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Bone & Joint Open
Vol. 4, Issue 4 | Pages 241 - 249
7 Apr 2023
Bayram JM Wickramasinghe NR Scott CEH Clement ND

Aims

The aims were to assess whether preoperative joint-specific function (JSF) and health-related quality of life (HRQoL) were associated with level of clinical frailty in patients waiting for a primary total hip arthroplasty (THA) or knee arthroplasty (KA).

Methods

Patients waiting for a THA (n = 100) or KA (n = 100) for more than six months were prospectively recruited from the study centre. Overall,162 patients responded to the questionnaire (81 THA; 81 KA). Patient demographics, Oxford score, EuroQol five-dimension (EQ-5D) score, EuroQol visual analogue score (EQ-VAS), Rockwood Clinical Frailty Score (CFS), and time spent on the waiting list were collected.


The Bone & Joint Journal
Vol. 104-B, Issue 11 | Pages 1215 - 1224
1 Nov 2022
Clement ND Wickramasinghe NR Bayram JM Hughes K Oag E Heinz N Fraser E Jefferies JG Dall GF Ballantyne A Jenkins PJ

Aims

The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty.

Methods

This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from waiting lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five-dimension questionnaire (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood Clinical Frailty Scale (CFS), and 36-Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ-5D of less than zero.


The Bone & Joint Journal
Vol. 102-B, Issue 7 | Pages 933 - 940
1 Jul 2020
Maempel JF Clement ND Wickramasinghe NR Duckworth AD Keating JF

Aims

The aim was to compare long-term patient-reported outcome measures (PROMs) after operative and nonoperative treatment of acute Achilles tendon rupture in the context of a randomized controlled trial.

Methods

PROMs including the Short Musculoskeletal Function Assessment (SMFA), Achilles Tendon Total Rupture Score (ATRS), EuroQol five-dimension (EQ-5D), satisfaction, net promoter score and data regarding re-rupture, and venous thromboembolic rates were collected for patients randomized to receive either operative or nonoperative treatment for acute Achilles tendon rupture in a previous study. Of the 80 patients originally randomized, 64 (33 treated surgically, 31 nonoperatively) patients were followed up at a mean of 15.7 years (13.4 to 17.7).


The Bone & Joint Journal
Vol. 98-B, Issue 4 | Pages 490 - 497
1 Apr 2016
Maempel JF Wickramasinghe NR Clement ND Brenkel IJ Walmsley PJ

Aims

The pre-operative level of haemoglobin is the strongest predictor of the peri-operative requirement for blood transfusion after total knee arthroplasty (TKA). There are, however, no studies reporting a value that could be considered to be appropriate pre-operatively.

This study aimed to identify threshold pre-operative levels of haemoglobin that would predict the requirement for blood transfusion in patients who undergo TKA.

Patients and Methods

Analysis of receiver operator characteristic (ROC) curves of 2284 consecutive patients undergoing unilateral TKA was used to determine gender specific thresholds predicting peri-operative transfusion with the highest combined sensitivity and specificity (area under ROC curve 0.79 for males; 0.78 for females).


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_3 | Pages 1 - 1
1 Feb 2014
Duckworth A Wickramasinghe NR Clement N Court-Brown C McQueen M
Full Access

The aim of this study was to report the outcome of radial head replacement for complex fractures of the radial head, and determine any risk factors for prosthesis removal or revision. We identified 119 patients who were managed acutely using primary radial head replacement for an unstable fracture of the radial head over a 15-year period. Demographic data, fracture classification, management, complications and subsequent surgeries were recorded following retrospective clinical record review.

There were 105 (88%) patients with a mean age of 50 yrs (16–93) and 54% (n=57) were female. There were 95 (91%) radial head fractures and 96% were a Mason type 3 or 4 injury. There were 98 associated injuries in 70 patients (67%), with an associated coronoid fracture (n=29, 28%) most frequent. All implants were uncemented monopolar prostheses, with 86% metallic and 14% silastic. At a mean short-term follow-up of 1 year (range, 0.1–5.5; n=87) the mean Broberg and Morrey score was 80 (range, 40–99), with 49.5% achieving an excellent or good outcome. At a final mean review of 6.7 yrs (1.8–17.8), 29 (27%) patients had undergone revision (n=3) or removal (n=26) of the prosthesis. Independent risk factors of prosthesis removal or revision were silastic implant type (p=0.010) and younger age (p=0.015).

This is the largest series in the literature documenting the outcome following radial head replacement for complex fractures of the radial head. We have demonstrated a high rate of removal or revision for all implants, with younger patients and silastic implants independent risk factors.