Aim

To evaluate a panel of peripheral blood and synovial fluid biomarkers for the identification of periprosthetic joint infection PJI.

Aim

This study aimed to identify risk factors for development of deep periprosthetic joint infection (PJI) in patients following surgical treatment of neck of femur fracture.

Aim

The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile.

In June 2012 the Orthopaedic Speciality Advisory of the Joint Committee on Surgical Training defined ‘minimum indicative numbers’ that trainees would have to meet before completion of specialist training. It has been speculated that regions have varied in their ability to provide operative opportunities to their trainees. This study aims to test the hypothesis that there are regional differences in operative training experience. The eLogbook database was interrogated for cases over a 12 month period from 7 August 2013 to 5 August 2015. Within each region, the mean of the cases registered by orthopaedic trainees in each year of training during the study period was calculated and summed to give a representative surgical experience for the years ST3-8. First surgeon only cases were analysed for 11 index procedures in 30 T&O rotations. Considerable variation in training existed across rotations. In three index procedures, including DHS, no rotation achieved the minimum indicative number required. All rotations achieved the minimum indicative number of external fixator applications. This study proves the extent of the significant regional variation in surgical training in Trauma and Orthopaedics in the UK and raises concerns regarding the volume of operative training currently achieved.

Hemiarthroplasty and proximal femoral fixation are common procedures performed in trauma units, but there is very little information regarding post-operative pain experience. Pain control is a keystone in the successful management of hip fractures. A sound strategy of pain management is easier to implement in patients where pain levels can be predicted, allowing for an effective balanced analgesic regime.

Analysis was performed on patients presenting with a hip fracture in two hospitals. Patients with a diagnosis of dementia were excluded. Post-operative pain scores were taken from patient observation charts using a verbal analogue scale. Post-operative opiate consumption was calculated from inpatient drug charts.

357 patients were included, 205 patients underwent a cemented hemiarthroplasty (HG) and 152 had fixation with a dynamic hip screw (DG). No significant difference was found in the length of hospital stay. HG patients recorded a mean morphine requirement of 20.2mg compared with 40.3mg for the DG group. Although the early pain score difference was significant (p=0.009), after 4 days, the scores were equivalent. This may support the notion of non-surgical factors determining the total length of hospital stay.

The reason for the elevated pain scores and higher morphine requirement in the DHS group remains unclear. One theory is the fracture site still exists, and it is possible that pre-existing hip arthritis may continue to be symptomatic. It is important to recognise the difference in pain experienced between the groups and analgesia should be tailored towards the individual, allowing for improved peri-operative surgical care and patient experience.

INTRODUCTION

Deep infection is a potentially catastrophic complication of joint replacement surgery. Early intervention in suspected prosthetic joint infection in the form of aggressive Debridement and targeted Antibiotics can lead to successful Implant Retention (DAIR). In our centre, we adopt an aggressive approach to suspected prosthetic joint infection, working in a multi-disciplinary team with microbiologists and an infection surveillance team to identify and treat suspected infected cases at the earliest opportunity.

Introduction

National Institute for Health and Clinical Excellence (NICE) guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractured neck of femur (NOF) in cognitively intact patients who were independently mobile prior to the injury. The National Joint Registry for England and Wales (NJR) has collected data on THRs performed since 2003. This retrospective cohort study explores risk factors independently associated with implant failure and perioperative mortality.

Background

Both surgeon and hospital volume influence patient outcomes following revision knee arthroplasty.

Introduction

Following in-depth analysis of the market leading brand combinations in which we identified implant influences on risk of revision, we compared revision in patients implanted with different categories of hip replacement in order to find implant with the lowest revision risk, once known flawed options were removed.

Introduction

Procedure Based Assessments (PBAs) were recently introduced for orthopaedic trainees and play an increasing role in assessment. The study aims to describe the attitudes of trainees to the educational benefit of PBAs and the factors which underlie these attitudes.

Purpose

To determine how patient characteristics; health status and pre-operative knee function effect patient reported satisfaction and operative success following total knee replacement (TKR). We hypothesised that a number of patient factors would influence the reported levels of symptomatic improvement (success) and satisfaction and that these two outcomes would represent different aspects of the patient's perception of outcome.

