Surgical
Novel immersive virtual reality (IVR) technologies are revolutionizing medical
Novel immersive virtual reality (IVR) technologies are revolutionizing medical
Musculoskeletal (MSK) disorders continue to be a major cause of pain and disability worldwide. The mission statement of the Canadian Orthopaedic Association (COA) is to “promote excellence in orthopaedic and musculoskeletal health for Canadians,” and orthopaedic surgeons serve as leaders in addressing and improving musculoskeletal health. However, patients with MSK complaints most commonly present first to a primary care physician. According to a survey of family physicians in British Columbia, 13.7-27.8% of patients present with a chief complaint that is MSK-related (Pinney et Regan, 2001). Therefore, providing excellent MSK care to Canadians requires that all physicians, especially those involved in primary care, be adequately trained to diagnose and treat common MSK conditions. To date, there has been no assessment of the total mandatory MSK training Canadian family medicine residents receive. It is also unclear, despite the prevalence of MSK complaints among Canadian patients, if current family physicians are competent or confident in their ability to provide fundamental MSK care. The purpose of this study is to determine the amount of mandatory MSK training Canadian family medicine residents are currently receiving. Web-based research was used to determine how many weeks of mandatory MSK training was incorporated into current Canadian family medicine residency training programs. This information was gathered from either the Canadian Resident Matching Service website (carms.ca) or the residency program's individual website. If this information was not available on a program's website, a program administrator was contacted via email in order to ascertain this information directly. MSK training was considered to be any rotation in orthopaedic surgery, spine surgery, sports medicine, or physiatry. 156 Canadian family medicine residency training sites were identified. Information pertaining to mandatory MSK
As residency training programmes around the globe
move towards competency-based medical
Background. Advice and
While surgeon-industry relationships in orthopaedics have a critical role in advancing techniques and patient outcomes, they also present the potential for conflict of interest (COI) and increased risk of bias in surgical
Background. The COVID-19 pandemic caused an abrupt disruption in fellowship training, with most in-person teaching ceasing in mid-March 2020. An online lecture series was quickly initiated named the Fellows Online COVID-19 AAHKS Learning (FOCAL) initiative. This study will summarize the results of that initiative. Methods. Beginning March 31, 2020, an online teaching program was initiated. Adult reconstruction fellows and senior residents with interest in adult reconstruction were invited to participate in the free, live, online
Aging of Population – Baby Boomers, Millennials, Generation X. Burden of TJR in USA – Estimated ∼ 4 million US adults currently live with TKR (4.2% of the population aged 50 or older) – Females (4.8%); Males (3.4%). Prevalence increased with increasing age. Estimated lifetime risk of primary TKR – 7.0% for males, 9.5% for females. Changes in Resident
Aims. The COVID-19 pandemic has had a significant impact on the provision of orthopaedic care across the UK. During the pandemic orthopaedic specialist registrars were redeployed to “frontline” specialties occupying non-surgical roles. The impact of the COVID-19 pandemic on orthopaedic training in the UK is unknown. This paper sought to examine the role of orthopaedic trainees during the COVID-19 and the impact of COVID-19 pandemic on postgraduate orthopaedic
Aims. Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal
Purpose of the study. The purpose of this project was to evaluate whether OHEIs could facilitate student physiotherapy placement training in their educational outpatient clinics. Background. The National Health Service (NHS) is actively promoting Allied Health Professionals (AHPs) to have a greater role in supporting healthcare delivery. There are challenges to increasing AHP numbers and one of these is providing enough student training placements to meet demand. Methods. This evaluation used quantitative and qualitative methods. The OHEI clinical tutors and students collected activity data Anonymised questionnaires for physiotherapy students examining expectation were completed online before placement and an experience questionnaire after placement. Interviews and focus groups were conducted to investigate the experiences of stakeholders involved in the project. This included physiotherapy and osteopathy students, clinic tutors, and placement coordinators in OHEIs and physiotherapy HEIs. Results. Four universities with physiotherapy courses participated, and 37 students in 2 cohorts completed either five- or six-week placements at three OHEI clinics between April and August 2021. Cohort 1 expressed uncertainties about roles and integration in clinic and with patients. Concerns were addressed for Cohort 2 and physiotherapy student learning experiences were much better with 83% of physiotherapy students satisfied or very satisfied with their placement. Conclusion. The placement of physiotherapists in OHEI clinics is feasible. Careful expectation management is essential. Future sustainability is dependent upon managing costs to the OHEIs as it is unlikely placements will generate income. The learning environment could be made more reciprocal with time and experience leading to better understanding of the different professions and enhanced multidisciplinary working. Conflicts of interest: Dawn Carnes and Carol Fawkes are both trained osteopaths. Sources of funding: Health
