Aims. The first death in the UK caused by COVID-19 occurred on 5 March 2020. We aim to describe the clinical characteristics and outcomes of major trauma and orthopaedic patients admitted in the early COVID-19 era. Methods. A prospective trauma registry was reviewed at a Level 1 Major Trauma Centre. We divided patients into Group A, 40 days prior to 5 March 2020, and into Group B, 40 days after. Results. A total of 657 consecutive trauma and orthopaedic patients were identified with a mean age of 55 years (8 to 98; standard deviation (SD) 22.52) and 393 (59.8%) were males. In all, 344 (approximately 50%) of admissions were major trauma. Group A had 421 patients, decreasing to 236 patients in Group B (36%). Mechanism of injury (MOI) was commonly a fall in 351 (52.4%) patients, but road traffic accidents (RTAs) increased from 56 (13.3%) in group A to 51 (21.6%) in group B (p = 0.030). ICU admissions decreased from 26 (6.2%) in group A to 5 (2.1%) in group B. Overall, 39 patients tested positive for COVID-19 with mean age of 73 years (28 to 98; SD 17.99) and 22 (56.4%) males. Common symptoms were dyspnoea, dry cough, and pyrexia. Of these patients, 27 (69.2%) were nosocomial infections and two (5.1%) of these patients required intensive care unit (ICU) admission with 8/39 mortality (20.5%). Of the patients who died, 50% were older and had underlying comorbidities (hypertension and cardiovascular disease, dementia, arthritis). Conclusion. Trauma admissions decreased in the lockdown phase with an increased incidence of RTAs. Nosocomial infection was common in 27 (69.2%) of those with COVID-19. Symptoms and comorbidities were consistent with previous reports with noted inclusion of dementia and arthritis. The mortality rate of trauma and COVID-19 was 20.5%, mainly in octogenarians, and COVID-19 surgical mortality was 15.4%. Cite this article: Bone Joint Open 2020;1-7:330–338

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. Methods. This is a prospective study of 121 patients who underwent elective orthopaedic procedures through a COVID-free pathway. All patients underwent a 14-day period of self-isolation, had a negative COVID-19 test within 72 hours of surgery, and underwent surgery at a COVID-free site. Baseline patient characteristics were recorded including age, American Society of Anaesthesiologists (ASA) grade, body mass index (BMI), procedure, and admission type. Patients were contacted 14 days following discharge to determine if they had had a positive COVID-19 test (COVID-confirmed) or developed symptoms consistent with COVID-19 (COVID-19-presumed). Results. The study included 74 females (61.2%) and 47 males (38.8%) with a mean age of 52.3 years ± 17.6 years (18 to 83 years). The ASA grade was grade I in 26 patients (21.5%), grade II in 70 patients (57.9%), grade III in 24 patients (19.8%), and grade IV in one patient (0.8%). A total of 18 patients (14.9%) had underlying cardiovascular disease, 17 (14.0%) had pulmonary disease, and eight (6.6%) had diabetes mellitus. No patients (0%) had a positive COVID-19 test in the postoperative period. One patient (0.8%) developed anosmia postoperatively without respiratory symptoms or a fever. The patient did not undergo a COVID-19 test and self-isolated for seven days. Her symptoms resolved within a few days. Conclusion. The development of a COVID-free pathway for elective orthopaedic patients results in very low viral transmission rates. While both surgeons and patients should remain vigilant, elective surgery can be safely restarted using dedicated pathways and procedures. Cite this article: Bone Joint Open 2020;1-9:562–567

Purpose. We compared visible blood loss and calculated blood loss after bipolar hemiarthroplasty in femoral neck fracture, and evaluated correlation between blood loss and its risk factors. Materials and Methods: A total of 356 patients who underwent bipolar hemiarthroplasty in femoral neck fracture between 2004 and 2010 were enrolled in this study. The total blood loss was calculated using the formula reported by Mercuiali and Brecher. We analyzed several factors, including gender, age, body mass index (BMI), anesthesia method, cardiovascular and cerebrovascular disease, preoperative anemia, American Society of Anesthesiologists (ASA) score, use of cement, and use of antithrombotic agents. Results: Total calculated blood loss (1,408±72 ml) differed significantly from visible blood loss(980±102 ml). In addition, calculated blood loss differed between risk factors (1,526±369 ml in cardiovascular disease, 1,588±279 ml in general anesthesia, 1,645±920 ml in obesity, and 1,605±439 ml in use of antithrombotic agents). Conclusion: Total calculated blood loss was much greater than visible blood loss. Patients with risk factors such as cardiovascular disease, obesity, use of antithrombotic agents, and general anesthesia should be treated with care in order to reduce blood loss

