The attitudes of orthopaedic surgeons regarding radiology reporting is not well-described in the literature. We surveyed Orthopaedic Surgeons in Australia and New Zealand to assess if they routinely review formal radiology reports. An anonymized, 14 question online survey was distributed to consultant surgeons of the Australian and New Zealand Orthopaedic Associations (AOA, NZOA). Two hundred respondents completed the survey (Total number of Fellows: 283 NZOA, 1185 AOA). 18.5% of respondents always reviewed the formal Radiology report, 44.5% most of the time, 35% sometimes and 2% never. By imaging modality, MRI reports were the most frequently reviewed (92%), followed by ultrasound (74%) and nuclear medicine (63%). Only 10% of surgeons consulted formal reports for plain radiography. 55% of surgeons were still likely to disagree with the MRI report, followed by 46% for plain radiography. In cases of disagreement, only 21% of surgeons would always contact the reporting radiologist. The majority of Surgeons (85.5%) think there should be more collaboration between the disciplines, although only 50.5% had regular attendance of a Radiologist at their departmental audit. This survey reveals that the majority of orthopaedic surgeons are not routinely reading radiology reports. This points towards a need for further interdisciplinary collaboration. To our knowledge, this is the first survey directly assessing attitudes of orthopaedic surgeons towards radiology reports

This work aims to quantitatively assess the current opinions of foot and ankle surgery provision by podiatric surgeons within the UK. Three groups were targeted by postal questionnaire; Orthopaedic surgeons with membership to BOFAS, Orthopaedic surgeons not affiliated to the specialist foot and ankle society and surgical Podiatrists. In addition we aim to identify areas of conflict and suggestions for future integration. A postal questionnaire was sent to all Fellows of the Faculty of Podiatric Surgery, College of Podiatrists (136), members of the British Orthopaedic Foot and Ankle Society, (156), and a randomly selected number of Fellows of the British Orthopaedic Association, who are not members of BOFAS (250). We have received replies from 99 (73%) of the Podiatric Surgical group, 77 (49%) of the Orthopaedic Foot and Ankle surgeons and 66 (26%) from non-Foot and Ankle Orthopaedic Surgeons. Respondents were asked to detail their present practice and issues that they considered to restrict closer working between Orthopaedic Surgeons and Podiatric surgeons. Additionally, each surgeon was given a range of surgical procedures and asked to identify the most appropriate surgical profession to undertake the procedure. The good response rate amongst Foot and Ankle Practitioners (both Podiatric and Orthopaedic) reflects the interest in these issues compared to Orthopaedic Surgeons from other sub-specialties. Poor understanding of Podiatric surgical training, impact on private practice and medical protectionism were areas identified by podiatric respondents. Conflicts over job-title, concerns over training, role boundaries and responsibilities were identified by Orthopaedic respondents as being significant restrictors to further integration. The paper will present the full results of the survey and discuss the suitability and feasibility of closer working practices between Orthopaedic and Podiatric surgeons

There is growing interest in the peri-operative management of patients with indications for hip and knee arthroplasty in the setting of modifiable risk factors such as morbid obesity, type 2 diabetes mellitus, and smoking. A recent survey of the American Association of Hip and Knee Surgeons (AAHKS) found that 95% of respondents address modifiable risk factors prior to surgery. The aim of this study was to poll Australian arthroplasty surgeons regarding their approach to patients with modifiable risk factors. The survey tool used in the AAHKS study was adapted for use in the Australian context and distributed to the membership of the Arthroplasty Society of Australia via Survey Monkey. Seventy-seven survey responses were received, representing a response rate of 64%. The majority of respondents were experienced, high volume arthroplasty surgeons. Overall, 91% of respondents restricted access to arthroplasty for patients with modifiable risk factors. Seventy-two percent of surgeons restricted access for excessive body mass index, 85% for poor diabetic control, and 46% for smoking. Most respondents made decisions based on personal experience or literature review rather than hospital or departmental pressures. Despite differences in healthcare systems, our findings were similar to those of the AAHKS survey, although their responses were more restrictive in all domains. Differences were noted in responses concerning financial considerations for potentially underprivileged populations. The survey is currently being administered by arthroplasty societies in six other countries, allowing comparison of orthopaedic practice across different healthcare systems around the world. In conclusion, over 90% of Australian arthroplasty surgeons who responded to the survey address modifiable risk factors prior to surgery

