During the COVID-19 pandemic, video/phone consultations (VPC) were increasingly utilised as an alternative to face-to-face (F2F) consultations, to minimise nosocomial viral exposure. We previously demonstrated that VPCs were highly rated by both patients and clinicians. This study compared satisfaction between both clinic modalities in contemporaneously delivered outpatient surveys. We also assessed the feasibility and effects of converting F2F orthopaedic consultations to VPC. Surveys were posted to patients who attended VPCs and F2F consultations at a large tertiary centre from August to October 2020 inclusive, across 51 specialties. F2F and VPC patients ranked their overall satisfaction with their consultation on a 10-point numerical scale (10=highest satisfaction). Simultaneously, a pilot study was undertaken of outpatient fracture clinics to identify patients suitable for VPCs, with X-rays (if needed) taken and transferred from satellite sites to reduce tertiary centre footfall. For F2F consultations, 1419 of 4465 surveys (31.8%) were returned with similar rates for VPCs (1332 of 4572, 29.1%). While mean satisfaction ratings were high for both clinic modalities, they were significantly higher for F2F: 9.13 (95% CI 9.05-9.22) for F2F clinics, compared to 8.23 (95% CI 8.11-8.35) for VPCs (p<0.001, t-test). F2F patients were almost four times more likely to state a preference for future F2F appointments compared to VPCs, whereas patients who attended VPCs showed an equal preference for either option (p< 0.001, chi2 test). 53% of 111 fracture clinic patients sampled were identified as suitable for VPCs. 1 patient (1.7%) requested their VPC to be converted to F2F due to poor symptom control. Our study showed patients reported high satisfaction ratings for both F2F clinics and VPCs, with prior experience of VPCs affecting patients’ future preferences. Only 1.7% of F2F patients converted to VPCs declined their virtual appointment. Our results support future use of VPCs.
Lateral lumbar interbody fusion (LLIF) has biomechanical advantages due to the preservation of ligamentous structures (ALL/PLL), and optimal cage height afforded by the strength of the apophyseal ring. We compare the biomechanical motion stability of multiple levels LLIF (4 segments) utilising PEEK interbody 26mm cages to stand-alone cage placement and with supplemental posterior fixation with pedicle screw and rods. Six lumbar human cadaver specimens were stripped of the paraspinal musculature while preserving the discs, facet joints, and osteoligamentous structures and potted. Specimens were tested under 5 conditions: intact, posterior bilateral fixation (L1-L5) only, LLIF-only, LLIF with unilateral fixation and LLIF with bilateral fixation. Non-destructive testing was performed on a universal testing machine (MTS Systems Corp) to produce flexion-extension, lateral-bending, and axial rotation using customized jigs and a pulley system to define a non-constraining load follower. Three-dimensional spine motion was recorded using a motion device (Optotrak). Results are reported for the L3-L4 motion segment within the construct to allow comparison with previously published works of shorter constructs (1-2 segments). In all conditions, there was an observed decrease in ROM from intact in flexion/extension (31%-89% decrease), lateral bending (19%-78%), and axial rotation (37%-60%). At flexion/extension, the decreases were statistically significant (p<0.007) except for stand-alone LLIF. LLIF+unilateral had similar decreases in all planes as the LLIF+bilateral condition. The observed ROM within the 4-level construct was similar to previously reported results in 1-2 levels for stand-alone LLIF and LLIF+bilateral. Surgeons may be concerned about the biomechanical stability of an approach utilizing stand-alone multilevel LLIF. Our results show that 4-level multilevel LLIF utilizing 26 mm cages demonstrated ROM comparable to short-segment LLIF. Stand-alone LLIF showed a decrease in ROM from the intact condition. The addition of posterior supplemental fixation resulted in an additional decrease in ROM. The results suggest that unilateral posterior fixation may be sufficient.
Tibiotalocalcaneal (TTC) fusion is indicated for severe arthritis, failed ankle arthroplasty, avascular necrosis of talus and as a salvage after failed ankle fixation. Patients in our study had complex deformities with 25 ankles having valgus deformities (range 50–8 degrees mean 27 degrees). 12 had varus deformities (range 50–10 degrees mean 26 degrees) 5 ankles an accurate measurement was not possible on retrospective images. 10 out of 42 procedures were done after failed previous surgeries and 8 out of 42 had talus AVN. Retrospective case series of patients with hindfoot nails performed in our centre identified using NHS codes. Total of 41 patients with 42 nails identified with mean age of 64 years. Time to union noted from X-rays and any complications noted from the follow-up letters. Patients contacted via telephone to complete MOXFQ and VAS scores and asked if they would recommend the procedure to patients suffering similar conditions. 17 patients unable to fill scores (5 deceased, 4 nails removed, 2 cognitive impairment and 6 uncontactable)Abstract
Background
Methods
Local anaesthetic injections are regularly used for perioperative pain relief for shoulder arthroscopies. In our practice all shoulder arthroscopies were performed under general aneasthesia supplemented by perioperative subacromial local anaesthetic injections or landmark guided axillary nerve together with suprascapular nerve injections. We compared pain relief achieved with these two methods. We hypothesized that the selective nerve blocks would provide better post operative pain relief as described in literature. We conducted a retrospective cohort study on two patient groups with 17 patients each. Group one patients received 20mls 50:50 mixture of 1% lignocaine and 0.5% chirocaine injections before and after start of procedure and group two patients received 20 mls of chirocaine around the axillary and suprascapular nerves. VAS scores were collected at 1 and 4 hours and analgesia taken during the first 24 hours was recorded.Abstract
Introduction
Methods
Hip simulators have been used for ten years to determine the tribological performance of large-head metal-on-metal devices using traditional test conditions. However, the hip simulator protocols were originally developed to test metal-on-polyethylene devices. We have used patient activity data to develop a more physiologically relevant test protocol for metal-on-metal devices. This includes stop/start motion, a more appropriate walking frequency, and alternating kinetic and kinematic profiles. There has been considerable discussion about the effect of heat treatments on the wear of metal-on-metal cobalt chromium molybdenum (CoCrMo) devices. Clinical studies have shown a higher rate of wear, levels of metal ions and rates of failure for the heat-treated metal compared to the as-cast metal CoCrMo devices. However, hip simulator studies in vitro under traditional testing conditions have thus far not been able to demonstrate a difference between the wear performance of these implants. Using a physiologically relevant test protocol, we have shown that heat treatment of metal-on-metal CoCrMo devices adversely affects their wear performance and generates significantly higher wear rates and levels of metal ions than in as-cast metal implants.