Purpose:. Total knee and hip arthroplasty is a commonly performed surgical procedure. As the population ages the numbers of these procedures are predicted to increase. Maximizing patient outcomes and decreasing healthcare delivery costs will be essential to creating a higher value U.S. healthcare system. The purpose of our study was to analyze the effect of a multidisciplinary preoperative
We share our experiences in designing a complete simulator prototype and provide the technological basis to determine whether an immersive medical training environment for vertebroplasty is successful. In our study, the following key research contributions were realised: (1) the effective combination of a virtual reality surgical simulator and a computerised mannequin in designing a novel training setup for medical
Introduction. Pre-operative patient
Evidence exists of a consistent decline in the value and time that medical schools place upon their undergraduate orthopaedic placements. This limited exposure to trauma and orthopaedics (T&O) during medical school will be the only experience in the speciality for the majority of doctors. This review aims to provide an overview of undergraduate orthopaedic training in the UK. This review summarizes the relevant literature from the last 20 years in the UK. Articles were selected from database searches using MEDLINE, EMBASE, ERIC, Cochrane, and Web of Science. A total of 16 papers met the inclusion criteria.Aims
Methods
Current fracture-clinic models, especially in the advent of reductions in junior doctors hours, may limit outpatient trainee
Introduction: Patient
Objective: Dislocation is a well known complication after total hip arthroplasty (THA), and the second cause of revision surgery. Our objective was to assess the effect of a pre-operative patient
The aim of this study was to evaluate the impact of a preoperative
Introduction: Ranked as the second most common cause of long-term disability amongst American adults, osteoarthritis (OA) affects well over 60 million Americans per year. OA is one of the major contributors to health care-related economic cost in the US, which is generally considered unacceptably high when compared other Western industrialized nations. Methods: Three hundred and thirty-five patients undergoing primary unilateral or bilateral total hip arthroplasty (THA), metal-on-metal hip resurfacing (MOMHR), total knee arthroplasty (TKA), or unicondylar knee arthroplasty (UKA) were offered voluntary participation in an one-on-one preoperative
Introduction. The advent of ambulatory total joint replacements has called for measures to reduce postoperative length of stay, while improving patient function and postoperative satisfaction. This prospective, randomized trial evaluated the efficacy of one-on-one preoperative physical therapy (PT)
Identifying the core competencies of musculoskeletal medicine has been the basis for the development of the Australian Musculoskeletal
Background. Patterns of opioid overprescribing following arthroplasty likely developed given that poor pain control can diminish patient satisfaction, delay disposition, and lead to complications. Recently, interventions promoting responsible pain management have been described however most of the existing literature focuses on opioid naive patients. We sought to describe the effect of an educational intervention on prescribing for opioid tolerant patients. Methods. As the start to a quality improvement initiative to reduce opioid overprescribing, a departmental grand rounds was conducted. Prescribing data, for the year before and after this intervention, were retrospectively collected for all opioid tolerant patients undergoing primary total knee arthroplasty (TKA) and primary total hip arthroplasty (THA). Opioid prescribing data was standardized to mean morphine equivalents (MME). Segmented time series regression was utilized to estimate the change in opioid prescribing associated with the intervention. Results. A total of 508 opioid tolerant patients underwent TKA and 342 opioid tolerant patients underwent THA at our institution during the study period. The intervention was associated with a statistically significant decrease of 468 mean MME (23%) from 2,062 to 1,594 (P=0.005)in TKA patients and 594 mean MME (28%) from 2,159 to 1,565 (P=0.003) in THA patients. There were no readmissions for pain control during the study period. Conclusions. This study demonstrates an educational intervention is associated with decreased opioid prescribing to opioid tolerant arthroplasty patients. While the effective management of these patients is challenging, surgeon
Current fracture-clinic models, especially in the advent of reductions in junior doctors hours, may limit outpatient trainee
Background:. Developing a successful outpatient service for Ilizarov frame removal provides both patient and cost benefits. Misinformation and patient trepidation can be detrimental to recovery and influence choices.
