Aim. Surgical site infection (SSI) is associated with substantial morbidity, mortality and economic burden. Management of spinal SSI is becoming more challenging especially in instrumented cases, but is not well recognized as high risk procedure. The objective of this study was to determine the impact of procedure type comparing SSI risk with arthroplasties among all
During the COVID-19 pandemic, drilling has been classified as an aerosol-generating procedure. However, there is limited evidence on the effects of bone drilling on splatter generation. Our aim was to quantify the effect of drilling on splatter generation within the orthopaedic operative setting. This study was performed using a Stryker System 7 dual rotating drill at full speed. Two fluid mediums (Videne (Solution 1) and Fluorescein (Solution 2)) were used to simulate drill splatter conditions. Drilling occurred at saw bone level (0 cm) and at different heights (20 cm, 50 cm, and 100 cm) above the target to simulate the surgeon ‘working arm length’, with and without using a drill guide. The furthest droplets were marked and the droplet displacement was measured in cm. A surgical microscope was used to detect microscopic droplets.Aims
Methods
Aims. This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common
Aims. The use of fluoroscopy in orthopaedic surgery creates risk of radiation exposure to surgeons. Appropriate personal protective equipment (PPE) can help mitigate this. The primary aim of this study was to assess if current radiation protection in orthopaedic trauma is safe. The secondary aims were to describe normative data of radiation exposure during common
Aims. Orthopaedic infection is a potentially serious complication of elective and emergency trauma and
Aims. Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common
Aims. There is little published on the outcomes after restarting elective
Orthopaedic surgery uses many varied instruments with high-speed, high-impact, thermal energy and sometimes heavy instruments, all of which potentially result in aerosolization of contaminated blood, tissue, and bone, raising concerns for clinicians’ health. This study quantifies the aerosol exposure by measuring the number and size distribution of the particles reaching the lead surgeon during key orthopaedic operations. The aerosol yield from 17 orthopaedic open surgeries (on the knee, hip, and shoulder) was recorded at the position of the lead surgeon using an Aerodynamic Particle Sizer (APS; 0.5 to 20 μm diameter particles) sampling at 1 s time resolution. Through timestamping, detected aerosol was attributed to specific procedures.Aims
Methods
Cite this article:
Prophylactic antibiotic regimens for elective primary total hip and knee arthroplasty vary widely across hospitals and trusts in the UK. This study aimed to identify antibiotic prophylaxis regimens currently in use for elective primary arthroplasty across the UK, establish variations in antibiotic prophylaxis regimens and their impact on the risk of periprosthetic joint infection (PJI) in the first-year post-index procedure, and evaluate adherence to current international consensus guidance. The guidelines for the primary and alternative recommended prophylactic antibiotic regimens in clean orthopaedic surgery (primary arthroplasty) for 109 hospitals and trusts across the UK were sought by searching each trust and hospital’s website (intranet webpages), and by using the MicroGuide app. The mean cost of each antibiotic regimen was calculated using price data from the British National Formulary (BNF). Regimens were then compared to the 2018 Philadelphia Consensus Guidance, to evaluate adherence to international guidance.Aims
Methods
Cite this article:
Sarcopenia is characterized by a generalized progressive loss of skeletal muscle mass, strength, and physical performance. This systematic review primarily evaluated the effects of sarcopenia on postoperative functional recovery and mortality in patients undergoing orthopaedic surgery, and secondarily assessed the methods used to diagnose and define sarcopenia in the orthopaedic literature. A systematic search was conducted in MEDLINE, EMBASE, and Google Scholar databases according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies involving sarcopenic patients who underwent defined orthopaedic surgery and recorded postoperative outcomes were included. The quality of the criteria by which a diagnosis of sarcopenia was made was evaluated. The quality of the publication was assessed using Newcastle-Ottawa Scale.Aims
Methods
The aim of this study was to surveil whether the standard operating procedure created for the NHS Golden Jubilee sufficiently managed COVID-19 risk to allow safe resumption of elective orthopaedic surgery. This was a prospective study of all elective orthopaedic patients within an elective unit running a green pathway at a COVID-19 light site. Rates of preoperative and 30-day postoperative COVID-19 symptoms or infection were examined for a period of 40 weeks. The unit resumed elective orthopaedic services on 29 June 2020 at a reduced capacity for a limited number of day-case procedures with strict patient selection criteria, increasing to full service on 29 August 2020 with no patient selection criteria.Aims
Methods
