bluuebunny/crossref_metadata_2025 huggingface dataset:
Managing blunt cardiac injury
Authors: Nair Lawrence , Winkle Brendan , Senanayake Eshan
Published: February 2023

Blunt cardiac injury (BCI) encompasses a spectrum of pathologies ranging from clinically silent, transient arrhythmias to deadly cardiac wall rupture. Of diagnosed BCIs, cardiac contusion is most common. Suggestive symptoms may be unrelated to BCI, while some injuries may be clinically asymptomatic. Cardiac rupture is the most devastating complication of BCI. Most patients who sustain rupture of a heart chamber do not reach the emergency department alive. The incidence of BCI following blunt thoracic trauma remains variable and no gold standard exists to either diagnose cardiac injury or provide management. Diagnostic tests should be limited to identifying those patients who are at risk of developing cardiac complications as a result of cardiac in jury. Therapeutic interventions should be directed to treat the complications of cardiac injury. Prompt, appropriate and well-orchestrated surgical treatment is invaluable in the management of the unstable patients.
Resection of a schwannoma originating from vagus nerve in the right superior mediastinum
Authors: Zhang Ming , Shi Hao , Tu Xiabin , Li Weidong , Wei Zhengliang
Published: February 2023

Background

Schwannoma is the most common mediastinal neurogenic tumor, while schwannoma originating from mediastinal vagus nerve is rare.

Case presentation

This article reported one case of schwannoma originating from vagus nerve in the right superior mediastinum. The mediastinal schwannoma was completely resected through a right-sided video-assisted thoracoscopic thoracotomy. Histologic examination clarified the diagnosis as schwannoma.

Conclusion

Chest CT scan and MRI can be used to determine the location of mediastinal schwannoma and its relationship with adjacent tissue. Histologic examination showing distinctive feature of Antoni A areas and Antoni B areas can help clarify the diagnosis. Complete surgical resection is the first-line treatment option for mediastinal schwannomas.
Efficiency and optimization of government service resource allocation in a cloud computing environment
Authors: Guo Ya-guang , Yin Qian , Wang Yixiong , Xu Jun , Zhu Leqi
Published: February 2023

According to the connotation and structure of government service resources, data of government service resources in L city from 2019 to 2021 are used to calculate the efficiency of government service resource allocation in each county and region in different periods, particularly by adding the government cloud platform and cloud computing resources to the government service resource data and applying the data envelopment analysis (DEA) method, which has practical significance for the development and innovation of government services. On this basis, patterns and evolutionary trends of government service resource allocation efficiency in each region during the study period are analyzed and discussed. Results are as follows. i) Overall efficiency level in the allocation of government service resources in L city is not high, showing an increasing annual trend among the high and low staggering. ii) Relative difference of allocation efficiency of government service resources is a common phenomenon of regional development, the existence and evolution of which are the direct or indirect influence and reflection of various aspects, such as economic strength and reform effort. iii) Data analysis for the specific points indicates that increased input does not necessarily lead to increased efficiency, some indicators have insufficient input or redundant output. Therefore, optimization of the physical, human, and financial resource allocation methods; and the intelligent online processing of government services achieved by the adoption of government cloud platform and cloud computing resources are the current objective choices to realize maximum efficiency in the allocation of government service resources.
The translation of William Shakespeare’s plays and the changing concept of womanhood in Greece (1875-1955)
Authors: Δαλπαναγιώτη Δήμητρα
Published: February 2023