The process of obtaining informed consent is an important and complex pursuit, especially within a paediatric setting. Medical governing bodies have stated that the role of the trainee surgeon must be explained to patients and their families during the consent process. Despite this, attitudes and practices of surgeons and their trainees regarding disclosure of the trainee's participation during the consent process has not been reported in the paediatric setting. Nineteen face-to-face interviews were conducted with surgical trainees and staff surgeons at a tertiary level paediatric hospital in Toronto, Canada. These were transcribed and subsequently thematically coded by three reviewers. Five main themes were identified from the interviews. 1) Surgeons do not consistently disclose the role of surgical trainees to parents. 2) Surgical trainees are purposefully vague in disclosing their role during the consent discussion without being misleading. 3) Surgeons and surgical trainees believe parents do not fully understand the specific role of surgical trainees. 4) Graduated responsibility is an important aspect of training surgeons. 5) Surgeons feel a responsibility towards both their patients and their trainees. Surgeons don't explicitly inform patients about the involvement of trainees, believing there is a lack of understanding of the training process. Trainee perspectives reflect this, with the view that families are aware of their participation but likely underestimate their role, and suggest that information is kept purposely vague to reduce anxiety. The majority of surgeons and surgical trainees do not voluntarily disclose the degree of trainee participation in surgery during the informed consent discussion with parents. An open and honest discussion should occur, allowing for parents to make an informed decision regarding their child's care. Further patient education regarding trainees' roles would help develop a more thorough and patient centred informed consent process

Introduction. The demands placed upon joint surgeons are perhaps greatest when treating the revision arthroplasty patient, who present with complications demanding skill in diagnosis and evaluation, interpersonal communication and the technical aspects of the revision procedure. However, little information exists identifying which specific tasks in revision arthroplasty are most difficult for surgeons to master, and whether the greatest challenges arise from clinical, cognitive or technical facets of patient treatment. This study was undertaken to identify which tasks associated with revision total knee replacement (TKR) are perceived as most challenging to young surgeons and trainees to guide future efforts in surgical training and curriculum development. Methods. We developed an online survey instrument consisting of 69 items encompassing pre-operative, intraoperative, and post-operative tasks that preliminary studies identified as the essential components of revision TKR. These tasks encompassed 4 domains: clinical decision-making skills (n=9), interpersonal assessment and communication (n=7), surgical decision-making (n=35) and procedural surgical tasks (n=18). Respondents rated the difficulty of each item on a 5-level Likert scale, with an ordinal score ranging from 1 (“very easy”) to 5 (“very difficult”. The survey instrument was administered to a cohort of 109 US surgeons: 31 trainees enrolled in a joint fellowship program (Fellows) and 78 surgeons who had graduated from a joint fellowship program within the previous 10 years (Joint Surgeons). Using appropriate parametric and non-parametric tests, the responses were analyzed to examine the variation of reported difficulty of each of the 69 items, in addition to the nature of the task (cognitive, surgical, clinical and interpersonal), and differences between Fellows and Surgeons. Results. Both Fellows and Surgeons reported a wide variation in the difficulty of performing the tasks identified in each f the 4 domains. Fellows reported a higher average difficulty score than Surgeons (2.94 vs 2.74; p=0.032), corresponding to a greater frequency of tasks entailing some degree of difficulty (34.9% vs 24.4%, p<0.0001). Both groups experienced difficulty in performing tasks involving interpersonal interaction with patients (Fellows: 34.6% vs Surgeons: 34.3%, p=0.93). Fellows also found the technical aspects of revision surgery most challenging with 38.5% of items considered difficult compared to 28.7% for the Surgeon group (p<0.001). Highly significant differences between Fellows and Surgeons were also observed in facility with surgical decision making (p<0.001) and to a lesser extent, clinical decisions relating to patient care (% difficulty: p=0.0251). A compilation of the specific items cited as most difficult by the participants appears in Table 2. Conclusions. The young surgeons surveyed in this study reported difficulty in performing some tasks within both the clinical, cognitive and technical domains of revision knee arthroplasty. The high incidence of difficulty in tasks involving clinical decision-making and operative performance are characterized by a lack of accepted guidelines and the lack of a standard surgical practice. In general, our findings highlight the need for improvements in surgeon training to improve decision-making and procedural skills as part of the comprehensive management of patients undergoing revision knee arthroplasty. For any figures or tables, please contact authors directly

