The Ponseti method is the gold standard treatment for clubfoot. It begins in early infancy with weekly serial casting for up to 3 months. Globally, a commonly reported barrier to accessing clubfoot treatment is increased distance patients must travel for intervention. This study aims to evaluate the impact of the distance traveled by families to the hospital on the treatment course and outcomes for idiopathic clubfoot. No prior studies in Canada have examined this potential barrier. This is a retrospective cohort study of patients managed at a single urban tertiary care center for idiopathic clubfoot deformity. All patients were enrolled in the Pediatric Clubfoot Research Registry between 2003 and April 2021. Inclusion criteria consisted of patients presenting at after percutaneous Achilles tenotomy. Postal codes were used to determine distance from patients’ home address to the hospital. Patients were divided into three groups based on distance traveled to hospital: those living within the city, within the Greater Metro Area (GMA) and outside of the GMA (non-GMA). The primary outcome evaluated was occurrence of deformity relapse and secondary outcomes included need for surgery, treatment interruptions/missed appointments, and complications with bracing or casting. A total of 320 patients met inclusion criteria. Of these, 32.8% lived in the city, 41% in the GMA and 26% outside of the GMA. The average travel distance to the treatment centre in each group was 13.3km, 49.5km and 264km, respectively. Over 22% of patients travelled over 100km, with the furthest patient travelling 831km. The average age of presentation was 0.91 months for patients living in the city, 1.15 months for those within the GMA and 1.33 months for patients outside of the GMA. The mean number of total casts applied was similar with 7.1, 7.8 and 7.3 casts in the city, GMA and non-GMA groups, respectively. At least one two or more-week gap was identified between serial casting appointments in 49% of patients outside the GMA, compared to 27% (GMA) and 24% (city). Relapse occurred in at least one foot in 40% of non-GMA patients, versus 27% (GMA) and 24% (city), with a mean age at first relapse of 50.3 months in non-GMA patients, 42.4 months in GMA and 35.7 months in city-dwelling patients. 12% of the non-GMA group, 6.8% of the GMA group and 5.7% of the city group underwent surgery, with a mean age at time of initial surgery of 79 months, 67 months and 76 months, respectively. Complications, such as pressure sores, casts slips and soiled casts, occurred in 35% (non-GMA), 32% (GMA) and 24% (city) of patients. These findings suggest that greater travel distance for clubfoot management is associated with more missed appointments, increased risk of relapse and treatment complications. Distance to a treatment center is a modifiable barrier. Improving access to clubfoot care by establishing clinics in more remote communities may improve clinical outcomes and significantly decrease the burdens of travel on patients and families

Abstract. Background. During COVID-19 pandemic, there has been worldwide cancellation of elective surgeries to protect patients from nosocomial transmission and peri-operative complications. With unfolding situation, there is definite need for exit strategy to reinstate elective services. Therefore, more literature evidence supporting exit plan to elective surgical services is imperative to adopt a safe working principle. This study aims to provide evidence for safe elective surgical practice during pandemic. Methods. This single centre, prospective, observational study included adult patients who were admitted and underwent elective surgical procedures in the trust's COVID-Free environment at Birmingham Treatment Centre between 19th May and 14th July’2020. Data collected on demographic parameters, peri-operative variables, surgical specialities, COVID-19 RT-PCR testing results, post-operative complications and mortality. The study also highlighted the protocols it followed for the elective services during pandemic. Results. 303 patients were included with mean age of 49.9 years (SD 16.5) comprising of 59% (178) female and 41% (125) male. They were classified according to American Society of Anaesthesiologist Grade, different surgical specialities and types of anaesthesia used. 96% patients were discharged on the same day. 100% compliance to pre-operative COVID-19 testing was maintained. There was no 30-day mortality or major respiratory complications. Conclusion. Careful patient selection, simultaneous involvement of the pre-assessment and anaesthetic team, strict adherence to peri-operative protocols and delivering vigilant post-operative care for COVID-19 infection can help providing safe elective surgical services if the community transmission under reasonable control. However, it is particularly important to maintain COVID-free safe environment for such procedures

