partial dislocations, formation of debris, etc. These additional factors greatly contribute to activate degradation mechanisms which, unfortunately, may lead to failure of the implant.

In this study, five alumina femoral heads were investigated, which were retrieved from patients after different periods of time. Among those investigated femoral heads, two belonged to a first-generation type of alumina material with a relatively coarse grainsize (average value 8 microns) and were retrieved due to surface degradation after long periods of implantation (19 and 17 years, respectively); the remaining three implants analyzed were instead recently manufactured implants with a fine grain size; they were retrieved after relatively short periods because of different causes as, for example, cup or stem loosening.

Surface stress analysis using the luminescence of Cr3+impurity in alumina was performed on the retrieved femoral heads and a statistical comparison was attempted among implants with different microstructural characteristics. The investigation led to estimate average residual stress and statistical stress distributions as a function of the location on the femoral head.

The analysis was performed both on the very surface and in the sub-surface of the head, using the confocal and the through-focus configurations of the optical spectrometer, respectively. Different statistical distributions of residual stress were observed in alumina femoral heads with different grain sizes and models were created to understand their dependence on processing and surface loading.

There is conflicting information regarding the recommendations of bracing, physical therapy and cessation of sports for young athletes with symptomatic spondylolysis. The purpose of this study was to identify factors affecting the prognosis and to find the optimal method of non-operative treatment.

The patients in our study were athletes who visited our children's hospital for low back pain with lumbar spondylolysis and were treated non-operatively from 1990 to 2002. Clinical and radiological outcomes were reviewed retrospectively. The effects of bracing, physical therapy, cessation of sports, duration of symptoms before the first hospital visit, lateralisation of spondylolysis, age, gender, onset of low back pain after lumbar trauma during sports, bone scan uptake, vertebral level of the lesion, associated scoliosis or spina bifida and radiological bony healing were analysed using univariate and multivariate analysis with logistic regression. The mean age of patients was 13 years (range 7 to 18 years). The mean follow-up was 4.2 years (range 1.2 to 12 years).

Of 132 patients, 48 patients had excellent results with no pain during sports, 76 good, 6 fair, and 4 poor. Cessation of sports, early non-operative intervention, and a unilateral spondylolysis appeared to be factors associated with excellent outcomes. However, bracing, physical therapy, age, gender, level of lesion, history of trauma, increased uptake on bone scan, or associated scoliosis or spina bifida were not factors. Bony healing was not related to the clinical outcome. The non-operative treatment of spondylolysis in children can yield excellent clinical outcomes, and the absence of bony healing has no influence on clinical outcome. Factors in this study found to correlate with an excellent outcome include unilateral spondylolysis, acute spondylolysis, and treatment with cessation of sports for 12 weeks.

Introduction: To train the surgeon adds to the length of procedures and this is currently not accounted for, in the finance received to perform the operation by the hospital.

Objective: Our study focussed on these main questions:

What is the effect on the length of a procedure when a trainee is involved?

Method: Data was taken from two different sources, firstly, the ORMIS theatre system and patient operation notes. These were used to determine the length of six different types of orthopaedic procedures and the level of the main surgeon. This was collected in Stepping Hill hospital, Stockport, United Kingdom between June and July 2008. The second source used was a consultant’s logbook comprising 227 primary total knee replacements between 2004 and 2008.

Results: The data collected via the ORMIS system produced trends suggesting trainees took longer to perform procedures than consultants. The data from the consultant logbook statistically proved this. List times appeared unaffected by trainee presence. In Orthopaedic surgeries, 92% times trainees were present during the procedure and out of this 17% cases were performed by trainees. For total hip replacements done by trainees the procedure took significantly longer surgical time than consultant performed procedures (p = 0.0337).

Among these cases, 71% were performed by senior trainees. The consultant’s log book data also suggested the similar trends. In all comparisions, time taken by trainees to perform surgeries were statistically significant. Trainee performed with consultant scrubbed versus consultant performed (P = < 0.0001), trainee performed with consultant in theatre versus consultant performed(P = 0.0318) and trainee performed with consultant scrubbed versus trainee performed with consultant in theatre (P = 0.002)

Discussion and Conclusion: Hospitals are paid a fixed fees per operation due to introduction of payment by results system as they are paid a fixed tariff for a particular procedure. Training increases the length of a procedure and therefore in an efficient structured environment prevents as many cases being done on a list. Therefore, training future surgeons costs the hospital money. To counter this, training hospitals should be given financial incentives to train in surgery, or procedures performed by trainees should be priced differently to account for the time lost by training.

