Extended patient waiting lists for assessment and treatment are widely reported for planned elective joint replacement surgery. The development of regionally based Elective Orthopaedic Centres, separate from units that provide acute, urgent or trauma care has been suggested as one solution to provide protected capacity and patient pathways. These centres will adopt protocolised care to allow high volume activity and increased day-case care. We report the plan to establish a new elective orthopaedic centre serving a population of 2.4 million people. A census conducted in 2022 identified that 15000 patients were awaiting joint replacement surgery with predictions for further increases in waiting times. The principle of care will be to offer routine primary
There is an increasing incidence of revision for periprosthetic joint infection. The addition of vancomycin to beta-lactam antimicrobial prophylaxis in joint arthroplasty may reduce surgical site infections, however, the efficacy and safety have not been established. This was a multicenter, double-blind, superiority, placebo-controlled trial. We randomized 4239 adult patients undergoing
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. There were 404 arthroplasty simulations with fluorescent gel, in which SHS was used (H+) or not (H-), and GGI was sealed (S+) or not (S-), divided into four groups: H+S+, H+S-, H-S+, and H-S-, varying by exposure duration (15 to 60 minutes) and frequency of glove exchanges (0 to 6 times). The intensity of fluorescent leakage through GGI was quantified automatically with an image analysis software. The effect of the above factors on fluorescent leakage via GGI were compared and analyzed.Aims
Methods
Healthcare associated infections (HAI) pose a major threat to patients admitted to hospitals, and infection rates following orthopaedic
Objectives: To compare the results of various surgical approaches to the knee in primary
Introduction. Oral factor Xa inhibitors have recently been licensed for use as thromboprophylaxis in
Aims. It is common practice for patients to have postoperative blood tests after total joint replacement (TJR). However, there have been significant improvements in perioperative care with
Aims. Waiting times for
Aims. The rate of day-case total knee arthroplasty (TKA) in the UK is currently approximately 0.5%. Reducing length of stay allows orthopaedic providers to improve efficiency, increase operative throughput, and tackle the rising demand for
There have been no complications or skin reactions related to this method of skin preparation. There has been no significant difference in the incidence of early post operative wound infection.
Osteolysis and subsequent mechanical loosening often occurs in hip arthroplasties using polyethylene-on-ceramic (POC) bearings. This has prompted an ongoing search for alternative bearing surfaces. Ceramic-on-ceramic (COC) and metal-on-metal (MOM) prostheses are widely used, with good clinical results. Using hip simulator studies, we compared ceramic-on-metal (COM) and MOM prostheses. We found COM pairings had 100-fold lower wear rates than MOM. The wear particles from both articulations were oval to round in shape and in the nanometer size range, with the COM producing smaller particles than the MOM. In both pairings, particle size decreased as the bearings bedded in. The volumetric particle loads were far smaller with COM bearing-surfaces than in currently-used MOM prostheses. These findings have encouraged us to investigate the use of these novel bearing surfaces. Ethical approval has been obtained, and a prospective randomised clinical trial comparing POC, MOM, COC and COM bearing surfaces has started.
We have come up with a 4-part stratification based on the patient’s primary condition and comorbidities and have evaluated this for a single-surgeon cohort of TKR patients and a multi-surgeon group of THR patients. We present the results and the implications of the findings and highlight the usability of the system.
The introduction of the laminar flow theatre was responsible for a decrease in wound infection four and a half fold. Further research has found that total body exhaust suits were also responsible for a reduction in infection rate. These exhaust suits include a toga hood, also supplied sterile and attached to the gown. There is no information from the manufacturers regarding microbial penetration of these hoods. Therefore we have performed an experiment to examine the potential for microbial penetration of these toga hoods, both when wet and dry.
Both wet and dry toga circles were applied to the previously prepared lawns of Staphylococcus epidermidis NCTC 11047, with the internal surface in contact with the lawn. Swabbings were taken from the external surface of both wet and dry toga circles at regular intervals. The timing of the swabbings were: 1 min, 5 mins, 20 mins, and 60 mins. The swabs were then used to inoculate blood agar plates, which were incubated overnight at 37°C, after which they were examined for growth of Staphylococcus epidermidis.