Η παρούσα διατριβή συνεισφέρει στην επιστημονική έρευνα που αφορά τη μετάφραση και το φύλο, διερευνώντας την αναπαράσταση των γυναικείων δραματικών χαρακτήρων του Ουίλλιαμ Σαίξπηρ στις ελληνικές μεταφράσεις των έργων του. Η μελέτη καλύπτει το χρονικό διάστημα ογδόντα ετών (περίπου 1875-1955), μια σημαντική περίοδος όσον αφορά τις αλλαγές που επηρέασαν βαθιά την ταυτότητα και την κοινωνική θέση των Ελληνίδων. Πέντε κεφάλαια αποτελούν το κύριο σώμα της διατριβής, το καθένα από τα οποία επικεντρώνεται στη μετάφραση ενός ή δύο έργων του Σαίξπηρ και περιλαμβάνει παράλληλη συγκριτική εξέταση των προηγούμενων μεταφράσεων κάθε έργου. Η διερεύνηση των μεταμορφώσεων των γυναικών του Σαίξπηρ ξεκινά με την οικειοποίηση από τον Δημήτριο Βικέλα της Δυσδαιμόνας (1875) και της Λαίδης Μακβέθ (1882) σύμφωνα με το πρότυπο της γυναικείας υπόστασης που υπαγόρευε η ιδεολογία της μεσαίας αστικής τάξης των εμπόρων της διασποράς. Στη συνέχεια, η μελέτη επικεντρώνεται στην προοδευτική ανάγνωση του χαρακτήρα της Δυσδαιμόνας (1915) από τον Κωνσταντίνο Θεοτόκη, η οποία επηρεάστηκε από τις σοσιαλιστικές και φιλικές προς τις γυναίκες απόψεις του. Στο πλαίσιο των πειραματισμών της δεκαετίας του 1920 εξετάζεται η ανασυγκρότηση του χαρακτήρα της Κλεοπάτρας από τον Νίκο Βέλμο (1924) ως ένα θύμα της αγάπης που προκαλεί τη συμπάθεια. Τα δύο τελευταία κεφάλαια εξετάζουν την αναπαράσταση της Γερτρούδης και της Οφηλίας (1938) από τον Βασίλη Ρώτα πριν από τον Β' Παγκόσμιο Πόλεμο και το πορτρέτο του για την Κλεοπάτρα (1954-1955) μετά τον Β' Παγκόσμιο Πόλεμο. Η ανάλυση των παραπάνω μεταφράσεων αποδεικνύει την προσαρμοστικότητα των γυναικείων χαρακτήρων του Σαίξπηρ και καταδεικνύει ότι καθώς επαναμεταφράζονται, ερμηνεύονται με διαφορετικούς τρόπους που, μεταξύ άλλων, αντικατοπτρίζουν την μεταβαλλόμενη έννοια της γυναικείας ταυτότητας στην Ελλάδα και τη στάση των μεταφραστών στο γυναικείο ζήτημα. Η πρόσληψη των γυναικείων χαρακτήρων του Σαίξπηρ φαίνεται να κινείται, αν και με μη γραμμικό τρόπο, από μια συντηρητική προοπτική της γυναικείας ταυτότητας προς πιο προοδευτικές εικόνες γυναικών, οι οποίες ασκούν κριτική στις πατριαρχικές συμβάσεις, και φτάνουν ακόμη και στο σημείο να αγκαλιάσουν την έννοια του ανδρόγυνου.
Physicochemical characteristics of Pangasius sp. skin-gelatin-based-edible film enriched with silver nanoparticles
Authors: Nurdiani Rahmi , Prihanto Asep A. , Firdaus Muhamad , Aini Faridatul Nur , Nabilah Fajrin Adin , Talib Rosnita A , Huda Nurul
Published: February 2023

Background: Edible films intended for food packaging have been produced from hydrocolloids, lipids, resins, and composites, including gelatin. Gelatin is known to have a good filming ability and has been suggested as an alternative to non-biodegradable plastics. Naturally active compounds incorporated into film packaging may not only protect the food product from oxidation and microbial contamination, but they may also alter the physicochemical properties of the film. Silver nanoparticles have been used in food packaging as active agents due to their antibacterial and antifungal properties. The addition may affect the characteristics of the packaging. Therefore, this study aims to determine the effect of the addition of silver nanoparticles on the physicochemical characteristics of edible film from Pangasius sp. skin gelatin

Methods: Mangrove extract of Bruguiera gymnorrhiza was used to synthesize silver into nanoparticle size. In this study, silver nanoparticles (AgNPs) with different concentrations (0, 2, 4 and 8%) were added into gelatin-based edible film. The edible films produced were observed for their physicochemical characteristics, including thickness, tensile strength, elongation, water vapour transmission, moisture content, pH, and colour.

Results: AgNPs affected the colour of the fish-gelatin-based edible film, as an increased concentration of AgNPs resulted in a darker film. Nevertheless, the addition of AgNPs showed no significant effect on the thickness (145–216 µm), tensile strength (14.58–19.72 MPa), elongation (21.86–54.19%), water vapour transmission (30. 91–42.55 g/m2/day), moisture content (9.57–11.16%) or pH (5.92–6.01) of the fish-gelatin-based edible film.

Conclusions: The addition of AgNPs has no significant effect on gelatin-based edible film physicochemical properties except colour. Therefore, the incorporated edible film has the potential to be developed further.
Technical regulation in the mechanism of public administration
Authors: Kalmykova Anastasiya
Published: February 2023

The scientific and practical manual is devoted to the analysis of technical regulation in the mechanism of public administration in the Russian Federation. The concept and essence of technical regulation, its place in the system of state management, the object and subjects of technical regulation, types and methods of ensuring compliance of products with mandatory requirements established in the field of technical regulation, novelties of state control (supervision) over compliance with the requirements of technical regulations, as well as the problems of bringing business entities to administrative and criminal responsibility are revealed for violating the relevant requirements.
For civil servants, practicing lawyers, students, postgraduates, researchers, as well as anyone interested in technical regulation issues.
Official crimes (Chapter 30 of the Criminal Code of the Russian Federation). The concept. Qualification
Authors: Galahova Anna
Published: February 2023

The work is devoted to the concept and issues of qualification of crimes against state power, the interests of public service and service in
local self-government bodies. The general characteristics of this group of crimes, the concept of an official, and the legal analysis of each
of the elements of crimes included in Chapter 30 of the Criminal Code of the Russian Federation are outlined. The novelties included in the Criminal Code of the Russian Federation, delineation from related crimes are shown, attention
is drawn to errors in the application of the relevant norms of the Criminal Code of the Russian Federation.
The publication is addressed to persons studying criminal law, law enforcement officers, researchers.
Are doctors and nurses engaging in physical activity and its promotion?
Authors: Bhandari Sara , Watkinson Emma , Fawkner Samantha
Published: February 2023

Background:

Physical activity counselling in health care is inadequate but the reasons for this are not well understood.

