Introduction. Postvoid residualurine (PVR) can be an unknown chronic disorder, but it can also occur after surgery. A pilot-study initiated in Elective Surgery Center, Silkeborg led to collaboration with a urologist to develop a flowchart regarding treatment of PVR. Depending on the severity, men with significant PVR volumes were either recommend follow up by general practitioner or referred to an urologist for further diagnose and/or treatment. Aim: to determine the prevalence of pre- and postoperative PVR in men >65 years undergoing orthopedic surgeries and associated risk factors. Method. A single-center, prospective cohort study. Male patients were consecutively included during one year from April 2022. Data was extracted from the electronic patient files: age, lower urinary tract symptoms (LUTS), co-morbidity (e.g. diabetes), type of surgery and anesthesia, opioid use, pre- and postoperative PVR. Result. 796 participants; 316 knee-, 276 hip-, 26 shoulder arthroplasties and 178 lower back spinal surgeries. 95% (755) were bladder scanned preoperatively. 12% (89) had PVR 150-300ml, and 3% (23) had PVR >300ml. There was a higher risk of preoperative PVR ≥150ml in patients reporting LUTS, OR 1.97(1.28;3.03), having known neurological disease, OR 3.09(1.41;6.74), and the risk increased with higher age, OR 1.08 per year (1.04;1.12). Diabetes and the type of surgery was not associated with higher risk of PVR. 72% (569) had a postoperative bladder scan. 15% (95%CI: 12-19%) (70) patients without PVR preoperatively had PVR ≥150ml postoperatively. Conclusion. Approximately 15% of the men had PVR ≥150ml preoperatively. Neurological disease was the most severe risk factor and secondary if reporting LUTS. As expected, the risk increased with age. Neither diabetes nor the type of surgery was associated with higher risk. 15% of men without preoperative PVR had PVR after surgery. It is not possible to conclude if it is transient or chronic but further studies are ongoing

Objective. To determine the use of oral anti-inflammatory drugs use in the year before and the two years after primary total hip (THR) or knee (TKR) replacement, and to assess whether this varied according to the Body mass Index (BMI). Design. Population based retrospective case control study. Setting. 433 General Practitioner practices contributing to the General Practitioner Research Database. Participants. 28,068 patients who had undergone a THR and 24,364 patients who had undergone a TKR between 1991-2006. 5 controls per case were matched for age, sex and GP practice. Main Outcome measures. Two categories of oral anti-inflammatory usage: (1)”zero coverage” – patients who were not prescribed any anti-inflammatory medication; (2)”greater than 80% coverage” – patients who were prescribed anti-inflammatory medication for greater than 80% of the days in the year. Secondary subset analysis according to BMI. Results. At 1 year post surgery the proportion of cases on >80% coverage reduced from 21% (95%CI: 20% to 22%) to 8% (95%CI: 7% to 10%) for THR and 21% (95%CI: 20% to 22%) to 13% (95%CI: 11% to 14%) for TKR, with no ongoing reduction at 2 years. The proportion of THR/TKR cases on zero coverage increased at both 1 and 2 years post op (THR: Pre op 39%, 95%CI: 38% to 40%); 1 year post op 52% (95%CI: 51% to 53%); 2 year post op 66% (95%CI: 65% to 67%) and TKR: Pre op 39% (95%CI: 38% to 40%); 1 year post op 46% (95%CI: 45% to 47%); 2 year post op 58% (95%CI: 57% to 59%). BMI analysis. >80% coverage increased with BMI in the control groups. The proportion of THR cases on >80% coverage increased with BMI pre op. The magnitude in reduction of >80% coverage post op was similar across all BMI groups. The proportion of TKR cases on >80% coverage pre op was greatest in the extreme BMI categories. Again the magnitude in reduction of >80% coverage post op was similar across all BMI groups. Conclusion. THR/TKR's reduce the patients' need for anti-inflammatory medication, with implications regarding the side effects of their long-term use. The majority of the benefit from reduction in anti-inflammatory use is observed by 1 year post operatively. Increasing BMI affects anti-inflammatory use in both the general population as well as those undergoing THR/TKR surgery but without strong evidence of a detrimental effect on the benefits of pain relief

