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
Introduction. Oral factor Xa inhibitors have recently been licensed for use as thromboprophylaxis in
Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Retrospective review of consecutive arthroplasty cases performed at a District Hospital (DH), and a Tertiary Hospital (TH) in Cape Town, between January 2015 and December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Seven hundred and ninety-five primary
Abstract. Aim. To identify the difference in infection rates in ankle fracture surgery in Laminar and Non Laminar flow theatres. Background. The infection rates in ankle fracture surgery range between 1–8%. The risk factors include diabetes, alcoholism, smoking, open fractures, osteoporotic fractures in the elderly, and high BMI. Laminar flow has been shown to reduce infections in
In 2020, the COVID-19 pandemic meant that proceeding with elective surgery was restricted to minimise exposure on the wards. In order to maintain throughput of elective cases, our hospital was forced to convert as many cases as possible to same day procedures rather than overnight admission. In this retrospective analysis we review the cases performed as same day
Aboriginal and Torres Strait Islander (ATSI) people have higher elective wait times compared to non-ATSI population in Australia. The Murrumbidgee Local Health District (MLHD) in southern New South Wales services 125,242km. 2. and a population of 287,000 people, with 5.8% identifying as ATSI. The aim of this study is to investigate the arthroplasty waitlist time of ATSI, and the impact of rurality on joint replacement, within the MLHD and compared to the Australian national data. 1435 consecutive patients who underwent elective hip or knee arthroplasty from July 2018 to June 2021 were collated. Demographics, ATSI status, total wait time, readiness for care, and rurality were collected. Rurality was measured by distance from the arthroplasty hospital within MLHD. 1,151 patients were included after excluding patients with missing data or underwent emergent surgery. Within this cohort, 72 of 1,151 patients (6.2%) identified as ATSI. ATSI were younger than non-ATSI population (60.7y v 66.4y). There was no difference between Aboriginal status and ready for care wait time (368.0 v 349.9 days; p=0.116). The rurality of the groups was similar and increasing rurality did not affect total wait time (ATSI 103.1km v 98.6km; p=0.309). There was no difference in total or not-ready-for-care time between the groups (p: 0.68). Findings suggest equitable access to joint arthroplasty in the MLHD between ATSI and non-ATSI populations, which differs from the national experience. There is no significant difference between rurality and accessibility in the MLHD. This may be a result of the increased focus to ATSI and rural health within the district. A state or national study would be beneficial in identifying high performing regions and reviewing processes that enable equitable and accessible care. MLHD provides equitable access to
Aim. Deadspace is the tissue and bony defect in a surgical wound after closure. This space is presumably poorly perfused favouring bacterial proliferation and biofilm formation. In
Laminar flow theatres were first introduced in the United Kingdom in the 1960s and 1970s and have become standard in orthopaedic surgery involving implants. A study from 1982 showed a 50% reduction in infections with joint arthroplasties when compared to conventional theatres and laminar flow became standard in the following decades. Recent evidence including a meta-analysis from 2017 questions the effectiveness of these theatre systems. Most of the evidence for Laminar flow use is based on
Introduction. Total knee and hip arthroplasty were the main
It is estimated that a quarter to half of all hospital waste is produced in the operating room. Recycling of surgical waste in the perioperative setting is largely underutilized, despite the fact that many of the materials being discarded can be potentially recycled safely and easily. Given this mounting waste production, recycling programs have become increasingly popular. Therefore, the primary objective of this study is assess the effect of these recent eco-friendly polices by determining the amount of waste and recycling produced in the pre-operative and operative time period for several orthopaedic subspecialties. Surgical cases were prospectively chosen and assigned to an orthopaedic subspecialty category, which included trauma, arthroplasty, sports, foot and ankle, upper extremity, and paediatrics. The preoperative phase began with the opening of the surgical case carts and concluded with the end of skin preparation. The intraoperative period began after skin preparation was complete, and concluded after the operating room was cleaned. At the end of the preoperative period all surgical waste was weighed and divided into recyclables and non-recyclables. Following the intraoperative period, surgical waste was divided into recyclables, non-recyclables, linens, and biohazardous waste streams. All bags were weighed in a standardized fashion using a portable hand held scale. The primary outcome of interest was the amount of recyclable waste produced per case. Secondary outcomes included the amount of nonrecyclable, biohazardous and total waste produced during the same time intervals. Statistical analysis was then completed using (ANOVA) to detect differences between specialties. This study included 55 procedures collected over a 1-month period at two hospitals from October 2017 to November 2017. A total of 341 kg of waste was collected with a mean mass of 6.2 kg per case. In terms of primary outcomes,
The pain of arthritic disorders occurs in a social and environmental context. Thus, the pain of arthritis not only can affect the patient, but also the spouse. Numerous investigations have shown that the spouses of individuals with persistent pain report lower levels of marital satisfaction, higher rates of depression and lower quality of life. For the vast majority of patients with osteoarthritis, total hip (THA) or total knee (TKA) arthroplasty results in a significant reduction in pain, emotional distress, disability and a significant improvement in their quality of life and function. Little is currently known about how these recovery-related changes impact on the spouse or the marital relationship. Patients and their spouses were recruited within one-year following the
Our primary aim was to establish the proportion of female orthopaedic consultants who perform arthroplasty via cases submitted to the National Joint Registry (NJR), which covers England, Wales, Northern Ireland, the Isle of Man, and Guernsey. Secondary aims included comparing time since specialist registration, private practice participation, and number of hospitals worked in between male and female surgeons. Publicly available data from the NJR was extracted on the types of arthroplasty performed by each surgeon, and the number of procedures of each type undertaken. Each surgeon was cross-referenced with the General Medical Council (GMC) website, using GMC number to extract surgeon demographic data. These included sex, region of practice, and dates of full and specialist registration.Aims