Aims:

To evaluate physical activity participation and counselling perceptions and practices among doctors and nurses in the UK.

Methods:

This study used two anonymised online questionnaires distributed at different times to doctors and nurses throughout the UK.

Findings:

629 responses were obtained; 78.3% of doctors and 73.4% of nurses met the UK guideline for aerobic physical activity. Perceived importance of counselling on physical activity was high but less than 50% of participants were actually providing counselling. Counselling was more likely in primary care and doctors were marginally more likely than nurses to counsel.

Conclusion:

Doctors and nurses are an active cohort and view counselling on physical activity as important. Despite this, counselling levels are low especially in secondary care. Efforts should be made to improve knowledge and opportunity for physical activity counselling.
Dermatological diseases of snakes and lizards and how to investigate them
Authors: Chitty John
Published: February 2023

Snake and lizard skin is highly adapted to being tough and impervious, reflecting their evolutionary emergence in a more arid lifestyle. These special features include the formation of scales and the need to shed the skin at intervals to permit growth. To the clinician, these adaptations present a different range of diseases compared to those in more ‘routine’ species, most of all, the need for a different approach to their investigation. This article looks at the most common clinical signs of dermatological diseases in snakes and lizards and explains how to investigate based on the differential diagnoses for each sign.
All about … maps
Authors: Russell Meredith Jones
Published: February 2023

Young children display geographical awareness from an early age, and a new report on early years mapping is rich with links to curriculum and ideas for activities, finds Meredith Jones Russell
Telling it all
Authors: Allingham Sue
Published: February 2023

Taking time to properly listen to children and encouraging them to talk about their interests are vital, explains Dr Sue Allingham
The plants in my street
Authors: Mountain Julie
Published: February 2023

Our plant of the month is hazel, a tree whose catkins, nuts and coppicing opportunities make it an ideal activity resource. By Julie Mountain
We've explored…: a special tree
Authors: Rawstrone Annette
Published: February 2023

Finding an oak tree on a visit to a local country park acted as a catalyst for a year-long creative journey. By Annette Rawstrone
An A to Z of enhancements: F is for Fairy garden
Authors: Jackson Amy
Published: February 2023

One day, some fairies came to stay, leading to new avenues for imaginative play outdoors and in. By Amy Jackson
Good and wholesome
Authors: Hart Karen
Published: February 2023

How can early years settings cost-effectively provide children with nutritious and tasty meals at a time when food and energy bills are soaring? Karen Hart reports
Marketing: Make social media a hit
Authors: Read Nicola
Published: February 2023

How can settings get themselves seen on social media right now? Nicola Read offers some top tips
The new CQC assessment framework
Authors: Halliwell Amanda
Published: February 2023

The single assessment framework being introduced by the Care Quality Commission includes inspection of how local authorities and integrated care systems carry out their duties
A vision for improving children's mental health
Authors: Hancock Dave
Published: February 2023

A 2021 survey of half a million children found that one in five worried about their mental health. The Children's Commissioner for England outlined her six ambitions for early mental health support for children. Dave Hancock reports
A Modern Classic
Authors: Sampson Ben
Published: February 2023

The Oracle Challenger III is set to go on display at the Smithsonian next year to excite future aeronautical superstars
Digital Rebuild
Authors: Sampson Ben
Published: February 2023

Dowty Propellers has physically and digitally rebuilt its engineering capabilities after a fire that gutted the company’s buildings in 2015
Stormy Skies
Authors: Willis Paul
Published: February 2023

Stronger standards and testing is required to cover the development and operation of drones in bad weather
Return to the Skies
Authors: Pierobon Mario
Published: February 2023

Maintenance check flights are a crucial step in the safe return to service for commercial aircraft after the pandemic
CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF SARCOMA: DOES SURGERY AT A SPECIALIZED SARCOMA CENTRE IMPROVE OUTCOMES?
Authors: Sundaram A. , Perianayagam G. , Hong A. , Mar J. , Lo H. , Lawless A. , Carey Smith R.L.
Published: February 2023

The Australia and New Zealand Sarcoma Association established the Sarcoma Guidelines Working Party to develop national guidelines for the management of Sarcoma. We asked whether surgery at a specialised centre improves outcomes. A systematic review was performed of all available evidence pertaining to paediatric or adult patients treated for bone or soft tissue sarcoma at a specialised centre compared with non-specialised centres. Outcomes assessed included local control, limb salvage rate, 30-day and 90-day surgical mortality, and overall survival.

Definitive surgical management at a specialised sarcoma centre improves local control as defined by margin negative surgery, local or locoregional recurrence, and local recurrence free survival. Limb conservation rates are higher at specialised centres, due in part to the depth of surgical experience and immediate availability of multidisciplinary and multimodal therapy. A statistically significant correlation did not exist for 30-day and 90-day mortality between specialised centres and non-specialised centres. The literature is consistent with improved survival when definitive surgical treatment is performed at a specialised sarcoma centre.

Evidence-based recommendation: Patients with suspected sarcoma to be referred to a specialised sarcoma centre for surgical management to reduce the risk of local recurrence, surgical complication, and to improve limb conservation and survival.

