Non-surgical osteoarthritis management includes analgesia escalation to oral opiates; however, tolerance can occur. This study aims to assess analgesic effects of opiate use pre-operatively and whether this influences outcome 1-year post-operatively in patients undergoing total hip/knee arthroplasty (THA/TKA). This prospective study assessed 1487 patients undergoing primary THA (n=729) or TKA (n=758) for osteoarthritis, with 95 respectively reporting pre-operative opiate use >1 month. THA opiate users had significantly higher BMI (p=0.007) and more likely to suffer associated comorbidities. TKA opiate users were significantly younger (p<0.001), with higher BMI (p=0.019) and more likely to suffer associated comorbidities. Pre-operative quality of life (QoL) and joint specific function were significantly worse (Hip EQ-5D 0.17 vs 0.41, p<0.001, OHS 14.6 vs 21.2, p<0.001; Knee EQ-5D 0.27 vs 0.44, p<0.001, OKS 16.4 vs 21.4, p<0.001). Pre-operative pain was significantly worse in those taking opioids (Hip Pain VAS 42.73 vs 50.70, p<0.001; Knee Pain VAS 50.93 vs 53.36, p=0.30). Post-operatively the THA opiate group had significant improvement in EQ-5D (0.175, p<0.001) and OHS (6.5, p<0.001) but were significantly less improved than opiate naïve patients after adjusting for confounding (EQ-5D 0.10, p<0.001; OHS 3.2, p<0.001). TKA opiate group also had significant improvement in EQ-5D (p<0.001) and OKS (p<0.001) but were significantly less (EQ-5D 0.089, p<0.001; OKS 3.9, p<0.001) than opioid naïve patients. Pre-operative opiate use was associated with significantly worse pre-operative QoL, joint specific function and worse subjective pain. Post-operatively, the opiate group had significantly lower improvement in their QoL and joint specific function

Aims. The use of multimodal non-opioid analgesia in hip fractures, specifically acetaminophen combined with non-steroidal anti-inflammatory drugs (NSAIDs), has been increasing. However, the effectiveness and safety of this approach remain unclear. This study aimed to compare postoperative outcomes among patients with hip fractures who preoperatively received either acetaminophen combined with NSAIDs, NSAIDs alone, or acetaminophen alone. Methods. This nationwide retrospective cohort study used data from the Diagnosis Procedure Combination database. We included patients aged ≥ 18 years who underwent surgery for hip fractures and received acetaminophen combined with NSAIDs (combination group), NSAIDs alone (NSAIDs group), or acetaminophen alone (acetaminophen group) preoperatively, between April 2010 and March 2022. Primary outcomes were in-hospital mortality and complications. Secondary outcomes were opioid use postoperatively; readmission within 90 days, one year, and two years; and total hospitalization costs. We used propensity score overlap weighting models, with the acetaminophen group as the reference group. Results. We identified 93,018 eligible patients, including 13,068 in the combination group, 29,203 in the NSAIDs group, and 50,474 in the acetaminophen group. Propensity score overlap weighting successfully balanced patient characteristics among the three groups, with no significant difference in in-hospital mortality rates observed among the groups (combination group risk difference 0.0% (95% CI -0.5 to 0.4%); NSAIDs group risk difference -0.2% (95% CI -0.5 to 0.2%)). However, the combination group exhibited a significantly lower risk of in-hospital complications than the acetaminophen group (risk difference -1.9% (95% CI -3.2 to -0.6%)) as well as a significantly lower risk of deep vein thrombosis (risk difference -1.4% (95% CI -2.2 to -0.7%)). Furthermore, total hospitalization costs were higher in the NSAIDs group than in the acetaminophen group (difference USD $438 (95% CI 249 to 630); p < 0.001). No significant differences in other secondary outcomes were observed among the three groups. Conclusion. The combination of acetaminophen with NSAIDs appears to be safe and advantageous in terms of reducing in-hospital complications. Cite this article: Bone Joint J 2024;106-B(8):849–857

Aims

The aim of this study was to assess the association of mortality and reoperation when comparing cemented and uncemented hemiarthroplasty (HA) in hip fracture patients aged over 65 years.

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To identify the prevalence of neuropathic pain after lower limb fracture surgery, assess associations with pain severity, quality of life and disability, and determine baseline predictors of chronic neuropathic pain at three and at six months post-injury.

Aims. Falls are a common occurrence among hospital inpatients and can lead to injury, prolonged hospitalisation and delayed rehabilitation. There is major economic burden associated with this. Post operative orthopaedic patients have certain risk factors that predispose them to falls including decreased mobility, use of opioids and, in some cases, history of previous falls. Methods. A Prospective cohort study with a historical control group was performed looking at falls before and after implementation of a Falls Prevention Program (FFP). A cost analysis of the intervention was then undertaken. Patient data, HIPE data and fall-incident report data were reviewed to identify fall-related injuries and related costs. Results. A total of 415 falls occurred over a 5 year period pre-intervention. The fall rate of 3.49/1000 bed days pre-intervention was significantly higher than the fall rate post-intervention (2.68/1000 bed days) (p=0.0348). There was a significant decrease in falls relating to elimination (p=0.0025). Elective patients also fell less in the post-intervention period (p=0.0115). 85 falls occurred in the 12 months pre-intervention. 15.29% (13/85) of falls resulted in minor injuries, and 9.42% (8/85) resulted in major injuries. The total cost incurred during this period as a result of falls was €84,285.74. Over 95% of total costs related to patients who sustained a hip fracture (n=4). The total cost of implementing the FFP was €11,234.25. In the 12 months post-intervention, 52 falls occurred. 25% (13/52) of falls resulted in minor injuries, and 5.76% (2/52) resulted in major injuries (no hip fractures). The total costs accrued during this period as a result of falls was €510.60. Conclusion. Following the implementation of a FPP the incidence of falls and consequent costs decreased significantly. The large proportion of saving results from preventing hip fractures