Around 1% of total hip replacements are follow by prosthetic joint infection (PJI). There is uncertainty about best treatment method for PJI, and the most recent high quality systematic reviews in unselected patients indicates that re-infection rates following one-stage and two-stage revision arthroplasty are relatively similar. In the absence of evidence randomised controlled trials will help to identify the most clinically and cost-effective treatment for PJI. Before such trials are conducted, there is a need to establish reasons for current practice and to identify whether trials are feasible. This study aimed to deliver research that would inform trial design. Specifically, we aimed to characterise consultant orthopaedic surgeons' decisions about performing either one-stage or two-stage exchange arthroplasty for patients with PJI after hip replacement and to identify whether a randomised trial comparing one-stage with two-stage revision would be possible. Semi-structured interviews were conducted with 12 consultant surgeons from 5 high-volume National Health Service (NHS) orthopaedic departments in the UK. Surgeons were sampled on the basis that they perform revision surgery for PJI after hip arthroplasty and final sample size was justified on the basis of thematic saturation. Surgeons were interviewed face-to-face (n=2) or via telephone (n=10). The interview study took place before design of a multicentre prospective randomised controlled trial comparing patient and clinical outcomes after one-stage or two-stage revision arthroplasty. Data were audio-recorded, transcribed, anonymised and analysed using a thematic approach, with 25% of transcripts independently double-coded. Results: There is no standard surgical response to the treatment of PJI and surgeons manage a complex balance of factors when choosing a surgical strategy. These include multiple patient-related factors, their own knowledge and expertise, available infrastructure and the infecting organism. Surgeons questioned whether evidence supports the emergence of two-stage revision as a method. They described the use of loosely cemented articulating spacers as a way of managing uncertainty about best treatment method. All surgeons were supportive of a randomised trial to compare one-stage and two-stage revision surgery for PJI after hip replacement. Surgeons reported that they would put patients forward for randomisation when there was uncertainty about best treatment. Surgeons highlighted the need for evidence to support their choice of revision. Some surgeons now use revision methods that can better address both clinical outcomes and patients' quality of life, such as loosely cemented articulating spacers. Surgeons thought that a randomised controlled trial comparing one-stage and two-stage exchange joint replacement is needed and that randomisation would be feasible. The next stage of the work was to design a multi-centre randomised controlled trial, this has been achieved and the trial is now ongoing in the UK