The Accreditation Council of Graduate Medical
Enhanced recovery programmes have improved outcomes following elective arthroplasty surgery. Most studies assess whole advanced recovery programmes. There are few studies assessing the role of patient
Fluoroscopic guidance is common in interventional pain procedures. In spine surgery, injections are used for differential diagnosis and determination of indication for surgical treatment as well. Fluoroscopy ensures correct needle placement and accurate delivery of the drug. Also, exact documentation of the intervention performed is possible. However, besides the patient, interventional pain physicians, surgeons and other medical staff are chronically exposed to low dose scatter radiation. The long-term adverse consequences of low dose radiation exposure to the medical staff are still unclear. Especially in university hospital settings, where
The NHS long term plan endorses ‘personalised’, ‘digitally enabled’, ‘out of hospital’ care. Multiagency guidance (CPOC(2021)/NICE(2021)/GIRFT(2021)/NHSX(2021)) advocates an integrated ‘pathway’ approach to information sharing, shared-decision making and patient support. Digital solutions are the vehicle to deliver these agendas. In 2018 we developed a digital joint pathway (DJP) spanning the surgical care pathway (prehabilitation to rehabilitation) using the GoWellHealth platform. Patients listed for joint replacement are offered the DJP as routine care. Activity and engagement are monitored using the DJP data library. We sought to evidence our DJP by assessing patient engagement, experience and outcomes (OKS/EQ5D/Readmission).Abstract
Introduction
Methods
The use of journal clubs and, more recently,
case-based discussions in order to stimulate debate among orthopaedic
surgeons lies at the heart of orthopaedic training and
Introduction and Aims: Computer-assisted surgery may significantly improve the accuracy of total knee arthroplasty. The reproducibility of acquiring points that facilitate the computer generation of joint morphology which is fundamental for guiding surgery remains unclear. The aim of this study was to assess inter- and intra-operator reproducibility using a computer guidance system. Method: Three surgeons were involved in this study, who under instruction from a proprietary computer system acquired points on a sawbone model of the knee that correlated with specific anatomic landmarks. This process was performed five times each and repeated on another identical model. The points acquired allowed the computer to generate a knee joint model that predicted size, orientation and alignment of the knee joint. Inter- and intra-operator comparisons of the size of the prostheses, the amount of resection, the rotation of the prostheses, and the relationship of the epicondylar to the posterior femoral condylar axis were made. Results: This study was commenced one day after an eight-hour hands-on workshop describing the use of the computer guidance system. The computer system accurately recorded the acquisition of points on a sawbone model. There was little difference in the time taken by each surgeon to acquire the points. Although, all iterations of point acquisition were performed sequentially, there was no clear reduction in the time taken for the process of acquisition. Despite the repetitive use of identical sawbone models, all three surgeons demonstrated significant variation within their own and between each others’ acquisitions. This resulted in variations of prosthetic sizes, amounts of bone resection and rotation of implants. The consistency at which certain indices differed suggested a specific bias between surgeons that may reflect technique or interpretation of anatomic landmarks, e.g. relationship between the epicondylar and posterior condylar axes. Conclusion: An important reason for the variation may be the difference in interpretation of the location of anatomic landmarks. This may have a significant impact on the generation of computer model for guiding subsequent surgery. Clear definitions of landmarks and a robust
Orthopaedic training sessions, vital for surgeons to understand post-operative joint function, are primarily based on passive and subjective joint assessment. However, cadaveric knee simulators, commonly used in orthopaedic research,1 could potentially benefit surgical training by providing quantitative joint assessment for active functional motions. The integration of cadaveric simulators in orthopaedic training was explored with recipients of the European Knee Society Arthroplasty Travelling Fellowship visiting our institution in 2018 and 2019. The aim of the study was to introduce the fellows to the knee joint simulator to quantify the surgeon-specific impact of total knee arthroplasty (TKA) on the dynamic joint behaviour, thereby identifying potential correlations between surgical competence and post-operative biomechanical