We performed a systematic review of the current literature regarding
the outcomes of unconstrained metacarpophalangeal joint (MCPJ) arthroplasty. We initially identified 1305 studies, and 406 were found to be
duplicates. After exclusion criteria were applied, seven studies
were included. Outcomes extracted included pre- and post-operative
pain visual analogue scores, range of movement (ROM), strength of
pinch and grip, satisfaction and patient reported outcome measures
(PROMs). Clinical and radiological complications were recorded.
The results are presented in three groups based on the design of
the arthroplasty and the aetiology (pyrocarbon-osteoarthritis (pyro-OA),
pyrocarbon-inflammatory arthritis (pyro-IA), metal-on-polyethylene
(MoP)).Aims
Materials and Methods
Total hip arthroplasty (THA) has well known subjective benefits,
but little is known objectively about the recovery of mobility in
the early post-operative period. A total of 33 patients aged >
60 years who underwent elective
primary THA had their activity monitored for 30 days post-operatively
using an at-home (Fitbit) ankle accelerometer. Their mean age was
70.7 years (61 to 86); 15 (45.5%) were female. The rate of compliance
and the mean level of activity were determined. Comparisons between subgroups
based on age, body mass index (BMI), surgical approach, and the
destination of the patients when discharged were also performed.Aims
Patients and Methods
The National Institute for Health and Clinical
Excellence (NICE) has thus far relied on historical data and predominantly
industry-sponsored trials to provide evidence for venous thromboembolic
(VTE) prophylaxis in joint replacement patients. We argue that the
NICE guidelines may be reliant on assumptions that are in need of
revision. Following the publication of large scale, independent
observational studies showing little difference between low-molecular-weight
heparins and aspirin, and recent changes to the guidance provided
by other international bodies, should NICE reconsider their recommendations? Cite this article:
Total knee arthroplasty (TKA) and total hip arthroplasty
(THA) are recognised and proven interventions for patients with
advanced arthritis. Studies to date have demonstrated a steady increase
in the requirement for primary and revision procedures. Projected
estimates made for the United States show that by 2030 the demand
for primary TKA will grow by 673% and for revision TKA by 601% from
the level in 2005. For THA the projected estimates are 174% and
137% for primary and revision surgery, respectively. The purpose
of this study was to see if those predictions were similar for England
and Wales using data from the National Joint Registry and the Office
of National Statistics. Analysis of data for England and Wales suggest that by 2030,
the volume of primary and revision TKAs will have increased by 117%
and 332%, respectively between 2012 and 2030. The data for the United
States translates to a 306% cumulative rate of increase between
2012 and 2030 for revision surgery, which is similar to our predictions
for England and Wales. The predictions from the United States for primary TKA were similar
to our upper limit projections. For THA, we predicted an increase
of 134% and 31% for primary and revision hip surgery, respectively. Our model has limitations, however, it highlights the economic
burden of arthroplasty in the future in England and Wales as a real
and unaddressed problem. This will have significant implications
for the provision of health care and the management of orthopaedic
services in the future. Cite this article:
Our aim was to determine whether, based on the current literature,
bariatric surgery prior to total hip (THA) or total knee arthroplasty
(TKA) reduces the complication rates and improves the outcome following
arthroplasty in obese patients. A systematic literature search was undertaken of published and
unpublished databases on the 5 November 2015. All papers reporting
studies comparing obese patients who had undergone bariatric surgery
prior to arthroplasty, or not, were included. Each study was assessed
using the Downs and Black appraisal tool. A meta-analysis of risk ratios
(RR) and 95% confidence intervals (CI) was performed to determine
the incidence of complications including wound infection, deep vein
thrombosis (DVT), pulmonary embolism (PE), revision surgery and
mortality.Aims
Methods
“Virtual fracture clinics” have been reported as a safe and effective alternative to the traditional fracture clinic. Robust protocols are used to identify cases that do not require further review, with the remainder triaged to the most appropriate subspecialist at the optimum time for review. The objective of this study was to perform a “top-down” analysis of the cost effectiveness of this virtual fracture clinic pathway. National Health Service financial returns relating to our institution were examined for the time period 2009 to 2014 which spanned the service redesign.Objectives