Practice point: Patients with suspected sarcoma should be referred to a specialised sarcoma centre early for management including planned biopsy.
CUSTOM ACETABULAR TRI-FLANGE AND FEMORAL OSSEOINTEGRATION COMPONENTS FOR THE TREATMENT OF SYMPTOMATIC IPSILATERAL HIP AND KNEE ARTHROPATHY IN A PATIENT WITH PROXIMAL FEMORAL FOCAL DEFICIENCY: A NOVEL SOLUTION TO A CHALLENGING PROBLEM
Authors: Sundaram A. , Carey Smith R.L.
Published: February 2023

Proximal femoral focal deficiency is a congenital disorder of malformation of the proximal femur and/or the acetabulum. Patients present with limb length discrepancy and clinical features along a spectrum of severity. As these patients progress through to skeletal maturity and on to adulthood, altered biomechanical demands lead to progression of arthropathy in any joint within the lower limb. Abnormal anatomy presents a challenge to surgeons and conventional approaches and implants may not necessarily be applicable.

We present a case of a 62-year-old lady with unilateral proximal femoral focal deficiency (suspected Aitken Class A) who ambulated with an equinus prosthesis for her entire life. She presented with ipsilateral knee pain and instability due to knee arthritis but could not tolerate a total knee arthroplasty due to poor quadriceps control.

A custom osteointegration prosthesis was inserted with a view to converting to the proximal segment to a total hip replacement if required. The patient went on to develop ipsilateral symptomatic hip arthritis but altered acetabular anatomy required a custom tri-flange component (Ossis, Christchurch, New Zealand) and a custom proximal femoral component to link with the existing osseointegration component (Osseointegration Group of Australia, Sydney, Australia) were designed and implanted.

The 18 month follow up of the custom hip components showed that the patient had Oxford hip scores that were markedly improved from pre-operatively. Knee joint heights were successfully restored to equal when the patient's prosthesis was attached. The patient describes feeling like “a normal person”, walks unaided for short distances and can ambulate longer distances with crutches.

Advances in design and manufacture of implants have empowered surgeons to offer life improving treatments to patients with challenging anatomy. Using a custom acetabular tri-flange and osseointegration components is one possible solution to address symptomatic ipsilateral hip and knee arthropathy in the context of PFFD in adulthood.
THE DOSTAR STUDY: A DOUBLE-BLINDED, RANDOMIZED CONTROLLED TRIAL COMPARING DUAL OR SINGLE HAMSTRING TENDON ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
Authors: Lawless A.M. , Ebert J. , Edwards P. , Aujla R. , Finsterwald M. , Dalgleish S. , Malik S. , Raymond R. , Giwnewer U. , Simpson A. , Grant M. , Leys T. , D'Alessandro P.A.
Published: February 2023

Hamstring grafts have been associated with reduced strength, donor site pain and muscle strains following Anterior Cruciate Ligament Reconstruction (ACLR). Traditional graft fixation methods required both semitendinosus and gracilis tendons to achieve a graft of sufficient length and diameter, but newer techniques allow for shorter, broad single tendon grafts.

This study seeks to compare the outcomes between Single Tendon (ST) and Dual Tendon (DT) ACLR, given there is no prospective randomised controlled trial (RCT) in the literature comparing outcomes between these options.

In this ongoing RCT: (ANZ Clinical Trials Registry ACTRN126200000927921) patients were recruited and randomised into either ST or DT groups. All anaesthetic and surgical techniques were uniform aside from graft technique and tibial fixation. 13 patients were excluded at surgery as their ST graft did not achieve a minimum 8mm diameter. 70 patients (34 ST, 36DT) have been assessed at 6 months, using PROMS including IKDC2000, Lysholm and Modified Cincinnati Knee, visual analog scale for pain frequency (VAS-F) and severity (VAS-S), dedicated donor site morbidity score, KT-1000 assessment, and isokinetic strength.

Graft diameters were significantly lesser in the ST group compared to the DT group (8.44mm/9.11mm mean difference [MD],-0.67mm; P<0.001). There was a significant and moderate effect in lower donor site morbidity in the ST group compared to the DT group (effect size [ES], 0.649; P = .01). No differences between groups were observed for knee laxity in the ACLR limb (P=0.362) or any of the patient-reported outcome measures (P>0.05). Between-group differences were observed for hamstrings strength LSI favouring the ST group, though these were small-to-moderate and non-significant (ES, 0.351; P = .147).

ST (versus DT) harvest results in significantly less donor site morbidity and this is the first prospective RCT to determine this. There were no differences between ST and DT hamstring ACLR were observed in PROMs, knee laxity and hamstring strength. Younger female patients tend to have inadequate single tendon size to produce a graft of sufficient diameter, and alternative techniques should be considered. Further endpoints include radiological analysis, longer term donor site morbidity, revision rates and return to sport and will continue to be presented in the future.
COMPARING MODERN UNCEMENTED, HYBRID AND CEMENTED IMPLANT COMBINATIONS IN OLDER PATIENTS UNDERGOING PRIMARY TOTAL HIP ARTHROPLASTY: A NEW ZEALAND JOINT REGISTRY STUDY
Authors: Boyle A.B. , Zhu M. , Frampton C. , Poutawera V. , Vane A.
Published: February 2023

Multiple joint registries have reported better implant survival for patients aged >75 years undergoing total hip arthroplasty (THA) with cemented implant combinations when compared to hybrid or uncemented implant combinations. However, there is considerable variation within these broad implant categories, and it has therefore been suggested that specific implant combinations should be compared. We analysed the most common contemporary uncemented (Corail/Pinnacle), hybrid (Exeter V40/Trident) and cemented (Exeter V40/Exeter X3) implant combinations in the New Zealand Joint Registry (NZJR) for patients aged >75 years.