Periprosthetic joint infections (PJIs) and osteosynthesis-associated infections (OSIs) present significant challenges in trauma and orthopaedic surgery, substantially impacting patient morbidity, mortality, and economic burden. This concern is heightened in patients with pre-existing comorbidities, such as diabetes mellitus, which are not always modifiable at presentation. A novel intraoperative strategy to prevent these infections is the use of Defensive Antibacterial Coating (DAC), a bio-absorbable antibiotic-containing hydrogel applied to implant surfaces at implantation, acting as a physical barrier to prevent infection. The purpose of this study is to assess the use of a commercially available hydrogel (DAC), highlighting its characteristics that make it suitable for managing PJIs and OSIs in orthopaedics and traumatology. Twenty-five patients who underwent complex
Abstract. Introduction. The NHS generates 4–5% of the nation's total carbon emissions and over 500,000 tonnes of waste annually. Up to one-third of waste from
The use of cannabis is increasingly medically relevant as it is legalized and gains acceptance more broadly. However, the effects of marijuana use on postoperative outcomes following orthopedic surgery have not been well-characterized. This study seeks to illuminate the relationship between marijuana use and the incidence postoperative complications including: DVT, PE, nonunion, and infection following common
Introduction. The role of diathermy in orthopaedic surgical practice has increased since its introduction. It is widely used for underlying tissue dissection, cutting, and haemostasis. Previous studies have compared electrosurgical and scalpel incisions in terms of wound infection, wound-related pain, and blood loss. There are well documented hazards associated with diathermy use including burns injury, electrocution, hypoxic stress, inhalation of diathermy plume, and gene mutation. No single study to date has focused on the potential for diathermy tips to cause wound contamination and infection. We sought to identify whether diathermy tips could be possible sources of infection in
The role of diathermy in orthopaedic surgical practice has increased since its introduction. It is widely used for underlying tissue dissection, cutting, and haemostasis. Previous studies have compared electrosurgical and scalpel incisions in terms of wound infection, wound-related pain, and blood loss. There are well documented hazards associated with diathermy use including burns injury, electrocution, hypoxic stress, inhalation of diathermy plume, and gene mutation. No single study to date has focused on the potential for diathermy tips to cause wound contamination and infection. We sought to identify whether diathermy tips could be possible sources of infection in
Aims. The aim of this study was to characterize the relationship between pre- and postoperative opioid use among patients undergoing common elective
Aims. Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components. Methods. Patients were defined as at risk to vascular injuries when components or cement migrated 5 mm or more beyond the ilioischial line in any of the pelvic incidences (anteroposterior and Judet view). In those patients, a serial investigation was initiated by a CT angiography, followed by a vascular surgeon evaluation. The investigation proceeded if necessary. The main goal was to assure a safe tissue plane between the hardware and the vessels. Results. In ten at-risk patients undergoing revision hip arthroplasty and submitted to our algorithm, six were recognized as being high risk to vascular injury during surgery. In those six high-risk patients, a preventive preoperative stent was implanted before the
Aims. Total knee arthroplasty (TKA) is a common and safe
Emerging evidence suggests preoperative opioid use may increase the risk of negative outcomes following
Hip and knee arthroplasty (HKA) are two of the most successful
Aims. The COVID-19 pandemic posed significant challenges to healthcare systems across the globe in 2020. There were concerns surrounding early reports of increased mortality among patients undergoing emergency or non-urgent surgery. We report the morbidity and mortality in patients who underwent arthroplasty procedures during the UK first stage of the pandemic. Methods. Institutional review board approval was obtained for a review of prospectively collected data on consecutive patients who underwent arthroplasty procedures between March and May 2020 at a specialist orthopaedic centre in the UK. Data included diagnoses, comorbidities, BMI, American Society of Anesthesiologists grade, length of stay, and complications. The primary outcome was 30-day mortality and secondary outcomes were prevalence of SARS-CoV-2 infection, medical and surgical complications, and readmission within 30 days of discharge. The data collated were compared with series from the preceding three months. Results. There were 167 elective procedures performed in the first three weeks of the study period, prior to the first national lockdown, and 57 emergency procedures thereafter. Three patients (1.3%) were readmitted within 30 days of discharge. There was one death (0.45%) due to SARS-CoV-2 infection after an emergency procedure. None of the patients developed complications of SARS-CoV-2 infection after elective arthroplasty. There was no observed spike in complications during in-hospital stay or in the early postoperative period. There was no statistically significant difference in survival between pre-COVID-19 and peri-COVID-19 groups (p = 0.624). We observed a higher number of emergency procedures performed during the pandemic within our institute. Conclusion. An international cohort has reported 30-day mortality as 28.8% following
Abstract. Introduction. Total joint arthroplasty (TJA) is one of the commonest and most successful