Introduction. Previous studies have demonstrated that higher volume hospitals have better outcomes following revision total knee arthroplasty (rTKA), in current literature there are no reports investigating the effect of surgeon volume. The purpose of this study is to investigate if patients of high-volume revision surgeons have better outcomes following rTKA as compared to patients of low volume surgeons. Methods. This retrospective observational analysis examined the rTKA database at a large urban academic medical center for aseptic, unilateral rTKA between January 2016 and March 2019 with at least 1-year of follow-up. Surgeon operative volume during the same time period was evaluated. Surgeons who performed at least 18 aseptic rTKA per year were considered high volume (HV), whereas surgeons who performed fewer than 18 aseptic rTKA per year were considered low volume (LV). Demographics, surgical factors, and post-operative outcomes were collected and compared between the two cohorts. A post-hoc power analysis was conducted for full revisions (1-ß=0.909, α=0.05). Results. 307 cases were identified: 177 performed by LV surgeons and 130 performed by HV surgeons. The only demographic difference was a greater proportion of non-smokers in the LV cohort (59.4% vs. 50.0%; p=0.031). Patients of HV surgeons were more likely to receive a full revision (64.6% vs. 47.5%; p<0.001). For all revisions, HV surgeons had shorter surgical times by about 17 minutes (p=0.010). For the 168 full revisions (84 HV, 84 LV), patients of HV surgeons had shorter hospital stays (2.92±1.62 vs. 3.57±2.69 days; p=0.048), shorter surgical times (131.42±33.86 vs. 171.65±49.88 minutes; p<0.001), lower re-revision rates (7.1% vs. 19.0%; p=0.038), and fewer re-revisions (0.07±0.26 vs. 0.29±0.74 re-revisions; p=0.018). Conclusions. Patients of HV revision surgeons have better outcomes following full rTKA. These findings support the development of revision teams within arthroplasty centers of excellence to offer patients the best possible outcomes following rTKA

Background. Total knee arthroplasty (TKA) is a routine, cost-effective treatment for end-stage arthritis. While the evidence for good-to-excellent patient-reported outcomes and objective clinical data is present, approximately 20% of patients continue to be dissatisfied with results of their surgery. Dissatisfaction is strongly correlated with unmet patient expectations, and these patients may experience a higher cost of care due to recurring office and emergency visits. Therefore, this survey asked a large group of United States (U.S) and international surgeons to prioritize areas of opportunity in primary TKA. Specifically, we compared surgeon responses regarding: 1) the top 5 areas needing improvement; which were stratified by: 2) surgeons' years of experience; and 3) surgical case volume. Methods. A total of 418 orthopaedic surgeons were surveyed. Two hundred U.S. surgeons and 218 international surgeons participated from 7 different countries including: The United Kingdom (40), France (40), Germany (43), Italy (40), Spain (38), and Australia (17). To participate, surgeons had to be board certified, in practice for 2 years, spend 60% of their time in clinical practice, and perform a minimum of 25 joint arthroplasties per year. Surgeons were asked to choose the top 5 areas of improvement for TKA from a list of 17 attributes including clinical and functional outcomes, procedural workflow and economic variables. Surgeons were able to specify additional options if needed. Results were stratified by annual case volume (25 to 50; 51 to 100; greater than 100 cases) and years of experience (1 to 10; 11 to 20; greater than 20). Single-tail proportion tests were used to compare results between cohorts, where an alpha of 0.05 was set as significant. Results. The most frequently identified opportunity in both groups was functional outcomes, selected by 63% of U.S. surgeons (p=0.001) compared to 71% of international surgeons (p=0.002). In the U.S. cohort, this was followed by cost (47%), which was not identified in the top 5 choices for international surgeons. Cost was followed by implant survivorship (45%), patient satisfaction (42%), and accuracy/precision (39%). In the international cohort, implant survivorship (57%), dynamic joint balancing (40%), accuracy/precision (39%), and patient satisfaction rates (35%) were noted. When stratified by years of experience and case volume, the top area for improvement remained functional outcomes for U.S. and International groups. Conclusion. The responses in the international survey demonstrate that functional outcomes, implant survivorship and costs had greater perceived potential for improvement, compared to the specific targeting of post-operative patient satisfaction. Functional outcomes remained a top area for improvement, regardless of years of experience or case volume. As a result, enhancing functional outcomes and implant survivorship may ultimately address patient satisfaction, by more consistently meeting patient expectations. These results serve as baseline data to help guide future improvements in knee arthroplasty

Escalating health care expenditure worldwide is driving the need for effective resource decision-making, with medical practitioners increasingly making complex resource decisions within the context of patient care. Despite raising serious legal and ethical issues in practice, this has attracted little attention in Australia, or internationally. In particular, it is unknown how orthopaedic surgeons perceive their obligations to the individual patient, and the wider community, when rationing care, and how they reconcile competing obligations. This research explores legal and ethical considerations, and resource allocation by Australian orthopaedic surgeons, as a means of achieving public health cost containment driven by macro-level policy and funding decisions.