parameters. Eight fellows were assigned a fresh-frozen lower limb each to plan and perform posterior-stabilised TKA using MRI-based patient-specific instrumentation. Surgical competence was adjudged using the Objective Structured Assessment of Technical Skills (OSATS) adapted for TKA.2 All fellows participated in the OSATS scores ranged from 79.6% to 100% (mean=93.1, SD=7.7). A negative correlation was observed between surgical competence and change in post-operative tibial kinematics over the entire range of motion during passive flexion – OSATS score vs. change in tibial abduction (r=−0.87; p=0.003), OSATS score vs. change in tibial rotation (r=−0.76; p=0.02). When compared to the native condition, post-operative tibial internal rotation was higher during passive flexion (p<0.05), but lower during squatting (p<0.033). Post-operative joint stiffness was greater in extension than in flexion, without any correlation with surgical competence. Although trained at different institutions, all fellows followed certain standard intraoperative guidelines during TKA, such as achieving neutral tibial abduction and avoiding internal tibial rotation,4 albeit at a static knee flexion angle. However, post-operative joint kinematics for dynamic motions revealed a strong correlation with surgical competence, i.e. kinematic variability over the range of passive flexion post-TKA was lower for more skilful surgeons. Moreover, actively loaded motions exhibited stark differences in post-operative kinematics as compared to those observed in passive motions. In conclusion, the inclusion of cadaveric simulators replicating functional joint motions could help quantify training paradigms, thereby enhancing traditional orthopaedic training, as was also the unanimous opinion of all participating fellows in their positive feedback.
Aim: To demonstrate that a multidisciplinary protocol reduces both in-patient stay and the need for out-patient physiotherapy following minimally invasive (MIS) uni-condylar knee replacements (UKR). Methods: The data for hospital stay was collated for a consecutive group of primary UKR at our institution during 2002. We then compared this with a consecutive group of patients seen in a dedicated physiotherapist run clinic, with the provision of brochures and a “patient experience video”, with input from nurses, physiotherapists, anaesthetists, and surgeons, as well as time of expected discharge. The data was compared between informed (dedicated pre-operative assessment and patient video) and uninformed patients (standard pre-operative care). Results: Total of 57 patients were initially assessed and compared with 81 patients after introduction of specific pre-op care pathway. Average hospital stay was reduced from 3.7 days to 2.1 days, with 60% going home within 24 hours. Discussion: By changing the preconception of long hospital stays after arthroplasty ingrained in patients and staff we have reduced hospital stay significantly. Major factors contributing to this include the team approach, patient and ward staff
The primary aim of the survey was to map the current provision of simulation training within UK and Republic of Ireland (RoI) trauma and orthopaedic (T&O) specialist training programmes to inform future design of a simulation based-curriculum. The secondary aims were to characterize; the types of simulation offered to trainees by stage of training, the sources of funding for simulation, the barriers to providing simulation in training, and to measure current research activity assessing the educational impact of simulation. The development of the survey was a collaborative effort between the authors and the British Orthopaedic Association Simulation Group. The survey items were embedded in the Performance and Opportunity Dashboard, which annually audits quality in training across several domains on behalf of the Speciality Advisory Committee (SAC). The survey was sent via email to the 30 training programme directors in March 2019. Data were retrieved and analyzed at the Warwick Clinical Trials Unit, UK.Aims
Methods
Introduction Over 250 patients older than 50 years with fractured neck of femur (NOF) are treated annually at The Canberra Hospital (TCH). Our aim was to improve patient outcomes and reduce length of stay by developing a protocol driven approach to management of patients with NOF fractures, particularly focusing on efficient peri-operative assessment and management of fluid and electrolyte status. Methods A prospective study of all patients over 50 years, admitted with a diagnosis of fractured neck of femur was carried out at TCH for a 12 month period. Baseline data was collected for a period of six months. We measured clinical factors including; time to theatre, pre-operative fluid resuscitation, length of stay and morbidity. A protocol was then introduced according to agreed best practice dealing with the issues identified in baseline data.
