Introduction. The purpose of this study is to evaluate the radiological and clinical outcomes in Northern Ireland of free vascularised fibular bone grafting for the treatment of humeral bone loss secondary to osteomyelitis. Upper limb skeletal bone loss due to osteomyelitis is a devastating and challenging complication to manage for both surgeon and patient. Patients can be left with life altering disability and functional impairment. This limb threatening complication raises the question of salvage versus amputation and the associated risk and benefits of each. Free vascularised fibula grafting is a recognised treatment option for large skeletal defects in long bones but is not without significant risk. The benefit of vascularised over non-vascularised fibula grafts include preservation of blood supply lending itself to improved remodeling and osteointegration. Materials & Methods. Sixteen patients in Northern Ireland had free vascularised fibula grafting. Inclusion criteria included grafting to humeral defects secondary to osteomyelitis. Six patients were included in this study. Patients were contacted to complete DASH (Disabilities of the Arm, Shoulder and Hand) questionnaires as our primary outcome measure. Secondary outcome measures included radiological evaluation of osteointegration and associated operative complications. Complications were assessed via review of Electronic Care Record outpatient and in-patient documents

Aims. 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. Methods. 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. Results. Of 2,895 surgeons contributing to the NJR in 2023, 102 (4%) were female. The highest proportions of female surgeons were among those who performed elbow (n = 25; 5%), shoulder (n = 24; 4%), and ankle (n = 8; 4%) arthroplasty. Hip (n = 66; 3%) and knee arthroplasty (n = 39; 2%) had the lowest female representation. Female surgeons had been practising for a median of 10.4 years since specialist registration compared to 13.7 years for males (p < 0.001). Northern Ireland was the region with the highest proportion of female arthroplasty surgeons (8%). A greater proportion of male surgeons worked in private practice (63% vs 24%; p < 0.001) and in multiple hospitals (74% vs 40%; p < 0.001). Conclusion. Only 4% of surgeons currently contributing cases to the NJR are female, with the highest proportion performing elbow arthroplasty (5%). Female orthopaedic surgeons in the NJR are earlier in their careers than male surgeons, and are less involved in private practice. There is a wide geographical variation in the proportion of female arthroplasty surgeons. Cite this article: Bone Jt Open 2024;5(8):637–643

Objectives. Neurogenic intermittent claudication secondary to lumbar spinal stenosis is a posture dependant complaint typically affecting patients aged 50 years or older. Various treatment options exist for the management of this potentially debilitating condition. Non-surgical treatments: activity modification, exercise, NSAIDs, epidural injections. Surgical treatment options include decompression surgery and interspinous process device surgery. Interspinous process decompression is a relatively new, minimally invasive, stand-alone alternative to conservative and standard surgical decompressive treatments. The aim of this review is to evaluate the use of the X-Stop interspinous implant in all patients with spinal stenosis who were managed using the device in Northern Ireland up to June 2009. Method. We performed a retrospective review of all patients who had the X-Stop device inserted for spinal stenosis by all consultant spinal surgeons in Northern Ireland. Patient demographics, clinical symptomatology, investigative modality, post-operative quality of life, cost effectiveness, complications and long-term outcomes were assessed. Information was collected from patients using a questionnaire which was posted to them, containing the SF-36 generic questionnaire and some additional questions. Results. A total of 23 patients underwent X-stop insertion in Northern Ireland at the time of this review, 19 patients returned their questionnaires and of these 17 were completed in full and therefore included. The mean age of the study population was 60.1 years and all patients included in the study had symptoms of neurogenic claudication secondary to lumbar spinal stenosis confirmed on MRI scan. The average hospital stay was 1.5 days compared to 7.5 days for decompressive laminectomy patients. Also, at a mean follow-up of 17.8 months, 2 patients suffered direct complications of device insertion requiring removal of the implant both of these patients agreed that they would undergo the operation again in the future. SF-36 scores indicate a quality of life improvement which equates to that of other popular orthopaedic operations such as total hip and total knee replacement. X-stop insertion has been shown to be much more cost-effective than decompressive laminectomy in previous studies. Conclusion. Decompression of the lumbar spine with the X-stop interspinous implant device is safe, cost-effective, minimally invasive, and at least as effective at improving symptomatology from lumbar spinal stenosis. It is obviously more invasive than non-surgical techniques, but is less invasive than lumbar decompression procedures, is less destructive to surrounding tissues and if it fails to produce the desired results can be removed easily and the option remains for the patient to under decompression

