Purpose. To review the Five year survivorship of Kinnemax TKA performed at the NHS Treatment Cantre, Weston-Super-Mare (WSM), and compare it to a similar cohort from our institution. Introduction. As part of the government's initiative to reduce waiting times for major joint surgery in Wales, the Cardiff and Vale NHS Trust (CAVOC) sent 224 patients (258 knees) to the NHS Treatment Centre in Weston-Super-Mare (WSM) for total knee arthroplasty. Controversy remains as to the unexpectedly high revision rates previously seen. Method. Between April 2004 and January 2006, 224 patients (258 TKAs) were performed at WSM. 90% have been followed up to five years. The WSM Cohort was compared to a similar cohort of 260 consecutive TKAs from CAVOC over a similar time period (2004/5) performed by a number of surgeons. Oxford Knee Score, EQ5D, VAS for pain, re-operation and overall satisfaction were obtained. Statistical testing was performed with chi-squared tests using SPSS v16.0 (a=0.05). Results. Mean age in years at date of operation was 68 (36-85) from WSM and 70 (41 to 87) fromCAVOC. The 5 year cumulative survival rate using ‘revision any cause’ as the endpoint, was 79.9% (95% CI 72.46 to 85.9) in the WSM cohort and 96.4% (95%CI 94.1 to 99.1) in the CAVOC cohort. The relative risk for revision at the ISTC as opposed to the referring centre was 3.76 (p<0.001). The mean Oxford Knee Score was 27.5 (range 2-48) for the WSM cohort. The average, non-revised, oxford knee score for the WSM cohort lower than expected at 29. This is lower than other published series of primary TKA. Conclusion. This is the first published five year survivorship for total knee arthroplasty performed at a first generation ISTC in the UK. Revision rates, functional outcomes, and overall health status results are below expected when compared to a similar cohort from a standard NHS Orthopaedic Unit

Following introduction of the second offer scheme in April 2004, Cardiff and Vale NHS Trust sent 227 patients (254 knees) to the independent sector treatment centre in Weston-Super-Mare for total knee arthroplasty. The Kinemax total knee system was used in all cases. There was a perception that there were a large number of dissatisfied patients, and a previous British Orthopaedic Association report (of a 14 case sample) questioned the quality of the surgery performed. All of the patients concerned were offered a review in order to assess the outcome. Of the 227 patients (254 knees), 77% have been reviewed (167 patients, 190 knees). 23% (59 patients, 64 Knees) have not been seen. Of these, 30 patients (34 knees) declined review on the basis that they were happy with the result of surgery. 14 Patients (15 knees) were unobtainable by post of by phone. A further 12 patients (12 knees) did not attend appointments. 3 Patients (3 Knees) had died. The total number of re-operations was 27/254, giving a re-operation rate of 10.6%. There were 21 revisions, 17 for aseptic causes (oversized components, malalignment, aseptic loosening) and 4 for infection. There were 6 secondary patella resurfacings. A life table survivorship analysis was calculated for the 254 knees. The cumulative survival rate at 3 years was 85.8%. These results are considerably worse than those reported in the current published literature. This has resulted in a significant economic impact on our service

144 total hip replacements were performed by Swedish Orthopaedic Surgeons at Weston NHS Treatment Centre between 2004–2006, in an attempt to reduce the waiting list in Cardiff. Following concerns regarding the outcome of knee arthroplasty patients, the Welsh Assembly funded a clinical and radiographic review of all hip arthroplasty patients from the same unit. 100 hips were reviewed at a mean follow-up of 24 months. The mean Oxford Hip Score was 30 (range 12–60). Radiolucencies were seen in acetabular zone 1 in 34, and all 3 zones in 28 hips. Femoral component position was > 4 degrees varus in 41 cases. Medial floor breach with intrapelvic cement was seen in 12 cases. 10 cases had > 1cm leg length discrepancy. There were 3 early dislocations, 1 intraoperative distal femoral fracture, 1 Pulmonary Embolus and 2 superficial infections. 4 patients have received further treatment so far, and 12 have been listed for acetabular component revision for loosening. 1 has been listed for stem revision for symptomatic leg length discrepancy of 2.5cm. There is an unacceptably high early failure rate in this group of patients. The cost of further investigation and revision surgery far outweighs cost-savings achieved by outsourcing treatment to a distant centre