Purpose of the study: What is the effect on the length of a procedure and the number of procedures performed on the list when a trainee is involved? What percentage of cases had trainee involvement for orthopaedic surgery?

Methods: Data was taken from two different sources, firstly, the ORMIS theatre system and patient operation notes. These were used to determine the length of six different types of orthopaedic procedures and the level of the main surgeon. The second source used was a consultant’s logbook comprising 227 primary total knee replacements between 2004 and 2008.

Results: The data collected via the ORMIS system produced trends suggesting trainees took longer to perform procedures than consultants. The data from the consultant logbook statistically proved this. List times appeared unaffected by trainee presence. In Orthopaedic surgeries, 92% times trainees were present during the procedure and out of this 17% cases were performed by trainees. For total knee replacements done by trainees the procedure took significantly longer surgical time than consultant performed procedures (p = 0.0337).

Among these cases, 71% were performed by senior trainees. The consultant’s log book data also suggested the similar trends. Statistically, trainee performed with consultant scrubbed versus consultant performed (P = < 0.0001), trainee performed with consultant in theatre versus consultant performed(P = 0.0318) and trainee performed with consultant scrubbed versus trainee performed with consultant in theatre (P = 0.002)

Discussion & Conclusion: To train the surgeon adds to the length of procedures and this is currently not accounted for, in the finance received to perform the operation by the hospital.

To counter this, training hospitals should be given financial incentives to train in surgery, or procedures performed by trainees should be priced differently to account for the time lost by training.

Aims. Hip fractures are some of the most common fractures encountered in orthopaedic practice. We aimed to identify whether perioperative hypotension is a predictor of 30-day mortality, and to stratify patient groups that would benefit from closer monitoring and early intervention. While there is literature on intraoperative blood pressure, there are limited studies examining pre- and postoperative blood pressure. Methods. We conducted a prospective observational cohort study over a one-year period from December 2021 to December 2022. Patient demographic details, biochemical results, and haemodynamic observations were taken from electronic medical records. Statistical analysis was conducted with the Cox proportional hazards model, and the effects of independent variables estimated with the Wald statistic. Kaplan-Meier survival curves were estimated with the log-rank test. Results. A total of 528 patients were identified as suitable for inclusion. On multivariate analysis, postoperative hypotension of a systolic blood pressure (SBP) < 90 mmHg two to 24 hours after surgery showed an increased hazard ratio (HR) for 30-day mortality (HR 4.6 (95% confidence interval (CI) 2.3 to 8.9); p < 0.001) and was an independent risk factor accounting for sex (HR 2.7 (95% CI 1.4 to 5.2); p = 0.003), age (HR 1.1 (95% CI 1.0 to 1.1); p = 0.016), American Society of Anesthesiologists grade (HR 2.7 (95% CI 1.5 to 4.6); p < 0.001), time to theatre > 24 hours (HR 2.1 (95% CI 1.1 to 4.2); p = 0.025), and preoperative anaemia (HR 2.3 (95% CI 1.0 to 5.2); p = 0.043). A preoperative SBP of < 120 mmHg was close to achieving significance (HR 1.9 (95% CI 0.99 to 3.6); p = 0.052). Conclusion. Our study is the first to demonstrate that postoperative hypotension within the first 24 hours is an independent risk factor for 30-day mortality after hip fracture surgery. Clinicians should recognize patients who have a SBP of < 90 mmHg in the early postoperative period, and be aware of the increased mortality risk in this specific cohort who may benefit from a closer level of monitoring and early intervention. Cite this article: Bone Joint J 2024;106-B(2):189–194

From October 2003 to September 2007 at Rizzoli 161 GMRS^® prostheses were implanted after resections of the lower limb. This is a modular system with a knee rotating hinge mechanism, cemented and uncemented stems, in titanium and chromium-cobalt-molybdenum, curved and straight-fluted, with or without hydroxyapatite coating. Adaptors are available to revise HMRS^® prostheses with hybrid implants. This study includes 88 males and 73 females ranging in age from 9 to 80 years. Sites of reconstruction were 109 distal femurs, 19 proximal femurs, 1 total femur and 32 proximal tibias. There were 149 oncologic and 12 non oncologic diagnoses, including 96 primary reconstructions and 65 revisions for failures of previous reconstructions. Analysis of imaging and complications was performed and function assessed according to MSTS system. Kaplan-Meier curves were used to statistically evaluate implant survival.