Introduction. The health sector contributes the equivalent of 4.4% of global net emissions to the climate carbon footprint. It has been suggested that between 20% and 70% of health care waste originates from a hospital's operating room, the second greatest component of this are the textiles used, and up to 90% of waste is sent for costly and unneeded hazardous waste processing. Waste from common orthopaedic operations was quantified, the carbon footprint calculated, and cost of disposal assessed. A discussion of the circular economy of textiles, from the author of the textile guidance to the Green Surgery Report follows. Methods. The amount of waste generated from a variety of trauma and elective orthopaedic operations was calculated across a range of hospital sites. The waste was separated primarily into clean and contaminated, paper or plastic. The carbon footprint and the cost of disposal across the hospital sites was subsequently calculated. Results. Elective procedures can generate up to 16.5kg of plastic waste per procedure. Practices such as double draping the patient contribute to increasing the quantity of waste. The cost to process waste vary widely between hospital sites, waste disposal contractors and the method of waste disposal. Conclusion. This study sheds new light on the environmental impact of waste produced in trauma and elective
Aims. Distraction osteogenesis (DO) is a useful
Elective
Surgeons must explain the risk of complications to prospective patients and get informed consent. If a complication that occurred was omitted in the process or given the wrong risk level, culpability of the surgeon is judged in court against what a “reasonable patient” would like to know to give or refuse consent. ObjectivesThe concept “reasonable patient” is widely used, no attempt has been made to define it objectively. We assessed insight of patients, presumed “reasonable”, about risks of certain complications after they underwent one of five
Abstract. Introduction. In recent years, CTA has been an effective training adjunct for
Total Joint Arthroplasty (TJA) is a successful
Abstract. Introduction. Challenges in surgical training have led to the exploration of technologies such as augmented reality (AR), which present novel approaches to teaching
Shoulder replacement surgery is a well-established
Augmented reality simulators offer opportunities for practice of
Total joint arthroplasty (TJA) is one of the commonest and most successful
Trauma and elective orthopaedic demands in New Zealand are increasing. In this study, prospective and retrospective data has been collected at Nelson Hospital and across New Zealand to identify the percentage of elective theatre time lost due to cancellation for acute patient care. Data has been collected from theatre management systems, hospital data systems and logged against secretarial case bookings, to calculate a percentage of elective theatre time lost to acute operating or insufficient bed capacity. Data was collected over a five-month period at Nelson Hospital, with a total of 215 elective and 226 acute
Introduction: Wound discharge is a well-known and troubling problem after
Evidence supporting the use of virtual reality (VR) training in
Aims. To evaluate safety outcomes and patient satisfaction of the re-introduction of elective orthopaedic surgery on ‘green’ (non-COVID-19) sites during the COVID-19 pandemic. Methods. A strategy consisting of phased relaxation of clinical comorbidity criteria was developed. Patients from the orthopaedic waiting list were selected according to these criteria and observed recommended preoperative isolation protocols. Surgery was performed at green sites (two local private hospitals) under the COVID-19 NHS contract. The first 100 consecutive patients that met the Phase 1 criteria and underwent surgery were included. In hospital and postoperative complications with specific enquiry as to development of COVID-19 symptoms or need and outcome for COVID-19 testing at 14 days and six weeks was recorded. Patient satisfaction was surveyed at 14 days postoperatively. Results. There were 54 females and 46 males (mean age 44 years, mean body mass index (BMI) 25.6 kg/m. 2. ). In all, 56 patients underwent major
The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures. However, if containment of COVID-19 community spread is achieved, resumption of elective
Introduction. Perioperative antibiotic prophylaxis use in modern
Aims. The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery. Methods. This is a prospective study of 121 patients who underwent elective
Aim. Local antibiotics released through a carrier is a commonly used technique to prevent infection in
Aims. A recent report from France suggested an association between the use of cobalt-chrome (CoCr) femoral heads in total hip arthroplasties (THAs) and an increased risk of dilated cardiomyopathy and heart failure. CoCr is a commonly used material in orthopaedic implants. If the reported association is causal, the consequences would be significant given the millions of joint arthroplasties and other
Total Hip Replacements (THR) and Hip Hemiarthroplasties (HA) are both successful and common
INTRODUCTION. Warfarin remains the treatment of choice for the majority of patients with venous thromboembolism, atrial fibrillation and valvular heart disease or valve replacement unless contraindicated. Poor management of patients on warfarin often leads to delay in surgery, life threatening bleeding during or after operation and unnecessary delay in discharge from hospitals in United Kingdom. METHODS. We carried out a prospective study on patients who were on warfarin and underwent elective and emergency
