The COVID-19 pandemic has disrupted the provision of arthroplasty services in England, Wales, and Northern Ireland. This study aimed to quantify the backlog, analyze national trends, and predict time to recovery. We performed an analysis of the mandatory prospective national registry of all independent and publicly funded hip, knee, shoulder, elbow, and ankle replacements in England, Wales, and Northern Ireland between January 2019 and December 2022 inclusive, totalling 729,642 operations. The deficit was calculated per year compared to a continuation of 2019 volume. Total deficit of cases between 2020 to 2022 was expressed as a percentage of 2019 volume. Sub-analyses were performed based on procedure type, country, and unit sector.Aims
Methods
The aim of this study was to evaluate the diagnostic accuracy of the synovial alpha-defensin enzyme-linked immunosorbent assay (ELISA) for the diagnosis of prosthetic joint infection (PJI) in the work-up prior to revision of total hip (THA) and knee arthroplasty (TKA). Inclusion criteria for this prospective cohort study were acute or chronic symptoms of the index joint without specific exclusion criteria. Synovial fluid aspirates of 202 patients were analyzed and semiquantitative laboratory alpha-defensin ELISA was performed. Final diagnosis of PJI was established by examination of samples obtained during revision surgery.Aims
Patients and Methods
This study aimed to develop a virtual clinic for the purpose of reducing face-to-face orthopaedic consultations. Anonymized experts (hip and knee arthroplasty patients, surgeons, physiotherapists, radiologists, and arthroplasty practitioners) gave feedback via a Delphi Consensus Technique. This consisted of an iterative sequence of online surveys, during which virtual documents, made up of a patient-reported questionnaire, standardized radiology report, and decision-guiding algorithm, were modified until consensus was achieved. We tested the patient-reported questionnaire on seven patients in orthopaedic clinics using a ‘think-aloud’ process to capture difficulties with its completion.Aims
Patients and Methods
The EuroQol five-dimension (EQ-5D) questionnaire is a widely used multiattribute general health questionnaire where an EQ-5D < 0 defines a state ‘worse than death’ (WTD). The aim of this study was to determine the proportion of patients awaiting total hip arthroplasty (THA) or total knee arthroplasty (TKA) in a health state WTD and to identify associations with this state. Secondary aims were to examine the effect of WTD status on one-year outcomes. A cross-sectional analysis of 2073 patients undergoing 2073 THAs (mean age 67.4 years (Aims
Patients and Methods
The aims of this study were to determine the indications and
frequency of ordering a CT pulmonary angiography (CTPA) following
primary arthroplasty of the hip and knee, and to determine the number
of positive scans in these patients, the location of emboli and
the outcome for patients undergoing CTPA. We analyzed the use of CTPA, as an inpatient and up to 90 days
as an outpatient, in a cohort of patients and reviewed the medical
records and imaging for each patient undergoing CTPA.Aims
Patients and Methods
The aim of this study was to identify predictors of return to
work (RTW) after revision lower limb arthroplasty in patients of
working age in the United Kingdom. We assessed 55 patients aged ≤ 65 years after revision total
hip arthroplasty (THA). There were 43 women and 12 men with a mean
age of 54 years (23 to 65). We also reviewed 30 patients after revision
total knee arthroplasty (TKA). There were 14 women and 16 men with
a mean age of 58 years (48 to 64). Preoperatively, age, gender,
body mass index, social deprivation, mode of failure, length of
primary implant survival, work status and nature, activity level
(University of California, Los Angeles (UCLA) score), and Oxford
Hip and Knee Scores were recorded. Postoperatively, RTW status,
Oxford Hip and Knee Scores, EuroQol-5D (EQ-5D), UCLA score, and
Work, Osteoarthritis and Joint-Replacement Questionnaire (WORQ)
scores were obtained. Univariate and multivariate analysis was performed.Aims
Patients and Methods
There is evidence that high levels of physical
activity following arthroplasty of the hip or knee can lead to early revision.
However, the term ‘highly active’ is not well defined. A validated ankle accelerometer was used to quantify activity
in 13 patients, who had undergone a total of 20 arthroplasties of
the lower limbs and who had active lifestyles. The assessments were
taken at a mean of 8.7 years post-operatively (1.8 to 15.8). The mean gait cycles per day was 8273 (5964 to 12 557), which
extrapolates to 3.0 million cycles per year (cpy) (2.2 to 4.6).
The mean percentage of time spent in high activity mode was 4.3%,
or about one hour per day. The mean percentage of cycles in high
activity was 40%. Based on these data, we propose the following definitions of
high activity: >
3 million cpy; one hour per day in high activity
mode; 40% of cycles in high activity mode. Extrapolating the sample of activity over the time since operation,
the mean cycles per arthroplasty was 25.2 million, with a maximum
of 44.1 million. No joint has been revised, or shows evidence of
impending failure. Cite this article:
Using general practitioner records and hospital
notes and through direct telephone conversation with patients, we investigated
the accuracy of nine patient-reported complications gathered from
a self-completed questionnaire after elective joint replacement
surgery of the hip and knee. A total of 402 post-discharge complications
were reported after 8546 elective operations that were undertaken
within a three-year period. These were reported by 136 men and 240
women with a mean age of 71.8 years (34 to 93). A total of 319 reported
complications (79.4%; 95% confidence interval 75.4 to 83.3) were
confirmed to be correct. High rates of correct reporting were demonstrated
for infection (94.5%) and the need for further surgery (100%), whereas
the rates of reporting deep-vein thrombosis (DVT), pulmonary embolism,
myocardial infarction and stroke were lower (75% to 84.2%). Dislocation,
peri-prosthetic fractures and nerve palsy had modest rates of correct
reporting (36% to 57.1%). More patients who had knee surgery delivered
incorrect reports of dislocation (p = 0.001) and DVT (p = 0.013). Despite these variations, it appears that post-operative complications
may form part of a larger patient-reported outcome programme after
elective joint replacement surgery.
