Evidence suggests that the alleviation of pain is enhancedby a strong patient-clinician relationship and attending to a patient’s social and mental health. There is a limited role for medication, opioids in particular.

Orthopaedic surgeons can use comprehensive biopsychosocial strategies to help people recover and can work with colleagues who have the appropriate expertise in order to maximize pain alleviation with optimal opioid stewardship.

Preparing patients for elective surgery and caring for them after unplanned injury or surgery can benefit from planned and practiced strategies based in communication science.

Cite this article: Bone Joint J 2020;102-B(9):1122–1127.

Aims. Perthes’ disease (PD) is a childhood hip disorder that can affect the quality of life in adulthood due to femoral head deformity and osteoarthritis. There is very little data on how PD patients function as adults, especially from the patients’ perspective. The purpose of this study was to collect treatment history, demographic details, the University of California, Los Angeles activity score (UCLA), the 36-Item Short Form survey (SF-36) score, and the Hip disability and Osteoarthritis Outcome score (HOOS) of adults who had PD using a web-based survey method and to compare their outcomes to the outcomes from an age- and sex-matched normative population. Methods. The English REDCap-based survey was made available on a PD study group website. The survey included childhood and adult PD history, UCLA, SF-36, and HOOS. Of the 1,182 participants who completed the survey, the 921 participants who did not have a total hip arthroplasty are the focus of this study. The mean age at survey was 38 years (SD 12) and the mean duration from age at PD onset to survey participation was 30.8 years (SD 12.6). Results. In comparison to a normative population, the PD participants had significantly lower HOOS scores across all five scales (p < 0.001) for all age groups. Similarly, SF-36 scores of the participants were significantly lower (p < 0.001) for all scales except for age groups > 55 years. Overall, females, obese participants, those who reported no treatment in childhood, and those with age of onset > 11 years had significantly worse SF-36 and HOOS scores. Pairwise correlations showed a strong positive correlation within HOOS scales and between HOOS scales and SF-36 scales, indicating construct validity. Conclusion. Adult PD participants had significantly worse pain, physical, mental, and social health than an age- and sex-matched normative cohort. The study reveals a significant burden of disease on the adult participants of the survey, especially females. Cite this article: Bone Joint J 2022;104-B(12):1304–1312

Aims. The increase in prescription opioid misuse and dependence is now a public health crisis in the UK. It is recognized as a whole-person problem that involves both the medical and the psychosocial needs of patients. Analyzing aspects of pathophysiology, emotional health, and social wellbeing associated with persistent opioid use after injury may inform safe and effective alleviation of pain while minimizing risk of misuse or dependence. Our objectives were to investigate patient factors associated with opioid use two to four weeks and six to nine months after an upper limb fracture. Methods. A total of 734 patients recovering from an isolated upper limb fracture were recruited in this study. Opioid prescription was documented retrospectively for the period preceding the injury, and prospectively at the two- to four-week post-injury visit and six- to nine-month post-injury visit. Bivariate and multivariate analysis sought factors associated with opioid prescription from demographics, injury-specific data, Patient Reported Outcome Measurement Instrumentation System (PROMIS), Depression computer adaptive test (CAT), PROMIS Anxiety CAT, PROMIS Instrumental Support CAT, the Pain Catastrophizing Scale (PCS), the Pain Self-efficacy Questionnaire (PSEQ-2), Tampa Scale for Kinesiophobia (TSK-11), and measures that investigate levels of social support. Results. A new prescription of opioids two to four weeks after injury was independently associated with less social support (odds ratio (OR) 0.26, p < 0.001), less instrumental support (OR 0.91, p < 0.001), and greater symptoms of anxiety (OR 1.1, p < 0.001). A new prescription of opioids six to nine months after injury was independently associated with less instrumental support (OR 0.9, p < 0.001) and greater symptoms of anxiety (OR 1.1, p < 0.001). Conclusion. This study demonstrates that potentially modifiable psychosocial factors are associated with increased acute and chronic opioid prescriptions following upper limb fracture. Surgeons prescribing opioids for upper limb fractures should be made aware of the screening and management of emotional and social health. Cite this article: Bone Jt Open 2021;2(2):119–124

Obesity is clearly a worldwide epidemic with significant social, health care and economic implications. A clear association between obesity and the need for both hip and knee replacement surgery has been demonstrated. Specifically the presence of class 3 obesity (BMI > 40) increases the incidence of THA by 8.5 times and the incidence of TKA by 32.7 times, compared with patients of normal weight. Issues related to TJA in the morbidly obese include:. Outcomes - There is a growing body of evidence to support the premise that patients undergoing either THA or TKA who are morbidly obese derive significant benefit from the surgical intervention. Specifically patient and disease specific outcome measures (WOMAC, SF-12, KSCRS, HSS) demonstrate equal change between pre-operative and post-operative scores in those patients of normal weight compared to the morbidly obese cohort. Complications - It would appear that the rate of deep infection is increased in the morbidly obese, and that the greater the BMI, the greater the risk of infection. This is important to understand and appreciate pre-operatively as the surgeon discusses the risk/benefit ratio of the operative intervention. There is little debate that performing total joint arthroplasty in the morbidly obese is technically challenging and that the potential for increased peri-operative morbidity, particularly in the form of infection is present. That being said, the realised benefit to the patient of the surgical intervention is significant, and denying surgery on the basis of obesity alone is not justified

Aims

The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery.