Aims. To capture the views of various members of the healthcare system with regards to whiplash injuries and in particular, the cumulative effects of whiplash on a patient seeking compensation. Method. A questionnaire was set up on “Surveymonkey” which consisted of three scenarios outlining 1. single whiplash injury 2. Past history of neck pain with new whiplash injury 3. Chronic history of neck pain with a new whiplash injury seeking long term compensation and early retirement. The respondents were asked whether or not they agreed or disagreed with fictional expert opinions for each scenario. The questionnaire was distributed to orthopaedic surgeons, accident & emergency doctors, general practitioners and physiotherapists. Results. In Scenario 1, half of the respondents believed that after a single whiplash injury with no past history of neck pain a decision of 3 months worth of disability compensation was acceptable. In Scenario 2, 67% of respondents opined that a previous history of whiplash injury makes a patient more susceptible to further soft tissue damage. Finally, in Scenario 3 100% of respondents believe that a decision of 12 years of compensation and early retirement due to his new injury was unjustifiable. Conclusions. Our questionnaire revealed that the majority of respondents believe that whiplash injuries are cumulative in nature. They also are of the opinion that chronic neck pain, once settled, does not contribute to subsequent whiplash injury. Conflicts of Interest. None. Source of Funding. None

Few doctors answer their bleep by stating who they are. Answering the phone in a formal manner is of utmost importance in the hospital setting especially by on-call teams who are normally referred patients by other specialties, general practitioners and in some cases by other hospitals. An audit to evaluate the internal hospital communication was completed. In the first part of this audit, junior doctors within the orthopaedic department at the RAH were bleeped. Doctors were expected to answer by initiating the conversation by stating (1) name, (2) department, (3) grade and (4) a greeting. A list of omissions was recorded. If the call went through switchboard, it was expected that the hospital name was stated. The second part of the audit extended to other specialties in the RAH as well as orthopaedic departments in hospitals within the Greater Glasgow and Clyde health board (NHS GGC). Forty-three bleeps were made to doctors of various grades over a period of two months. Nine bleeps (two from other hospitals) were not answered. Five doctors answered their bleep in full. Only twenty-one doctors stated their name whilst eleven stated their grade. In both instances the department was not necessarily stated. The results were similar between the different departments as well as between the seven hospitals offering an orthopaedic service within NHS GGC. Of the thirteen on-call doctors that were bleeped as an external call through switchboard, only one doctor stated the hospital name. This has implications since most hospitals within NHS GGC share a common switchboard. These results emphasise the need for a protocol within NHS GGC for a standard etiquette for intra and inter hospital communication to ensure that patient safety and confidentiality is safeguarded

Background. The physiotherapy profession has experienced a paradigm shift in recent years where mounting research evidence, indicating better patient outcomes, has led to an increase in popularity of a biopsychosocial model of care. In turn physiotherapists have begun to address psychosocial ‘obstacles’ to recovery, as means of improving outcomes for patients. To date, research has not examined how this change has affected the perceptions of physiotherapists about delivering care. The aim of this study was to explore these perceptions through exploratory interviews with physiotherapists in the UK. Methods. A qualitative interview study using a purposive sample of physiotherapists (n=12), nested within a larger study, exploring the attitudes and behaviours of UK general practitioners and physiotherapists about managing patients with low back pain. Interview transcripts were coded by the lead researcher and independently validated by a further team member. Transcripts were coded thematically using the constant comparative method to identify similarities and differences between the data and to determine fit and relevance. Results. The findings demonstrate that a combination of traditional physical therapy with a biopsychosocial approach presented significant challenges for professionals during the consultation. Physiotherapists perceived a number of ‘obstacles to recovery’ and responded to these through adoption of ‘health corrective’ strategies and by imposing limits around the management of these concerns with patients. Conclusion. A model of care combining a biopsychosocial approach with traditional physiotherapy can increase pressure on physiotherapists to use consultation strategies which appear to be patient-centred but may fail to shift from a professional-led agenda. Conflicts of interest. None. Sources of funding. Arthritis Research UK and the North Staffordshire Primary Care Research Consortium. We confirm that this abstract has not been previously published in whole or part nor has it been presented at a national meeting