Methods
Satisfaction with care is important to both patients
and to those who pay for it. The Net Promoter Score (NPS), widely
used in the service industries, has been introduced into the NHS
as the ‘friends and family test’; an overarching measure of patient
satisfaction. It assesses the likelihood of the patient recommending
the healthcare received to another, and is seen as a discriminator
of healthcare performance. We prospectively assessed 6186 individuals
undergoing primary lower limb joint replacement at a single university
hospital to determine the Net Promoter Score for joint replacements
and to evaluate which factors contributed to the response. Achieving pain relief (odds ratio (OR) 2.13, confidence interval
(CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR
2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI
2.03 to 2.68) are the domains that explain whether a patient would
recommend joint replacement services. These three factors, combined
with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17),
drove a predictive model that was able to explain 95% of the variation
in the patient’s recommendation response. Though intuitively similar,
this ‘recommendation’ metric was found to be materially different
to satisfaction responses. The difference between THR (NPS 71) and
TKR (NPS 49) suggests that no overarching score for a department
should be used without an adjustment for case mix. However, the
Net Promoter Score does measure a further important dimension to
our existing metrics: the patient experience of healthcare delivery. Cite this article:
The October 2012 Hip &
Pelvis Roundup360 looks at: diagnosing the infected hip replacement; whether tranexamic acid has a low complication rate; the relationship between poor cementing technique and early failure of resurfacing; debridement and retention for the infected replacement; triple-tapered stems and bone mineral density; how early discharge can be bad for your sleep; an updated QFracture algorithm to predict the risk of an osteoporotic fracture; and local infiltration analgesia and total hip replacement.
Vancomycin is commonly added to acrylic bone cement during revision
arthroplasty surgery. Proprietary cement preparations containing
vancomycin are available, but are significantly more expensive.
We investigated whether the elution of antibiotic from ‘home-made’
cement containing vancomycin was comparable with more expensive
commercially available vancomycin impregnated cement. A total of 18 cement discs containing either proprietary CopalG+V;
or ‘home-made’ CopalR+G with vancomycin added by hand, were made.
Each disc contained the same amount of antibiotic (0.5 g gentamycin,
2 g vancomycin) and was immersed in ammonium acetate buffer in a
sealed container. Fluid from each container was sampled at eight
time points over a two-week period. The concentrations of gentamicin
and vancomycin in the fluid were analysed using high performance
liquid chromatography mass spectrometry.Aims
Materials and Methods
Evidence -based medicine (EBM) is designed to inform clinical decision-making within all medical specialties, including orthopaedic surgery. We recently published a pilot survey of the Canadian Orthopaedic Association (COA) membership and demonstrated that the adoption of EBM principles is variable among Canadian orthopaedic surgeons. The objective of this study was to conduct a broader international survey of orthopaedic surgeons to identify characteristics of research studies perceived as being most influential in informing clinical decision-making. A 29-question electronic survey was distributed to the readership of an established orthopaedic journal with international readership. The survey aimed to analyse the influence of both extrinsic (journal quality, investigator profiles, etc.) and intrinsic characteristics (study design, sample size, etc.) of research studies in relation to their influence on practice patterns.Objectives
Materials and Methods
Venous thromboembolism (VTE) is a major potential complication following orthopaedic surgery. Subcutaneously administered enoxaparin has been used as the benchmark to reduce the incidence of VTE. However, concerns have been raised regarding the long-term administration of enoxaparin and its possible negative effects on bone healing and bone density with an increase of the risk of osteoporotic fractures. New oral anticoagulants such as rivaroxaban have recently been introduced, however, there is a lack of information regarding how these drugs affect bone metabolism and post-operative bone healing. We measured the migration and proliferation capacity of mesenchymal stem cells (MSCs) under enoxaparin or rivaroxaban treatment for three consecutive weeks, and evaluated effects on MSC mRNA expression of markers for stress and osteogenic differentiation.Objectives
Methods