At a mean follow up of 2.5 yrs. 106 patients are continuously NED, 31 NED after treatment of relapse, 7 AWD, 5 DWD. There were 10 major complications: 8 infections (4.7%) (5 in primary and 3 in secondary implants) and 2 aseptic loosenings (1.2%) (1 each). There were 9 minor complications requiring minor revisions. Comparative statistical analysis of implant survival showed no statistically significant difference between primary and secondary implants. Functional results were good or excellent in 95% of patients, without any poor.

Middle term results are promising with no breakages of implant components. Besides oncological cases, there are selected indications in non oncological settings, such as revisions of prosthetic or allografts failures. While a higher complication rate was expected in secondary implants, statistical analysis shows similar survival.

Purpose: Instability is a major cause of revision total hip arthroplasty (rTHA). It was the third leading cause (5%) after aseptic loosening (75.7%), and infection (7.2%) in the Swedish registry for 2000. The rate of dislocation is however variable depending on the reported series. We conducted a statistical analysis of nearly 3000 files of rTHA to study factors favouring failure.

Material and methods: AVIO, a watch association for orthopaedic implants, was created in 1994 to evaluate factors favouring failure of THA in France, and to furnish statistical data on prosthesis revision. About one hundred orthopaedic surgeons throughout France completed an information card for each revision for a five year period (September 1994 to September 1999). A total of 2926 card were analysed. Patient data (gender, side, number of revisions, age at implantation, age at removal, reason for THA, reason for revision, duration of THA) were cross analysed. The statistical analysis was conducted with chi-square tests and non-parametric tests. Significant results were compared with data in the literature. We present here the results concerning dislocation as the reason for revision.

Results: The rTHA for dislocation accounted for 9.2% of the revisions. Dislocation was the primary reason for revision in patients with repeated revisions and was also the main reason for revision in patients aged over 70 years (20.6%). In this group of older patients, 72.8% of the prostheses were implanted for degenerative disease.

Discussion: The original finding in this study, not clearly reported in the literature, is that dislocation is the primary cause of revision after 70 years, coming before aseptic acetabular loosening. Although mentioned by Charnley in 1979, very few studies (Newington in 1990, Edelund in 1992) have studied the relationship between dislocation and age.

Conclusion: Patient-related factors play an important role in the stability of THA. After 70 years, dislocation becomes the primary reason for revision and should be taken into consideration in our ageing population. This study has led us to modify our therapeutic strategy in patients aged over 70 years.

Introduction

Historically, amputation or rotationplasty were the treatment of choice in skeletally immature patients. The introduction of expandable endoprostheses in the late 1980s offered the advantages of limb-salvage and limb length equality at skeletal maturity and a promising alternative with improved cosmetic results and immediate weight bearing.

Non-linear methods in statistical shape analysis have become increasingly important in orthopedic research as they allow for more accurate and robust analysis of complex shape data such as articulated joints, bony defects and cartilage loss. These methods involve the use of non-linear transformations to describe shapes, rather than the traditional linear approaches, and have been shown to improve the precision and sensitivity of shape analysis in a variety of applications. In orthopedic research, non-linear methods have been used to study a range of topics, including the analysis of bone shape and structure in relation to osteoarthritis, the assessment of joint deformities and their impact on joint function, and the prediction of patient outcomes following surgical interventions. Overall, the use of non-linear methods in statistical shape analysis has the potential to advance our understanding of the relationship between shape and function in the musculoskeletal system and improve the diagnosis and treatment of orthopedic conditions.

Aims

The surgical helmet system (SHS) was developed to reduce the risk of periprosthetic joint infection (PJI), but the evidence is contradictory, with some studies suggesting an increased risk of PJI due to potential leakage through the glove-gown interface (GGI) caused by its positive pressure. We assumed that SHS and glove exchange had an impact on the leakage via GGI.