Background. In 2009, the National Institute for Health and Clinical Excellence (NICE) produced the guidance: Low back pain: early management of persistent non-specific low back pain aimed at general practitioners (GPs), consultants, and manual therapists in order to ensure all involved in the care of this complex and often debilitating condition are aware of the options most likely to yield a positive outcome. Two years since the publication of the clinical guidance, services have had ample time to adapt and overcome early teething issues in order to deliver these guidelines. Methods. A retrospective audit was carried out at an out-patient physiotherapy department. One-hundred notes were randomly selected from those who meet the NICE criteria, i.e. non-specific low back pain for six weeks to 12 months in duration. A questionnaire was developed to target National Health Service (NHS) musculoskeletal physiotherapists using electronic media, mail shot and professional networking (clinical interest) groups within the Chartered Society of Physiotherapy (CSP). Sixty-one completed questionnaires were returned detailing the barriers for implementation. The results show that 75% of patients received NICE recommended care, and they improved by numerical rating scale (NRS) −3.89, while those who did not, improved by NRS −1.24 producing a significant difference of 2.654 (95% Confidence Interval 1.008–4.300), p≤0.002. The main perceived barriers were too few follow-up slots, local policy, managerial demands, and inadequate training. Conclusions. The conclusions are that while three-quarters of patients are receiving and benefiting from NICE recommended care, many practitioners feel departmental policy and procedures reduce compliance. Conflicts of Interest. None. Source of Funding. Poster funding via the University of Leicester. This abstract has not been previously published in whole or in part; nor has it been presented previously at a national meeting

Objectives

This study reports on a secondary exploratory analysis of the early clinical outcomes of a randomised clinical trial comparing robotic arm-assisted unicompartmental knee arthroplasty (UKA) for medial compartment osteoarthritis of the knee with manual UKA performed using traditional surgical jigs. This follows reporting of the primary outcomes of implant accuracy and gait analysis that showed significant advantages in the robotic arm-assisted group.

Aims

Osteoporosis and abnormal bone metabolism may prove to be significant factors influencing the outcome of arthroplasty surgery, predisposing to complications of aseptic loosening and peri-prosthetic fracture. We aimed to investigate baseline bone mineral density (BMD) and bone turnover in patients about to undergo arthroplasty of the hip and knee.

Injection or aspiration of the ankle may be performed through either an anteromedial or an anterolateral approach for diagnostic or therapeutic reasons. We evaluated the success of an intra-articular puncture in relation to its site in 76 ankles from 38 cadavers. Two orthopaedic surgical trainees each injected methylene blue dye into 18 of 38 ankles through an anterolateral approach and into 20 of 38 through an anteromedial. An arthrotomy was then performed to confirm the placement of the dye within the joint.

Of the anteromedial injections 31 of 40 (77.5%, 95% confidence interval (CI) 64.6 to 90.4) were successful as were 31 of 36 (86.1%, 95% CI 74.8 to 97.4) anterolateral injections. In total 62 of 76 (81.6%, 95% CI 72.9 to 90.3) of the injections were intra-articular with a trend towards greater accuracy with the anterolateral approach, but this difference was not statistically significant (p = 0.25). In the case of trainee A, 16 of 20 anteromedial injections and 14 of 18 anterolateral punctures were intra-articular. Trainee B made successful intra-articular punctures in 15 of 20 anteromedial and 17 of 18 anterolateral approaches. There was no significant difference between them (p = 0.5 and p = 0.16 for the anteromedial and anterolateral approaches, respectively). These results were similar to those of other reported studies. Unintended peri-articular injection can cause complications and an unsuccessful aspiration can delay diagnosis. Placement of the needle may be aided by the use of ultrasonographic scanning or fluoroscopy which may be required in certain instances.