Aims. The new COVID-19 variant was reported by the authorities of the UK to the World Health Organization (WHO) on 14 December 2020. We aim to describe the clinical characteristics and nosocomial infection rates in major trauma and orthopaedic patients comparing the first and second wave of COVID-19 infection. Methods. A retrospective analysis of a prospectively collected trauma database was reviewed at a level 1 major trauma centre from 1 December 2020 to 18 February 2021 looking at demographics, clinical characteristics, and nosocomial infections and compared to our previously published first wave data (26 January 2020 to 14 April 2020). Results. From 1 December 2020 to 18 February 2021, 522 major trauma patients were identified with a mean age of 54.6 years, and 53.4% (n = 279) were male. Common admissions were falls (318; 60.9%) and road traffic accidents (RTAs; 71 (13.6%); 262 of these patients (50.2%) had surgery. In all, 75 patients (14.4%) tested positive for COVID-19, of which 51 (68%) were nosocomial. Surgery on COVID-19 patients increased to 46 (61.3%) in the second wave compared to 13 (33.3%) in the first wave (p = 0.005). ICU admissions of patients with COVID-19 infection increased from two (5.1%) to 16 (20.5%), respectively (p = 0.024). Second wave mortality was 6.1% (n = 32) compared to first wave of 4.7% (n = 31). Cardiovascular (CV) disease (35.9%; n = 14); p = 0.027) and dementia (17.9%; n = 7); p = 0.030) were less in second wave than the first. Overall, 13 patients (25.5%) were Black, Asian and Minority ethnic (BAME), and five (9.8%) had a BMI > 30 kg/m. 2. The mean time from admission to diagnosis of COVID-19 was 13.9 days (3 to 44). Overall, 12/75 (16%) of all COVID-19 patients died. Conclusion. During the second wave, COVID-19 infected three-times more patients. There were double the number of operative cases, and quadruple the cases of ICU admissions. The patients were younger with less dementia and CV disease with lower mortality. Concomitant COVID-19 and the necessity of major trauma surgery showed 13% mortality in the second wave compared with 15.4% in the first wave. In contrast to the literature, we showed a high percentage of nosocomial infection, normal BMI, and limited BAME infections. Cite this article: Bone Jt Open 2021;2(8):661–670

Of the 6075 patients enrolled in EU-CORE registry, 206 patients had orthopaedic device-related infections. Significant underlying diseases were reported in 71% patients, most frequently cardiovascular disease (38%). The common sites of infection were knee (40%) and hip (33%). Among the 170 patients with available culture results, 135 (79%) were positive. Coagulase-negative staphylococci (CoNS, 44%) and Staphylococcus aureus (43%, of those 47% were methicillin resistant) were the most commonly isolated pathogens. Daptomycin was used empirically in 48% patients and as second-line therapy in 67% patients. During daptomycin therapy, 67% patients had undergone surgery (debridement, 61%; removal of foreign device, 39%; incision and drainage, 9%). Over half of the inpatients (54%) received concomitant antibiotics. Daptomycin was most frequently prescribed at a dose of 6 mg/kg/day (48%), with a median duration of therapy of 16 (range, 1–176) days. The overall clinical success rate was 85%, and was similar whether daptomycin was administered as first- or second-line therapy. The success rates achieved for infections caused by S. aureus and CoNS were 86% and 83%, respectively. Among the 79 patients who entered the long-term follow-up, 85% had a sustained response. Adverse events (AEs) and serious AEs possibly related to daptomycin were reported in 4.4% and 1.9% patients, respectively. Results from this real-world clinical experience showed that daptomycin is an effective and well-tolerated treatment option for orthopaedic device-related infections with a high success rate up to 2 years of follow-up

