Introduction. Legg-Calve-Perthes (Perthes Disease) was first recognised by three physicians, Arthur Legg (1874–1939), Jacqui Calve (1875–1954) and George Perthes (1869 – 1927) in 1910. Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the femoral head is disrupted. Without this blood supply, the bone cells die and avascular necrosis can occur. The Herring classification is used to diagnose the stages of Perthes Disease. It is an important prognostic factor. There are three classifications, Herring A, B and C. Herring A has no involvement of the lateral pillar with no density changes noted on x-ray. Herring B has at least 50% of the lateral pillar height maintained on x-ray. Herring C has less than 50% of the lateral pillar height on x-ray (Herring et al, 1992). Children with Perthes disease require specialist Limb Reconstruction team throughout their treatment journey, this includes Orthopaedic surgery and therapy (Physiotherapy and Occupational Therapy). The National Limb Reconstruction Therapy Team is based at the National Orthopaedic Hospital, Cappagh. The therapy team consists of 1 Clinical Specialist Physiotherapist, 1 Senior Physiotherapist and 1 Senior Occupational Therapist who provide input to this cohort. This study aims to analyse the importance of a comprehensive pre-operative assessment by the therapy team (Physiotherapist and Occupational Therapist) to maximise patient outcomes post operatively. Methodology. This is a quantitative research study conducted by the National Limb Reconstructive Therapy Service of the National Orthopaedic Hospital in Cappagh, Dublin. The inclusion criteria for this study consisted of:. Age – Patient must be part of the Paediatric Service, i.e., under the age of 16. Diagnosis – Patient must have a diagnosis of Perthes Disease with a Herring Classification documented. Application of a Hip Distractor Frame formed part of the patient's surgical management. Surgery was completed by Mr Connor Green. Surgery was completed between January 2021 and December 2022. Patient were required to have their external hip distractor frame removed by December 2022. Exclusion Criteria: Those not meeting the above inclusion criteria. Following the inclusion criteria, a number of cases were identified of which 10 cases were selected at random. A retrospective analysis of these samples was completed. The medical charts were reviewed as well as patient electronic healthcare records. Microsoft Excel was utilised to analyse the data and capture results. Results. From analysing the data, the following results were identified:. 80% of the sample cohort had a length of stay of 5 days following surgery. There were two outliers due to infection who had a length of stay of 14 days. 90% of the sample received a pre-operative Physiotherapy and
Introduction. The number of hip fracture admissions is rising; with reduced hospital bed capacity and increasing patient numbers, care pathways must be optimised to maximise inpatient bed efficiency. There is currently significant interest in improving healthcare services across all 7 days in the United Kingdom. It is unclear whether lack of allied healthcare professional review at the weekend is detrimental to hip fracture patient care. This study aims to examine whether providing 7-day physiotherapy and
The availability of seven-day NHS services for patients is currently receiving widespread national attention. Rehabilitation services including physiotherapy and
In 2008 The Christie was chosen by Manchester United Football Club to form a unique partnership. This funded a specialist Physiotherapist and Occupational Therapist to work exclusively on the Young Oncology Unit, creating the first posts of their kind in the UK. The YOU treats patients between 16–24 years old with a diagnosis of cancer, sarcoma being one of the most common in this age group. All patients attending the YOU now receive a fully comprehensive Physiotherapy and
The February 2024 Wrist & Hand Roundup. 360. looks at:
Background. To aid recovery, rehabilitation is an important adjunct to surgery. Acknowledging the MRC framework for complex interventions we assessed the evidence-base for components of comprehensive rehabilitation in total hip (THR) and total knee replacement (TKR) pathways. Methods. We conducted systematic reviews and meta-analyses of randomised controlled trials (RCT) of pre-surgical exercise and education,
In Asia, traditional bands are placed around limbs of children to ward off evil spirits and ensure good health. This practice may lead to the Rubber Band Syndrome (RBS) a rare paediatric condition described mainly in Asia which results from a forgotten thread or elastic band applied to the limb of a child. Because pressure necrosis beneath the band is slow, rapid healing of tissues over the band can obscure its presence. This makes the condition difficult to diagnose and distinguish from other infective conditions. This study presents the first case of RBS reported in South Africa. Case: The patient aged 18 months presented with a swollen hand, circumferential scar and discharging sinus on the wrist. A radiograph was negative. In theatre the volar wound was explored. Debridement revealed a yellow rubber band deep to the wrist flexors and neurovascular bundles but superficial to the extensor retinaculum. Complete removal of the rubber band and antibiotics was followed by rehabilitation with