This research found that Australian orthopaedic surgeon's perceptions, and resource allocation decision making, can be explained by understanding how principles of distributive justice challenge, and shift, the traditional medical paradigm. It found that distributive justice, and challenges of macro level health policy and funding decisions, have given rise to two new medical paradigms. Each which try to balance the best interests of individual patients with demands in respect of the sustainability of the health system, in a situation where resources may be constrained. This research shows that while bedside rationing has positioned the medical profession as the gate keepers of resources, it may have left them straddling an increasingly irreconcilable void between the interests of the individual patient and the wider community, with the sustainability of the health system hanging in the balance.

Study aim. There is an ever increasing demand for quality clinical trials in surgery. Surgeons' co-operation and enthusiasm to participate are important, if not crucial in success of such studies, especially if they are multi-centred. Clinician's individual uncertainty (equipoise) about a case has been often cited as an ethical basis for inviting a patient to take part in a clinical trial. This study aims to establish current attitudes of surgeons participating in a national multi-centred randomised controlled trial and explores an on line tool for instant assessment of collective uncertainty (equipoise) for individual clinical cases eligible for a trial. Study design. Surgeons taking part in the UK Heel Fracture Trial were invited to take part. If agreed, they were asked to evaluate treatment prognosis for eligible for the trial anonymised cases of calcaneal fractures online by means of specially designed system. The cases were published on a password protected website on ad-hoc basis during the three years course of the trial. Their responses were submitted instantly on line. Results. 16 out of 24 surgeons agreed to participate. The participating surgeons were emailed links to cases (normally in butches of three) less than once a month. It took them 10-15 min to assess all three cases via interactive interface. Of those who agreed 12 submitted their opinion at least once. 7 voted consistently during the course of the trial. Seventy one cases had been published. The data collected from responses allowed to assess individual and collective uncertainty about clinical cases. 4 surgeons demonstrated tendency towards individual uncertainty, balanced by 4 who did not accept it. However, sufficient collective uncertainty was demonstrated in 84.5% of cases. Discussion. Level of surgeons' enthusiasm towards clinical research appears to be moderate in a selected population of orthopaedic surgeons who already agreed to take part in a randomised clinical trial, despite a very low research time burden of this study. It is important to continue to promote multi-centred studies in order to improve surgeons' attitude towards quality clinical research. Extra efforts by academic clinicians to develop further low research time burden methodologies may increase acceptance and volume of multi-centred clinical research. This study supports previously expressed view that individual uncertainty is a very unreliable and unnecessary justification to offer a subject to take part in a clinical trial. The system used in the study offers surgeons to express their opinions and preferences freely. The instant on line comparison of opinions provides a clear assessment of collective uncertainty, which can be returned to a treating surgeon and a patient him/herself within 48 hours. In absence of collective uncertainty it would be ethical to offer a patient the best treatment according to current opinion. These cases can then be followed up as part of an inclusive trial, if a subject agrees. We believe that using the system may improve decision making process in randomised controlled trials, for example in selected challenging cases