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The aim of this study was to determine the prevalence of depressive and anxiety disorders prior to total hip (THA) and total knee arthroplasty (TKA) and to assess their impact on the rates of any infection, revision, or reoperation.

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Gram-negative infections are associated with comorbid patients, but outcomes are less well understood. This study reviewed diagnosis, management, and treatment for a cohort treated in a tertiary spinal centre.

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The aim of this study was to understand the experience of mature patients who undergo a periacetabular osteotomy (PAO), a major hip-preserving surgical procedure that treats symptomatic hip dysplasia by realigning the acetabulum. Our aim was to improve our understanding of how the operation affected the lives of patients and their families, with a long-term goal of improving their experience.

Background. The economic crisis has significantly altered the quality of life in Greece. The obvious negative impact on the offered social and health services has been adequately analysed. We aimed to determine whether the economic crisis has influenced the quantity and quality of Orthopaedic research in Greece, as mirrored from the papers presented at the annual meetings of Hellenic Association of Orthopaedic Surgery between the years 2008–2014. Methods. The abstracts of the papers (oral and posters) presented in these meetings have been examined. Details regarding the department of origin were registered. We determined the level of evidence (according to the AAOS classification system), found the amount of papers that were published in PubMed journal and noted if a department of another country participated. Results. Through the years 2008–2014 the papers concerning clinical and basic orthopaedic research that were presented were 146, 207, 304, 331, 318, 234 and 191 respectively. The percentage of those that were level 1 studies was approximately 2%, 3%, 2%, 3%, 2%, 4% and 4% respectively. The percentage of level 2 studies was 2%, 1%, 2%, 3%, 1%, 3% and 0%. Level 3 studies were the 10%, 9%, 7%, 7%, 7%, 9% and 6%. The percentage of level 4 studies was 75%, 74%, 60%, 59%, 61%, 65% and 64%. Level 5 studies were the 10%, 17%, 31%, 27%, 28%, 19% and 26%. Each year, the papers that were published in PubMed were 7%, 21%, 13%, 7%, 6%, 6% and 9%. A department of another country participated in 18%, 17%, 18%, 16%, 16%, 21% and 13% of the total of papers. Conclusion. As the economic crisis deepens, the quantity of the presented papers has been reduced. More importantly, the percentage of level 1 and 2 studies has been remained steadily low. Also, we could remark a reduction on the published studies in PubMed journals. These results raise concerns about the potential impact of the crisis in the future. Level of Evidence. IV

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Golf is a popular pursuit among those requiring total hip arthroplasty (THA). The aim of this study was to determine if participating in golf is associated with greater functional outcomes, satisfaction, or improvement in quality of life (QoL) compared to non-golfers.

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In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip.

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Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care.

Based on the data from the Health Ministry’s Epidemiological Survey Office, 84.188 Hip fractures were recorded in Italy (from DRG), in 2001 in patients over 50 years of age. They underwent many different types of treatment, but up to now no analyses on the medical outcomes are available for these patients. This means that it is not possible to state a reliable social cost and a right strategy for treatment. The need for creating a National Register for Hip fractures to collect data from different areas and to create the basis for standardized national care has been documented from Swedish Register (started in 1979), and from SAHFE European search (1998–2000). In Italy an attempt to start a national Register was done in 2001 with leading hospitals that represent each part of the country Veneto (Padova) and Liguria (Genova) for the North, Emilia Romagna (Parma) for the Centre, and Campania (Napoli), and Basilicata (Matera) for the South. The results are presented, and it appears clear that Hip fracture are one of the most important causes of death (20% in the first 6 months after fracture) and disability among older people (33% do not return to pre-fracture physical functioning). The incidence rate of hip fractures is about 1.4 fracture/1.000 inhabitans/year, and ranges from 6.5–7.5/1.000 individuals aged over 65. This study looked at different parameters at recruitment like: pre-fracture social and health conditions, ASA grade, type of fracture, type of operation, waiting time between hospital arrival and operation, length of hospital stay, inpatients’ mortality, if discharged back home or to nursing home or rehabilitation centers. At 6 month after discharge, a follow-up for assessing the health and social conditions was performed and the results will be presented. Data analysis was carried out using SAS package. (SAS/STAT User’s guide, vol 1–2; version 6, fourth edition 1994. SAS Institute Inc.). Hip Fracture Registry Working Group: A Del Puente (Napoli), R. Laforgia (Matera), E. Palummeri (Genova), P.P. Benetollo (Schio) R. Rozzini (Brescia), M.L. Brandi (Firenze)

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Responsiveness to clinically important change is a key feature of any outcome measure. Throughout Europe, health-related quality of life following total knee arthroplasty (TKA) is routinely measured with EuroQol five-dimension (EQ-5D) questionnaires. The Patient-Reported Outcomes Measurement Information System 10-Question Short-Form (PROMIS-10 Global Health) score is a new general heath outcome tool which is thought to offer greater responsiveness. Our aim was to compare these two tools.

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Outcome measures quantifying aspects of health in a precise, efficient, and user-friendly manner are in demand. Computer adaptive tests (CATs) may overcome the limitations of established fixed scales and be more adept at measuring outcomes in trauma. The primary objective of this review was to gain a comprehensive understanding of the psychometric properties of CATs compared with fixed-length scales in the assessment of outcome in patients who have suffered trauma of the upper limb. Study designs, outcome measures and methodological quality are defined, along with trends in investigation.