Mortality following hip arthroplasty is affected by a large number of confounding variables each of which must be considered to enable valid interpretation. The aim of this study was to establish whether it is possible to determine a true cause-and-effect relationship between the risk of mortality and data that are routinely collected by the NJR and to establish the degree to which variation in the mortality rate could be explained by each variable. Relevant variables available from the 2011 NJR data setwere included in a Cox model. We carried out two analyses:. Firstly, we conducted an analysis of data collected from the NJR data set used in preparation of the NJR's 8th Annual Report (2011) looking for an association between the variables collected and the risk of mortality. Secondly, as social deprivation is also known to influence mortalityrates but is not routinely collected as part of the NJR data set, a further analysis was performed which included social deprivation data derived from partial postcodes. Mortality rates in hip arthroplasty patients were lower than in the age matched population across all hip types. Age at surgery, ASA grade, diagnosis, gender, provider type, hip type and lead surgeon grade all had a significant effect on mortality. Schemper's statistic showed that only 18.98% of the variation in mortality was explained by the variables available in the NJR data set. It is inappropriate to use Registry data to study an outcome affected by a multitude of confounding variables when these cannot be adequately accounted for in the available data set

Socially deprived patients face significant barriers that reduce their access to care, presenting unique challenges for orthopaedic surgeons. Few studies have investigated the outcomes of surgical fracture care among those socially deprived, despite the increased incidence of fractures, and the inequality of care received in this group. The purpose of this study was to evaluate whether social deprivation impacted the complications and subsequent management of marginalized/homeless patients following ankle fracture surgery. In this retrospective, population-based cohort study involving 202 hospitals in Ontario, Canada, we evaluated 45,444 patients who underwent open reduction internal fixation for an ankle fracture performed by 710 different surgeons between January 1, 1994, and December 31, 2011. Socioeconomic deprivation was measured for each patient according to their residential location by using the “deprivation” component of the Ontario Marginalization Index (ON-MARG). Multivariable logistic regression models were used to assess the relationship between deprivation and shorter-term outcomes within 1 year (implant removal, repeat ORIF, irrigation and debridement due to infection, and amputation). Multivariable cox proportional hazards (CPH) models were used to assess longer-term outcomes up to 20 years (ankle fusion and ankle arthroplasty). A higher level of deprivation was associated with an increased risk of I&D (quintile 5 vs. quintile 1: odds ratio (OR) 2.14, 95% confidence interval (CI), 1.25–3.67, p = 0.0054) and amputation (quintile 4 vs. quintile 1: OR 3.56, 95% CI 1.01–12.4, p = 0.0466). It was more common for less deprived patients to have their hardware removed compared to more deprived patients (quintile 5 vs. quintile 1: OR 0.822, 95% CI 0.76–0.888, p < 0.0001). There was no correlation between marginalization and subsequent revision ORIF, ankle fusion, or ankle arthroplasty. Marginalized patients are at a significantly increased risk of infection and amputation following operatively treated ankle fractures. However, these complications are still extremely rare among this group. Thus, socioeconomic deprivation should not prohibit marginalized patients from receiving operative management for unstable ankle fractures

Background. Vitamin D deficiency may increase predisposition to a number of paediatric orthopaedic conditions and the prevalence of vitamin D deficiency is increasing in children in developed countries. The aim of this study was to determine the epidemiology of vitamin D deficiency and insufficiency in children presenting to a regional paediatric orthopaedic service. We also examined the relationships between vitamin D status, social deprivation and ethnicity. Methods. Individuals, age < 18 years, presenting to the regional paediatric orthopaedic service at Southampton, UK from 2008 to 2010 were investigated. Deprivation index scores were calculated from indices of deprivation. Results. 187 children (97 male, 90 female, mean age 7.1 years) underwent serum 25-(OH) D level measurement. 82% were white British and 11% of Asian ethnicity. The calculation of the total depravation index for the whole cohort showed 34 (18%) of subjects were in quartile 1 (least deprived), 54 (29%) in quartile 2, 49 (26%) in quartile 3 and 50 (27%) in quartile 4 (Most deprived). 60 (32%) had vitamin D insufficiency with 25-(OH) levels < 50nmol/l and 15 (8%) had vitamin D deficiency. No relation ship was identified between vitamin D level and social depravation score. Conclusions. There is a need for awareness of the prevalence of vitamin D deficiency in the paediatric orthopaedic population presenting with bone pain and lower limb deformity before commencing ‘observation or orthopaedic surgical treatment’

Background. There is a lack of information on the independent preoperative predictors of perioperative mortality, including the influence of previous stroke and acute coronary syndromes (myocardial infarction + unstable angina, ACS). Previous studies have grouped variables under the umbrella term “ischaemic heart disease”. In this study, we investigated the influence of vascular risk factors separately. Methods. The Hospital Episode Statistics database was analyzed for elective admissions for total hip (THR) and total knee (TKR) replacements between 2004 and 2009. Independent preoperative predictors of perioperative outcome were identified from admission secondary diagnosis codes. Perioperative mortality was defined as 30-day in-hospital death. Logistic regression analysis was used to identify independent predictors of 30-day mortality. Data was adjusted for age, social deprivation and Charlson co-morbidity score. Results. 414,985 THRs and TKRs were performed in the study period. There were 829 deaths within 30 days (0.2%). Previous ACS (OR: 1.73 [1.33 to 2.25]) and stroke (OR: 1.64 [1.02 to 2.65]) predicted 30-day mortality. ACS (OR: 3.81 [1.55 to 9.34]) within six months of THKR surgery was associated with increased odds of perioperative mortality. The effect of ACS persisted up to 12 months (OR: 1.99 [1.02 to 3.88]). Renal failure, liver disease, heart failure, peripheral vascular disease and non-atrial fibrillation arrhythmia also increased the odds of mortality. Discussion. Previous stroke and ACS increase the odds of perioperative mortality, together with several other vascular risk factors. Within 12 months of ACS, risk of mortality is significantly elevated. Elective surgery should be avoided in this period

Aims

Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford.

Aims

The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O).