The purpose of this prospective pilot study is to examine the feasibility of a physiotherapist led rapid access shoulder screening clinic (RASC). The goal of this study is to assess for improvements in patient access to care, patient reported outcome measures, patient reported experience measures, and cost outcomes using time driven activity based costing methods. Patient recruitment began in January 2021. Consultation requests from general practitioners and emergency rooms are analyzed and triaged through a central system. One half of patients awaiting consultation were triaged to the traditional route used at our center while the other half were triaged to be assessed at the RASC. Outcome measures consisting of the Simple Shoulder Test and SF-12 were recorded at the initial consultation and at follow up appointments. Cost benefit analysis was conducted using time driven activity based costing methods (TD-ABC). From January to August of 2021, 123 new patients were triaged for RASC assessment. On average, the RASC gets 10 new referrals per month. As of September 2021, there are 65 patients still on waitlist for RASC assessment with 58 having been assessed. Of the 58, 11% were discharged through the RASC, 48% pursued private physiotherapy, 14% had injections, 19% proceeded on for surgical consultation, and 8% did not show. Over time same time period, approximately 15 new patients were seen in consultation by the surgeon's office. Thirty-five responses were obtained from RASC patients during their initial intake assessment. The average age of respondents was 54.7 with 21 females and 14 males. Median SF-12 scores in the physical dimension (PCS-12) for RASC patients were 36.82 and mental (MCS-12) 49.38927. Median Simple Shoulder Test scores measured 6. Of the patients who responded to the follow up questionnaires after completing physiotherapy at the RASC, both the SF-12 and Simple Shoulder Test scoring improved. Median PCS-12 measured 47.08, MCS-12 of 55.87, and Simple Shoulder Test measured 8. RASC assessments by PT saved $172.91 per hour for consultation and $157.97 per hour for patient follow ups. Utilization of a physiotherapy led rapid access shoulder clinic resulted in improvements in patient outcomes as measured by the SF-12 and Simple Shoulder Test as well as significant direct cost savings. Proper triage protocols to identify which patients would be suitable for RASC assessment, buy-in from physiotherapists, and timely assessment of patients for early initiation of rehabilitation for shoulder pain is paramount to the success of a RASC system at our centre. Future research direction would be geared to analyzing a larger dataset as it becomes available.
Although most joint surgeons have reached a consensus that preoperative risk assessment and appropriate medical intervention for elderly patients of primary total hip arthrplasty (PTHA) could significantly reduce postoperative complications and mortality, there is still lack of a detailed and comprehensive approach for risk stratifying and a systematic method for risk allaying. We aimed to explore the risk factors related to the aggravation of preoperative complications and the appearance of complications post-operation of primary total hip arthrplasty (PTHA) in elderly patients for hip fracture. We retrospectively reviewed the demographic and clinical data of 156 patients who underwent PTHA for hip fracture from January 2014 to December 2016, of which there were 61 male (39.1%) and 95 female (60.9%) patients; 111 patients aged 60–79 years (71.2%) and 45 patients ≥ 80 years old (28.8%); 125 patients of femoral neck fracture (80.1%) and 31 patients of inter-trochanteric fracture (19.9%); 109 patients of spinal anesthesia (69.9%) and 48 patients of general anesthesia (30.1%); 85 patients undergoing surgery within 3 days (54.5%) and 71 patients operated ≥ 4 days (45.5%) since admission. We evaluated the correlations among gender, age, type of fracture, methods of anesthesia, time of operation since admission, the aggravation of preoperative complications and the appearance of postoperative complications post PTHA using the IBM SPSS Statistics (version 21) and the Exce1 2016.Objectives
Patients and methods
Soft tissue tension and intra-articular pressure distribution plays a crucial role in postoperative function and survivorship of TKA prosthesis. Although posterior stabilized (PS) and cruciate retaining (CR) knees have both been successful in relieving pain and restore function, it is reported that the joint gaps were significantly distinct between the two designs during flexion. The aim of this study is to find out what is the difference in intra-articular pressure distribution between PS and CR knees. We prospectively included 45 consecutive patients (50 knees) scheduled for total knee arthroplasty between August, 2013 and April, 2014 in our hospital. 23 patients (25 osteoarthritic knees) received a Genesis II CR TKA (Smith & Nephew, Memphis, USA), and the other 22 patients (25 osteoarthritic knees) received Genesis II PS TKA (Smith & Nephew, Memphis, USA). During operation, after the bone osteotomy and soft tissue balance were completed, we measured and compared the intra-articular pressure distribution at 0°, 30°, 45°, 60°, 90°, and 120° flexion with a previously validated “Wireless Force Measurement System (WFMS)”. Joint gaps were measured at extension and 90° flexion. The soft tissue was not considered balanced until the medial and lateral joint gap difference ≤ 2mm at extension and 90° flexion. There are no significant differences in age, gender, BMI, varus angle and flexion deformity, and preoperative range of motion between the two groups. The medial-lateral pressure distribution and total pressure were compared at different angles between CR and PS knees.Background
Methods