The significance of ring-fencing orthopaedic beds and protected elective sites have recently been highlighted by the British Orthopaedic Association & Royal College of Surgeons. During the pandemic many such elective setups were established with various degrees of success. This study aimed to compare the functioning and efficiency of a Orthopaedic Protected Elective Surgical Unit (PESU) instituted during the pandemic with the pre-pandemic elective service at our hospital (Pre-Pandemic ward or PPW). We retrospectively collected data of all patients who underwent elective
A recent French report suggested that cobalt metal ions released from total hip replacements (THRs) were associated with an increased risk of dilated cardiomyopathy and heart failure. If the association is causal the consequences would be significant given the millions of
Abstract. Objectives. Evidence supporting the use of immersive virtual reality (iVR) training in
Introduction. The aim of this study is to report the 30 day COVID-19 related morbidity and mortality of patients assessed as SARS-CoV-2 negative who underwent emergency or urgent orthopaedic surgery in the NHS during the peak of the COVID-19 pandemic. Method. A retrospective, single centre, observational cohort study of all patients undergoing surgery between 17 March 2020 and 3May 2020 was performed. Outcomes were stratified by British Orthopaedic Association COVID-19 Patient Risk Assessment Tool. Patients who were SARS-CoV-2 positive at the time of surgery were excluded. Results. Overall, 96 patients assessed as negative for SARS-CoV-2 at the time of surgery underwent 100 emergency or urgent
Background. Surgical quality improvement has received increasing attention in recent years, yet it isn't clear where orthopaedic surgeons should focus their efforts for the greatest impact on peri-operative safety and quality. We sought to guide these efforts by prioritising
Aims. Due to widespread cancellations in elective
The risk of falls in patients undergoing
Aims. COVID-19 represents one of the greatest global healthcare challenges in a generation. Orthopaedic departments within the UK have shifted care to manage trauma in ways that minimize exposure to COVID-19. As the incidence of COVID-19 decreases, we explore the impact and risk factors of COVID-19 on patient outcomes within our department. Methods. We retrospectively included all patients who underwent a trauma or urgent
Introduction. Four weeks after the earthquake in Kashmir, multidisciplinary surgical teams were organised within the UK (MiST). The aim was to help with disaster victims who had been transferred to Rawalipindi. We reviewed the work carried by one such team from the 5-18 November 2005. Patients. There were 78 patients: 50 lower limb injuries only, 21 upper limb, 7 combined, injuries. Mean age was 24 (0.5-80). 24 patients were under 10 and only 5 over 60. 274 procedures were performed over 11 days (average 25 per day). Results. The majority of injuries involved 3B open injuries n=50 (64%) of which there were already 12 lower limb amputees before we arrived. 202 EUAs, washouts and debridements, 34 definitive
The aims of the study presented here were to compare the frequency of surgical glove perforation among major and minor orthopaedic surgical procedures and to determine the efficacy of use of double glove in these procedures. A prospective study was performed to assess the perforation rate of surgical gloves in 100 major (total hip and knee arthroplasty) and 100 minor (arthroscopy)
Background: Evidence on pre and post- prophylactic antibiotics given with open
Background. Revision total knee arthroplasty (rTKA) is a high stakes procedure with complex equipment and multiple steps. For rTKA using the ATTUNE system revising femoral and tibial components with sleeves and stems, there are over 240 pieces of equipment that require correct assembly at the appropriate time. Due to changing teams, work rotas, and the infrequency of rTKR, scrub nurses may encounter these operations infrequently and often rely heavily on company representatives to guide them. In turn, this delays and interrupts surgical efficiency and can result in error. This study investigates the impact of a fully immersive virtual reality (VR) curriculum on training scrub nurses in technical skills and knowledge of performing a complex rTKA, to improve efficiency and reduce error. Method. Ten orthopaedic scrub nurses were recruited and trained in four VR sessions over a 4-week period. Each VR session involved a guided mode, where participants were taught the steps of rTKA surgery by the simulator in a simulated operating theatre. The latter 3 sessions involved a guided mode followed by an unguided VR assessment. Outcome measures in the unguided assessment were related to procedural sequence, duration of surgery and efficiency of movement. Transfer of skills was assessed during a pre-training and post-training assessment, where participants completed multi-step instrument selection and assembly using the real equipment. A pre and post-training questionnaire assessed the participants knowledge, confidence and anxiety. Results. All participants reported orthopaedics as their primary speciality with mean of 6-years experience. 80% reported they are ‘sometimes’ required to scrub for operations in which they do not feel comfortable with the equipment. All participants improved across the 3 unguided sessions reducing their operative time by 47%, assistive prompts by 75%, dominant hand motion by 28% and head motion by 36%. This transferred into the real-world: Participants completed 11.3% of tasks correctly in pre-training compared to 83.5% correct in the timely selection and assembly of rTKA equipment, post-training. All participants reported increased confidence and reduced anxiety after the training. Conclusion. Unfamiliarity with