Introduction. Complication reporting and assessment is an important part of orthopaedic trials assessing new technologies. Because the reliability of the assessment by the treating surgeon compared to central review is still unknown, it was quantified in this study and possible patterns were identified. Materials and methods. 176 patients with trochanteric fractures, treated with a trochanteric nail, were included in a prospective multicenter study. Surgeons were encouraged to report honestly every single potential complication, to rate severity, most likely cause, relation to implant, and to report the outcome of the complication. After 1-yr follow-up, 3 experienced orthopedic surgeons reassessed independently the same variables (agreement determined using kappa coefficient). Discrepancies were resolved by consensus. Results. Surgeons rated sig. fewer complications as severe than central reviewers (88 complications: 59% mild, 27% moderate, and 14% severe vs. 47% mild, 26% moderate, and 27% severe, p<0.001, kappa 0.47). Surgeons attributed more complications to the tested implant (10 vs. 0 by reviewers); in contrast, reviewers defined more complications as unlikely related to the implant (21 vs. 10 by surgeons) but attributed more complications to . surgery/surg.technique. (12 vs. 8). Discussion. The analysis revealed significant differences in the complication assessment between treating surgeons and central review and highlight the need for central complication assessment

While double-bundle anterior cruciate ligament (ACL) reconstruction attempts to recreate the two-bundle anatomy of the native ACL, recent research also indicates that double-bundle reconstruction more closely reproduces the biomechanical properties of the ACL and restores the rotatory and sagittal stability to the level of the intact knee that was not attainable with anatomic single-bundle reconstruction. Though double-bundle reconstruction provides these potential biomechanical benefits, it poses a significant challenge to the surgeon who must attempt to accurately place twice as many tunnels while avoiding tunnel convergence compared to single-bundle reconstruction. In addition, previous work has shown that tunnel malpositioning may cause grafts that fail to reproduce the native biomechanics of the ACL, increase graft tension in deep knee flexion, increase anterior tibial translation, and produce lower IKDC (International Knee Documentation Committee) scores.

We hypothesise that experienced surgeons without the use of computer-assisted navigation will place tunnels on the tibial plateau and lateral femoral condyle that more closely emulate the locations of the native anteromedial (AM) and posterolateral (PL) ACL bundles than inexperienced surgeons with the use of computer-assisted navigation.

A novice surgeon group comprised of three medical students each performed double-bundle ACL reconstruction using passive computer-assisted navigation on a total of eleven cadaver knees. Their individual results were compared to three experienced orthopaedic surgeons each performing the identical procedure without the use of computer-assisted navigation on a total of nine cadaver knees.

There were no significant differences in placement of either the AM or PL tunnels on the tibial plateau between novice surgeons using computer-assisted navigation and experienced surgeons without the use of computer navigation. On the lateral femoral condyle, novice surgeons placed the AM and PL tunnels significantly more anterior along Blumensaat's line on average compared to experienced surgeons. Both groups placed femoral AM and PL tunnels anterior to previously described AM and PL bundle positions.

Novice surgeons utilizing computer-assisted navigation and experienced surgeons without computer assistance place the AM and PL tunnels on the tibial side with no significant difference. On the lateral femoral condyle, novice surgeons utilising computer-assisted navigation place tunnels significantly anterior along Blumensaat's line compared to experienced surgeons without the use of computer navigation.

Objectives

To explore whether orthopaedic surgeons have adopted the Proximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial results routinely into clinical practice.