Since its introduction in 2007 the UKITE exam has been an annual event in the diary of Orthopaedic trainees. It aims to simulate the written FRCS (T&O) examination style and offers trainees practice, immediate feedback and an update of the progress they have made through their training. It also allows bench marking against their peers nationally. The editorial process has been overhauled to allow online editing of questions throughout the year, and this has streamlined the question selection process.

The fifth edition of UKITE was held in December 2011. 669 trainees and 35 non-trainees sat for the examination. Consistently over the five years of UKITE we have seen a similar distribution of results showing improving performance until the final year (64.5% for 2011) and a drop in the performance in the last year (56.6% for 2011). Overall 80% of the trainees felt the exam was fair and better than last year. 80% of the trainees who had sat FRCS (T&O) previously thought that the UKITE 2011 was similar in difficulty. 98% trainees want to sit it again and 95% thought there was educational value in sitting the exam. Over 93% were satisfied with central and local provisions made for the exam. Some examining centres in NHS hospitals faced server failure issues and provision was made to sit for their trainees to sit un-invigilated from home. The mean score for the invigilated examination (53.6%) was significantly (p< 0.001) lower than that of un-invigilated examination (63.6%).

UKITE continues to evolve and has become a regular feature in the post-graduate orthopaedic calendar. It is perceived as a useful way of revising and maintaining a core level of knowledge as part of the exam preparation.

Background

The most appropriate form of chemical thromboprophylaxis following knee replacement is a contentious issue. Most national guidelines recommend the use of low molecular weight Heparin (LMWH) whilst opposing the use of aspirin. We compared thromboembolic events, major haemorrhage and death after knee replacement in patients receiving either aspirin or LMWH.

Since its introduction in 2007 the UKITE exam has been an annual event in the diary of Orthopaedic trainees. It aims to simulate the written FRCS (T&O) examination style and offers trainees practice, immediate feedback and an update of the progress they have made through their training. It also allows bench marking against their peers nationally.

UKITE 2010 has made further progress and for the first time trainees from all the deaneries in UK participated. A total of 645 trainees appeared for the examination that was held in December 2010. We introduced remote access from home for trainees (N=171, 26.5%) who could not appear in an “examination centre”. An online editorial process was also introduced, which made the work of the question editing team easier.

The scores ranged from 25.5 to 93.4% with a mean of 54.2% (sd=11.8). The score consistently improved from ST1 (41.8%) to ST7 (64.3%) level and then declined at ST8 (54.7%) level. The mean score for candidates sitting at home (53.3%, sd=11.4) was similar (p=0.23) to those sitting at an invigilated examination venue (54.6%, sd=11.9). The extreme low and high scores were more frequent invigilated exam. The feedback suggested that 95% trainees felt that UKITE has educational benefit and 98% wish to sit again. 75% want it as an annual self-assessment tool. 80% feel that it was better than last year and of those who had sat FRCS (T&O) nearly 80% felt it was very similar.

UKITE continues to evolve and has become a regular feature in the post-graduate orthopaedic calendar. It is perceived as a useful way of revising and maintaining a core level of knowledge as part of the exam preparation.

Background

There is a lack of information on the independent preoperative predictors of perioperative mortality, including the influence of previous stroke and acute coronary syndromes (myocardial infarction + unstable angina, ACS). Previous studies have grouped variables under the umbrella term “ischaemic heart disease”. In this study, we investigated the influence of vascular risk factors separately.

Background

Dislocation is a major complication following total hip arthroplasty (THA). Aetiology is multi-factorial, but increasing femoral head size may result in lower dislocation rates. The latest England and Wales National Joint Registry (NJR) annual report has highlighted a statistically significant increase in the use of femoral heads of size 36mm+ from 5% in 2005 to 26% in 2009, together with an increase in the use of the posterior approach. The aim of this study was to determine whether national dislocation rates have fallen over the same period.

Introduction

Rivaroxaban has been recommended for routine use as a thromboprophylactic agent in patients undergoing lower limb arthroplasty. Trials supporting its use have not fully evaluated the risks of wound complications related to rivaroxaban.

Background

Medical complications and death are rare events following elective orthopaedic surgery. Diagnostic and operative codes are routinely collected on every patient admitted to English NHS hospitals. This is the first study investigating rates of these events following total joint replacement (TJR) on a national scale.

Background

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.

Background

A recent Cochrane review has shown that total shoulder arthroplasty (TSA) seems to offer an advantage in terms of shoulder function over hemiarthroplasty, with no other obvious clinical benefits. This is the first study to compare complication rates on a national scale.