All THAs performed using the selected implants in the NZJR for patients aged >75 years between 1999 and 2018 were included. Demographic data, implant type, and outcome data including implant survival, reason for revision, and post-operative Oxford Hip Scores were obtained from the NZJR, and detailed survival analyses were performed. Primary outcome was revision for any reason. Reason for revision, including femoral or acetabular failure, and time to revision were recorded.

5427 THAs were included. There were 1105 implantations in the uncemented implant combination group, 3040 in the hybrid implant combination group and 1282 in the cemented implant combination group. Patient reported outcomes were comparable across all groups. Revision rates were comparable between the cemented implant combination (0.31 revisions/100 component years) and the hybrid implant combination (0.40 revisions/100 component years) but were statistically significantly higher in the uncemented implant combination (0.80/100 component years). Femoral-sided revisions were significantly greater in the uncemented implant combination group.

The cemented implant and hybrid implant combinations provide equivalent survival and functional outcomes in patients aged over 75 years. Caution is advised if considering use of the uncemented implant combination in this age group, predominantly due to a higher risk of femoral sided revisions. The authors recommend comparison of individual implants rather than broad categories of implants.
ANTIBITOIC HYDROGEL FOR SINGLE-STAGE REVISION IN ORTHOPAEDIC INFECTION: A PRECLINICAL STUDY
Authors: Foster A.L. , Boot W. , Stenger V. , D'Este M. , Jaiprakash A. , Crawford R. , Schuetz M.A. , Eglin D. , Zeiter S. , Richards R.G. , Moriarty T.F.
Published: February 2023

Local antimicrobial therapy is an integral aspect of treating orthopaedic device related infection (ODRI), which is conventionally administered via polymethylmethacrylate (PMMA) bone cement. PMMA, however, is limited by a suboptimal antibiotic release profile and a lack of biodegradability.

In this study, we compare the efficacy of PMMA versus an antibioticloaded hydrogel in a single- stage revision for chronic methicillin-resistant Staphylococcus aureus (MRSA) ODRI in

sheep. Antibiofilm activity of the antibiotic combination (gentamicin and vancomycin) was determined in vitro. Swiss alpine sheep underwent a single-stage revision of a tibial intramedullary nail with MRSA infection. Local gentamicin and vancomycin therapy was delivered via hydrogel or PMMA (n = 5 per group), in conjunction with systemic antibiotic therapy. In vivo observations included: local antibiotic tissue concentration, renal and liver function tests, and quantitative microbiology on tissues and hardware post-mortem.

There was a nonsignificant reduction in biofilm with an increasing antibiotic concentration in vitro (p = 0.12), confirming the antibiotic tolerance of the MRSA biofilm. In the in vivo study, four out of five sheep from each treatment group were culture negative. Antibiotic delivery via hydrogel resulted in 10–100 times greater local concentrations for the first 2–3 days compared with PMMA and were comparable thereafter. Systemic concentrations of gentamicin were minimal or undetectable in both groups, while renal and liver function tests were within normal limits.

This study shows that a single-stage revision with hydrogel or PMMA is equally effective, although the hydrogel offers certain practical benefits over PMMA, which make it an attractive proposition for clinical use.
VANCOMYCIN SOAKING IS HIGHLY COST-EFFECTIVE IN PRIMARY ACLR INFECTION PREVENTION: A COST-EFFECTIVENESS STUDY
Authors: Truong A.P. , Perez-Prieto D. , Byrnes J. , Monllau J.C. , Vertullo C.J.
Published: February 2023

While pre-soaking grafts in vancomycin has demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection prevention, the economic benefit of the technique is uncertain. The primary aim of this study was to determine the cost-effectiveness of vancomycin pre-soaking during primary ACLR to prevent post-operative joint infections. The secondary aims of the study were to establish the breakeven cost-effectiveness threshold of the technique.

A Markov model was used to determine cost effectiveness and the incremental cost effectiveness ratio of additional vancomycin pre-soaking compared to intravenous antibiotic prophylaxis alone. A repeated meta-analysis of nine cohort studies (Level III evidence) was completed to determine the odds ratio of infection with vancomycin pre-soaking compared to intravenous antibiotics alone. Estimated costs and transitional probabilities for further surgery were obtained from the literature. Breakeven threshold analysis was performed.

The vancomycin soaking technique provides an expected cost saving of $600AUD per patient. There was an improvement in the quality-adjusted life years of 0.007 compared to intravenous antibiotic prophylaxis alone (4.297 versus 4.290). If the infection rate is below 0.023% with intravenous antibiotics alone or the additional intervention cost more than $1000AUD, the vancomycin wrap would no longer be cost-effective.