Five surgeons independently rated clinical photographs of forty patients with AIS. Ratings of shoulder blades, shoulder symmetry, and waist symmetry were related to “overall appearance”, and were also correlated with rib prominence and Cobb angle. Because the components of surgeons’ ratings of appearance differed, this may lead to inconsistent recommendations regarding surgery. To identify patient characteristics associated with surgeons’ ratings of patient physical deformity in Adolescent Idiopathic Scoliosis (AIS). Five surgeons independently rated clinical photographs of forty patients with AIS. Surgeons separately rated the appearance of patients’ shoulder blades, shoulder symmetry, waist symmetry and also rated their “overall appearance” [in five categories from zero (best) to five (worst)]. The following clinical and radiographic data was also collected: rib prominence, vertebral rotation, shoulder height, spinal imbalance, Cobb angle, age, sex, and body mass index. Surgeons’ mean rating for “overall appearance” was moderately correlated with rib prominence (r = 0.48), vertebral rotation (r = 0.44) and Cobb angle (r = 0.53). Surgeons’ rating of patients’ “overall appearance” was affected by each of: shoulder blades (p = 0.001), shoulder symmetry (p = 0.01) and waist symmetry (p = 0.001). However, each surgeon weighted components of patients’ appearance differently to arrive at their overall rating of appearance (p< 0.006). Because patients’ physical appearance is an important element of surgical decision making, differences among surgeons could be contributing to inconsistent recommendations. Surgeons’ ratings of physical appearance are based on surgeons’ ratings of patients’ shoulder blades, waist symmetry and shoulder symmetry but surgeons weight those elements differently. Surgeon decision making is complicated. It is based on radiographs and subjective assessment. Patients’ appearance undoubtedly influences surgeon recommendation for surgery. We need to clarify surgeons’ ratings and improve the criteria for surgeon decision making. Funding: This trial was funded by (in alphabetical order) The Canadian Institutes of Health Research, DePuyAcroMed-Johnson & Johnson Medical Products, and Synthes, Canada

The Use of bone allograft in orthopaedic Surgery has been predicted to increase particularly in joint revision surgery. This has led to a potential problem with supply. Questionnaires were distributed to all 146 Consultant orthopaedic Surgeons working in Scotland in 2000. They were asked to indicate their current usage of bone and tissue allograft, any problems encountered with supply and if alternatives to allograft such as processed bone, might be used. The questions asked were very similar to those asked in a survey by the author (GG) in 1995 to enable comparisons to be made. 74% of all bone issued by the SNBTS in 2000 –2001 was used in revision hip arthroplasy. This compares with only 66% of bone issued in 1998–1999. Replies were received from 125 consultants (87%) of whom 93 reported using bone allograft. 41 consultants (46%) predicted an increase in their requirement for bone allograft, and 23 (26%) felt they could currently use more bone if this became available. Sixty percent of Surgeons would consider using processed bone as an alternative. In comparison with figures from a previous study in 1995, an increasing number of surgeons are prepared to use processed bone as an alternative to fresh frozen allograft. As the number of revision THR’ s continues to increase the amount of bone required is likely to continue to increase. The need to increase efficiency in harvest and supply of bone is therefore great. The use of more SNBTS nurses in selection of patients and collection of bone may increase efficiency. More surgeons may have to use processed bone, which would allow more bone to be released. Also processing may help reduce transmission of infective particles such as HIV and new variant CJD. With rising public and medical concerns over these issues this seems most desirable

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.

The aim of this study was to investigate surgeons’ reported change of treatment preference in response to the results and conclusion from a randomized controlled trial (RCT) and to study patterns of change between subspecialties and nationalities.

Two questionnaires were developed through the Delphi process for this cross-sectional survey of surgical preference. The first questionnaire was sent out before the publication of a RCT and the second questionnaire was sent out after publication. The RCT investigated repair or non-repair of the pronator quadratus (PQ) muscle during volar locked plating of distal radial fractures (DRFs). Overall, 380 orthopaedic surgeons were invited to participate in the first questionnaire, of whom 115 replied. One hundred surgeons were invited to participate in the second questionnaire. The primary outcome was the proportion of surgeons for whom a treatment change was warranted, who then reported a change of treatment preference following the RCT. Secondary outcomes included the reasons for repair or non-repair, reasons for and against following the RCT results, and difference of preferred treatment of the PQ muscle between surgeons of different nationalities, qualifications, years of training, and number of procedures performed per year.

Of the 100 surgeons invited for the second questionnaire, 74 replied. For the primary outcome, 6 of 32 surgeons (19%), who usually repaired the PQ muscle and therefore a change of treatment preference was warranted, reported a change of treatment preference based on the RCT publication. Of the secondary outcomes, restoring anatomy was the most common response for repairing the PQ muscle.