224 patients from the Cardiff and Vale NHS Trust who had total knee replacements at the NHS Treatment Centre in Weston-Super-Mare by surgeons from overseas appeared to have significantly worse results than those recorded in the published literature. We wished to establish whether a group of patients treated in the same hospital with the same prosthesis at a similar time by local NHS orthopaedic surgeons in substantive posts would have a similar outcome. Follow-up of all 214 patients (223 knee replacements) treated in 2004 was conducted with questionnaires, clinical review and x-ray assessment. In cases of no response, contact was made with GPs to establish the outcome of the surgery. The outcome of all patients was known and of the 125 knee replacements available for clinical review at six years (mean), 119 cases (96%) achieved satisfactory coronal alignment with reference to the published literature. There were six revisions, five for loosening and one for malalignment. The cumulative survival rate for re-operation at six years was 97.2% (95% confidence interval 95.2 to 99.1). This study shows that the results of total knee replacement performed by a group of NHS orthopaedic surgeons were comparable with other institutions and were significantly better than those reported from the NHS Treatment Centre in Weston-Super-Mare, using the same facilities and implant over the same period of time. This work supports previous recommendations for single surgeon supervision of the patient pathway and appropriate follow-up procedures

Purpose. A comparison of patient satisfaction of service provided by independent sector treatment centres versus an index NHS hospital in total knee replacement surgery. Methods. Patients were all initially listed for total knee replacement (TKR) by a single consultant from the index NHS hospital, Derbyshire Royal Infirmary (DRI). Patients were sent a postal questionnaire and asked to rate the TKR service provided by a given hospital, based on recent inpatient experience. Questions covered quality of care delivered by hospital staff and quality of ward environment. Overall satisfaction was rated. Patients electing surgery under Patient Choice at an independent sector treatment centre (ISTC) were asked about factors that influenced their hospital choice. 100 consecutive patients undergoing TKR at DRI and 100 patients choosing ISTC hospitals were identified. All surgery occurred between April 2003 and September 2006. Results. Questionnaire response rates were 79% for DRI patients and 54% for ISTC. Overall patient satisfaction for TKR service was 95% for DRI and 87% for ISTC. An equal 61% rated the surgeons as excellent in both DRI and ISTC hospitals. Nurses and physiotherapists (& occupational therapists) both scored more highly in ISTC groups (Nurses 69% v 45%; physio/OT 57% v 35%). Ward environment rated excellent in 73% for ISTC and 24% for DRI. The most common reason for choosing ISTC was shorter waiting list (42%). Conclusion. ISTC hospitals scored more highly in terms of nurses, physiotherapy & occupational therapy, and ward environment. In part, this may arise from better staffing levels and newer facilities in the ISTC sector. Despite this, overall patient satisfaction for TKR service remained greater at the index NHS hospital. This suggests overall satisfaction depends on more complex factors than staff and ward environment. Further work is needed to compare objective clinical outcomes of TKR between hospital groups within the NHS

This study investigates the experience of one treatment centre with routine surveillance MRI following excision of sarcoma. Casenotes, MRI and histology reports for fifty-nine patients were reviewed. The primary outcome was the presence of local tumour recurrence and whether this was identified on surveillance or interval scanning. Forty-eight patients had a diagnosis of soft tissue sarcoma, the remaining 11 a primary bone tumour. Fifteen patients had local recurrence (25%). Eight were identified on surveillance scan, and the remaining 7 required interval scans. Surveillance scanning has a role in the early detection of local recurrence of bone and soft tissue sarcoma

At the Peninsula NHS Treatment Centre in Plymouth some of the surgeons are UK trained and some trained elsewhere in Europe. This paper examines the outcomes of a large series of joint replacements from 2006 to 2008 at a minimum of one year follow up to determine whether the place of orthopaedic specialist training makes any difference to the outcome. The same implants were used by all surgeons and the anaesthetic technique and post-operative management was identical. 1700 patients were interviewed by a structured telephone questionnaire with over 92% follow-up and the results entered into a joint replacement database. Additional data about length of stay and blood transfusion was added. Results will be presented about length of stay, transfusion requirements, any further treatment or hospital attendance relating to the new joint, reoperation, deep or superficial infection, hip dislocation, VTE and patient satisfaction. The surgeon's place of orthopaedic training was found to make no difference to the surgical outcome