From 2004–2006, in an attempt to reduce the waiting time for patients listed for total knee and total hip arthroplasty at Cardiff and Vale NHS Trust, 156 total hip replacements (THRs) were performed by Swedish Orthopaedic surgeons at an NHS treatment centre in England. All patients were contacted and invited to a review appointment with a Consultant specialising in hip and revision hip replacement. Oxford Hip Scores and clinical and radiographic evaluation were performed. Patients who declined an appointment were sent a postal questionnaire. Radiographs were analysed for component position, radiolucent lines, medial floor breach, leg length discrepancy. One hundred and thirteen hips were reviewed at a mean 23 month follow-up. The mean Oxford score was 26. Mean age at surgery was 69. Cemented THR was performed in 104 hips; hybrid in 7; cementless in 2. The Exeter stem and Cenator cemented cup were used in the majority of cases. 16% had acetabular inclination greater than 55 degrees. Radiolucent lines around the cup were seen in 76/113 hips. Femoral stem position was greater than 4 degrees varus in 47/113. Medial floor breach seen in 13/113. 10/113 had leg length discrepancy > 1cm. There were 3 dislocations, 1 femoral fracture, 1 pulmonary embolus, 3 deep infections, 2 superficial infections. Revision surgery has been performed in 18/113 – the majority for a painful loose acetabular component. A further 5/113 have been recommended for surgery. The further surgery rate was 12% at 2 year follow-up. The revision rate far exceeds the 0.5% 5-year failure rate reported in the Swedish Registry for the components used. This initiative has left a legacy of unhappy patients, and increased the workload required in our unit to correct the problems. The lack of long-term ownership of patients may be an important factor

The DTC approach to patient management aims to decrease waiting list times and length of stay (LOS). To implement a reduction in the LOS it is imperative that suitable patients are selected. Factors such as co-morbidity and social support are important but other factors may also influence LOS. To investigate if pre-operative measures of function were predictive of length of stay for patients treated in a Diagnostic & Treatment Centre for elective hip arthroplasty. The first 75 patients treated by the DTC were assessed pre-operatively recording timed measures of function for sit-to-stand, and stair climbing as well as ratings of pain and the WOMAC questionnaire. These measures were compared with the LOS for patients and their functional outcome at 6 weeks after discharge. Linear regression was used to examine the influence of the measures on LOS. T-tests were used to compare the outcome at 6 weeks for pain and function between patients discharged within 5 days versus > 5 days. The mean age was 65 years (39 – 80 years SD 8.4); 33 male and 42 female. Mean LOS was 6 days (4–14 SD 1.8), 52 % reached the DTC target of discharge on the 5th day. Regression analysis showed sit-to- stand was the best predictor of LOS (R2 = 46.7%) followed by WOMAC pain and climbing stairs. There were no significant differences in the pain or function scores at 6 weeks for patients discharged at 5 days or later. Conclusion: There was a linear relationship between pre-operative sit-to-stand and LOS. The timed measures were simple to perform and patients could be tested in their own homes. Early discharge did not result in poorer self-reported outcome at 6 weeks. The routine measurement of sit-to-stand may be useful to clinicians as a prognostic indicator for treatment allocation and planning

Treatment Centres (TCs) specialise in common elective operations with long waiting lists. One of the concerns that has arisen with this enforced new healthcare model is the potential for suboptimal outcomes after joint arthroplasty. In order to decrease this risk we set in place a number of measures and have evaluated the outcome of the fist 100 total hip and total knee replacements undertaken at our TC and compared these to 100 consecutive controls undertaken concurrently by out hip and knee service. •Cases were only to be performed by consultant orthopaedic surgeons appointed to our trust – to the exclusion of visiting / sessional arrangements. •Same implants and care pathways as used within the rest of our department. •Weekly team arthroplasty rounds and planning sessions. There was no significant difference in baseline demographics with both groups showing a slight female preponderance, and similar age ranges (35–88 av. 62; 42–86 av. 64). The treatment centres patients were heavier (78Kg range 48–111Kg; 72Kg range 43–101Kg). The TC group averaged 2.9 comorbidities per patient compared to 2.2. The average time to discharge was similar at 7.6 days . There was no significant difference in the improvement in Harris Hip or Knee Society Scores at a minimum 6 months follow-up. There were 2 infections in the TC group and one in the control group. There were 3 thromboembolic complications in each group and there was one unrelated death in each group. There was one dislocation and one fracture in the TC group and two fractures in the control group. Radiographic criteria including implant size, position, slope, offset, cementing and alignment were comparable in the two groups. TC patients are not “fitter more predictable” patients and may have greater comorbidity. Our insistence on a local consultant led service and on identical standards to those of our non TC department have generated similar short term outcomes to those of non TC patients