Purpose: Arthrogryposis Multiplex Congenita is a rare congenital disorder associated with multiple musculo-skeletal contractures which causes substantial morbidity. Knee involvement is commonly seen among children with arthrogryposis, with flexion contracture of the knee being the most frequent knee deformity. Knee flexion contractures in the paediatric population are particularly debilitating as they affect ambulation. Treatment for knee flexion contractures requires numerous
Rapid discharge pathways (RDP) have been implemented throughout most areas of orthopaedics. The primary goal of these pathways is to standardize the post-surgical hospital course for patients in order to decrease hospital length-of-stay (LOS). Surgical treatment of adolescent idiopathic scoliosis (AIS) remains one of the most invasive pediatric
Perioperative glucocorticoids have been used as a successful non-opioid analgesic adjunct for various
Obesity is a risk factor for complications following
many
Purpose. Infections in orthopaedic surgery are costly, debilitating complications. The search for new treatments and prevention strategies has led to the use of antibiotic-filled calcium sulfate (CaS) as a bone void filler that is both safe and effective. The purpose of this study was to examine the available data on the efficacy of this technology. Methods. A literature search was performed for studies that evaluated the use of antibiotic-loaded CaS cement in orthopaedics published between inception of the databases to 2017. Selected studies included randomized controlled trials (RCTs) and observational studies published in the English language that met the following criteria: 1) patients underwent an
In the period from 1999 to 2003 bacterial contamination of explanted cadaver bones and tendons from the Regional Tuscan Tissue and Cell Bank was studied. During this period 1124 explants from 402 donors were taken, of which 311 donors whose heart was beating and from 91 whose heart was not beating. The bone explantation procedure followed a standardized protocol. Al the samples were explanted in the operation room by a team of two surgeons and a nurse during the first 24 hours after death. The protocol concerning the sterility of the explanting procedure was standardized and followed accurately. The bacteriological examination was performed immediately after the explantation and before the samples were treated with antibiotic solution. Three different tests were used: superficial microbiological swabs of the bone surface, one from the medullar canal and a small bone or soft tissue sample. The samples were inoculated immediately in culture medium and incubated for at least 10 days. From 1124 explanted samples 430 were contaminated: 99 with pathological bacteria such as Staphylococcus aureus, Enterococcus, Escherichia coli etc., 331 with nosocomial bacteria such as coagulase neg. Staphylococcus, Corynebacteria, etc. The samples that were contaminated with pathological bacteria were excluded from the study. The other contaminated group was re-processed and re-tested for contamination. The factors influencing the results of contamination were anatomical location of the explants and the experience of the surgical team. In contrast, the donor type (heart beating vs. heart not beating) did not play any role. From 1999 to 2003 the University Hospital of Careggi in Florence, Italy, used 721 explants from which 624 were retrieved from the Regional Tuscan Tissue and Cell Bank, 72 from foreign banks and 14 from another national bank. The explants from foreign banks were all re-tested according to our standards. Among those, 699 samples were sterile and 22 samples (3%) were contaminated. Seventeen (2.3%) of the 22 samples were contaminated with pathological bacteria with low morbidity and 5 (0.7%) with medium morbidity. Compared to the control group contamination of the explants retrieved from the Regional Tuscan Tissue and Cell Bank was 2.8%. However, the contamination of samples of an explant is not necessarily correlated with a true infection of the specimen. This study shows that factors such as retrieval techniques, contamination factors in the operating room and laboratory mistakes can cause false-positive contamination results. In fact, only three of 604 patients who were operated in major
Glenoid replacement is a manual bone removal procedure that can be difficult for surgeons to perform. Surgical robotics have been utilized successfully in hip and knee
Rotator cuff injuries represent a significant burden to the health care system, affecting more than 30% of the population over the age of sixty. Despite the advanced surgical techniques that are available, poor results are sometimes seen in a subset of patients receiving surgical treatment for their rotator cuff disease. The reasons for this failure of treatment remain unclear, particularly if the surgery was ‘technically’ successful. An increasing body of evidence has demonstrated a strong correlation between pre-operative psychological factors and functional outcome following several
Radiological imaging is necessary in a wide variety
of trauma and elective orthopaedic operations. The evolving orthopaedic
workforce includes an increasing number of pregnant workers. Current
legislation in the United Kingdom, Europe and United States allows
them to choose their degree of participation, if any, with fluoroscopic procedures.