Cartilage is known to have limited intrinsic repair capabilities and cartilage defects can progress to osteoarthritis (OA). OA is a major economic burden of the 21st century, being among the leading causes of disability. The risk of disability from knee OA is as great as that derived from cardiovascular disease; a fact that becomes even more concerning when considering that even isolated cartilage defects can cause pain and disability comparable to that of severe OA. Several cartilage repair procedures are in current clinical application, including microfracture, osteochondral autograft transfer, osteochondral allograft transplantation, and autologous chondrocyte implantation (ACI). Given the economic challenges facing our health care system, it appears prudent to choose procedures that provide the most durable long-term outcome. Comparatively few studies have examined long-term outcomes, an important factor when considering the substantial differences in cost and morbidity among the various treatment options. This study reviews the clinical outcomes of autologous chondrocyte implantation at a minimum of 10 years after treatment of chondral defects of the knee. Mean age at surgery was 36 ± 9 years; mean defect size measured 8.4 ± 5.5cm2. Outcome scores were prospectively collected pre- and postoperatively at the last follow up. We further analyzed potential factors contributing to failure in hopes of refining the indications for this procedure. Conclusions: ACI provided durable outcomes with a survivorship of 71% at 10 years and improved function in 75% of patients with symptomatic cartilage defects of the knee at a minimum of 10 years after surgery. A history of prior marrow stimulation as well as the treatment of very large defects was associated with an increased risk of failure

Background. Navigation systems that increase alignment accuracies of the lower limbs have been applied widely in total knee arthroplasty and are currently being adopted for minimally invasive UKA (MIS UKA) with good alignment results. There is little debate that when compared with total knee arthroplasty (TKA), UKA is less invasive, causes less morbidity, better reproduces kinematics, and therefore offers quicker recovery, better range of movement and more physiologic function. However, despite improved alignment accuracies, advantages of use of navigation system in UKA in clinical outcomes and survivals are still debatable. To the best of our knowledge, no reports are available on the long-term results after UKA performing using a navigation system. The purpose of this prospective study was to compare the radiological, clinical, and survival outcomes of UKA that performed using the navigation system and using the conventional technique at average 8 years follows up. Methods. Between January 2003 and December 2005, Total of 98 UKAs were enrolled for this study, 56 UKAs in the navigation group and 42 UKAs in conventional group were included in this study after a average 8 years follow-up. At the final follow up, the radiological measurements with regard to the mechanical axis, the inclination of the femoral and tibial components, and radiolucent line or loosening were evaluated and compared between two groups. The clinical evaluations were performed using range of motion, Western Ontario and McMaster Arthritis index (WOMAC) scores and Knee Society (KS) score. Results. Of the 98 patients (98 UNI knees), 2 (2.0%) had died at a mean 5.8years after surgery because of cardiovascular disease, 3 (3.1%) underwent revision surgery that 1 cases of periprosthetic stress fractures in medial tibial plateaus in the navigation group and a case of tibial component loosening and polyethylene wear in conventional groups were observed. At a final follow up, the mean of mechanical axis was statistically different between two groups (2.7 vs. 3.9 of varus). And there were significant difference between 2 groups in terms of the mean values (p=0.042) for the tibial component coronal alignment, mean coronal alignments of tibial components were 89.1 ± 2.4° in the NA-MIS and 87.6 ± 1.8° in the MIS group, however outlier result were similar in the 2 group (5 and 5 knees, respectively, p=0.673). Sagittal alignments of femoral and tibial component were similar in the two groups (p>0.05) Significant differences were found in WOMAC or HSS knee scores, in which, stiffness did not show any difference between two groups, but pain and function showed difference at the last follow-up. The mean knee flexion has improved from 135.0 ± 14.8° and 135.0 ± 14.1° preoperatively to 137.1 ± 6.5° and 136.5 ± 7.2° in the NA-MIS and MIS groups on the latest follow-up, which was not significants different (p =0.883). Conclusion. The navigation system in UKA can provide improved alignment accuracy. And better clinical outcomes in pain and HSS score compared with conventional technique after a average of 8 year follow-up