Background: Independent Sector Treatment Centres (ISTC) are now providing significant volumes of elective orthopaedic care in the UK. They have been the subject of considerable publicity. The ISTC in Plymouth was the first newly built orthopaedic centre to open.

This paper describes the methods of working and analyses the early results of nearly a thousand joint replacements implanted between May 2005 and April 2006. It is the first set of such results to be become available.

Methods: Data on each case was collected prospectively and entered into a database. This included demographic information, surgical and implant data, blood loss and transfusion requirements, length of stay, patient satisfaction, readmission rate, complications and mortality. One hundred consecutive postoperative hip replacement x-rays were scored by an independent orthopaedic surgeon. The alignment of one hundred consecutive postoperative knee x-rays was evaluated by long leg views. Comparison is made to published UK and international data.

Results: Ongoing

Conclusion: Ongoing

The Ponseti method is the gold standard treatment for clubfoot. It begins in early infancy with weekly serial casting for up to 3 months. Globally, a commonly reported barrier to accessing clubfoot treatment is increased distance patients must travel for intervention. This study aims to evaluate the impact of the distance traveled by families to the hospital on the treatment course and outcomes for idiopathic clubfoot. No prior studies in Canada have examined this potential barrier. This is a retrospective cohort study of patients managed at a single urban tertiary care center for idiopathic clubfoot deformity. All patients were enrolled in the Pediatric Clubfoot Research Registry between 2003 and April 2021. Inclusion criteria consisted of patients presenting at after percutaneous Achilles tenotomy. Postal codes were used to determine distance from patients’ home address to the hospital. Patients were divided into three groups based on distance traveled to hospital: those living within the city, within the Greater Metro Area (GMA) and outside of the GMA (non-GMA). The primary outcome evaluated was occurrence of deformity relapse and secondary outcomes included need for surgery, treatment interruptions/missed appointments, and complications with bracing or casting. A total of 320 patients met inclusion criteria. Of these, 32.8% lived in the city, 41% in the GMA and 26% outside of the GMA. The average travel distance to the treatment centre in each group was 13.3km, 49.5km and 264km, respectively. Over 22% of patients travelled over 100km, with the furthest patient travelling 831km. The average age of presentation was 0.91 months for patients living in the city, 1.15 months for those within the GMA and 1.33 months for patients outside of the GMA. The mean number of total casts applied was similar with 7.1, 7.8 and 7.3 casts in the city, GMA and non-GMA groups, respectively. At least one two or more-week gap was identified between serial casting appointments in 49% of patients outside the GMA, compared to 27% (GMA) and 24% (city). Relapse occurred in at least one foot in 40% of non-GMA patients, versus 27% (GMA) and 24% (city), with a mean age at first relapse of 50.3 months in non-GMA patients, 42.4 months in GMA and 35.7 months in city-dwelling patients. 12% of the non-GMA group, 6.8% of the GMA group and 5.7% of the city group underwent surgery, with a mean age at time of initial surgery of 79 months, 67 months and 76 months, respectively. Complications, such as pressure sores, casts slips and soiled casts, occurred in 35% (non-GMA), 32% (GMA) and 24% (city) of patients. These findings suggest that greater travel distance for clubfoot management is associated with more missed appointments, increased risk of relapse and treatment complications. Distance to a treatment center is a modifiable barrier. Improving access to clubfoot care by establishing clinics in more remote communities may improve clinical outcomes and significantly decrease the burdens of travel on patients and families