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Complex joint fractures of the lower extremity are often accompanied by soft-tissue swelling and are associated with prolonged hospitalization and soft-tissue complications. The aim of the study was to evaluate the effect of vascular impulse technology (VIT) on soft-tissue conditioning in comparison with conventional elevation.

Introduction. New methods to reduce inpatient stay, post-operative complications and recovery time are continually being sought in surgery. Many factors affect length of hospital stay, such as, analgesia, patient and surgeon expectations, as well as provision of nursing care and physiotherapy. Development of the use of postoperative local anaesthetic infiltration delivered intra-articularly by a catheter appears to be an effective analgesic method which reduces patient's opioid requirements and allows early physiotherapy without motor blockade of muscles. Our study aimed to explore if the use of local anaesthetic infiltration intra-articularly following joint athroplasty affected the patient's duration of hospitalisation. Methods. Looking retrospectively at arthroplasty audit data, we compared two groups of age and sex-matched patients who underwent primary hip arthroplasty (replacement and resurfacing) and knee arthroplasty performed by a single surgeon using the same surgical techniques. The surgeon began to utilize local anesthetic infiltration intra-articularly in 2009. The first group included patients operated on the year prior to the change and the second group were those operated on within a year of the change of practice. There were 103 patients (27 resurfacings, 28 knees, 48 hips) in the local anaesthetic group and 141 patients (48 resurfacings, 36 knees, 64 hips) in the non-local anaesthetic group. The length of stay was investigated for plausible Normality using the Shapiro Wilks statistic. Between-treatment group differences were examined using one-way analysis of variance (ANOVA). Factors observed were, use of local anaesthetic (yes/no), joint (hip/knee) and day of surgery (weekend/not weekend). Between treatment group differences in gender and complications were investigated using Chi-squared methods. Results. Patients who received local anaesthetic had shorter stays, irrespective of the joint or day of operation. Patients undergoing hip arthroplasty discharged sooner when local anaesthetic was used compared with those without (mean 4.0 days and 4.4 days respectively P=0.04). Patients undergoing knee replacement also discharged sooner when local anaesthetic was used compared with those without (mean 4.9 days and 6.1 days respectively P=0.09). When knee and hip figures were combined and analysed to measure the significance of effects of treatment on the length of stay, local anaesthetic use was found to be statistically significant in reducing length of stay (P=0.01). There were no between-treatment group differences in proportions of complications, gender or day of surgery. Conclusion. The findings of this study highlight that local anaesthetic infiltration reduces duration of in-patient stay following knee and hip joint athroplasty and there is no associated significant increase in immediate post-operative complications

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Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture.

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The purpose of this study was to identify factors associated with limitations in function, measured by patient-reported outcome measures (PROMs), six to nine months after a proximal humeral fracture, from a range of demographic, injury, psychological, and social variables measured within a week and two to four weeks after injury.

Objectives

To determine the morbidity and mortality outcomes of patients presenting with a fractured neck of femur in an Australian context. Peri-operative variables related to unfavourable outcomes were identified to allow planning of intervention strategies for improving peri-operative care.

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Flail chest from a blunt injury to the thorax is associated with significant morbidity and mortality. Its management globally is predominantly non-operative; however, there are an increasing number of centres which undertake surgical stabilisation. The aim of this meta-analysis was to compare the efficacy of this approach with that of non-operative management.

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We examined risk of developing acute renal failure and the associated mortality among patients aged > 65 years undergoing surgery for a fracture of the hip.

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Amputation in intractable cases of complex regional pain syndrome (CRPS) remains controversial.

The likelihood of recurrent Complex Regional Pain Syndrome (CRPS), residual and phantom limb pain and persistent disability after amputation is poorly described in the literature. The aims of this study were to compare pain, function, depression and quality of life between patients with intractable CRPS who underwent amputation and those in whom amputation was considered but not performed.

We undertook a trial on 60 patients with AO 31A2 fractures of the hip who were randomised after stabilisation of the fracture into two equal groups, one of which received post-operative treatment using a non-invasive interactive neurostimulation device and the other with a sham device. All other aspects of their rehabilitation were the same. The treatment was continued for ten days after operation.

Outcome measurements included the use of a visual analogue scale for pain, the brief pain inventory and Ketorolac for post-operative control of pain, and an overall assessment of outcome by the surgeon. There were significantly better results for the patients receiving treatment by active electrical stimulation (repeated measures analysis of variance, p < 0.001). The findings of this pilot trial justify a larger study to determine if these results are more generally applicable.