Aims

Surgeon and patient reluctance to participate are potential significant barriers to conducting placebo-controlled trials of orthopaedic surgery. Understanding the preferences of orthopaedic surgeons and patients regarding the design of randomized placebo-controlled trials (RCT-Ps) of knee procedures can help to identify what RCT-P features will lead to the greatest participation. This information could inform future trial designs and feasibility assessments.

Radiological examination is a useful tool in assessing osteoarthritis (OA) in the knee. We have compared the extent of osteoarthritis in the knee graded on radiographs and by intraoperative observation to determine if there is significant difference with relevance to preop-erative planning.

Radiographs for fifty-eight patients were graded for OA under blind conditions using the Ahlback classification system and direct measurement of the medial and lateral joint spaces. Intraoperative assessment of the corresponding joint surfaces was performed under blind conditions by a separate surgeon and graded using the Outerbridge classification system.

OA was found to be more common in the medial compartment than the lateral, both on radiographs and intraoperatively. Spearman correlation coefficient for the medial compartment comparing joint space narrowing and intraoperative assessment was −0.545. For the lateral compartment the Spearman correlation coefficient was lower at –0.406. Positive predictive values for OA in the medial and lateral compartments on radiography were 90% and 66.67% respectively. Negative predictive values for OA in the medial and lateral compartments on radiography were 44.74% and 34.69% respectively.

Conclusion: We have demonstrated that although radiographs have reasonable to good accuracy at showing OA in both compartments the absence of OA on radiographs does not correlate well with the absence of OA in the knee. This is of importance when planning operations, particularly unicompartmental knee replacement, as intraoperative findings of bilateral disease will change the operation required.

To assess the percentage of patients with an osteoporotic distal radial fracture who had any subsequent investigation or treatment for osteoporosis, and to compare this to the gold standard, all patients seen in a hospital fracture clinic with an osteoporotic fracture should be advised of the possibility of osteoporosis and their primary care team informed of the need for follow-up (Royal College of Physicians, National Osteoporosis Society and The Advisory Group on Osteoporosis).

All patients over 50 years old who sustained a distal radial fracture and a subsequent fractured neck of femur after simple falls, over a 7-year period, were included. Evidence of any treatment for, or investigation of, osteoporosis between the initial radial fracture and subsequent neck of femur fracture was recorded.

74 patients met the above criteria. 7 male and 67 female, median age 83 (54 to 99). Eight percent of cases were on treatment for osteoporosis at time of first fracture. A further 8% had evidence of treatment for, or investigation of, osteoporosis commenced by time of their 2nd fracture. 84% of patients received no advice, investigation or treatment.

As orthopaedic surgeons we have a duty to inform the primary care team of the need to follow-up patients with osteoporotic fractures. There is a significant cost benefit both to the patient and the health service. We aim to introduce a system whereby a letter is automatically sent to the GP informing them that their patient has been seen in fracture clinic with an osteoporotic distal radial fracture. The letter will also advise them of the current Royal College and Government guidelines on investigation and treatment of osteoporosis. We aim to repeat the audit cycle after a 5-year period with the new system in place.