Aims. The primary aim of this study was to assess the feasibility of recruiting and retaining patients to a patient-blinded randomized controlled trial comparing corticosteroid injection (CSI) to autologous protein solution (APS) injection for the treatment of subacromial shoulder pain in a community care setting. The study focused on recruitment rates and retention of participants throughout, and collected data on the interventions’ safety and efficacy. Methods. Participants were recruited from two community musculoskeletal treatment centres in the UK. Patients were eligible if aged 18 years or older, and had a clinical diagnosis of subacromial impingement syndrome which the treating clinician thought was suitable for treatment with a subacromial injection. Consenting patients were randomly allocated 1:1 to a patient-blinded subacromial injection of CSI (standard care) or APS. The primary outcome measures of this study relate to rates of recruitment, retention, and compliance with intervention and follow-up to determine feasibility. Secondary outcome measures relate to the safety and efficacy of the interventions. Results. A total of 53 patients were deemed eligible, and 50 patients (94%) recruited between April 2022 and October 2022. Overall, 49 patients (98%) complied with treatment. Outcome data were collected in 100% of participants at three months and 94% at six months. There were no significant adverse events. Both groups demonstrated improvement in patient-reported outcome measures over the six-month period. Conclusion. Our study shows that it is feasible to recruit to a patient-blinded randomized controlled trial comparing APS and CSI for subacromial pain in terms of clinical outcomes and health-resource use in the UK. Safety and efficacy data are presented. Cite this article: Bone Jt Open 2024;5(7):534–542

Abstract. Introduction. 30-day emergency readmission is an indicator of treatment related complication once discharged, resulting in readmission. A board-approved quality improvement pathway was introduced to reduce elective re-admissions. Method. The pathway involved telephone and email contact details provision to patients for any non-life threatening medical assistance, allowing for initial nurse led management of all issues. A new clinic room available 7 days, and same day ultrasound scanning for DVT studies were introduced. A capability, opportunity and behavior model of change was implemented. Readmission rates before and six months after implementation were collected from Model Hospital. A database used to document patient communications was interrogated for patient outcomes. Results. Prior to implementation, readmission rates following elective primary total knee replacement (TKR) at the 1st business quarter of 2021 (April – June 2021), was 8.7%, (benchmark 3.8%). Following implementation, readmission rates decreased to 4.1% (October – December 2021). 54% of patients making contact were managed with telephone advice. 15% of patients required face-to-face clinic. 32% of those required a same day scan to exclude DVT (1/4). 20 out of 684 TKRs performed following protocol introduction were re-admitted within 30 days. Readmissions were 41% surgical, 29% medical. 52% were unaware of the newly implemented protocol. Further improvements have been made to the protocol based on these findings. Implementation of a suitable pathway can significantly reduce re-admission rates in our center and could be used to reduce readmission rates in other national elective treatment centers

Introduction. Hip prosthetic joint infection (PJI) is a debilitating complication following joint replacement surgery, with significant impact on patients and healthcare systems. The INFection ORthopaedic Management: Evidence into Practice (INFORM: EP) study, builds upon the 6-year INFORM programme by developing evidence-based guidelines for the identification and management of hip PJI. Methods. A panel of 21 expert stakeholders collaborated to develop best practice guidelines based on evidence from the previous INFORM research programme. An expert consensus process was used to refine guidelines using RAND/UCLA criteria. The guidelines were then implemented over a 12-month period through a Learning Collaborative of 24 healthcare professionals from 12 orthopaedic centres in England. Qualitative interviews were conducted with 17 members of the collaborative and findings used to inform the development of an implementation support toolkit. Patient and public involvement contextualised the implementation of the guidelines. The study is registered with the ISCRTN (34710385). Result. The INFORM guidelines, structured around the stages of PJI management, were largely supported by surgeons, although barriers included limited awareness among non-surgical team members, lack of job planning for multidisciplinary teams, and challenges in ensuring timely referrals from primary care. Psychological support for patients was identified as a critical gap. Advanced Nurse Practitioners and multidisciplinary team (MDT) coordinators were seen as potential bridges to address these knowledge gaps. The guidelines were also viewed as a useful tool for service development. Conclusions. This study presents the first evidence-based guidelines for hip PJI management, offering a comprehensive approach to prevention, treatment, and postoperative care. Effective implementation is crucial, involving wider dissemination amongst primary and community care, as well as non-specialist treatment centres. Further resources are needed to ensure job planning for MDTs and psychological support for patients. Overall, this study lays the foundation for improved PJI management, benefiting patients and healthcare systems