For $30AUD, the vancomycin soaking technique provides a $600AUD cost saving by both reducing the risk of ACLR related infection and economic burden of infection. Treating septic arthritis represents a mean cost per patient of 6 times compared to that of the primary surgery. There has been no previous cost-effectiveness study of the vancomycin wrap technique.

The vancomycin pre-soaking technique is a highly cost-effective method to prevent post-operative septic arthritis following primary ACLR.
TRANSCUTANEOUS OSSEOINTEGRATION RECONSTRUCTION FOR WHEELCHAIR-BOUND TRANSFEMORAL AMPUTEES (K0 LEVEL)
Authors: Chavan A. , Hoellwarth J. , Tetsworth K. , Lu W. , Oomatia A. , Alam S. , Vrazas E. , Al Muderis M.
Published: February 2023

Traditional socket prosthesis (TSP) rehabilitation for amputees is associated with substantial dissatisfaction due to poor mobility and pain from soft tissue squeezing. Osseointegration (OI), eliminates skin compression and prosthesis fit issues, providing superior mobility and quality of life (QOL) for most amputees. The potential for OI to benefit patients with exceptionally poor mobility is understudied. To address this knowledge gap, this project investigated the mobility and QOL changes.

A retrospective review was performed to identify transfemoral amputees who presented with wheelchair-bound mobility (K0) and had at least five years of post-osseointegration follow-up. Outcome measures included changes in mobility (K-level, daily prosthesis wear hours, Timed Up and Go (TUG), 6 minute walk test (6MWT)) and QOL (Questionnaire for persons with a Transfemoral Amputation (QTFA); Short Form Health Survey 36 (SF36). Adverse events recorded included debridement for infection, implant revision surgery, fractures, and implant failures.

9 patients with mean age 48.2±7.7 (range 34-59) years were included. The proportion of patients achieving K-level >2 improved from 0/9=0% to [9/9=100%], p<0.001. The 6MWT improved from 0±0 to 320.65±57 meters (p<0.001). The TUG improved from incapable to 10.68±2.7 seconds (p<0.001). Statistically significant QOL metrics included QTFA global score (33.33±31 vs 68.52±21, p=0.039), SF36 physical component score (30.03±6.3 vs 42.34±12, p=0.023) and the SF36 mental component score (47.89±8.8 vs 51.95±10.4, p=0.332). Six patients required operative intervention to address complications. Five developed infections: three had debridement, and 2 required implant removal and reimplantation.

Osseointegration does confer significant sustained mobility and quality of life improvement for wheelchair bound transfemoral amputees. All 9 K0 patients had statistically improved mobility and QOL after osseointegrated reconstruction. This supports osseointegration as an effective rapid and long-term rehabilitation alternative for patients who have the neurologic and muscular capacity to walk but are unable due to issues related to their TSP.
A PROSPECTIVE, MULTICENTRE RANDOMIZED COMPARATIVE STUDY ASSESSING A NEW MORPHOMETRIC-DESIGNED STEM FOR TOTAL HIP ARTHROPLASTY: BENCHMARKING AGAINST AN ESTABLISHED COMPARATOR
Authors: Driessen B. , Yap V. , Ng D.J. , Korshid O. , Wall S. , Yates P. , Prosser G. , Wilkinson M. , Hazratwala K. , Tran. T.
Published: February 2023

Clinical success of prostheses in joint arthroplasty is ultimately determined by survivorship and patient satisfaction. The purpose of this study was to compare (non-inferiority) a new morphometric designed stem for total hip arthroplasty (THA) against an established comparator.

A prospective randomised multi-centre study of 144 primary cementless THA performed by nine experienced orthopaedic surgeons was completed (70 received a fully coated collarless tapered stem and 70 received a morphometric designed proximally coated tapered stem). PROMs and blood serum markers were assessed preoperatively and at intervals up to 2-years postoperatively. In addition, measures of femoral stem fit, fill and subsidence at 2-years post-operatively were measured from radiographs by three observers, with an intra-class correlation coefficient of 0.918. A mixed effects model was employed to compare the two prostheses over the study period. A p-value <0.05 was considered statistically significant.

Demographics and Dorr types were similar between groups. Both stems demonstrated a significant improvement in PROMs between the pre- and post-operative measurements, with no difference at any timepoint (p > 0.05). The fully coated tapered collarless femoral stem had a non-significantly higher intra-operative femoral fracture rate (5.8% vs 1.4%, p = 0.24), with all patients treated with cable fixation and partial weight bearing. The mean subsidence at 2-years was 2.5mm +/- 2.3mm for the morphometric stem and 2.4mm +/- 1.8mm for the fully coated tapered collarless femoral stem (p = 0.879). There was one outlier in each group with increased subsidence (fully coated tapered collarless femoral stem 6.9mm, morphometric wedge stem 7.4mm), with both patients reporting thigh pain at 2 years.