Introduction. The National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man (NJR) monitors the performance of primary total hip arthroplasty (THA) implants and summarizes usage and outcomes for specific hip systems. The objectives of this study were to 1) determine if survivorship for the PROCOTYL® L acetabular cup, a hemispherical press-fit cup coated with hydroxyapatite and a metal on XLPE articulation, is significantly different from all other cementless cups in the NJR and 2) to analyze patient reported outcomes measures (PROMs) at a minimum five year follow-up for the subject cup. Methods. The database of the NJR was searched for demographic information and survivorship data for all THAs performed with the PROCOTYL® L cup (metal on XLPE) and all other cementless cups. Survivorship data for both groups was adjusted to exclude metal on metal bearings and compared for all revisions and acetabular revisions only. The Cox Proportional Hazards model for the revision risk ratio of the subject cup to all cementless cups was also calculated. Patients with the subject cup implanted for at least five years were mailed a PROMs program questionnaire consisting of the Oxford Hip, EQ-5D, and EQ VAS scores. No pre-operative PROMs scores were collected. Results. Patient demographic information for the subject system and all cementless cups is provided in Figure 1. As seen in Figure 2, the six-year survivorship for the 1,172 THAs using the subject system (97.8%) was slightly higher than the survivorship for all cementless cups (97.5%), but the difference was not statistically significant (Figure 3). The 1, 2, and 5 year survivorship for the subject cup also exceeded the survivorship of all cementless cups, but without statistically significant differences. When just the cup was revised, the subject system survivorship was similar to survivorship for all cementless cups for years 1 through 6 (Figure 2). Patients with the subject system implanted for an average of 5.73 – 5.75 years reported average Oxford Hip, EQ-5D, and EQ VAS Scores of 39.13 ± 9.93, 0.775 ± 0.273, and 75.87 ± 17.71, respectively. Conclusions. The subject acetabular cup was associated with survivorship similar to that of other cementless acetabular cups. Patients implanted with the subject system for at least five years reported what are considered satisfactory Oxford Hip, EQ5D, and EQVAS score outcomes. These results represent the first report of midterm outcomes with the subject system. For figures/tables, please contact authors directly.