Introduction. Fractures of the distal radius are one of the most common extremity fractures encountered in A&E departments and general adult fracture clinics. Over the last 10 years the rate of operation for distal radial fractures has been steadily increasing. Staff within our unit felt that formal teaching, particularly of new medical staff, with regards to fracture reduction and appropriate cast application could result in a reduction in operation rates. Methods. Retrospective data was extracted from FORD (Fracture Outcome and Research Database). Data included: the number of fractures in a 6 month period, number of fractures undergoing ORIF in that period, fracture configuration, patient demographics, and mechanism of injury. All patients undergoing ORIF had their radiographs assessed by 2 separate reviewers. Information regarding adequate fracture reduction, adequate cast application (using Gap Index calculation), and appropriate plaster cast moulding was recorded. Formal teaching was then given to the next group of medical staff rotating through the unit, and the same data was collected prospectively for that 6 month period. Exclusion criteria included bilateral injuries, and polytrauma patients. Results. A total of 1712 distal radial fractures were treated in our unit over the 12 month period, with 71 undergoing ORIF in the first 6 months and 37 in the second 6 months. Our study found that formal teaching and
Introduction: Increasing costs for health care has forced its providers to economize with current resources. This paper reports on cost analysis from a randomized study where the study group (SG) was subjected to pre-operative
This information was provided by the specialist nurses and orthopaedic surgeons within the SAC team. A multi-portal website was created to allow patients easy access to this information: and to also allow, the information to be updated as and when needed. A facility was also included to allow the provision of external resources that would be of benefit to the patient.
Osteoarthritis (OA) and chronic low back pain (CLBP > 12 weeks duration) are two of the most common and costly chronic musculoskeletal conditions globally. Healthcare service demands mean that group-based multiple condition interventions are of increasing clinical interest and a priority for research, but no reviews have evaluated the effectiveness of group-based physiotherapy-led self-management interventions (GPSMI) for both conditions concurrently. Rapid review methodologies are an increasingly valid means of expediting knowledge dissemination and are particularly useful for addressing focused research questions. The electronic databases of MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials were searched from the earliest date possible to August 26th 2013. Structured group-based interventions that aimed to promote self-management and that were delivered by health-care professionals (including at least one physiotherapist) involving adults with OA and/or CLBP were eligible for inclusion. The screening and selection of studies, data extraction and risk of bias assessment were conducted independently by two reviewers.Background
Methods
Implementation fidelity is the extent to which an intervention is delivered as intended by intervention developers, and is extremely important in increasing confidence that changes in study outcomes are due to the effect of the intervention itself and not due to variability in implementation. Growing demands on healthcare services mean that multiple condition interventions involving highly prevalent musculoskeletal pain conditions such as chronic low back pain (CLBP) and/or osteoarthritis (OA) are of increasing clinical interest. This is the first in-depth review of implementation fidelity within self-management interventions for any musculoskeletal pain condition. Structured self-management interventions delivered by health-care professionals (including at least one physiotherapist) in a group format involving adults with OA of the lumbar spine, hip or knee and/or CLBP were eligible for inclusion. The National Institutes of Health Behaviour Change Consortium Treatment Fidelity checklist was used by two independent reviewers to assess fidelity.Background
Methods
Aims. Meeting preoperative expectations is known to be of major influence on postoperative satisfaction after total knee arthroplasty (TKA). Improved management of expectation, resulting in more realistic expectations can potentially lead to higher postoperative satisfaction. The objective of this study was to assess the effect of an additional preoperative
Aims. Mendelian randomization (MR) is considered to overcome the bias of observational studies, but there is no current meta-analysis of MR studies on rheumatoid arthritis (RA). The purpose of this study was to summarize the relationship between potential pathogenic factors and RA risk based on existing MR studies. Methods. PubMed, Web of Science, and Embase were searched for MR studies on influencing factors in relation to RA up to October 2022. Meta-analyses of MR studies assessing correlations between various potential pathogenic factors and RA were conducted. Random-effect and fixed-effect models were used to synthesize the odds ratios of various pathogenic factors and RA. The quality of the study was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology using Mendelian Randomization (STROBE-MR) guidelines. Results. A total of 517 potentially relevant articles were screened, 35 studies were included in the systematic review, and 19 studies were eligible to be included in the meta-analysis. Pooled estimates of 19 included studies (causality between 15 different risk factors and RA) revealed that obesity, smoking, coffee intake, lower