For those who wish to engage in radiation-prone procedures, specific
regulations apply to limit the radiation dose to the pregnant worker
and unborn child. This paper considers those aspects of radiation protection, the
potential effects of exposure to radiation in pregnancy and the
dose of radiation from common
Aims . Few studies have evaluated the relationship between patients’
pre-operative expectations and the outcome of
Total hip arthroplasty has become one of the most successful
Total knee arthroplasty (TKA) is a common
INTRODUCTION. Joint replacement is one of the most common
Background. The advent of value-based conscientiousness and rapid-recovery discharge pathways presents surgeons, hospitals, and payers with the challenge of providing the same total hip arthroplasty episode of care in the safest and most economic fashion for the same fee, despite patient differences. Various predictive analytic techniques have been applied to medical risk models, such as sepsis risk scores, but none have been applied or validated to the elective primary total hip arthroplasty (THA) setting for key payment-based metrics. The objective of this study was to develop and validate a predictive machine learning model using preoperative patient demographics for length of stay (LOS) after primary THA as the first step in identifying a patient-specific payment model (PSPM). Methods. Using 229,945 patients undergoing primary THA for osteoarthritis from an administrative database between 2009– 16, we created a naïve Bayesian model to forecast LOS after primary THA using a 3:2 split in which 60% of the available patient data “built” the algorithm and the remaining 40% of patients were used for “testing.” This process was iterated five times for algorithm refinement, and model performance was determined using the area under the receiver operating characteristic curve (AUC), percent accuracy, and positive predictive value. LOS was either grouped as 1–5 days or greater than 5 days. Results. The machine learning model algorithm required age, race, gender, and two comorbidity scores (“risk of illness” and “risk of morbidity”) to demonstrate excellent validity, reliability, and responsiveness with an AUC of 0.87 after five iterations. Hospital stays of greater than 5 days for THA were most associated with increased risk of illness and risk of comorbidity scores during admission compared to 1–5 days of stay. Conclusions. Our machine learning model derived from administrative big data demonstrated excellent validity, reliability, and responsiveness after primary THA while accurately predicting LOS and identifying two comorbidity scores as key value-based metrics. Predictive data has the potential to engender a risk-based PSPM prior to primary THA and other elective
We evaluated the safety and efficacy of total
knee replacement in patients receiving continuous warfarin therapy. . We identified 24 consecutive patients receiving long-term warfarin
therapy who underwent total knee replacement between 2006 and 2008
and compared them with a group of age- and gender-matched patients
not on long-term anticoagulation. Primary observations were changes
in haemoglobin, transfusion rates and complications. Secondary observations
were fluctuations in the international normalised ratio (INR) and
post-operative range of movement. . There was no significant difference between the two groups in
pre- or post-operative haemoglobin, incidence of transfusion or
incidence of post-operative complications. There were no surgical
delays due to a high INR level. The mean change in INR during the
peri-operative phase was minimal (mean 0.4; . sd. 0.7). There
was no significant difference in the range of movement between the
two groups after day two post-operatively. Current American College of Chest Physicians guidelines recommend
bridging therapy for high-risk patients receiving oral anticoagulation
and undergoing major
Arthroscopy of the knee is one of the most commonly
performed
Robots have been used in surgery since the late
1980s. Orthopaedic surgery began to incorporate robotic technology
in 1992, with the introduction of ROBODOC, for the planning and
performance of total hip replacement. The use of robotic systems
has subsequently increased, with promising short-term radiological
outcomes when compared with traditional
Total knee arthroplasty (TKA) is the most commonly performed elective
Aim. A number of orthopaedic strategies have been described for limb salvage following periprosethic joint infection (PJI). However, this is often only possible with concomitant soft tissue reconstruction in the form of flap coverage. The purpose of this study was to determine the long-term clinical outcome of patients who underwent pedicled gastrocnemius flap coverage as part of their treatment for knee PJI. Method. We performed a retrospective review of all patients undergoing gastrocnemius muscle transfer with split thickness skin grafting as part of their treatment for knee PJI at a tertiary referral centre between 1994 and 2015. Data recorded included patient characteristics,
Total joint arthroplasty (TJA) is a high value elective
Smoking is negatively implicated in healing and may increase the risk of surgical complications in orthopaedic patients. Carbon monoxide (CO) breath testing provides a rapid way of measuring recent smoking activity, but so far, to our knowledge, this has not been studied in elective orthopaedic patients. We studied whether CO-testing can be performed preoperatively in elective orthopaedic patients and whether testing accurately correlates with self-reported smoking status?. CO breath testing was performed on and a brief smoking history was obtained from 154 elective orthopaedic patients on the day of surgery. All patients admitted over 6 weeks for elective orthopaedic intervention were enrolled. 16.2% patients admitted to smoking. The mean CO levels were 15.2 ppm for self-reported smokers and 3.1 ppm for self-reporting non-smokers. One self-reporting non-smoker admitted to smoking after testing. 5 non-smoking patients had a CO breath of >=7, 1 had a CO level of >= 10 ppm. Using a cutoff of 7 ppm gave a sensitivity of 65.4% and a specificity of 96.1%, whilst a cutoff of 10 ppm gave a sensitivity of 57.6% and specificity of 99.2%. Whilst most patients are honest about smoking, CO testing can identify non-disclosing smokers undergoing elective