Introduction. Total ankle arthroplasty is increasingly used as an alternative to arthrodesis to treat advanced ankle arthritis. In an attempt to assess the survivorship and patient outcome as well as peri- and postoperative complications and possible risk factors, we retrospectively analyzed the demographics, clinical outcome and radiographic characteristics of 100 ankle prostheses (97 patients). Patients and methods. Between 3/2005 and 5/2010 114 S.T.A.R. Prostheses were implanted by one surgeon at our institution. Indication for TAA was primary and secondary osteoarthritis, 81 cases were posttraumatic. From the 53 female and 44 male patients the mean age was 63 and the mean BMI was 28,4. 11 patients had been smoking for longer than 12 years, 29 patients either had a history of diabetes, peripheral vascular or cardiovascular disease or varicosis. All operations were performed with a tourniquet, using a standard anterior midline incision. All patients received the same postoperative rehabilitation and follow up program. Postoperative evaluation included the AOFA Score and clinical radiographic follow ups 6 weeks after surgery and yearly thereafter. Additional procedures during surgery included lengthening of the Achilles tendon for 12 patients and fusion of the subtalar ankle for 5 patients. Results. The average follow up was 36 months. The preoperative AOFA Score of 36.87 (22–58) increased to 75.99 postoperative. 87 cases reported a better life quality and 82 cases would go for surgery again. 27 ankles incurred complications after primary surgery. 21 prostheses had to go for revision surgery. Most complications were due to aseptic loosening/ implant failure. Other complications include arthrofibrosis and impingement as well as delayed wound healing and deep infection. Four patients had to be revised to an athrodesis. Conclusion. Our study shows a high satisfaction rate after total ankle replacement and clear pain relief which is the primary indication for ankle arthroplasty. Patients with a body mass Index higher than 30 as well as patients with a history of diabetes or peripheral vascular disease and smokers showed a higher rate of complications. Although these are encouraging results, the rate of complications should be discussed with patients. Compared with ankle fusion, the rates of complications seem to be comparable

Navigation systems that increase alignment accuracies of the lower limbs have been applied widely in total knee arthroplasty and are currently being adopted for minimally invasive UKA (MIS UKA) with good alignment results. There is little debate that when compared with total knee arthroplasty (TKA), UKA is less invasive, causes less morbidity, better reproduces kinematics, and therefore offers quicker recovery, better range of movement and more physiologic function. However, despite improved alignment accuracies, advantages of use of navigation system in UKA in clinical outcomes and survivals are still debatable. To the best of our knowledge, no reports are available on the long-term results after UKA performing using a navigation system. The purpose of this prospective study was to compare the radiological, clinical, and survival outcomes of UKA that performed using the navigation system and using the conventional technique at average 8 years follows up. Between January 2003 and December 2005, Total of 98 UKAs were enrolled for this study, 56 UKAs in the navigation group and 42 UKAs in conventional group were included in this study after a average 8 years follow-up. At the final follow up, the radiological measurements with regard to the mechanical axis, the inclination of the femoral and tibial components, and radiolucent line or loosening were evaluated and compared between two groups. The clinical evaluations were performed using range of motion, Western Ontario and McMaster Arthritis index (WOMAC) scores and Knee Society (KS) score. Of the 98 patients (98 UNI knees), 2 (2.0%) had died at a mean 5.8years after surgery because of cardiovascular disease, 3 (3.1%) underwent revision surgery that 1 cases of periprosthetic stress fractures in medial tibial plateaus in the navigation group and a case of tibial component loosening and polyethylene wear in conventional groups were observed. At a final follow up, the mean of mechanical axis was statistically different between two groups (2.7 vs. 3.9 of varus). And there were significant difference between 2 groups in terms of the mean values (p=0.042) for the tibial component coronal alignment, mean coronal alignments of tibial components were 89.1 ± 2.4° in the NA-MIS and 87.6 ± 1.8° in the MIS group, however outlier result were similar in the 2 group (5 and 5 knees, respectively, p=0.673). Sagittal alignments of femoral and tibial component were similar in the two groups (p>0.05) Significant differences were found in WOMAC or HSS knee scores, in which, stiffness did not show any difference between two groups, but pain and function showed difference at the last follow-up. The mean knee flexion has improved from 135.0 ± 14.8° and 135.0 ± 14.1° preoperatively to 137.1 ± 6.5° and 136.5 ± 7.2° in the NA-MIS and MIS groups on the latest follow-up, which was not significant different (p=0.883). The navigation system in UKA can provide improved alignment accuracy. And better clinical outcomes in pain and HSS score compared with conventional technique after a average of 8 year follow-up