Midvastus (MV) vs Medial Parapatellar (MPP) approach: Quadriceps function in the early post operative period was better preserved in the MV group. Post operative pain, blood loss and the need for LRR tended to be lower in the MV group. Subvastus (SV) vs Medial Parapatellar approach: Quadriceps function was better preserved in the SV group up to 3 months post operatively. ROM was generally greater up until the 4 week time point. Post operative pain and blood loss was lower in the SV group. Midvastus vs Subvastus approach: The SV group suffered with significantly more pain at six months post operatively. Quadriceps-sparing versus Medial Parapatellar Approach: Significantly longer operative times and more complications were noted in the QS group. Modified ‘Quadriceps sparing’ Medial Parapatellar vs Mini-Subvastus (MSV) approach: A tendency for earlier restoration of SLR and better early ROM was noted in the MSV group.
MIS tends to result in an improved early quadriceps function and decreased blood loss. However, these approaches are technically more demanding, result in longer operative times and provide no long-term benefit. There is concern that they result in a greater number of major complications and risk implant mal-alignment. Eversion of the patella seems to correlate with poor quadriceps function.
It is unclear whether mortality outcomes differ for patients undergoing total hip arthroplasty (THA) or total knee arthroplasty (TKA) surgery who are readmitted to the index hospital where their surgery was performed, or to another hospital. We analyzed linked hospital and death records for residents of New South Wales, Australia, aged ≥ 18 years who had an emergency readmission within 90 days following THA or TKA surgery between 2003 and 2022. Multivariable modelling was used to identify factors associated with non-index readmission and to evaluate associations of readmission destination (non-index vs index) with 90-day and one-year mortality.Aims
Methods
New methods to reduce inpatient stay, post-operative complications and recovery time are continually being sought in surgery. Many factors affect length of hospital stay, such as, analgesia, patient and surgeon expectations, as well as provision of nursing care and physiotherapy. Development of the use of postoperative local anaesthetic infiltration delivered intra-articularly by a catheter appears to be an effective analgesic method which reduces patient's opioid requirements and allows early physiotherapy without motor blockade of muscles. Our study aimed to explore if the use of local anaesthetic infiltration intra-articularly following joint athroplasty affected the patient's duration of hospitalisation. Looking retrospectively at arthroplasty audit data, we compared two groups of age and sex-matched patients who underwent primary hip arthroplasty (replacement and resurfacing) and knee arthroplasty performed by a single surgeon using the same surgical techniques. The surgeon began to utilize local anesthetic infiltration intra-articularly in 2009. The first group included patients operated on the year prior to the change and the second group were those operated on within a year of the change of practice. There were 103 patients (27 resurfacings, 28 knees, 48 hips) in the local anaesthetic group and 141 patients (48 resurfacings, 36 knees, 64 hips) in the non-local anaesthetic group. The length of stay was investigated for plausible Normality using the Shapiro Wilks statistic. Between-treatment group differences were examined using one-way analysis of variance (ANOVA). Factors observed were, use of local anaesthetic (yes/no), joint (hip/knee) and day of surgery (weekend/not weekend). Between treatment group differences in gender and complications were investigated using Chi-squared methods.Introduction
Methods
Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients’ decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research. Participants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached.Aims
Methods
Data of high quality are critical for the meaningful interpretation of registry information. The National Joint Registry (NJR) was established in 2002 as the result of an unexpectedly high failure rate of a cemented total hip arthroplasty. The NJR began data collection in 2003. In this study we report on the outcomes following the establishment of a formal data quality (DQ) audit process within the NJR, within which each patient episode entry is validated against the hospital unit’s Patient Administration System and vice-versa. This process enables bidirectional validation of every NJR entry and retrospective correction of any errors in the dataset. In 2014/15 baseline average compliance was 92.6% and this increased year-on-year with repeated audit cycles to 96.0% in 2018/19, with 76.4% of units achieving > 95% compliance. Following the closure of the audit cycle, an overall compliance rate of 97.9% was achieved for the 2018/19 period. An automated system was initiated in 2018 to reduce administrative burden and to integrate the DQ process into standard workflows. Our processes and quality improvement results demonstrate that DQ may be implemented successfully at national level, while minimizing the burden on hospitals. Cite this article: