For all the research into arthroplasty, provision of total knee arthroplasty (TKR) services based on gender in the Australian context is yet to be explored. International literature points toward a heavily gender biased provision of TKA services, skewed away from female patients. This research has aimed to assess the current experience of Australian female patients and to explore better assessment techniques that could provide more equitable services. A retrospective cohort analysis has been conducted using pre-op PROMs data, where available, from the Australian National Joint Replacement Registry (AOANJRR), between 7 August 2018 and 31 December 2021, including: EQ VAS Health; Oxford Knee Score; joint pain; and KOOS-12. Data was adjusted for age, ASA score, BMI, primary diagnosis, public vs private hospital, surgeon gender and years of practice (as estimated from years of registry data available). Of 1,001,231 procedures performed, 27,431 were able to be analysed (12,300 male and 15,131 female). Gender-based bias against female patients reached statistical significance across all PROM scores, according to the Kruskal-Wallis test of difference (p-value <0.0001). Males were more likely to undergo TKR than females, with odds ratios remaining statistically significant when adjusted for age, ASA score, BMI, primary diagnosis, and hospital type. Numbers were further analysed for surgeon years of recorded practice and surgeon gender with mixed results. This study found that women were less likely to undergo TKR despite worse scores on every pre-op PROM available, thus we demonstrate a statistically significant gender-based bias against female patients. More effort needs to be made to identify the base of this bias and find new ways to assess patients that can provide more equitable provision of healthcare

Higher levels of socioeconomic deprivation have been associated with worse health outcomes. The influence of socioeconomic deprivation on patients undergoing periacetabular osteotomy (PAO) has not previously been investigated. A total of 217 patients (171 female, 46 male; median age 23.4 years) who underwent PAO by a single surgeon were identified. Patients were categorised into three groups according to their New Zealand Deprivation (NZDep) Index: minimal deprivation (NZDep Index 1–3, n=89), moderate deprivation (NZDep Index 4–6, n=94), and maximal deprivation (NZDep Index 7–10, n=34). The three groups were compared with respect to baseline variables, surgical details, complications, and pre-operative and two-year post-operative functional scores (including International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, and University of California Los Angeles (UCLA) activity score). Multivariate regression was undertaken to assess for the effect of NZDep Index on patient outcomes. Patients in the maximal deprivation group were more likely to be Māori (p<0.001) and have surgery in a public rather than a private hospital (p=0.004), while the minimal deprivation group demonstrated a lower BMI (p=0.005). There were otherwise no other significant differences in baseline variables, surgical details, complications, nor pre-operative or two-year post-operative functional scores between the three groups (all p>0.05). Multivariate analysis identified a higher NZDep Index to be independently predictive of a lower pre-operative UCLA activity score (p=0.014) and a higher two-year iHOT-12 score (p<0.001). Our results demonstrate an inequality in access to PAO, with patients exposed to higher levels of socioeconomic deprivation under-represented in our study population. When provided access to PAO, these vulnerable patients achieve significant functional improvement at least as great as patients with less socioeconomic deprivation. Initiatives to improve access to hip preservation care in socioeconomically deprived populations appear warranted

Total hip arthroplasty (THA) has high rates of patient satisfaction; however patient expectations for recreational and sporting activities are not always met. Our study aimed to identify preoperative factors that predict whether patient expectations for sporting or recreational activity are met 12 months following THA. Patient reported outcome measures (PROMs) were collected prospectively from 2015-2018 at one private hospital in Sydney. Age, gender, postcode, weight, and height were recorded preoperatively. Included participants underwent primary THA by one of the investigating surgeons. Univariable and multivariable analyses were performed with an expectation fulfilment score used as the primary outcome variable. Preoperative predictor variables included: age, gender, BMI, Socio-economic Indexes for Areas (SEIFA), Oxford Hip Score, Hip Osteoarthritis Outcome Score, EQ-5D-5L and EQ Visual Analogue Scale (EQ VAS). 1019 participants were eligible and included. 13% reported that preoperative expectations of sport or recreation were not met at 12 months. Younger age, lower preoperative EQ VAS, and higher BMI were associated with failed expectations on multivariable analysis. Odds of failed expectations increased by 2% for every one year younger in age (OR= 0.98, 95% CI = 0.96 to 1.00, p=.048), by 2% for every one point lower on EQ VAS (OR=0.98, 95% CI = 0.98 to 0.99, p=.002), and by 4% for every one-point increase in BMI (OR = 1.04, 95% CI = 1.00 to 1.09, p=.042). Failure to have expectations met for sporting or recreational activity was associated with younger age, poorer general health, and high BMI. With a rise in younger patients who likely have higher physical demands, a tailored preoperative education is preferable to generic models to better manage patient expectations. Younger age, higher BMI, and poorer health may predict unmet expectations for sport and recreation after THA. Tailored education in these groups should be considered

Introduction. Total Knee Arthroplasty (TKA) is a proven successful and cost-effective method to relieve pain and improve joint function and quality of life in patients with advanced knee arthritis. However, after a TKA, only 75 to 89% of patients are satisfied. Since patient satisfaction is one of the main objectives of elective orthopaedic surgery, it is important to investigate the reasons for dissatisfaction and develop remedial strategies. Objectives. The aims of the current project are to investigate patient satisfaction after TKA and establish physical, mental and social determinants of patient satisfaction and overall socio-economic costs associated with unsatisfactory outcome. The global objective is to identify patients most likely to benefit from primary TKA, establish optimal evidence-based indications and timing for TKA, and address the necessity to educate patients preoperatively towards realistic expectations or propose alternative therapies. Based on the results, a composite score for patient selection will be developed using objective and subjective parameters. Cut-off values for acceptable indications for TKA will be proposed. Methods. General determinants of patient satisfaction are first investigated in a retrospective and prospective survey of TKA. Expectations regarding the global benefit of TKA, postoperative pain and difficulties are evaluated. Psychological tests assessing the ability of patients to cope with pain are performed. Objective clinical and radiographic parameters, patient reported outcomes and satisfaction are compared between subgroups based on (1) patient intrinsic factors such as gender and age, BMI, co-morbidities, general physical and mental health, activity, level of education and socio-economic situation, (2) implant factors, (3) surgery and surgical experience related factors. Subsequently, a randomized controlled trial of 330 consecutive primary TKAs using 3 contemporary implants of different design concepts will be carried out. Evaluation will be double-blinded (immediately preoperative randomisation, patient blinded, postoperative observer blinded). In addition, a surgeon's assessment of subjective technical difficulty will be performed. A university/teaching hospital setting will be compared with a private hospital and the influence of the surgeon on the level of patient satisfaction will be assessed. Results. Intermediate evaluation of the study revealed extensive logistic difficulties in setting up such a large scale trial and in motivating patients, nursing and medical staff to participate and sustain the necessary commitment and discipline to collect all necessary data at all follow-up intervals. Patients often felt overwhelmed by a multitude of clinical scores and technical assessments leading to a decrease in study compliance and rapid loss to follow-up. Motivation proved easier in a smaller private hospital environment. At the university hospital, patient involvement was enhanced by a personalized approach with information sessions in small groups. The introduction of a new software system with direct patient input via touch screens or remote online completion of scores reduced the data input burden. Scores are examined for simultaneous digital answering of overlapping questions. Conclusions. A large scale trial to investigate longer term patient satisfaction after TKA and establish its determinants involves continuous motivation and sustained discipline of patients and staff. A personalized approach and digital patient reported outcomes prove to maximize data acquisition

Rural surgical practice in Australia provides a unique environment to the Orthopaedic Surgeon. Whilst most of the work load mimics that of city practice, the rural surgeon has little choice but to master a broad schema of surgical skills, and keeping up with the current literature and techniques can be challenging. At our public hospital over the last audited twelve month period, 108 primary total knee replacements were performed by 4 surgeons out of 236 joint replacements including revision surgeries. At the Private hospital a total of 215 joint replacements were performed in the same period including revision surgeries, of which 127 were knee arthroplasties. It is recognised that the incidence of complications from arthroplasty can be increased in low volume joint replacement surgeons. This centre is a mid volume centre, but rural and generally underfunded. In light of this, it is not unreasonable to look at techniques or evolving technologies that may improve the ability of an individual surgeon to position a joint replacement in an optimal position and with economic consideration. Conventional navigation has a number of factors associated with it that may make its use in a rural centre less attractive. These include capital cost of both hardware and software; Most rural centres do not have the ability to purchase the hardware and thus the issue of transporting hard ware on site, and representative support, may all be issues. The potential benefit of patient specific implants [PSI] may thus be two-fold in this setting. The surgeon and the patient benefit from the technology, but the technology does not need to be transported to the site. As a result of these considerations, a single surgeon in a rural centre, commenced using PSI's after gaining initial experience with the implant using traditional techniques. This early study looks at this experience and attempts to quantify some of the issues around this technology

Introduction. Elective Orthopaedics has been targeted by the UK Department of Health as a maximum six-month waiting time for operations could not be met. The National Orthopaedic Project was initiated as a consequence and Independent Sector Treatment Centres (ISTCs) and well established private hospitals were utilised to treat NHS long wait patients. Materials and methods. We audited the primary total hip replacements performed in our hospital in 1998 and 2003 to compare the differences in the patient characteristics in particular age, length of stay and ASA grade. Results. The number of hip replacements increased to 308 in year 2003 from 194 in year 1998. Whilst the number of ASA I patients was the same, the ASA II, III and IV increased by 40%, 260% and 266% respectively. The average length of stay decreased from 14.3 to 11.9 days which was statistically significant, in spite of increased numbers of ASA II - IV patients. Discussion. The NHS hospitals are treating an increasing number of patients who have a higher anaesthetic risk and stay longer in the hospital in the post-operative period. The case mix for primary total hip replacements in large tertiary referral hospitals has changed due to altered patient flow due to cherry picking of NHS waiting lists by the ISTCs. NHS hospitals should be appropriately remunerated for dealing with complex cases. On average based on our data, ASA III patients stay 3 days longer than ASA I (ASA IV - 5 days). The extra cost incurred is £221 (£433) / day x 3 extra days = £ 663 (£ 1329) / case. According to the 2nd annual NJR report, 4,617 ASA III patients were operated in NHS hospitals and the extra cost incurred towards their length of stay would be £3.06 million (£6.1 million)

Greater trochanteric pain syndrome (GTPS) is common, yet the impact on function and quality of life has not been measured. The aim of this study was to quantify the impact on function and quality of life, comparing the results to people with severe hip osteoarthritis and an asymptomatic control group. Forty two people with GTPS – including 11 not actively seeking treatment and 11 seeking surgical treatment, 20 with severe hip osteoarthritis (OA), and 23 age and sex matched asymptomatic participants (ASC) where recruited from public and private hospitals, and the community. Upon confirming meeting inclusion and exclusion criteria participants were interviewed. Exclusion criteria included lumbar nerve root signs; inflammatory, neoplastic and metabolic disorders. Measured used were the Harris hip score (HHS); the Oswestry disability index (ODI); the Australian quality of life instrument (AQoL); the Functional co-morbidity index (FCI); and fulltime work assessments. No difference was found between the GTPS and the OA group on the HHS, ODI, AQoL or the FCI measures. Both symptomatic groups were significantly more disabled than the ASC group on the HHS and ODI (p<0.001). The GTPS and OA groups had lower AQoL than the ASC group (p<0.001); and higher FCI results than the ASC group (GTPS vs ASC, p=0.005; OA vs ASC, p=0.019). GTPS participants were least likely to be in full time work; full time work participation probability (95% C.I.): GTPS Prob=0.288 (0.160 to 0.463), OA Prob= 0.518 (0.273 to 0.753); ASC group of Prob=0.676 (0.439 to 0.847). People with GTPS have similar levels of pain, disability and quality of life, but are less likely to be in full time employment than people with severe hip OA which puts them at risk of economic hardship. Research on conservative and surgical treatments should measure pain, disability and work participation

Hip fracture is a common cause of hospital admission and is often followed by reduced quality of life, or by death. International experiences indicate there are many benefits to be gained from national hip fracture registries. This pilot project aims to implement a hip fracture registry at three sites, a large metropolitan public hospital (Flinders Medical Centre), a large metropolitan private hospital (Epworth HealthCare) and a rural regional hospital (Goulburn Valley Health) to assess the feasibility of establishing a national registry. Patients undergoing surgery for a hip fracture will be recruited from the three participating hospitals between March and September 2009. A minimum data set will be collected at discharge, from hospital records. Items include patient demographics, fracture descriptors, length of stay, residential status, mobility, health status, surgical details and discharge destination. A phone interview at four months after surgery will measure outcomes by using the Extended Glasgow Outcomes Scale and documenting residential status, mobility, hip pain and readmissions. Re- operations, if any, will be collected. The availability of data from State Health Departments for validation of hospital case data will be reported. The pilot study is in progress at the time of writing. Ethical approval has been obtained, data collection, transmission and storage systems have been developed and deployed, and case data collection is underway. Case data will be summarised to describe hip fracture at the participating hospitals. Analysis will review the data elements in the pilot data set and assess their priority for inclusion in a national register—taking account of the quality of the data obtained and the time and other resources required for their collection. We will also evaluate the four-month review process. Any potential obstacles to a national registry that are identified during the pilot will be described and ways to overcome them will be proposed. A national hip fracture registry will improve the quality of care and safety of patients following hip fracture by developing an efficient mechanism to compare and improve the effectiveness of acute health care delivery by all hospitals involved in the management of hip fractures

Aims

To evaluate safety outcomes and patient satisfaction of the re-introduction of elective orthopaedic surgery on ‘green’ (non-COVID-19) sites during the COVID-19 pandemic.

Aims

Hip fracture patients are at higher risk of severe COVID-19 illness, and admission into hospital puts them at further risk. We implemented a two-site orthopaedic trauma service, with ‘COVID’ and ‘COVID-free’ hubs, to deliver urgent and infection-controlled trauma care for hip fracture patients, while increasing bed capacity for medical patients during the COVID-19 pandemic.

Aims

The safe resumption of elective orthopaedic surgery following the peak of the COVID-19 pandemic remains a significant challenge. A number of institutions have developed a COVID-free pathway for elective surgery patients in order to minimize the risk of viral transmission. The aim of this study is to identify the perioperative viral transmission rate in elective orthopaedic patients following the restart of elective surgery.

Aims

The aim of this paper is to describe the impact of COVID-19 on spine surgery services in a district general hospital in England in order to understand the spinal service provisions that may be required during a pandemic.

Aims

COVID-19 has changed the practice of orthopaedics across the globe. The medical workforce has dealt with this outbreak with varying strategies and adaptations, which are relevant to its field and to the region. As one of the ‘hotspots’ in the UK , the surgical branch of trauma and orthopaedics need strategies to adapt to the ever-changing landscape of COVID-19.

Introduction

Studies have addressed the issue of increasing prevalence of work-related musculoskeletal (MSK) pain among different occupations. However, contributing factors to MSK pain have not been fully investigated among orthopaedic surgeons. Thus, this study aimed to approximate the prevalence and predictors of MSK pain among Saudi orthopaedic surgeons working in Riyadh, Saudi Arabia.