Objective. Carpal tunnel release surgery is a commonly performed procedure for alleviating symptoms of median nerve compression and restoring hand function. With pressure on theatre time these procedures are now commonly performed in a step-down out-patient facility under local anaesthetic. The choice of suture for skin closure in this procedure can impact the quality of wound healing, patient outcomes and the follow-up required however the question of the best type of suture remains unanswered. The purpose of this study was to compare the outcomes of absorbable and non-absorbable sutures using a randomised control trial design. Methods. Eighty patients diagnosed with bilateral carpal tunnel syndrome were enrolled and underwent outpatient carpal tunnel release surgery under local anaesthetic in a staged fashion. Random number generation was used to assign each hand to receive interrupted nylon or Vicryl Rapide sutures. Pre-operative data collection included patient demographics, ASA, inflammatory conditions, smoking status as well as a Boston Carpal Tunnel Questionnaire (BCTQ) for each hand. Patients were followed up at 2 and 6 weeks after each operation and the BCTQ was repeated along with the Patient and Observer Scar Assessment Scale and the VAS score for wound discomfort. This study has approval from the DHB ethics committee, Local Iwi, HDC and ANZ Clinical Trials:ACTRN12623000100695. Results. Statistical analysis assessed patient preference and the scores between the groups. Multi-variate analysis was performed to assess the factors that may be contributing to patient choice. Conclusion. Insights into patient preference and clinical outcomes associated with absorbable sutures and non-absorbable sutures in the setting of out-patient surgery are discussed

Current recommendations advocate for surgery within 48 hours from time of injury as a keystone in care for elderly patients with hip fractures. A spare population density within regional Australia provides physical challenges to meet time critical care parameters. This study aims to review the impact of delays to timely surgery for elderly hip fracture patients within a regional Australian population. A retrospective, comparative analysis was undertaken of 140 consecutive hip fracture patients managed at a single rural referral hospital, from June 2020 until June 2021. Factors such as age, time to transfer, time to surgery, 30-day complication and 6-month complication rates were collected. Statistical analysis was performed where applicable. Mean time to surgery was 33.9 hours. A greater proportion of patients whom directly presented underwent surgery within the recommended 48 hours (91.5% vs 75.3%). The statistically significant delay in time to surgery was found to be 6.4 hours. Lower 180-day morbidity and mortality rates were observed in patients undergoing surgery within 48 hours (13.8% vs 36%), This is in comparison to the overall mortality rate of 19.2%. Delay to surgery for elderly hip fracture patients was associated with an increase 30-day and 180-day morbidity and mortality rate. A greater proportion of patients transferred from peripheral hospitals experienced a delay in surgery. Early transfer and prioritization of such patients is recommended to achieve comparative outcomes for rural and remote Australians

Currently, the consensus regarding subscapularis tendon repair during a reverse total shoulder arthroplasty (rTSA) is to do so if it is possible. Repair is thought to decrease the risk of dislocation and improve internal rotation but may also increase stiffness and improvement in internal rotation may be of subclinical benefit. Aim is to retrospectively evaluate the outcomes of rTSA, with or without a subscapularis tendon repair. We completed a retrospective review of 51 participants (25 without and 26 with subscapularis repair) who received rTSR by a single-surgeon using a single-implant. Three patient reported outcome measures (PROM) were assessed pre-operatively and post-operative at twelve months, as well as range of movement (ROM) and plain radiographs. Statistical analysis utilized unpaired t tests for parametric variables and Mann-Whitney U test for nonparametric variables. External Rotation ROM pre-operatively was the only variable with a significance difference (p=0.02) with the subscapularis tendon repaired group having a greater range. Pre- and post-operative abduction (p=0.72 & 0.58), forward flexion (p=0.67 & 0.34), ASES (p=0.0.06 & 0.78), Oxford (p=0.0.27 & 0.73) and post-operative external rotation (p=0.17). Greater external rotation ROM pre-operatively may be indicative of the ability to repair the subscapularis tendon intra-operatively. However, repair does not seem to improve clinical outcome at 12 months. There was no difference of the PROMs and AROMs between the subscapularis repaired and not repaired groups for any of the variables at the pre-operative or 12 month post operative with the exception of the external rotation ROM pre-operatively. We can conclude that from PROM or AROM perspective there is no difference if the tendon is repaired or not in a rTSR and indeed the patients without the repair may have improved outcomes at 12 months