Introduction:. The risk factors for degenerative joint disease are well established: increasing age, obesity, joint abnormalities, trauma and overuse, together with female gender, ethnic and genetic factors. That obesity is a significant risk factor for developing osteoarthritis in non-weight-bearing as well as weight-bearing and joints was one of the first indications that the risk was nor purely that of aberrant biomechanical loading. Low grade chronic systemic inflammation is a component of each of ageing and obesity, atherosclerosis and diabetes, culminating in Metabolic Syndrome. In our study of 1684 patients with joint degeneration 85% were overweight or obese and 65% older than 65 years with 62% being both, 73% of patients were taking medications for serious, ‘non-orthopaedic’ health problems such as cardiovascular or respiratory disease, obesity or NIDDM. Monocytes are a major component of chronic inflammation, approximately 10% of white blood cells are monocytes which circulate for 2–3 days, before being recruited into tissues as inflammatory macrophages or undergoing apoptosis. Circulating S100A8/A9 (MRP8/14) is a measure of monocyte recruitment being shed during monocyte transmigration across the endothelium. The higher the S100A8/A9 the more monocytes being recruited giving an indirect measure of chronic inflammatory status. Methods:. 2154 blood samples were collected from arthroplasty patients (first or second joint replacement), 1135 Female and 1019 Male, age 29–93 years, body mass index (BMI) 18–56, with hip or knee osteoarthritis (primary, post-traumatic and secondary), 589 before a primary arthroplasty, 1187 patients >1 year post-arthroplasty, 101 patients before revision for aseptic loosening and 237 patients >1 year post-revision. All study patients received metal on UHMWPE implants. Plasma S100A8/A9 was measured using BMA Biomedicals Elisa kit, normal levels in healthy adults are 0.5–3 mg/ml. The data were analysed using SPSS, p values were calculated using Spearman's test. Results:. Pre-surgery (primary or revision), plasma concentrations of S100A8/A9 were significantly higher in overweight and obese patients 4.9 + 3.0 mg/ml and those over 65 years of age 5.0 + 3.0 mg/ml than in normal weight patients of any age 4.2 + 2.1 mg/ml. Further analysis revealed that in pre-operative lower limb arthroplasty patients >65 years and with a BMI >25, taking typical prescription NSAIDS (e.g. diclofenic, ibruprofen) circulating S100A8/A9 was 5.9 + 2.5 mg/ml while administration of anti-platelet/anti-coagulant therapies lowered plasma S100A8/A9 concentrations to 4.4 + 2.2 mg/ml, (p < 0.001). More than one year following an arthroplasty, circulating S100A8/A9 levels were significantly reduced including in overweight and obese patients >65 years of age regardless of their medication 4.2 + 2.2 mg/ml. Post-operative levels of S100A8/A9 were close to the normal healthy range in normal weight patients and only marginally higher in older obese patients. Discussion:. These data suggest that osteoarthritis is a significant driver of the chronic inflammation associated with obesity. Platelet activation and aggregation may underpin this as administration of low dose aspirin for cardiovascular diseases significantly reduces S100A8/A9

