Aims. Our rural orthopaedic service has undergone service restructure during the COVID-19 pandemic in order to sustain hip fracture care. All adult trauma care has been centralised to the Royal Shrewsbury Hospital for assessment and medical input, before transferring those requiring operative intervention to the Robert Jones and Agnes Hunt Orthopaedic Hospital. We aim to review the impact of COVID-19 on hip fracture workload and service changes upon management of hip fractures. Methods. We reviewed our prospectively maintained trust database and National Hip Fracture Database records for the months of March and April between the years 2016 and 2020. Our assessment included fracture pattern (intrascapular vs extracapsular hip fracture), treatment intervention, length of stay and mortality. Results. We treated 288 patients during March and April between 2016 and 2020, with a breakdown of 55, 58, 53, 68, and 54 from 2016 to 2020 respectively. Fracture pattern distribution in the pre-COVID-19 years of 2016 to 2019 was 58% intracapsular and 42% extracapsular. In 2020 (COVID-19 period) the fracture patterns were 65% intracapsular and 35% extracapsular. Our mean length of stay was 13.1 days (SD 8.2) between 2016 to 2019, and 5.0 days (6.3) days in 2020 (p < 0.001). Between 2016 and 2019 we had three deaths in hip fracture patients, and one death in 2020. Hemiarthroplasty and dynamic hip screw fixation have been the mainstay of operative intervention across the five years and this has continued in the COVID-19 period. We have experienced a rise in conservatively managed patients; ten in 2020 compared to 14 over the previous four years. Conclusion. There has not been a reduction in the number of hip fractures during COVID-19 period compared to the same time period over previous years. In our experience, there has been an increase in conservative treatment and decreased length of stay during the COVID -19 period. Cite this article: Bone Joint Open 2020;1-8:500–507

Musculoskeletal disorders have been recognised as common occupational risks for all orthopaedic surgeons. The nature of tasks performed by hip surgeons often requires both forceful and repetitive manoeuvres, potentially putting them at higher risk of musculoskeletal injuries compared to other orthopaedic sub-specialities. This study aimed to investigate the prevalence of musculoskeletal conditions among hip surgeons and evaluate the association between their workplace and lifestyle factors and musculoskeletal health. An online questionnaire consisting of 22 questions was distributed to UK-based consultant hip surgeons via email and social media platforms. This survey was completed by 105 hip surgeons. The mean age of the respondents was 49 years (range 35–69), with an average of 12 years (range 1–33) in service. 94% were full-time and 6% worked part-time. 49% worked at a district general hospital, 49% at a tertiary centre and 4% at a private institution. 80% were on the on-call rota and 69% had additional trauma commitments. 91% reported having one or more, 50% with three or more and 13% with five or more musculoskeletal conditions. 64% attributed their musculoskeletal condition to their profession. The most common musculoskeletal conditions were base of thumb arthritis (22%), subacromial impingement (20%), degenerative lumbar spine (18%) and medial or lateral epicondylitis (18%). 60% stated that they experienced lower back pain. Statistical analysis showed that being on the on-call rota was significantly (P<0.001) associated with a higher musculoskeletal burden. Regular resistance and/or endurance training and BMI<30 were statistically significant protective factors (P<0.001). Over the last few decades, most of the hip-related literature has focused on improving outcomes in patients, yet very little is known about the impact of hip surgery on the musculoskeletal health of hip surgeons. This study highlights a high prevalence of musculoskeletal conditions among UK-based hip surgeons. Hip surgeons have a pivotal role to play in the ongoing recovery of elective orthopaedics services. There is a pressing need for the identification of preventative measures and improvement in the surgical environment of our hip surgeons

There is sufficient evidence that specialised orthopaedic services, in the form of ‘hub’ or specialist centres, which undertake a high volume of workload in revision arthroplasty generate superior outcomes. The East Midlands South Orthopaedic Network (EMSSON) was set up in 2015 and is an example of a ‘hub and spoke’ network. The network has recently undergone adaptation in light of the COVID-19 pandemic. There is paucity of data considering the impact of such adaptations in a post-pandemic era and on adherence to advice given. Two data sets were obtained from the EMSSON data base, pertaining to pre and post pandemic eras respectively. Datasets were analysed and compared for case volumes, proportion of overall arthroplasty volume discussed and adherence to agreed management plans. Dataset one included 107 cases, of these 99 cases were discussed (54 knees and 45 hips). This equates to 35% of total revision arthroplasty volume recorded in the National Joint Registry (NJR), by units involved in the network. A change of plan was recommended in 45/99 cases (45%), of these 41 (93%) were adhered to. Dataset two included 99 cases, of these 98 were discussed (39 knees and 59 hips). This equates 68% of revision arthroplasty volume performed by the region according to NJR records. A change in plan was recommended in 20 cases (20.5%), all of which were adhered to. One case was referred to the ‘hub’ for surgery. Following the implementation of recent adaptations, the efficiency of the EMSSON network has significantly improved. A greater volume and proportion of revision arthroplasty cases are now being discussed on a weekly basis. Management plans for which adaptations are suggested have decreased, indicating an educational value of such networking practices. Adherence to agreed plans also showed improvement (p<0.03). These findings demonstrate a trend towards NHS England's target of 100% of revision arthroplasty cases undergoing MDT discussion. Changes made in light of the Covid-pandemic, are felt to have contributed significantly to the overall performance of regional networking and have been well received by consultants involved