Methods
Aim. The primary aim of this study was to examine whether the use of iodine impregnated incision drape (IIID) decreased the risk of periprosthetic joint infections (PJIs). The secondary aim was to investigate whether intraoperative contamination could predict postoperative infection. PJI is a devastating incident for the patients and in a population that is getting older and the incidence of
Image guided surgery (IGS), or “Navigation,” is now widely used in many areas of
Aim. Reveal the rate of surgical site infection (SSI) after primary hip and knee arthroplasty in patients with inflammatory joint disease and analyse if the infection rate was correlated to the given anti-rheumatic treatment. The background is that since 2006 patients operated at the orthopaedic department at Skåne University hospital, Lund, Sweden, have continued treatment with TNF-alpha inhibitors during the perioperative period. Method. During 2006 to 2015 494 planned primary hip and knee arthroplasties were performed on 395 patients (236 hip arthroplasties and 239 knee arthroplasties). Data on age, sex, diagnosis, BMI, operation time, ASA-classification, treatment with cDMARDs (conventional disease modifying anti-rheumatic drugs) and bDMARDs (biological disease modifying antirheumatic drugs) and use of prednisolone was collected. The primary outcome variable was prosthetic joint infection (PJI) within 1 year from surgery with a secondary outcome variable being superficial SSI. Results. In 32% (n=159) of the cases the patient was treated with a TNF-alpha inhibitor. The rate of PJI was 1.4% (n=7). The overall rate of infection, including superficial infections, was 2.4% (n=12). All the PJIs occurred after a knee arthroplasty and only 1 patient was treated with a TNF-alpha inhibitor (etanercept). Conclusions. We could not find that continuing treatment with TNF-inhibitors perioperatively led to a higher incidence of PJI or SSI than generally would be expected in a group of patients with an inflammatory joint disease. Based on these results there is no need to discontinue treatment with TNF-inhibitors when performing
Many hospitals and orthopaedic surgery teams across Canada have instituted quality improvement (QI) programs for hip and knee arthroplasty. One of the common goals is to reduce hospital length of stay (LOS) in order to improve operational efficiency, patient flow and, by achieving this, provide improved access for patients to
The number of shoulder arthroplasty procedures performed in the United States continues to rise. Currently, the number of procedures performed per year ranges from 55,000–80,000 and is expected to increase more than 300% in the coming years. Periprosthetic joint infection (PJI) is one of the most serious complications associated with
Introduction & Aims. Patient recovery after total knee arthroplasty remains highly variable. Despite the growing interest in and implementation of patient reported outcome measures (e.g. Knee Society Score, Oxford Knee Score), the recovery process of the individual patient is poorly monitored. Unfortunately, patient reported outcomes represent a complex interaction of multiple physiological and psychological aspects, they are also limited by the discrete time intervals at which they are administered. The use of wearable sensors presents a potential alternative by continuously monitoring a patient's physical activity. These sensors however present their own challenges. This paper deals with the interpretation of the high frequency time signals acquired when using accelerometer-based wearable sensors. Method. During a preliminary validation, five healthy subjects were equipped with two wireless inertial measurement units (IMUs). Using adhesive tape, these IMU sensors were attached to the thigh and shank respectively. All subjects performed a series of supervised activities of daily living (ADL) in their everyday environment (1: walking, 2: stair ascent, 3: stair descent, 4: sitting, 5: laying, 6: standing). The supervisor timestamped the performed activities, such that the raw IMU signals could be uniquely linked to the performed activities. Subsequently, the acquired signals were reduced in Python. Each five second time window was characterized by the minimum, maximum and mean acceleration per sensor node. In addition, the frequency response was analyzed per sensor node as well as the correlation between both sensor nodes. Various machine learning approaches were subsequently implemented to predict the performed activities. Thereby, 60% of the acquired signals were used to train the mathematical models. These models were than used to predict the activity associated with the remaining 40% of the experimentally obtained data. Results. An overview of the obtained prediction accuracy per model stratified by ADL is provided in Table 1. The Nearest Neighbor and Random Forest algorithms performed worse compared to the Support Vector Machine and Decision Tree approaches. Even for the latter, differentiating between walking and stair ascent/descent remains challenging as well as differentiating between sitting, standing and laying. The prediction accuracies are however exceeding 90% for all activities when using the Support Vector Machine approach. This is further illustrated in Figure 1, indicating the actual versus predicted activity for the validation set. Conclusions. In conclusion, this paper presents an evaluation of different machine learning algorithms for the classification of activities of daily living from accelerometer-based wearable sensors. This facilitates evaluating a patient's ability to walk, climb or descend stairs, stand, lay or sit on a daily basis, understanding how active the patient is overall and which activities are routinely performed following
Aim. Dexamethasone is often used as part of multimodal analgesia to prevent postoperative nausea and vomiting (PONV) and also to reduce postoperative pain. Because glucocorticoids have immunosuppressive and glucose-rising effects, the aim of current study was to examine if dexamethasone may be used safely in
Orthopaedic surgeries are complex, frequently performed procedures associated with significant haemorrhage and perioperative blood transfusion. Given refinements in surgical techniques and changes to transfusion practices, we aim to describe contemporary transfusion practices in orthopaedic surgery in order to inform perioperative planning and blood banking requirements. We performed a retrospective cohort study of adult patients who underwent orthopaedic surgery at four Canadian hospitals between 2014 and 2016. We studied all patients admitted to hospital for nonarthroscopic joint surgeries, amputations, and fracture surgeries. For each surgery and surgical subgroup, we characterized the proportion of patients who received red blood cell (RBC) transfusion, the mean/median number of RBC units transfused, and exposure to platelets and plasma.Aims
Methods