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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 10 - 10
1 Jul 2022
Baker P Scrimshire A Farrier A Jameson S Nagalingham P Kottam L Walker R
Full Access

Abstract

Introduction

COMPOSE describes the demographics, fracture characteristics, management and associated outcomes of knee femoral periprosthetic fractures (KFPPF).

Methods

Multicentre retrospective cohort study conducted 01/01/2018-31/12/2018. Data collected included: patient demographics, social and mobility characteristics, fracture characteristics, management strategy and post-treatment outcomes (length of stay, reoperation, readmission, 30-day and 12-month mortality).


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 8 | Pages 1058 - 1066
1 Aug 2012
Baker PN Deehan DJ Lees D Jameson S Avery PJ Gregg PJ Reed MR

Patient-reported outcome measures (PROMs) are increasingly being used to assess functional outcome and patient satisfaction. They provide a framework for comparisons between surgical units, and individual surgeons for benchmarking and financial remuneration. Better performance may bring the reward of more customers as patients and commissioners seek out high performers for their elective procedures. Using National Joint Registry (NJR) data linked to PROMs we identified 22 691 primary total knee replacements (TKRs) undertaken for osteoarthritis in England and Wales between August 2008 and February 2011, and identified the surgical factors that influenced the improvements in the Oxford knee score (OKS) and EuroQol-5D (EQ-5D) assessment using multiple regression analysis. After correction for patient factors the only surgical factors that influenced PROMs were implant brand and hospital type (both p < 0.001). However, the effects of surgical factors upon the PROMs were modest compared with patient factors. For both the OKS and the EQ-5D the most important factors influencing the improvement in PROMs were the corresponding pre-operative score and the patient’s general health status. Despite having only a small effect on PROMs, this study has shown that both implant brand and hospital type do influence reported subjective functional scores following TKR. In the current climate of financial austerity, proposed performance-based remuneration and wider patient choice, it would seem unwise to ignore these effects and the influence of a range of additional patient factors.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 11 - 11
1 Jul 2012
Jameson S Dowen D James P Reed M Deehan D
Full Access

Introduction

Unlike the NJR, no surgeon driven national database currently exists for ligament surgery in the UK and therefore information on outcome and adverse event is limited to case series.

Methods

Prospectively collected Hospital episode statistics (HES) data for England was analysed so as to determine national rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE) rate, significant wound infection and 30-day readmission rates with cause following anterior cruciate ligament (ACL) reconstruction. This diagnostic and operative codes information is routinely collected on every patient admitted to hospital in England NHS.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXIX | Pages 47 - 47
1 Jul 2012
Jameson S James P Serrano-Pedraza I Muller S Hui A Reed M
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Introduction

The National Institute for Health and Clinical Effectiveness recommends both low molecular weight heparin (LMWH) and Rivaroxaban for venous thromboembolic (VTE) prophylaxis following lower limb arthroplasty. Despite evidence in the literature that suggests Rivaroxaban reduces VTE events, there are emerging concerns from the orthopaedic community regarding an increase in wound complications following its use.

Methods

Through the orthopaedic clinical directors forum, Trusts replacing LMWH with Rivaroxaban for lower limb arthroplasty thromboprophylaxis during 2009 were identified. Prospectively collected Hospital episode statistics (HES) data was then analysed for these units so as to determine rates of 90-day symptomatic deep venous thrombosis (DVT), pulmonary thromboembolism (PTE), major bleed (cerebrovascular accident or gastrointestinal haemorrhage), all-cause mortality, and 30-day wound infection and readmission rates before and after the change to Rivaroxaban. 2752 patients prescribed Rivaroxaban following TKR or THR were compared to 10358 patients prescribed LMWH. Data was analysed using odds ratios (OR).


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_IX | Pages 13 - 13
1 Mar 2012
Kulkarni A Jameson S James P Woodcock S Reed M
Full Access

Background

Total Knee Replacement (TKR) is technically demanding, time consuming and has higher complication rates in super obese (BMI>45) patients. Bariatric surgery can be considered for such patients prior to TKR although its effect on complications is unknown.

Methods

All patients who underwent bariatric surgery and a TKR in the NHS in England between 2005 and 2009 were included. Hospital episode statistics data in the form of OPCS, ICD10 codes were used to establish 90-day DVT, PE and mortality rates (inpatient and outpatient). In addition, readmission to orthopaedics, joint revision and ‘return to theatre for infection’ rates were also established. Code strings for each patient were examined in detail to ensure the correct gastric procedures were selected. Fifty-three patients underwent bariatric surgery then TKR (44-1274 days) (group 1). Thirty-one patients underwent TKR then bariatric surgery (33-1398 days) (group 2).