Performance evaluation in specialist orthopaedic hospitals was reviewed in comparison to district general hospitals (DGHs) using a variety of outcome measures, including surgical activity, length of stay and infection rates. Data regarding admission rates, operations performed or cancelled, outpatient activity and waiting times were obtained from the Hospital Episode Statistics department of the Department of Health. Surgical site infection (SSI) and MRSA infection rates from the Royal National Orthopaedic Hospital (RNOH) are compared to national data supplied by the Health Protection Agency. In comparison with DGHs, specialist orthopaedic hospitals admit fewer patients, with fewer emergencies; have a higher ratio of waiting list patients to number of patients admitted; have longer waiting list times on average; perform more primary joint arthroplasty surgery; undertake more revision procedures; discharge patients home following joint arthroplasty surgery on average one day earlier; have a lower total hip arthroplasty SSI rate (0.8%) compared with 2.3% in 146 DGHs and from RNOH data, provide a service with a lower surgical site infection and MRSA rate. Specialist orthopaedic hospitals in England provide a unique, efficient and effective service compared to DGHs. However, short-term performance measures, though simpler to collate, may not be as valuable as longer-term outcome measures, thus making direct comparisons between DGHs, specialist orthopaedic hospitals and independent treatment centres difficult

Introduction. The outcomes programme of our institution has been developed from a system first used at Epsom and St Helier NHS Trust 15 years ago. The system was implemented at our institution when it opened in 2004, and has been used to collect data on over 17,000 joint replacement operations so far. A bespoke database is used to collect, analyse and report outcome data. Methods. An integrated system allows the collection of patient-reported outcome measures (PROMS), patient satisfaction scores, radiological assessment, and medical or surgical complications. Functionality allows the transfer of data from existing clinical management programmes, and the generation of customised letters and questionnaires to send to patients. Analysis of data and report production is fully automated. Data is collected pre-operatively, during the inpatient stay, and post-operatively at 6 weeks, 6, 12 and 24 months. Results are disseminated to the surgeons, the senior management team and the Clinical Governance Committee. Results. Response rates exceed 95% pre-operatively, 90% at 6 weeks and 6 months post-operatively and exceed 80% at 1 year and 2 year follow up. Data on over 17,000 joint replacement surgery have been compared to published literature. The results demonstrate high patient satisfaction and low complication rates. Discussion. This is an established outcome programme, effectively providing feedback to all involved in the care of our patients. Surgeons are thus able to identify where to invest efforts to improve their performance and management to assess the standard of service, monitor quality and promote the institution to healthcare purchasers as a cost-effective treatment centre. Patients can review the performance and the outcome of the health service at this centre prior to deciding where they have their treatment

Independent sector treatment centres (ISTCs) were introduced in October 2003 in the United Kingdom in order to reduce waiting times for elective operations and to improve patient choice and experience. Many concerns have been voiced from several authorities over a number of issues related to these centres. One of these concerns was regarding the practice of ‘cherry-picking’. Trusts are paid according to ‘payment by results’ at national tariffs. The national tariff is an average of costs occurring in an average mix of patients. The assumption is that the higher the co-morbidities of the patients the more likely they are to consume a higher amount of resource and to require a longer length of stay. Cherry-picking may also affect the quality of training available to trainees. This audit was aimed at identifying if, and how much this practice occurs. It also identifies what affect this has on the case-load of patients left for the NHS hospitals. We looked at the number of co-morbidities amongst 198 consecutive patients undergoing hip and knee primary total arthroplasty at an ISTC, a district general hospital whose PCTs provide patient to the ISTC (Doncaster Royal Infirmary - DRI), and a district general hospital in the same area whose PCT did not provide choice at that time and who therefore did not send patients to the ISTC (Bassetlaw District General Hospital - BDGH). We found a statistically significant difference in the number of co-morbidities per patient at the ISTC compared with the DRI (1.23 vs. 2.05) and the ISTC compared with the BDGH (1.23 vs. 1.76). We were unable to show a statistically significant difference between the DRI and the BDGH. We conclude that cherry-picking does take place, and further work should be done to assess the impact on training and finance

Aims

COVID-19 represents one of the greatest global healthcare challenges in a generation. Orthopaedic departments within the UK have shifted care to manage trauma in ways that minimize exposure to COVID-19. As the incidence of COVID-19 decreases, we explore the impact and risk factors of COVID-19 on patient outcomes within our department.