Pacific people in New Zealand experience significant disparity in health outcomes. There is little known about the burden of arthritis within this community or difficulties accessing specialist orthopaedic care. This qualitative study evaluated the experiences of Pacific patients who underwent hip or knee arthroplasty with a goal to identify barriers to accessing arthroplasty for this community. We interviewed Pacific patients within the Bay of Plenty region who had received either elective hip or knee arthroplasty between 2013 and 2022. Interviews were centred on perceptions of arthritis severity, duration of symptoms, primary care and specialist interactions. Patients were encouraged to offer feedback on ways to improve this experience. We identified 6087 publicly funded primary joints performed in Tauranga hospital and 58 patients were of Pacific ethnicity. After exclusion criteria was applied, we successfully interviewed 20 patients eligible for our study. Pacific patients represented 2.9% of the of the BOP catchment but only received 0.43% of the publicly funded joints. Most reported reluctance to seek help from primary care until symptoms were present for at least a year. Most commonly cited reasons for not seeking help were fear of hospital services and lack of awareness in the community about osteoarthritis. We identified a lack of community awareness of osteoarthritis and arthroplasty among Pacific. This may result in delayed presentation to primary care and decreased utilisation of publicly funded joint surgery. It is reassuring that most patients of Pacific ethnicity who receive primary hip or knee arthroplasty report a positive experience. Public health initiatives together with positive feedback from Pacific patients who have undergone surgery will help to increase awareness of arthroplasty as an option to restore function and relieve pain

The primary goal of this study was to understand the subjective impact of a diagnosis of Simple Bone Cyst on children with regards to activity participation and psychosocial development. We aimed to explore the concepts of labeling, embodiment and activity participation to understand the impact of SBC. This was a qualitative study. Ten children between the ages of 4 and 17 years with SBC and their families participated in semi-structured interviews related to activity participation, social interactions and psychological impact of SBC. Interview questions were derived from psychology, sociology and philosophy literatures pertaining to illness and activity, sense of embodiment, self-concept and interactions with the social environment. Interviews were transcribed and analyzed using thematic analysis. First, children and families view SBC as an injury more than an illness and did not experience labeling or significant changes in embodiment. Second, SBCs cause anxiety in children related fear of fracture or pain, however normal function and activity participation were maintained. Third, there were significant shortcomings identified in the communication and the decision-making process between families and physicians regarding SBC management. SBC as a benign disease does not neatly fit into the category of illness or injury based on children's experiences. Children who previously perceived themselves as normal feel different and not normal following diagnosis with SBC. The experience of parents is largely one of anxiety, and much of that anxiety is derived from the uncertainty over the treatment plans for their child. The proposed framework of normality allows for the more temporary and fluid changes in perception experienced by the children in our study. The results of this study suggest that the current decision-making process in SBC is unsatisfactory leading to anxiety and worry. Parents felt pressure to make decisions regarding surgery without feeling that they sufficient information. Though understanding how children experience SBCs and how parents experience the treatment course of their child with SBC, we can shared decision-making as a potential way to reduce parents' anxiety and limit negative experience in children

Aim. This study was conducted to investigate the clinical outcome, functional outcome, and quality of life of patients treated for post traumatic osteomyelitis (PTO) of femur and tibia from July 2007 to June 2014. Method. Forty seven patients consented and participated in this study. The median age of participants was 44 years old, and ranges from 16 to 80 years old. There were 26 tibia and 21 femur osteomyelitis evaluated in this study. Thirty-eight participants (80.9%) had implants inserted. The PTO patients were classified according to Cierny-Mader (CM) classification: 2 CM-I; 8 CM-II; 18 CM III; 19 CM IV and 25 CM-A and 19 CM-B. The participants were follow up for a mean duration of 4.6 years (range 2.3–9.5 years). Interviews were then conducted and clinical assessments were performed to evaluate the clinical outcome. Their functional outcome was evaluated using the Lower Extremity Functional Score (LEFS) and the quality of life was evaluated using the validated SF-36v2 and the results were compared to the general population (GP). Results. Forty four (93.6%) of participants had achieved union without recurrence of infection. Others who had failure of treatment were CM-IIIA, CM-IVA, and CM-IVB. Concurrent medical problem and CM-B (Systemic) hosts significantly contributed to poorer functional outcome, and lower quality of life score especially the Physical Component domain. Conclusions. Most patients with post traumatic osteomyelitis had successful treatment. However their quality of life was poorer in comparison to the general population. Concurrent medical problem and CM-B (Systemic) hosts had significantly poorer functional outcome and quality of life than the general population

Aims

The principles of evidence-based medicine (EBM) are the foundation of modern medical practice. Surgeons are familiar with the commonly used statistical techniques to test hypotheses, summarize findings, and provide answers within a specified range of probability. Based on this knowledge, they are able to critically evaluate research before deciding whether or not to adopt the findings into practice. Recently, there has been an increased use of artificial intelligence (AI) to analyze information and derive findings in orthopaedic research. These techniques use a set of statistical tools that are increasingly complex and may be unfamiliar to the orthopaedic surgeon. It is unclear if this shift towards less familiar techniques is widely accepted in the orthopaedic community. This study aimed to provide an exploration of understanding and acceptance of AI use in research among orthopaedic surgeons.

There has been a widespread adoption of training programs or “boot-camps” targeting new surgical residents prior to entrance to the hospital environment. A plethora of studies have shown positive reactions to implementations of “boot camps”. Reaction surveys, however, lack the ability to provide a deeper level of understanding into how and why “boot camps” are seen as effective. The purpose of this study was to develop a rich perspective on the role “boot camps” are perceived to play in resident education. A constructivist approach to qualitative grounded theory methodology, employing iterative semi-structured, in-person, interviews was used to explore the construct of a “boot camp” through the eyes of key stakeholders, including junior surgical residents (n=10), senior surgical residents (n=5), and faculty members (n=5) at a major academic centre. Interviews were coded and analysed thematically using NVIVO software. Three members of the research team coded data independently and compared themes until consensus was reached. A method of constant comparative analysis was utilised throughout the iterative process. Emerging themes were revisited with stakeholders as a measure of rigor. Axial coding of themes was used to discover the overlying purposes embedded in the “boot camp” construct. The overarching themes resonating from participants were ‘anxiety reduction’, ‘cognitive unloading’ and ‘practical logistics’. Resident anxiety was ameliorated through subthemes of ‘social inclusion’, ‘group formation’, ‘confidence building’ and ‘formalisation of expectations’. A resident commented “the nuances of how things work is more stressful than the actual job.” Residents bonded together to create personal and group identities, “forming the identity of who we are as a group”, that shaped ongoing learning throughout training, “right from the beginning we would be able to call on each other.” Junior residents found themselves cognitively unloaded for higher level learning through ‘expectation setting’ and ‘formalised basic skills’; “I knew how the equipment was going to fit together, it allowed me to focus more on what was happening from the operative perspective.” Stakeholders highlighted the importance of positioning “boot camp” at the beginning of residency training, as it directly influenced the point of transition. This highlights the strength of the “boot camp” construct at targeting the challenges associated with discrete moments of transition in the advancement in practice. While surgical preparatory “boot camps” were initially born out of a competency-based framework focused on technical skill development, our findings demonstrate that the benefits outweigh simple improvement in technical ability. The formation of a learner group identity has downstream effects on resident perceptions of anxiety and confidence, while priming for higher-level learning. “Boot camp” then, is re-imagined as an experience of social professional enculturation