When compared with an established stem, the newer designed morphometric wedge stem performed well with comparable radiological and PROM outcomes at 2 year follow up. Continued follow-up is required for long term benchmarking.
TIBIAL METAPHYSEAL CONES COMBINED WITH SHORT STEMS PERFORM AS WELL AS LONG STEMS IN REVISION TOTAL KNEE ARTHROPLASTY
Authors: Batinica B. , Bolam S.M. , Zhu M. , D'Arcy M. , Peterson R. , Young S. , Monk A.P. , Munro J.T.
Published: February 2023

Little information exists regarding optimal tibial stem usage in revision total knee arthroplasty (rTKA) utilising a tibial trabecular metal (TM) cone. The purpose of this study was to compare 1) functional outcomes, 2) radiographic outcomes, and 3) implant survivorship in rTKA utilising TM cones combined with either short stems (SS) or long stems (LS) at minimum two-years clinical follow-up.

In this retrospective, multi-centre study, patients undergoing TM cone utilising rTKA between 2008 and 2019 were included. Patients were divided into: SS group (no diaphyseal engagement), and LS group (diaphyseal engagement). All relevant clinical charts and post-operative radiographs were examined. Oxford Knee Score (OKS) and EuroQol-5D (EQ-5D-5L) data were collected at most recent follow-up.

In total, 44 patients were included: 18 in the SS group and 26 in the LS group. The mean time of follow-up was 4.0 years. Failure free survival was 94.5% for the SS group and 92.3% for the LS group. All failures were for prosthetic joint infections managed with debridement, antibiotics, and implant retention. At most recent follow-up, 3 patients demonstrated radiographic signs of lucency (1 SS 2 LS, p = 1) and the mean OKS were 37 ± 4 and 36 ± 6 (p = 0.73) in the SS and LS groups, respectively.

Tibial SS combined with TM cones performed as well as LS in rTKA at minimum two-years follow-up. A tibial SS in combination with a TM cone is a reliable technique to achieve stable and durable fixation in rTKA.
RISK FACTORS FOR DISTAL CONSTRUCT FAILURE IN POSTERIOR SPINAL INSTRUMENTED FUSION FOR ADOLESCENT IDIOPATHIC SCOLIOSIS: A RETROSPECTIVE COHORT STUDY
Authors: Tse C.B. , Mandler S.I. , Crawford H.A. , Field A.J.F.
Published: February 2023

The purpose of this study is to evaluate risk factors for distal construct failure (DCF) in posterior spinal instrumented fusion (PSIF) in adolescent idiopathic scoliosis (AIS). We observed an increased rate of DCF when the pedicle screw in the lowest instrumented vertebra (LIV) was not parallel to the superior endplate of the LIV, however this has not been well studied in the literature. We hypothesise a more inferiorly angled LIV screw predisposes to failure and aim to find the critical angle that predisposes to failure.

A retrospective cohort study was performed on all patients who underwent PSIF for AIS at the Starship Hospital spine unit from 2010 to 2020. On a lateral radiograph, the angle between the superior endplate of the LIV was measured against its pedicle screw trajectory. Data on demographics, Cobb angle, Lenke classification, instrumentation density, rod protrusion from the most inferior screw, implants and reasons for revision were collected.

Of 256 patients, 10.9% (28) required at least one revision. The rate of DCF was 4.6% of all cases (12 of 260) and 25.7% of revisions were due to DCF. The mean trajectory angle of DCF patients compared to all others was 13.3° (95%CI 9.2° to 17.4°) vs 7.6° (7° to 8.2°), p=0.0002. The critical angle established is 11°, p=0.0076. Lenke 5 and C curves, lower preoperative Cobb angle, titanium only rod constructs and one surgeon had higher failure rates than their counterparts. 9.6% of rods protruding less than 3mm from its distal screw disengaged.

We conclude excessive inferior trajectory of the LIV screw increases the rate of DCF and a screw trajectory greater than 11° predisposes to failure. This is one factor that can be controlled by the surgeon intraoperatively and by avoiding malposition of the LIV screw, a quarter of revisions can potentially be eliminated.
DO TOTAL HIP ARTHROPLASTIES PERFORMED WITH ROBOTIC ASSISTANCE HAVE BETTER PROM SCORES AT SIX MONTHS POST SURGERY WHEN COMPARED WITH TOTAL HIP ARTHROPLASTIES PERFORMED WITH CONVENTIONAL INSTRUMENTATION?
Authors: Tuffley C.H. , Tuffley J.C. , Donnelly W. , Harris I. , Cuthbert A.
Published: February 2023

In this study we compare survivorship and patient reported outcome measures in robotically assisted versus conventional Total Hip Arthroplasty (THA).

This paper investigates the hypothesis that implant survival and PROMS following THAs performed with robotic assistance were not different to outcomes following conventional THAs.

Data included all patients undergoing THA for osteoarthritis between 19 April 2016 and 31 December 2020. Analysis of PROMS outcomes was restricted to those who had completed PROMS data preoperatively and at 6 months postoperatively.

There were 157,647 procedures, including 3567 robotically assisted procedures, available for comparison of revision rates. 4557 procedures, including 130 robotically assisted procedures, had PROMS data available. The revision rate of primary THA performed with robotic assistance was not statistically different from THA performed by conventional methods (4 year cumulative percent revision 3.1% v 2.7%; HR = 1.05, p=0.67). The Oxford Hip Score, VAS for pain and the EQ-VAS score for overall health showed no statistically significant difference between the groups. The EQ-5D Utility Score showed an improved score (median score 1 v 0.88; OR = 1.58, p=0.007) for the robotically assisted group compared to the conventional group.

