The efficacy of Virtual Reality (VR) as a teaching augment for arthroplasty has not been well examined for unfamiliar multistep procedures such as unicompartmental knee arthroplasty (UKA). This study sought to determine if VR improves surgical competence over traditional procedural preparation when performing a UKA. 22 Orthopaedic trainees were randomized to training sessions: 1) “VR group” with access to an immersive VR learning module that had been designed in conjunction with the manufacturer or 2) “Guide group” with access to manufacture's technique guide and surgical video. Both groups then performed a full UKA on SawBones models. Surgical competence was assessed via Objective Structures Assessment of Technical Skills (OSATS) validated rating system (max 25 points).Introduction
Methods
Musculoskeletal tumours are relatively rare and as such, they are not well known by the population and by general practicioners. We observed that an important proportion of our patients has seen major delays at diferent stages of their referral pathway. It is well recognised that such delays can cause avoidable loss of function, local and systemic recurrence and increase in health system costs. The main objective of this study was to prospectively assess the referral paterns of our patients to pinpoint the causes of the delays. This should allow the formation of strategies to minimise delas and their impact. The secondary objective was to assess the performance of our centre in comparaison to other centre with the goal of improving quality of care. Prospective follow up data is available for 457 patient referred to our musculoskeletal oncology team between july 2011 and november 2014. Every patients filled questionnaires on their initial referral patterns. Site specific function and quality of life are evaluated at baseline and at subsequent follow-up (six months, one year, three years and five years). The average delay between the first symptoms and the first medical consultation with a general practitioner was 37 weeks (CI: 27–46). The average delay between the first medical consultation and the referral to orthopaedic oncology was 54 weeks (CI: 43–65). The delay between the first consultation with a general practitioner and the first radiologic test was 31 weeks (CI: 22–39). The delay between the first radiologic test and the referral to orthopaedic oncology was 28 weeks (CI 24–32). The delay between the referral to orthopaedic oncology and the first appointment to our centre was three weeks (CI 2–4). Before the referral to our center, 23% of the patients met two general practitioners and 10% met with 3 or more general practitioner. Fifty-two pervent of the patients had a consultation with a specialist and 19% saw two or more specialists. It is imperative to raise awareness of musculoskeletal tumours and indication for early referral in general practitioners. One of the main problems in our actual referral patern is early access to appropriate imaging. The creation of a referral program with specific guidelines is, in our opinion, the best way to significantly reduce the delays for appropriate management of patients with suspiscion of musculoskeletal tumours.
Major wound complication risk factors following soft tissue sarcoma resection. Wound-healing complications represent an important source of morbidity in patients treated surgically for soft tissue sarcomas (STS). The purpose of this study was to determine which factors are predictive of major wound complication rates following STS resection, including tumour site, size, grade, and depth, as well as radiotherapy and chemotherapy. We reviewed 256 cases of STS treated surgically between 2000 and 2011. The primary outcome was occurrence of major wound complications post STS resection. Major wound complications were more likely to occur post STS resection with larger tumour diameters (p = 0.001), high grade tumours (p = 0.04), location in the proximal lower extremity (p = 0.01), and use of preoperative radiotherapy (p = 0.01). Tumours located in the adductor compartment were at highest risk of complications. We did not demonstrate a significant difference in complications rates based on method of closure. Diabetes, smoking, obesity, tumour diameter, tumour location in the proximal lower extremity, and preoperative radiotherapy were independent predictors on multivariate analysis. There are multiple predictors for major wound complications post STS resection. A more aggressive resection of irradiated soft tissues, combined with primary reconstruction, should be considered in cases with multiple risk factors.