Background and Aims:. In 2009 a combined clinic was formed by the orthopaedic Surgeons and Developmental Paediatricians in our hospital. The aim was to help improve the assessment and management of patients with Cerebral Palsy. Included in the assessment team, are the paediatric orthopaedic surgeons, the developmental paediatricians, physiotherapists and occupational therapists. Our aim was to audit the patients presenting to this clinic over a 15 month period to look at the demographic data, clinical severity and decisions taken for these patients. Methods:. We looked at patients seen in the clinic from January 2013 to March 2014. We recorded the age, gender and primary caregiver. We also recorded the reason for referral. Clinically we wanted to know the type and distribution of the CP, GMFCS score, attainment of milestones and type of schooling. We recorded underlying aetiologies and HIV status of the patients. Finally the access the patients had to physiotherapy and
Introduction. Current CMS reimbursement policy for total joint replacement is aligned with more cost effective, higher quality care. Upon implementation of a standardized evidenced-based care pathway, we evaluated overall procedural costs and clinical outcomes over the 90-day episode of care period for patients undergoing TKA with either conventional (Conv.) or robotic-assisted (RAS) instrumentation. Methods. In a retrospective review of the first seven consecutive quarters of Bundled Payment for Care Improvement (BPCI) Model 2 participation beginning January 2014, we compared 90-day readmission rates, Length of Stay (LOS), discharge disposition, gains per episode in relation to target prices and overall episode costs for surgeons who performed either RAS-TKA (3 surgeons, 147 patients) or Conv. TKA (3 surgeons, 85 patients) at a single institution. All Medicare patients from all surgeons performing more than two TKA's within the study period were included. An evidence-based clinical care pathway was implemented prior to the start of the study that standardized pre-operative patient education, anesthesia, pain management, blood management, and physical/
Purpose of Study/Background. To identify whether patients were satisfied with the overall educational component of the specialist nurse (CNS)/occupational therapist (OT) led pre-operative assessment clinic in order to identify areas which required improvement. The pre-operative specialist nurse led clinic was set up in 2002. The aim was to provide high quality information to patients undergoing elective spinal surgery in order to manage expectations and optimise post-operative recovery. Initially the clinic was specialist nurse led however, in 2006
Around 1% of the 185,000 primary hip and knee arthroplasties performed in the UK are followed by prosthetic joint infection (PJI). Although PJI affects a small percentage of patients, it is one of the most devastating complications associated with this procedure. Treatment usually involves further major surgery which can adversely affect patients' quality of life. Understanding current service provision provides valuable information needed to design and evaluate support interventions for patients. The aim of this survey was to identify usual care pathways and support in UK NHS orthopaedic centres for this population. The 20 highestvolume UK NHS orthopaedic centresfor hip and knee arthroplasty account for 33–50% of all cases treated for prosthetic joint infection. Infection leads at each centre were invited to participate in a survey about usual care provision and support for PJI. Questions exploredfollow up time-points; use of standard outcome measures; multidisciplinary care plans; supportive in-patient care and care after treatment; and onward referrals. Survey responses were recorded on a standardised proforma. Data were entered into Excel for analysis, then reviewed and coded into categories and frequency statistics to describe categorical data. A descriptive summary was developed based on these categories. Eleven of the highestvolume orthopaedic centres completed the survey. Follow-up of patients varied greatly across centres; some centres reviewed patients at weekly or 2 week intervals, while all centres saw patients at 6 weeks. Long-term follow-up varied across centres from 3–4 monthsto 12 monthly. Length of follow-up period varied from until the infection had cleared toindefinitely. Follow-up timepoints were only standardised in 4 out of 11 centres. Only 1 centre had a dedicated infection clinic. Advice on who patients should contact if they had concerns included the consultant, community nurse, extended scope practitioner or the ward, while 3 centres told patients to avoid calling their GP. Only half of the centres routinely used standardised outcome measures with patients with PJI. The majority of centres provided standard physiotherapy and
To collate and present epidemiological data collected by Scottish National Brachial Injury Service over the past decade. The Brachial Plexus Injury Service is based at the Victoria Infirmary, Glasgow and has been a designated National Service since 2004. It provides an integrated multidisciplinary service for traumatic brachial plexus injury and plexus tumours. The Service maintains an active archive recording details of all clinical referrals and procedures conducted by the Service over the past decade. The data presented here was derived from analysis of this database and information contained in the National Brachial Plexus Injury Service Annual Report 2010/11 & 2011/12. Data shows that there has been a steady rate in the number of referrals to the Service, particularly since 2004, with an average of 50 cases referred per annum. Of these, approximately 25% required formal surgical exploration for traumatic injury and a further 10% required surgery for brachial plexus tumour removal. The vast majority of referred cases are treated non-operatively, with appropriate support from specialist physiotherapy and