The majority of the orthopaedic surgeons, where a change of treatment preference was warranted based on the results and conclusion of a RCT, did not report willingness to change their treatment preference.

To explore whether the fundamental concepts of informed consent and patient autonomy are acceptable and practical from a surgeon’s point of view. One hundred and fifty three questionnaires distributed to Orthopaedic Surgeons in NZ were analysed statistically. Seventy six percent of the surgeons guided their patients towards a particular procedure. Fifty five percent spent between 10% and 25% of their consultation time on obtaining informed consent. Forty eight percent of the surgeons felt that the patient did not have sufficient autonomy to choose to undergo a particular procedure, while 76% felt that it was impractical to offer all necessary information needed for that patient to choose the procedure. Although the length of time that a surgeon had been in practice did not influence the practice of obtaining consent or his/her opinion of the patient’s self autonomy, the degree of his/her specialisation did (P< 0.05). There was no correlation between the time spent on obtaining consent and the degree of specialisation. There was a very strong correlation between the surgeon’s belief in patient autonomy, the practicality of offering all the necessary information and the method of obtaining consent (P< 0.0001). The majority of Orthopaedic Surgeons in NZ do not believe it was practical to offer all the necessary information to a patient and to expect that patient to be fully autonomous in choosing to undergo a particular procedure. This indicates that it is time for re-evaluation of the practice of modern day informed consent based on its original concept

The identification of certain character traits in orthopaedic surgeons (OS), as compared with their general surgery counterparts, has potential implications in terms of the selection of registrars in orthopaedics.

A self-developed questionnaire about schooling, sports, hobbies, etc., was distributed to some 400 OS, 120 general surgeons, and 60 physicians across South Africa. There was a 29.2% response rate (117 replies) from OS, and 14 surgeons and 20 physicians replied.

The findings were inconclusive but nonetheless interesting. Profiles of the ‘average’ OS showed similarities with regard to race, gender, sports participation at school, and job satisfaction, especially when compared to the control group. There were notable individual differences in terms of age, marital status, number of children and use of free time. Most OS had attended urban public high schools. Golf was by far the most popular sport. More OS than members of the control group took part in sport, but they did not reach higher levels than their counterparts did.

The profile of the average OS does not seem to differ significantly from the control group, and more in-depth research seems necessary.

Glenoid baseplate orientation in reverse shoulder arthroplasty (RSA) influences clinical outcomes, complications, and failure rates. Novel technologies have been produced to decrease performance heterogeneity of low and high-volume surgeons. This study aimed to determine novice and experienced shoulder surgeon's ability to accurately characterise glenoid component orientation in an intra-operative scenario.

Glenoid baseplates were implanted in eight fresh frozen cadavers by novice surgical trainees. Glenoid baseplate version, inclination, augment rotation, and superior-inferior centre of rotation (COR) offset were then measured using in-person visual assessments by novice and experienced shoulder surgeons immediately after implantation. Glenoid orientation parameters were then measured using 3D CT scans with digitally reconstructed radiographs (DRRs) by two independent observers. Bland-Altman plots were produced to determine the accuracy of glenoid orientation using standard intraoperative assessment compared to postoperative 3D CT scan results.

Visual assessment of glenoid baseplate orientation showed “poor” to “fair” correlation to 3D CT DRR measurements for both novice and experienced surgeon groups for all measured parameters. There was a clinically relevant, large discrepancy between intra-operative visual assessments and 3D CT DRR measurements for all parameters. Errors in visual assessment of up to 19.2 degrees of inclination and 8mm supero-inferior COR offset occurred. Experienced surgeons had greater measurement error than novices for all measured parameters.

Intra-operative measurement errors in glenoid placement may reach unacceptable clinical limits. Kinesthetic input during implantation likely improves orientation understanding and has implications for hands-on learning.