Introduction. Rationing of orthopaedic services is increasingly being used by Care Commissioning Groups (CCG) within the United Kingdom to restrict the numbers of patients being referred for Total Hip Arthroplasty (THA). In Devon, only patients with an Oxford Hip Score (OHS) less than 20 are referred on for specialist Orthopaedic Review. The aim of this study was to look at long term outcomes after THA to see if this rationing has any rational base to justify its use. Methods. Consecutive patients undergoing THA in Exeter between 1996 and 2012 had OHS' collected prospectively pre-operatively and a minimum of 4 years post-operatively. These scores were analysed looking for trends in patient related outcome scores. Results. 2341 patients had an OHS at a minimum of 4 years' post-op (mean 4.97 years, SD 0.33, range 4.0–5.5). This accounted for just under 50% of patients operated on in this period. Average improvement in OHS post THA was 19.6 points (range 0–44). 45.7% of patients undergoing THA had a pre-operative OHS of greater than the CCG threshold of 20. Patients did have a significantly better increase in post-operative OHS when their starting score was less than 20 but patients above this threshold still had a significant benefit from THA. However, patients with a pre-operative OHS less than 32 seemed to have more benefit from THA compared to those with a pre-op OHS of greater than 32. Interesting 7.8% of patients did not achieve the mean detectable change of 5 points in OHS at a minimum of 4 years' post THA. Conclusion. Rationing has been introduced in many CCG's around the country. Little of the rationing decisions have their basis in scientific fact and reasoning. Our data would suggest that 92.2% of patients undergoing THA have excellent outcomes. If rationing were to be fully patient centred all patients with an OHS less than 32 should be considered for THA

Introduction. Between 2005 and 2010, the number of revision hip arthroplasties rose by 49.1%, and revision knee arthroplasties by 92.1%. This number is predicted to rise by 31% and 332% respectively by 2030. In March 2014, NHS England invited bids to run a pilot revision network. Nottingham Elective Orthopaedic Service (NEOS) was successful and the East Midlands Specialist Orthopaedic Network (EMSON) runs on a ‘hub-and-spoke’ model. Patients/Materials & Methods. All patients within the EMSON area requiring revision arthroplasty are discussed at a weekly meeting. The meeting is chaired by a revision hip and knee surgeon and attended by arthroplasty surgeons and an orthopaedic microbiologist. Other specialties are available as required. EMSON discussions and a proposed management plan are recorded, signed by the Chair and returned as a permanent record in the patient's notes. Results. To date, 255 arthroplasties in 253 patients have been discussed. 131 have been for revision hip arthroplasties. Two patients had both problematic hip and knee replacements. In 47% of the cases there was a recommendation to change the management plan. Several of these changes have been significant. 4% of cases have been transferred to NUH for revision surgery. In 35% of cases extra loan kit was likely to be required, predominantly in the spoke hospitals. Discussion. Although we have not seen many patients transferred to NEOS, we have seen a 20% increase in tertiary referrals from the spoke hospitals. Surgeons taking part in EMSON have expressed their satisfaction with the support received from EMSON. Conclusion. Discussing these complex cases supports revision surgeons in the region and is likely to improve patient care. We note a high number of changes to the management plan and an increase in direct referrals to NEOS. EMSON has been well received and we recommend this approach to other regions

Young Adult Hip [YAH] pathology is now better recognised and treated than decades ago. However, our patients have suggested to us that they encountered delays in recognition and referral. For the past four years incoming referrals of YAH have been questioned away from the ROH clinic environment in groups of 100 incoming referrals by TS Gambling, Senior Lecturer in Psychology. Time from onset of symptoms to clinic attendance; number of GP visits; Consultants seen before accurate diagnosis; validity of earlier investigations; severity and effects of symptoms on their daily lives and careers; social effects; body image; self-confidence; oxford hip scores. The median age was 28 years; the mean delay in being seen at a YAH clinic was 8.3–8.6 years. The mean number of consultants seen before the YAH clinic was 2.3 – 2.6. Fewer than 5% were properly investigated by these consultants. The mean oxford hip score was 30; in only 8% was it less than 20, the common level for hospital referral. 22% were unable to work. In 8% their career was unaffected. Although 70% were working or pursuing a career, almost all required adaptations /redeployment to sedentary work/Long-term sickness testing employers' tolerance/Intermittent sickness/putting off promotion/ further education/part time working/change of career. Only 8% were unaffected at work. In addition, there were profound social effects upon self-esteem, body image, relationships, as well as comfort during sex. These results do not make comforting news. In addition to the above difficulties, all our patients expressed; Powerlessness; Frustration; Anger; Not being listened to; being unsupported; Undermined; Humiliation. The family doctor/ GP services are poor at appreciating the disability in YAH patients. YAH onset is characteristically at 19.5 years, just when youngsters are becoming independent and self-reliant. The OHS is an invalid/misleading discriminator in these patients when considering referral. The hospital orthopaedic service is poor at recognising and investigating YAH disease

Aims

The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates.

Aims

Our objective was describing an algorithm to identify and prevent vascular injury in patients with intrapelvic components.

Aims

While interdisciplinary protocols and expedited surgical treatment improve the management of hip fractures in the elderly, the impact of such interventions on patients specifically undergoing arthroplasty for a femoral neck fracture is not clear. We sought to evaluate the efficacy of an interdisciplinary protocol for the management of patients with a femoral neck fracture who are treated with an arthroplasty.

Aims

This study aims to assess the feasibility of conducting a pragmatic, multicentre randomized controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery.

Aims

The primary aim was to determine the influence of COVID-19 on 30-day mortality following hip fracture. Secondary aims were to determine predictors of COVID-19 status on presentation and later in the admission; the rate of hospital acquired COVID-19; and the predictive value of negative swabs on admission.

Objectives

The purpose of this study was to compare the thickness of the hip capsule in patients with surgical hip disease, either with cam-femoroacetabular impingement (FAI) or non-FAI hip pathology, with that of asymptomatic control hips.