Objectives. Surgeons face a substantial risk of infection because of the occupational exposure to blood-borne pathogens (BBPs) from patients undergoing high-risk
Allografts of bone from the femoral head are often used in
Accurate, reproducible outcome measures are essential
for the evaluation of any
Blood donation in England is voluntary and a limited resource. Blood transfusion is essential and beneficial in some postoperative hip replacements, however is not without inherent risks. Royal College of Physician audit in 2007 has shown wide variation in transfusion with an average rate of 25% (22% – 97%). Patient blood management is an established approach to optimising need for post- operative transfusion. The Surgical Blood Conservation Service (SBCS) was set up in 2009 to enable a reduction in the demand for blood transfusion during and postoperatively in many
We report a double-blind study of the effectiveness of indomethacin suppositories in the relief of postoperative pain and the reduction in demand for opiate analgesia following
A key theme of the GIRFT project is centralisation of complex
Rapid prototyping (RP), especially useful in surgical specialities involving critical three-dimensional relationships, has recently become cheaper to access both in terms of file processing and commercially available printing resources. One potential problem has been the accuracy of models generated. We performed computed tomography on a cadaveric human patella followed by data conversion using open source software through to selective-laser-sintering of a polyamide model, to allow comparative morphometric measurements (bone v. model) using vernier calipers. Statistical testing was with Student's t-test. No significant differences in the dimensional measurements could be demonstrated. These data provide us with optimism as to the accuracy of the technology, and the feasibility of using RP cheaply to generate appropriate models for operative rehearsal of intricate
Background. Hip fractures affect 1.6 million people globally per annum, associated with significant morbidity and mortality. A large proportion are extracapsular neck of femur fractures, treated with the dynamic hip screw (DHS). Mechanical failure due to cut-out is seen in up to 7% of DHS implants. The most important predictor of cut-out is the tip-apex distance (TAD), a numerical value of the lag screw”s position in the femoral head. This distance is determined by the psychomotor skills of the surgeon guided by fluoroscopic imaging in theatre. With the current state of surgical training, it is harder for junior trainees to gain exposure to these operations, resulting in reduced practice. Additionally, methods of simulation using workshop bones do not utilise the imaging component due to the associated radiation risks. We present a digital fluoroscopy software, FluoroSim, a realistic, affordable, and accessible fluoroscopic simulation tool that can be used with workshop bones to simulate the first step of the DHS procedure. Additionally, we present the first round of accuracy tests with this software. Methods. The software was developed at the Royal National Orthopaedic Hospital, London, England. Two orthogonally placed cameras were used to track two coloured markers attached to a DHS guide-wire. Affine transformation matrices were used in both the anterior-posterior (AP) and cross table lateral (CTL) planes to match three points from the camera image of the workshop bone to three points on a pre-loaded hip radiograph. The two centre points of each marker were identified with image processing algorithms and utilised to digitally produce a line representing the guide-wire on the two radiographs. To test the accuracy of the system, the software generated 3D guide-wire apex distance (GAD) (from the tip of the guide-wire to a marker at the centre of calibration) was compared to the same distance measured with a digital calliper (MGAD). In addition, the same accuracy value was determined in a simulation scenario, from 406 attempts by 67 medical students. Results. The median absolute inaccuracy of FluoroSim with 270 measurements was 3.35mm (IQR = [1.15mm, 6.53mm]). The absolute inaccuracy showed a graded increase the further away the tip of the guide-wire was from the centre of calibration; MGAD ≤10mm, median absolute inaccuracy = 1.53mm; MGAD 10mm<x≤20mm, median absolute inaccuracy = 4.97mm; MGAD >20mm, median absolute inaccuracy = 7.23mm. Comparison between all three groups reached significance (p < 0.001). In a simulation scenario with medical students, FluoroSim had a significantly greater median absolute inaccuracy of 4.79mm compared to the testing scenario (p < 0.001). Conclusion. FluoroSim is a safe and inexpensive digital imaging adjunct to workshop bones simulation. To our knowledge this technology has not been explored in the context of DHS simulation, and has the potential to be extended to other