Background:. A large percentage of the patients who present for unilateral TKA have bilateral disease. Performing simultaneous, bilateral TKA has been debated and currently there is no consensus on the risks and benefit of this approach. In addition, specific selection criteria have not been defined to more accurately identify which patients are potentially appropriate candidates for this approach. Objectives:. The purpose of this study was to evaluate the clinical outcomes and peri-operative complications in simultaneous, bilateral TKA's using pre-operative patient selection criteria. Methods:. A retrospective analysis of 117 consecutive patients, (234 knees), was performed between February 2008 and March 2012 who underwent simultaneous, bilateral TKA performed by one surgeon under a single anesthetic. Pre-operative selection criteria were used for all patients to qualify for a simultaneous bilateral approach. This included the following: . 1). BMI less than 34,. 2). Minimum arc of motion to 100 degrees flexion,. 3). Flexion contracture less than 10 degrees,. 4). Varus or valgus alignment less than 10 degrees,. 5). No prior history of cardiovascular disease. 6). Age Less than 70 years old. Clinical outcomes were assessed including anesthesia type, tourniquet time, length of stay, transfusion rate, pre- op hemoglobin, post-op hemoglobin, pre-op range of motion, post-op range of motion, DVT and PE. Knee Society Score (KSS) and Functional KSS were assessed pre-operatively and 1 year post-operatively. Anatomic and mechanical axis evaluation was also performed on all patients with long standing radiographs pre and post operatively. A control group of 573 consecutive patients undergoing unilateral total knee arthroplasty during this same time period were identified and matched for the year of surgery, and prosthesis type. The same selection criteria were used for the control group and the same data points were evaluated. Results:. One hundred and seventeen consecutive patients, (234 knees), undergoing simultaneous, bilateral TKA were reviewed. There were no DVT's, or PE's. Nineteen percent required a transfusion for post-operative anemia. There were no cases of deep infection. Average pre-op KSS score was 49, with a post KSS score of 89 at an average follow-up of 1 year. Average pre-op Functional KSS score was 52, with an average post-op Functional KSS score of 91. Average ROM at one year post-op was 0 degrees of extension and 123 degrees of flexion. Average anatomic axis was 6 degrees valgus with a neutral mechanical axis restored in all patients. The clinical outcomes of the control group were comparable, with no statistically significant increase in the incidence of perioperative complications between the study group and the control group. Conclusion:. When the degenerative process involves both knees with comparable severity, the decision to perform total knee arthroplasty on one knee at a time with a staged approach, verses a simultaneous bilateral approach, has been challenging for many surgeons. There have been previous reports of increased perioperative complications associated with bilateral total knee arthroplasty, including increased risks of cardiovascular, neurological complications, as well as the increased demands on rehabilitation. Similarly, benefits of simultaneous bilateral total knee arthroplasty have also been identified such as, shortened rehabilitation, improved patient satisfaction, and decreased costs both to the patient and the hospital system. Using pre-operative patient selection criteria, the decision process in determining which patients are appropriate candidates for a bilateral approach can be facilitated, with clinical outcomes comparable to unilateral total knee arthroplasty

Aims

This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures.

Aims

Deprivation underpins many societal and health inequalities. COVID-19 has exacerbated these disparities, with access to planned care falling greatest in the most deprived areas of the UK during 2020. This study aimed to identify the impact of deprivation on patients on growing waiting lists for planned care.

Aims

The timing of when to remove a circular frame is crucial; early removal results in refracture or deformity, while late removal increases the patient morbidity and delay in return to work. This study was designed to assess the effectiveness of a staged reloading protocol. We report the incidence of mechanical failure following both single-stage and two stage reloading protocols and analyze the associated risk factors.

Osteoporosis is common and the health and financial cost of fragility fractures is considerable. The burden of cardiovascular disease has been reduced dramatically by identifying and targeting those most at risk. A similar approach is potentially possible in the context of fragility fractures. The World Health Organization created and endorsed the use of FRAX, a fracture risk assessment tool, which uses selected risk factors to calculate a quantitative, patient-specific, ten-year risk of sustaining a fragility fracture. Treatment can thus be based on this as well as on measured bone mineral density. It may also be used to determine at-risk individuals, who should undergo bone densitometry. FRAX has been incorporated into the national osteoporosis guidelines of countries in the Americas, Europe, the Far East and Australasia. The United Kingdom National Institute for Health and Clinical Excellence also advocates its use in their guidance on the assessment of the risk of fragility fracture, and it may become an important tool to combat the health challenges posed by fragility fractures.

We evaluated the quality of guidelines on thromboprophylaxis in orthopaedic surgery by examining how they adhere to validated methodological standards in their development. A structured review was performed for guidelines that were published between January 2005 and April 2013 in medical journals or on the Internet. A pre-defined computerised search was used in MEDLINE, Scopus and Google to identify the guidelines. The AGREE II assessment tool was used to evaluate the quality of the guidelines in the study.

Seven international and national guidelines were identified. The overall methodological quality of the individual guidelines was good. ‘Scope and Purpose’ (median score 98% interquartile range (IQR)) 86% to 98%) and ‘Clarity of Presentation’ (median score 90%, IQR 90% to 95%) were the two domains that received the highest scores. ‘Applicability’ (median score 68%, IQR 45% to 75%) and ‘Editorial Independence’ (median score 71%, IQR 68% to 75%) had the lowest scores.

These findings reveal that although the overall methodological quality of guidelines on thromboprophylaxis in orthopaedic surgery is good, domains within their development, such as ‘Applicability’ and ‘Editorial Independence’, need to be improved. Application of the AGREE II instrument by the authors of guidelines may improve the quality of future guidelines and provide increased focus on aspects of methodology used in their development that are not robust.

Cite this article: Bone Joint J 2014;96-B:19–23.