Introduction: Recent studies have shown that Minimally Invasive Total Hip Replacements (MISTHRs) have not reduced hospital stay. We seek to demonstrate the importance of infrastructure allowing early mobilisation and discharge thereby gaining the full benefits of MISTHRs. We compared the early outcomes of 2 units where MISTHRs were carried out by the same surgical teams but had 2 different infrastructure set-ups. In the first unit a “Short Stay Programme” (SSP) was in place. This involved early pre-operative assessment by medical, physiotherapy and
Introduction. The number of revision hip arthroplasty procedures is rising annually with 7852 such operations performed in the UK in 2010. These are expensive procedures due to pre-operative investigation, surgical implants and instrumentation, protracted hospital stay, and pharmacological costs. There is a paucity of robust literature on the costs associated with the common indications for this surgery. Objective. We aim to quantify the cost of revision hip arthroplasty by indication and identify any short-fall in relation to the national tariff. Methods. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1998 and 2008. These operations were categorised by indication into: aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical data included length of stay, operative time, estimated blood loss, prosthesis and instrumentation required. Financial data was collected on cost of implants, materials and augmentation utilised at time of surgery, operating room costs, recovery, inpatient stay, physiotherapy,
Purpose. A comparison of patient satisfaction of service provided by independent sector treatment centres versus an index NHS hospital in total knee replacement surgery. Methods. Patients were all initially listed for total knee replacement (TKR) by a single consultant from the index NHS hospital, Derbyshire Royal Infirmary (DRI). Patients were sent a postal questionnaire and asked to rate the TKR service provided by a given hospital, based on recent inpatient experience. Questions covered quality of care delivered by hospital staff and quality of ward environment. Overall satisfaction was rated. Patients electing surgery under Patient Choice at an independent sector treatment centre (ISTC) were asked about factors that influenced their hospital choice. 100 consecutive patients undergoing TKR at DRI and 100 patients choosing ISTC hospitals were identified. All surgery occurred between April 2003 and September 2006. Results. Questionnaire response rates were 79% for DRI patients and 54% for ISTC. Overall patient satisfaction for TKR service was 95% for DRI and 87% for ISTC. An equal 61% rated the surgeons as excellent in both DRI and ISTC hospitals. Nurses and physiotherapists (& occupational therapists) both scored more highly in ISTC groups (Nurses 69% v 45%; physio/OT 57% v 35%). Ward environment rated excellent in 73% for ISTC and 24% for DRI. The most common reason for choosing ISTC was shorter waiting list (42%). Conclusion. ISTC hospitals scored more highly in terms of nurses, physiotherapy &
Our aim was to assess the impact of the increasing number of patients on orthopaedic waiting lists on general practitioners in New Zealand. A 10-point questionnaire was developed in association with the General Practice Department at the Wellington School of Medicine, and mailed to 250 randomly chosen general practitioners around New Zealand. One hundred and fifty general practitioners returned the survey. Sixty three per cent of general practitioners reported having between eleven and thirty patients on an orthopaedic waiting list in their practice. 85% of general practitioners reported spending up to an extra 6 hours per month looking after problems caused by having to provide extra care for the patients. In 90% of cases general practitioners reported that their patients required considerably greater community support in the form of extra physiotherapy, meals-on-wheels and
Purpose: Evaluation of a hands free crutch. This interesting device is intended for patients who have undergone foot and ankle surgery and should be non-weight bearing. It involves a knee tray attached to a vertical beam with a rubber foot. The crutch is strapped to the lower limb and weight is transferred though the proximal tibia. Methods: Five Volunteers were assessed using the crutch, the K9 walker and 2 standard crutches in a simulated environment. A comparison was made between this device and the K9 walker which has been shown to be a liberating walking aid indoors. Tasks from activities of daily living, productivity and transfers were included. Assessment was undertaken by the
Multiple secondary surgical procedures of the shoulder, such as soft-tissue releases, tendon transfers, and osteotomies, are described in brachial plexus birth palsy (BPBP) patients. The long-term functional outcomes of these procedures described in the literature are inconclusive. We aimed to analyze the literature looking for a consensus on treatment options. A systematic literature search in healthcare databases (PubMed, Embase, the Cochrane library, CINAHL, and Web of Science) was performed from January 2000 to July 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The quality of the included studies was assessed with the Cochrane ROBINS-I risk of bias tool. Relevant trials studying BPBP with at least five years of follow-up and describing functional outcome were included.Aims
Methods