The number of hip fracture admissions is rising; with reduced hospital bed capacity and increasing patient numbers, care pathways must be optimised to maximise inpatient bed efficiency. There is currently significant interest in improving healthcare services across all 7 days in the United Kingdom. It is unclear whether lack of allied healthcare professional review at the weekend is detrimental to hip fracture patient care. This study aims to examine whether providing 7-day physiotherapy and occupational therapy (7DPOT) service improves outcomes for fractured neck of femur patients compared to a 5-day service (5DPOT). All patients admitted with an acute neck of femur fracture were grouped into three cohorts, depending on provision of 7DPOT services: the initial cohort received 5DPOT between December 2012 and March 2013. Seven-day physiotherapy and occupational therapy was introduced for one year from October 2014 until September 2015 (2nd cohort). The service then reverted to 5DPOT between January to June 2016 (3rd cohort). The third cohort was utilised to nullify changes in the overall service which had occurred which were not attributable to 7DPOT. Data was collected prospectively using a specially designed audit tool.Introduction
Methods
Heterotopic ossification (HO) is lamellar bone formation in the soft tissues following trauma or joint replacement for osteoarthritis (OA). A genome wide association study of HO patients after total hip arthroplasty for OA has identified Kinesin Family Member 26B (KIF26B) as a gene associated with HO severity. KIF26B has previously been associated with HO in mice. Hypothesis and aims: We hypothesised that Kif26b regulates the osteogenic trans-differentiation of myoblasts; a possible mechanism of HO. Using an We developed CRISPR/Cas9 mediated Kif26b knockout (KO) C2C12 myoblasts. Wild type (WT) and KO cells were transdifferentiated towards an osteogenic lineage using BMP-2 for 24 days. The effect of Kif26b KO on mineralisation was quantified by calcium staining. The mean difference (±SEM) in gene expression between WT and KO lines was compared with ANOVA.Background
Methods
Numerous factors have been hypothesized as contributing to mechanically-assisted corrosion at the head-neck junction of total hip prostheses. While variables attributable to the implant and the patient are amenable to investigation, parameters describing assembly of the component parts can be difficult to determine. Nonetheless, increasing evidence suggests that the manner of intraoperative assembly of modular components plays a critical role in the fretting and corrosion of modular implants. This study was undertaken to measure the magnitude and direction of the impaction forces applied by surgeons in assembling modular head-neck junctions under operative conditions where both the access and visibility of the prosthesis may potentially compromise component fixation. A surrogate consisting of the lower limb with overlying soft tissue was developed to simulate THR performed via a 10cm incision using the posterior approach. The surrogate was modified to match the resistance of the body to retraction of the incision, mobilization of the femur and hammering of the implanted femoral component. An instrumented femoral stem (SL PLUS) was surgically implanted into the bone after attachment of 3 miniature accelerometers (Dytran Inc) in an orthogonal array to the proximal surface of the prosthesis. A 32mm cobalt chrome femoral head was mounted on the trunnion (12/14 taper, machined) of the femoral stem. 15 Board-certified and trainee surgeons replicated their surgical technique in exposing the femur and impacting the modular head on the tapered trunnion. Impaction was performed using an instrumented hammer (5000 Lbf Dytran impact hammer) that provided measurements of the magnitude and temporal variation of the impact force. The components of force acting along the axis aof the neck and in the AP and ML directions were continuously samples using the accelerometers.Introduction
Methods
Patients with asymptomatic bacteriuria (ASB) have a significantly increased risk of both superficial wound infection and deep infection following arthroplasty. Debate continues as to whether treatment of pre-operative ASB reduces the risk of subsequent prosthetic joint infection. All arthroplasty units in Scotland were contacted by telephone and asked a standard series of questions regarding pre-operative urine testing in arthroplasty patients. A review of the literature was also performed.Introduction
Patients/Materials & Methods
Orthopaedic theatres can be noisy. Noise exposure is known to be related to reduced cognition, reduced manual dexterity and increased rates of post-operative wound infection. Up to 50% of orthopaedic theatre staff have features of Noise-Induced Hearing Loss (NIHL) with higher levels in consultants compared to registrars. Exposure to noise levels of 90dB(A) at work for a career of 40 years, equates to a 51% risk of hearing loss. A Casella CEL-242 meter was positioned in the corner of the theatre tent. Recordings were taken for 17 Total Knee Replacements (TKRs) and 11 Total Hip Replacements (THRs). This meter recorded the decibel level once per second (whereas EU Regulation requires equivalent continuous level measurement).Introduction
Materials & methods
The availability of seven-day NHS services for patients is currently receiving widespread national attention. Rehabilitation services including physiotherapy and occupational therapy are not routinely available at the weekend. The aim of this pilot study was to determine if seven-day rehabilitation services led to improved outcomes for hip fracture patients. All proximal femur fractures were included and formed into two cohorts. Data were collected prospectively in each cohort. Cohort one underwent standard five-day rehabilitation (n=79). Cohort two received seven-day rehabilitation (n=338). Both groups were followed up to 120 days. No significant differences were observed between the cohorts for pre-fracture place of residence, ASA score or age. Combined median length-of-stay in hospital and rehabilitation improved from 28 to 21 days (p=0.054) Combined median length of stay for patients admitted from home improved from 26 to 19 days (p=0.016). This pilot study suggests that a seven-day physiotherapy and occupational therapy service may result in decreased total length-of-stay in hospital and subsequent rehabilitation. This is a clear benefit for our patients but also for our hospitals and rehabilitation units where beds are at such a premium. A wider study across multiple institutions within NHS Scotland is now needed to investigate this further.