Hip prosthetic joint infection (PJI) is a debilitating complication following joint replacement surgery, with significant impact on patients and healthcare systems. The INFection ORthopaedic Management: Evidence into Practice (INFORM:EP) study, builds upon the 6-year INFORM programme by developing evidence-based guidelines for the identification and management of hip PJI. A panel of 21 expert stakeholders collaborated to develop best practice guidelines based on evidence from INFORM \[1\]. An expert consensus process was used to refine guidelines using RAND/UCLA criteria. The guidelines were then implemented over a 12-month period through a Learning Collaborative of 24 healthcare professionals from 12 orthopaedic centres in England. Qualitative interviews were conducted with 17 members of the collaborative and findings used to inform the development of an implementation support toolkit. Patient and public involvement contextualised the implementation of the guidelines. The study is registered with the ISCRTN (34710385). The INFORM guidelines, structured around the stages of PJI management, were largely supported by surgeons, although barriers included limited awareness among non-surgical team members, lack of job planning for multidisciplinary teams, and challenges in ensuring timely referrals from primary care. Psychological support for patients was identified as a critical gap. Advanced Nurse Practitioners and multidisciplinary team (MDT) coordinators were seen as potential bridges to address these knowledge gaps. The guidelines were also viewed as a useful tool for service development. This study presents the first evidence-based guidelines for hip PJI management, offering a comprehensive approach to prevention, treatment, and postoperative care. Effective implementation is crucial, involving wider dissemination amongst primary and community care, as well as non-specialist treatment centres. Further resources are needed to ensure job planning for MDTs and psychological support for patients. Overall, this study lays the foundation for improved PJI management, benefiting patients and healthcare systems

Aims. The outcomes of patients with unexpected positive cultures (UPCs) during revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) remain unknown. The objectives of this study were to establish the prevalence and infection-free implant survival in UPCs during presumed aseptic single-stage revision THA and TKA at mid-term follow-up. Methods. This study included 297 patients undergoing presumed aseptic single-stage revision THA or TKA at a single treatment centre. All patients with at least three UPCs obtained during revision surgery were treated with minimum three months of oral antibiotics following revision surgery. The prevalence of UPCs and causative microorganisms, the recurrence of periprosthetic joint infections (PJIs), and the infection-free implant survival were established at minimum five years’ follow-up (5.1 to 12.3). Results. Of the 297 patients undergoing aseptic revisions, 37 (12.5%) had at least three UPCs obtained during surgery. The UPC cohort included 23 males (62.2%) and 14 females (37.8%), with a mean age of 71.2 years (47 to 82). Comorbidities included smoking (56.8%), hypertension (48.6%), diabetes mellitus (27.0%), and chronic renal impairment (13.5%). The causative microorganisms included Staphylococcus epidermidis (49.6%), Bacillus species (18.9%), Micrococcus species (16.2%), and Cutibacterium acnes (16.2%). None of the study patients with UPCs developed further PJIs or required further surgical intervention during follow-up. Conclusion. The prevalence of UPCs during presumed aseptic revision THA and TKA was 12.5%. The most common causative microorganisms were of low virulence, and included S. epidermidis, Bacillus species, Micrococcus species, and C. acnes. Microorganism-specific antibiotic treatment for minimum three months’ duration of UPCs in presumed aseptic revision arthroplasty was associated with excellent infection-free implant survival at mid-term follow-up. Cite this article: Bone Jt Open 2024;5(10):832–836

Abstract. Background. During COVID-19 pandemic, there has been worldwide cancellation of elective surgeries to protect patients from nosocomial transmission and peri-operative complications. With unfolding situation, there is definite need for exit strategy to reinstate elective services. Therefore, more literature evidence supporting exit plan to elective surgical services is imperative to adopt a safe working principle. This study aims to provide evidence for safe elective surgical practice during pandemic. Methods. This single centre, prospective, observational study included adult patients who were admitted and underwent elective surgical procedures in the trust's COVID-Free environment at Birmingham Treatment Centre between 19th May and 14th July’2020. Data collected on demographic parameters, peri-operative variables, surgical specialities, COVID-19 RT-PCR testing results, post-operative complications and mortality. The study also highlighted the protocols it followed for the elective services during pandemic. Results. 303 patients were included with mean age of 49.9 years (SD 16.5) comprising of 59% (178) female and 41% (125) male. They were classified according to American Society of Anaesthesiologist Grade, different surgical specialities and types of anaesthesia used. 96% patients were discharged on the same day. 100% compliance to pre-operative COVID-19 testing was maintained. There was no 30-day mortality or major respiratory complications. Conclusion. Careful patient selection, simultaneous involvement of the pre-assessment and anaesthetic team, strict adherence to peri-operative protocols and delivering vigilant post-operative care for COVID-19 infection can help providing safe elective surgical services if the community transmission under reasonable control. However, it is particularly important to maintain COVID-free safe environment for such procedures

224 patients from the Cardiff and Vale NHS Trust who had total knee replacements at the NHS Treatment Centre in Weston-Super-Mare by surgeons from overseas appeared to have significantly worse results than those recorded in the published literature. We wished to establish whether a group of patients treated in the same hospital with the same prosthesis at a similar time by local NHS orthopaedic surgeons in substantive posts would have a similar outcome. Follow-up of all 214 patients (223 knee replacements) treated in 2004 was conducted with questionnaires, clinical review and x-ray assessment. In cases of no response, contact was made with GPs to establish the outcome of the surgery. The outcome of all patients was known and of the 125 knee replacements available for clinical review at six years (mean), 119 cases (96%) achieved satisfactory coronal alignment with reference to the published literature. There were six revisions, five for loosening and one for malalignment. The cumulative survival rate for re-operation at six years was 97.2% (95% confidence interval 95.2 to 99.1). This study shows that the results of total knee replacement performed by a group of NHS orthopaedic surgeons were comparable with other institutions and were significantly better than those reported from the NHS Treatment Centre in Weston-Super-Mare, using the same facilities and implant over the same period of time. This work supports previous recommendations for single surgeon supervision of the patient pathway and appropriate follow-up procedures

Purpose. A comparison of patient satisfaction of service provided by independent sector treatment centres versus an index NHS hospital in total knee replacement surgery. Methods. Patients were all initially listed for total knee replacement (TKR) by a single consultant from the index NHS hospital, Derbyshire Royal Infirmary (DRI). Patients were sent a postal questionnaire and asked to rate the TKR service provided by a given hospital, based on recent inpatient experience. Questions covered quality of care delivered by hospital staff and quality of ward environment. Overall satisfaction was rated. Patients electing surgery under Patient Choice at an independent sector treatment centre (ISTC) were asked about factors that influenced their hospital choice. 100 consecutive patients undergoing TKR at DRI and 100 patients choosing ISTC hospitals were identified. All surgery occurred between April 2003 and September 2006. Results. Questionnaire response rates were 79% for DRI patients and 54% for ISTC. Overall patient satisfaction for TKR service was 95% for DRI and 87% for ISTC. An equal 61% rated the surgeons as excellent in both DRI and ISTC hospitals. Nurses and physiotherapists (& occupational therapists) both scored more highly in ISTC groups (Nurses 69% v 45%; physio/OT 57% v 35%). Ward environment rated excellent in 73% for ISTC and 24% for DRI. The most common reason for choosing ISTC was shorter waiting list (42%). Conclusion. ISTC hospitals scored more highly in terms of nurses, physiotherapy & occupational therapy, and ward environment. In part, this may arise from better staffing levels and newer facilities in the ISTC sector. Despite this, overall patient satisfaction for TKR service remained greater at the index NHS hospital. This suggests overall satisfaction depends on more complex factors than staff and ward environment. Further work is needed to compare objective clinical outcomes of TKR between hospital groups within the NHS

Introduction: Local recurrence of tumour following definitive treatment of bone or soft tissue sarcoma is a predictor of increased morbidity. Early detection of local recurrence may affect outcome. The role of magnetic resonance imaging (MRI) screening following definitive treatment is controversial. This study investigates the experience of one treatment centre with routine surveillance MRI following treatment of sarcoma. Methods: Patients were identified from the records of the Regional Sarcoma Group. With Local Ethics Committee approval the casenotes, MRI and histology reports for sixty-five patients who had routine surveillance MRI scans following definitive treatment of sarcoma in a single treatment centre were reviewed. The minimum follow up period was 24 months. The primary outcome was the presence of local tumour recurrence and whether this was identified on surveillance or interval scanning. Results: There were sixty-four patients identified with a bone or soft tissue sarcoma. All had undergone surveillance scanning biannually for the first year then annually. Six patients with Ewing’s sarcoma were excluded because they had not had surgical excision. Fifty-eight patients (59% men) with a bone or soft tissue sarcoma without metastasis between 1996 and 2003 were available for study. The median age at diagnosis was 53 years (range 6–78 years). Eighty three percent had a diagnosis of soft tissue sarcoma. Ten patients had a primary bone tumour. Fourteen patients had local recurrence (24%). Six were identified on surveillance scan, and the remaining eight required interval scans because of clinical suspicion of tumour recurrence. There were no statistical differences in gender, age, or tumour characteristics between those identified on surveillance or interval scans. All those detected on surveillance had intra-lesional or marginal resections. Conclusions: Surveillance scanning has a role in the early detection of local recurrence of bone and soft tissue sarcoma. Whether this results improvements in prognosis require longer-term follow up studies

GIRFT was published in the United Kingdom with the aim of streamlining primary care pathways, secondary care, creating a network of hospitals and treatment centres and to better regulate introduction of new implants. It also proposed the use of Orthopaedic Devices Evaluation Panel (ODEP) 10A* rated cemented implants in hip arthroplasty. Aim: The purpose of this study was to assess the effects of adopting GIRFT on surgical time, length of stay, changes to the implants used and number of cases per surgical list. Prior to adopting GIRFT, elective primary total hip replacement (THR) was predominantly uncemented THR. Age, sex, Body Mass Index (BMI), American Society of Anesthetiss (ASA), closure technique and surgical time of 50 consecutive primary uncemented THR were analysed to identify the appropriate statistical methods. Mean and standard deviation for surgical time were identified. Threshold increase in surgical time was set at 20 minutes. Based on expected difference of 20 minutes and standardised difference, minimum sample size was calculated to be 19. Prospective data on 60 consecutive uncemented THR and 30 consecutive cemented primary THR were included in this study. Inclusion criteria – primary THR for arthritis by single surgeon. Exclusion criteria – previous hip surgery, complex primary, abnormal anatomy. No differences in age, sex, BMI, ASA and length of stay between the two groups. Surgical time was significantly increased by 28 minutes (p<0.001). Implants used changed from 7A*/5A* uncemented THR to 10A* (18/30) and 7A*(12/30) cemented THR. There was a reduction in number of THR done per surgical list due to the increase in surgical time (3 instead of 4). GIRFT compliance improved from 0% cemented to 100% cemented. 0% 10A* rated implants to 66% 10A* rated implants. Undertaking cemented THR instead of uncemented THR is associated with significantly increased surgical time. Hence, number of THR surgeries performed in a day's list is accordingly reduced. There is potential for financial loss when the savings in the implants used is compared with the reduction in the number of surgeries performed

This study investigates the experience of one treatment centre with routine surveillance MRI following excision of sarcoma. Casenotes, MRI and histology reports for fifty-nine patients were reviewed. The primary outcome was the presence of local tumour recurrence and whether this was identified on surveillance or interval scanning. Forty-eight patients had a diagnosis of soft tissue sarcoma, the remaining 11 a primary bone tumour. Fifteen patients had local recurrence (25%). Eight were identified on surveillance scan, and the remaining 7 required interval scans. Surveillance scanning has a role in the early detection of local recurrence of bone and soft tissue sarcoma

Aims

This study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.