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Following total hip arthroplasty (THA) and total knee arthroplasty (TKR) only the ‘visible’ measured blood loss is usually known. This underestimates the ‘true’ total loss, as some loss is ‘hidden’. Correct management of blood loss should take hidden loss into account. We studied 101 THAs and 101 TKAs (with re-infusion of drained blood). Following THA, the mean total loss was 1510 ml and the hidden loss 471 ml (26%). Following TKA, the mean total loss was 1498 ml. The hidden loss was 765 ml (49%). Obesity made no difference with either operation. THA involves a small hidden loss, the total loss being 1.3 times that measured. However, following TKA, there may be substantial hidden blood loss due to bleeding into the tissues and residual blood in the joint. The true total loss can be determined by doubling the measured loss.
The February 2023 Research Roundup360 looks at: Clinical and epidemiological features of scaphoid fracture nonunion; Routine sterile glove and instrument change at the time of abdominal wound closure to prevent surgical site infection (ChEETAh); Characterization of genetic risk of end-stage knee osteoarthritis treated with total knee arthroplasty; Platelet-rich plasma or autologous blood injection for plantar fasciitis; Volume and outcomes of joint arthroplasty; The hazards of absolute belief in the p-value laid bare.
Total hip and total knee arthroplasty both provide a considerable improvement in quality of life, but there is no evidence to suggest that one is more successful than the other. We studied 72 patients in a prospective trial before and after total hip or total knee replacement. We recorded scores for disability and distress derived from the Harris hip score and the British Orthopaedic Association knee assessment score, and used them to generate quality of life (QoL) scores using the Rosser Index Matrix immediately before and at one year after surgery. The patients awaiting knee replacement had significantly lower QoL scores than those awaiting hip replacement (p = 0.011). The QoL scores at one year were high and almost identical for both groups (p = 0.46). Further analysis showed that gender and weight were not significant predictors of improvement of QoL scores, but age (p = 0.03) and whether the hip or knee was replaced (p = 0.006) were significant factors.
Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients’ decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research. Participants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached.Aims
Methods
Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common orthopaedic procedures requiring postoperative radiographs to confirm implant positioning and identify complications. Artificial intelligence (AI)-based image analysis has the potential to automate this postoperative surveillance. The aim of this study was to prepare a scoping review to investigate how AI is being used in the analysis of radiographs following THA and TKA, and how accurate these tools are. The Embase, MEDLINE, and PubMed libraries were systematically searched to identify relevant articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews and Arksey and O’Malley framework were followed. Study quality was assessed using a modified Methodological Index for Non-Randomized Studies tool. AI performance was reported using either the area under the curve (AUC) or accuracy.Aims
Methods
Surgical site infection (SSI) is a common complication of surgery
with an incidence of about 1% in the United Kingdom. Sutures can
lead to the development of a SSI, as micro-organisms can colonize
the suture as it is implanted. Triclosan-coated sutures, being antimicrobical,
were developed to reduce the rate of SSI. Our aim was to assess
whether triclosan-coated sutures cause a reduction in SSIs following
arthroplasty of the hip and knee. This two-arm, parallel, double-blinded study involved 2546 patients
undergoing elective total hip (THA) and total knee arthroplasty
(TKA) at three hospitals. A total of 1323 were quasi-randomized
to a standard suture group, and 1223 being quasi-randomized to the
triclosan-coated suture group. The primary endpoint was the rate
of SSI at 30 days postoperatively.Aims
Patients and Methods
Waiting times for arthroplasty surgery in Northern Ireland are among the longest in the NHS, which have been further lengthened by the onset of the COVID-19 global pandemic in March 2020. The Department of Health in Northern Ireland has announced a new Elective Care Framework (ECF), with the framework proposing that by March 2026 no patient will wait more than 52 weeks for inpatient/day case treatment. We aimed to assess the feasibility of achieving this with reference to total hip arthroplasty (THA) and total knee arthroplasty (TKA). Mathematical modelling was undertaken to calculate when the ECF targets will be achieved for THA and TKA, as well as the time when waiting lists for THA and TKA will be cleared. The number of patients currently on the waiting list and percentage operating capacity relative to pre-COVID-19 capacity was used to determine future projections.Aims
Methods
To identify the responsiveness, minimal clinically important difference (MCID), minimal clinical important change (MIC), and patient-acceptable symptom state (PASS) thresholds in the 36-item Short Form Health Survey questionnaire (SF-36) (v2) for each of the eight dimensions and the total score following total knee arthroplasty (TKA). There were 3,321 patients undergoing primary TKA with preoperative and one-year postoperative SF-36 scores. At one-year patients were asked how satisfied they were and “How much did the knee arthroplasty surgery improve the quality of your life?”, which was graded as: great, moderate, little (n = 277), none (n = 98), or worse.Aims
Methods
The Oxford hip and knee scores (OHS and OKS)
are validated patient-reported outcome measures used in patients undergoing
total hip replacement (THR), hip resurfacing (HR), total knee replacement
(TKR) and unicompartmental knee replacement (UKR). We analysed the
absolute OHS and OKS and change in scores following THR, HR, TKR,
and UKR performed at one specialist centre. All patients undergoing
and completing at least one Oxford score were eligible for inclusion
in the study which included 27 950 OHS and 19 750 OKS in 13 682
patients. Data were analysed using non-linear quantile regression.
The median absolute Oxford scores for THR, HR, TKR and UKR were
pre-operative 68.8% (15.0/48), 58.3% (20.0/48), 66.7% (16.0/48),
60.4% (19.0/48) respectively: and post-operative asymptote was 14.6%
(41.0/48), 5.8% (45.2/48), 31.2% (33.0/48), 29.2% (34.0/48). The
median asymptotic change from the pre-operative score for THR, HR,
TKR and UKR were 47.9% (23.0/48), 47.9% (23.0/48), 33.3% (16.0/48)
and 32.4% (15.5/48), respectively. The median time at which no further
appreciable change in score was achieved post-operatively was 0.7
years for THR, 1.1 years for HR, 0.9 years for TKR and 1.1 years
for UKR. The curves produced from this analysis could be used to educate
patients, and to audit the performance of a surgeon and an institution.
The time to achieve a stable improvement in outcome varied between
different types of joint replacement, which may have implications
for the timing of post-operative review. Cite this article:
We performed routine venography after operation in a consecutive series of 252 patients with total joint arthroplasties in whom no form of routine chemical or mechanical prophylaxis had been used. The prevalence of deep-vein thrombosis (DVT) was 32% (16% distal, 16% proximal) after total hip replacement and 66% (50% distal, 16% proximal) after total knee replacement (p <
0.001). We did not treat distal DVT. There were only two readmissions within three months of surgery because of thromboembolic disease. There were two deaths within this period, neither of which was due to pulmonary embolism.