Rapid prototyping (RP), especially useful in surgical specialities involving critical three-dimensional relationships, has recently become cheaper to access both in terms of file processing and commercially available printing resources. One potential problem has been the accuracy of models generated. We performed computed tomography on a cadaveric human patella followed by data conversion using open source software through to selective-laser-sintering of a polyamide model, to allow comparative morphometric measurements (bone v. model) using vernier calipers. Statistical testing was with Student's t-test. No significant differences in the dimensional measurements could be demonstrated. These data provide us with optimism as to the accuracy of the technology, and the feasibility of using RP cheaply to generate appropriate models for operative rehearsal of intricate
A number of advantages of unicondylar arthroplasty (UKA) over total knee arthroplasty in patients presenting osteoarthritis in only a single compartment have been identified in the literature. However, accurate implant positioning and alignment targets, which have been shown to significantly affect outcomes, are routinely missed by conventional techniques. Computer Assisted Orthopaedic Surgery (CAOS) has demonstrated its ability to improve implant accuracy, reducing outliers. Despite this, existing commercial systems have seen extremely limited adoption. Survey indicates the bulk, cost, and complexity of existing systems as inhibitive characteristics. We present a concept system based upon small scale head mounted tracking and augmented reality guidance intended to mitigate these factors. A visible-spectrum stereoscopic system, able to track multiple fiducial markers to 6DoF via photogrammetry and perform semi-active speed constrained resection, was combined with a head mounted display, to provide a video-see-through augmented reality system. The accuracy of this system was investigated by probing 180 points upon a 110×110×50 mm known geometry and performing controlled resection upon a 60×60×15 mm bone phantom guided by an overlaid augmented resection guide that updated in real-time. The system produced an RMS probing accuracy and precision of 0.55±0.04 and 0.10±0.01 mm, respectively. Controlled resection resulted in an absolute resection error of 0.34±0.04 mm with a general trend of over-resection of 0.10±0.07 mm. The system was able to achieve the sub-millimetre accuracy considered necessary to successfully position unicondylar knee implants. Several refinements of the system, such as pose filtering, are expected to increase the functional volume over which this accuracy is obtained. The presented system improves upon several objections to existing commercial CAOS UKA systems, and shows great potential both within surgery itself and its training. Furthermore, it is suggested the system could be readily extended to additional
Hip resurfacing, like other
Surgical training has been greatly affected by the challenges of reduced training opportunities, shortened working hours, and financial pressures. There is an increased need for the use of training system in developing psychomotor skills of the surgical trainee for fracture fixation. The training system was developed to simulate dynamic hip screw fixation. 12 orthopaedic senior house officers performed dynamic hip screw fixation before and after the training on training system. The results were assessed based on the scoring system that included the amount of time taken, accuracy of guide wire placement and the number of exposures requested to complete the procedure. The result shows a significant improvement in amount of time taken, accuracy of fixation and the number of exposures after the training on simulator system. This was statistically significant using paired student t-test (p-value <0.05). Computer navigated training system appears to be a good training tool for young orthopaedic trainees The system has the potential to be used in various other
Computers arrived late in orthopaedic surgery. While the rest of the world already happily integrated computers into daily life, business and production, orthopaedic surgeons remained sceptical and denied any need for help from modern technology. It was in the mid-eighties though, that a young veterinary surgeon from California, specializing in total hip replacement in dogs, was contemplating the problems that he encountered during surgery. This veterinary surgeon, the late Hap Paul, was one of the founding members of the custom – implant society, from which evolved ISTA. He struggled with wrong positioning of implants and broken bones, and wondered why implants that were manufactured with highest technology finally were placed into the bone with crude instruments reminiscent of those found in a carpenters workshop. With the help of IBM and engineers from the University of California he created a system which he called ROBODOC. ®. , and it became the first computer based system helping the surgeon during an
There is high morbidity and mortality associated with infection following
Templates are used in the preoperative planning of many
We have developed a teaching programme for non-radiologists who use fluoroscopy, which includes techniques for reducing the radiation received by the patient and the surgeon during
The Spine Adverse Events Severity System (SAVES) and Orthopaedic Surgical Adverse Events Severity System (OrthoSAVES) are standardised assessment tools designed to record adverse events (AEs) in orthopaedic patients. The primary objective was to compare AEs recorded prospectively by orthopaedic surgeons compared to trained independent clinical reviewers. The secondary objective was to compare AEs following spine, hip, knee, and shoulder
Introduction. Hip and knee replacements are predictable
Introduction. Over the past several decades, numerous surgical procedures have been perfected in the inpatient hospital setting and then evolved into outpatient procedures. This has been shown to be a safe and economical transition for many