Objectives. Total hip replacement is increasingly being conducted in younger and more active patients, so surgeons often use bearing surfaces with improved wear characteristics, such as ceramic on ceramic. The primary objective of this study was to determine if survivorship for a BIOLOX® delta ceramic on delta ceramic couple used with the PROCOTYL® L acetabular cup is significantly different from all other cementless cups in a large arthroplasty registry. The secondary objective of this study was to analyze patient reported outcomes measures (PROMs) of the subject cup with a minimum five year follow-up. Methods. Patient demographics and survivorship data was collected from the National Joint Registry of England, Wales, Northern Ireland, and the Isle of Man (NJR) database for all total hip replacements performed with the PROCOTYL® L cup used in combination with a delta-on-delta articulation, as well as for all other cementless cups. Survivorship data was compared for all revisions and cup revisions only and data was adjusted to exclude metal on metal articulations. The hazard ratio of the subject system to all cementless cups was also calculated with the Cox Proportional Hazards model. Patients with the subject components implanted for a minimum of five years completed Oxford Hip, EQ-5D, and EQ VAS score questionnaires. Results. The patient demographic data collected for the subject components and all cementless cups is provided in Figure 1. Six-year survivorship for the subject cup (98.6%) was similar to survivorship for all cementless cup revisions in the NJR database (98.5%), as seen in Figure 2. When the cup alone was revised, six-year survivorship of the subject cup (98.6%) and all NJR cementless cups (98.5%) was also similar. However, the subject cup survivorship remained at 98.6% from 4 to 6 years post-implantation, while survivorship for all cementless cups decreased slightly from years 4 to 6. The similarities between the revision risk of the subject system and all cementless cups in the NJR can be seen in the Cox Proportional Hazards model for revision risk ratios provided in Figure 3. Patients with the subject cup implanted for an average of 5.88 years reported Oxford Hip, EQ-5D, and EQ VAS scores of 39.60 ± 10.78, 0.801 ± 0.259, and 75.49 ± 19.25, respectively. Conclusions. The subject acetabular cup with a ceramic on ceramic articulation exhibited similar survivorship to all other cementless acetabular cups, excluding those with metal on metal bearings, in the NJR. Patients implanted with the subject system for an average of 5.88 years reported what are considered satisfactory Oxford Hip, EQ-5D, and EQ VAS scores. This survivorship and PROMs data is the first report of mid-term outcomes with the subject components

The 2011 National Hip Fracture Database (NHFD) Report has shown our institute has the fewest number of patients meeting the 36-hour target to theatre in the UK (9%) but well above the national average for review by geriatrician (42.5%) at 76%. We believe our timely medical input means patients' are more physiologically normalised prior to surgery. We aimed to review our postoperative results to see if our patients had significantly different morbidity and mortality compared to the rest of the UK. We reviewed 152 patients between the period September 2009 and September 2010. All of the patients were prospectively identified and their information was added to our hip fracture database. Using the auditing software we reviewed the patients' outcomes and compared them to national averages using figures from the NHFD. Of the 152 patients identified 13% met the 36-hour target. The average time to theatre for the study group was 89 hours. 83% of the group had a pre-operative assessment by a geriatrician. The primary reason for surgical delay was a lack of space on a theatre list (61.2%) followed by being medical unfit (16.4%). The average length of acute hospital stay was 16.4 days matching the national average while 30 Day mortality at 7.9% was (0.5%) lower than NHFD figures. We continue to try and improve our time to surgery for hip fracture patients and accept this is mostly related to limited theatre access. Deficient resources due to Northern Ireland's exclusion from the best practice tariff means we are unable to compete with the top performing units in the NHFD. While it makes humanitarian sense to expedite surgery, evidence used to determine the 36-hour target is quoted as “low quality” or “very low quality”. Our data shows no significant difference in outcomes compared to national figures

Aims

The number of females within the speciality of trauma and orthopaedics (T&O) is increasing. The aim of this study was to identify: 1) current attitudes and behaviours of UK female T&O surgeons towards pregnancy; 2) any barriers faced towards pregnancy with a career in T&O surgery; and 3) areas for improvement.

Aims

Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region.

Aims

The primary aim is to estimate the current and potential number of patients on NHS England orthopaedic elective waiting lists by November 2020. The secondary aims are to model recovery strategies; review the deficit of hip and knee arthroplasty from National Joint Registry (NJR) data; and assess the cost of returning to pre-COVID-19 waiting list numbers.

The use of robots in orthopaedic surgery is an emerging field that is gaining momentum. It has the potential for significant improvements in surgical planning, accuracy of component implantation and patient safety. Advocates of robot-assisted systems describe better patient outcomes through improved pre-operative planning and enhanced execution of surgery. However, costs, limited availability, a lack of evidence regarding the efficiency and safety of such systems and an absence of long-term high-impact studies have restricted the widespread implementation of these systems. We have reviewed the literature on the efficacy, safety and current understanding of the use of robotics in orthopaedics.

Cite this article: Bone Joint J 2015; 97-B:292–9.