Background. Hip fractures cost the NHS £2 billion per annum. British guidelines within 36 hours of admission. However, these guidelines do not consider the time the patient spends between injury and admission. Our study aims to investigate pre-hospital time (PHT) and its effect on outcomes. Primary outcome measures were mortality, length of stay (LOS), pressure sores and abbreviated mental test scores (AMTS). Methods. Hip fracture data was retrospectively collected from our hospital IT system (Clinical Workstation) between February and August 2020. Admission data, ambulance timings, and outcome data was extracted. Statistical analysis was performed using GraphPad Prism V9.5.1. Results. Two hundred eleven data sets were analysed. Mean age was 82.4, with 2:1 Females to males and median ASA of 3. The mean PHT was 690 minutes (85 to 6057). There was a positive correlation between increased PHT and mortality, though this did not reach statistical significance. There was a significant positive association between PHT and LOS (P=0.0027). Increased PHT was associated with lower admission AMTS (P<0.0001) and higher rate of pressure sore formation (P=0.0001). There was also a significantly positive correlation between PHT and time to mobility (P=0.049). Conclusion. There is an unobserved delay in hip fracture patients presenting to the hospital. Current treatment guidelines advocate early surgery but do not consider pre-hospital time. PHT in our patient population is 690 minutes on average, with increasing delay correlating with worse outcomes. Pre-hospital time should be considered when managing hip fracture patients with a view to expedite surgery and medical assessment

Our aim was to ascertain if K-wire configuration had any influence on the infection and complication rate for base of 4th and 5th metacarpal fractures. We hypothesised that in individuals whose wires crossed the 4th and 5th carpometacarpal joint (CMCJ), the rate of complications and infection would be higher. Data was retrospectively analysed from a single centre. 106 consecutive patients with a base of 5th (with or without an associated 4th metacarpal fracture) were analysed between October 2016 and May 2021. Patients were split into two groups for comparison; those who did not have K-wires crossing the CMCJ's and those in whose fixation had wires crossing the joints. Confounding factors were accounted for and Statistical analysis was performed using SPSS version 20 software. Of 106 patients, 60 (56.6%) patients did have K-wires crossing the CMCJ. Wire size ranged from 1.2-2.0 with 65 individuals (65.7%) having size 1.6 wires inserted. The majority of patients, 66 (62.9%) underwent fixation with two wires (range 1-4). The majority of infected cases (88.9%) were in patients who had k-wires crossing the CMCJ, this trended towards clinical significance (p=0.09). Infection was associated with delay to theatre (p=0.002) and longer operative time (p=0.002). In patients with a base of 4th and 5th metacarpal fractures, we have demonstrated an increased risk of post-operative infection with a K-wire configuration that crosses the CMCJ. Biomechanical studies would be of use in determining the exact amount of movement across the CMCJ, with the different K-wire configuration in common use, and this will be part of a follow-up study

Aims. To assess the incidence of radiological lateral osteoarthritis (OA) at 15 years after medial unicompartmental knee arthroplasty (UKA) and assess the relationship of lateral OA with symptoms and patient characteristics. Methods. Cemented Phase 3 medial Oxford UKA implanted by two surgeons since 1998 for the recommended indications were prospectively followed. A 15-year cumulative revision rate for lateral OA of 5% for this series was previously reported. A total of 163 unrevised knees with 15-year (SD 1) anterior-posterior knee radiographs were studied. Lateral joint space width (JSW. L. ) was measured and severity of lateral OA was classified as: nil/mild, moderate, and severe. Preoperative and 15-year Oxford Knee Scores (OKS) and American Knee Society Scores were determined. The effect of age, sex, BMI, and intraoperative findings was analyzed. Statistical analysis included one-way analysis of variance and Kruskal-Wallis H test, with significance set at 5%. Results. The mean age was 80.6 years (SD 8.3), with 84 females and 79 males. The mean JSW. L. was 5.6 mm (SD 1.4), and was not significantly related to age, sex, or intraoperative findings. Those with BMI > 40 kg/m. 2. had a smaller JSW. L. than those with a ‘normal’ BMI (p = 0.039). The incidence of severe and moderate lateral OA were both 4.9%. Overall, 2/142 (1.4%) of those with nil/mild lateral OA, 1/8 (13%) with moderate, and 2/8 (25%) with severe subsequently had a revision. Those with severe (mean OKS 35.6 (SD 9.3)) and moderate OA (mean OKS 35.8 (SD 10.5)) tended to have worse outcome scores than those with nil/mild (mean OKS 39.5 (SD 9.2)) but the difference was only significant for OKS-Function (p = 0.044). Conclusion. This study showed that the rate of having severe or moderate radiological lateral OA at 15 years after medial UKA was low (both 4.9%). Although patients with severe or moderate lateral OA had a lower OKS than those with nil/mild OA, their mean scores (OKS 36) would be classified as good. Cite this article: Bone Jt Open 2023;4(3):210–218