Robotic assisted THA was not associated with significant improvement in early revision or joint-specific PROMs. The findings may have been biased, in either direction, by unmeasured patient, surgeon, hospital and prosthesis factors. The findings (including the difference in health-related quality of life) may have also been influenced by lack of blinding. Future research should include methods to minimise these biases.
3D BIOPRINTING OF ARTICULAR CARTILAGE FOR IN VIVO APPLICATION
Authors: Di Bella C.
Published: February 2023

3D printing and Bioprinting technologies are becoming increasingly popular in surgery to provide a solution for the regeneration of healthy tissues. The aim of our project is the regeneration of articular cartilage via bioprinting means, to manage isolated chondral defects.

Chrondrogenic hydrogel (chondrogel: GelMa + TGF-b3 and BMP6) was prepared and sterilised in our lab following our standard protocols. Human adipose-derived mesenchymal stem cells were harvested from the infrapatellar fat pad of patients undergoing total knee joint replacements and incorporated in the hydrogel according to our published protocols. The chondrogenic properties of the chondrogel have been tested (histology, immunohistochemistry, PCR, immunofluorescence, gene analysis and 2nd harmonic generation microscopy) in vitro and in an ex-vivo model of human articular defect and compared with standard culture systems where the growth factors are added to the media at repeated intervals.

The in-vitro analysis showed that the formation of hyaline cartilage pellet was comparable between the two strategies, with a similar metabolic activity of the cells. These results have been confirmed in the ex-vivo model: hyaline-like cartilage was observed within the chondral defect in both the chondrogel group and the control group after 28 days in culture.

The use of bioprinting techniques in vivo requires the ability of stem cells to access growth factors directly in the environment they are in, as opposed to in vitro techniques where these factors are provided externally at recurrent intervals. This study showed the successful strategy of incorporating chondrogenic growth factors for the formation of hyaline-like cartilage in vitro and in an ex-vivo model of chondral loss.

The incorporation of chondrogenic growth factors in a hydrogel is a possible strategy for articular cartilage regeneration.
CONTRALATERAL ACL RUPTURE IS MORE COMMON THAN ACL GRAFT RUPTURE IN AUSTRALIAN NETBALLERS AFTER ACL RECONSTRUCTION
Authors: Honeywill C. , Salmon L. , Pinczewski L. , Sundaraj K. , Roe J.
Published: February 2023

The aim of this study was to determine Anterior Cruciate Ligament (ACL) graft and contralateral ACL (CACL) survival in patients who have undergone ACL reconstruction (ACLR) with hamstring autograft following netball injuries, and determine factors associated with repeat ACL injury and return to netball.

From a prospectively collected database, a consecutive series of 332 female netballers who underwent primary ACLRs using hamstring autografts were identified. Subjects were surveyed at a minimum of five years following reconstruction, including details of further ACL injuries to either knee, return to netball or other sports and psychological readiness with the ACL-RSI score.

264 participants (80%) were reviewed at the mean follow up of 9 years (60-180 months). There were 12 ACL graft ruptures (5%) and 35 contralateral ACL ruptures (13%). ACL graft survival was 97% and 97%, 96% at 2, 5 and 7 years respectively. CACL survival was 99%, 94%, and 90% at 2, 5 and 7 years respectively. The 7-year ACL graft survival was 97% in those 25 or more and 93% in those under 25 years (p=0.126). The 7-year CACL survival was 93% in those 25 or more and 85% in those under 25 years (HR 2.6, 95%CI 1.3-5.0, p=0.007). A family history of ACL injury was reported by 32% of participants. A return to netball was reported by 61% of participants. The mean ACL-RSI score was 65 in those who returned to netball and 37 in those who did not (p=0.001).

ACLR with hamstring autografts is a reliable procedure for netballers with a survival rate of 96% at 7 years, allowing 63% of participants to return to netball. A successful return to sport was associated with greater psychological readiness. CACL injury occurred with more than double the frequency of ACL graft rupture and was increased by 2.6x in those <25 years.
ACHIEVING EQUITABLE ACCESS TO ELECTIVE ARTHROPLASTY FOR ABORIGINAL AND TORRES STRAIT ISLANDER POPULATION IN A REGIONAL NSW HEALTH DISTRICT: COMPARISON WITH NATIONAL DATA
Authors: Barrass E. , Lin J.L. , Lynch J. , Fielding K.
Published: February 2023

Aboriginal and Torres Strait Islander (ATSI) people have higher elective wait times compared to non-ATSI population in Australia. The Murrumbidgee Local Health District (MLHD) in southern New South Wales services 125,242km2 and a population of 287,000 people, with 5.8% identifying as ATSI. The aim of this study is to investigate the arthroplasty waitlist time of ATSI, and the impact of rurality on joint replacement, within the MLHD and compared to the Australian national data.

1435 consecutive patients who underwent elective hip or knee arthroplasty from July 2018 to June 2021 were collated. Demographics, ATSI status, total wait time, readiness for care, and rurality were collected. Rurality was measured by distance from the arthroplasty hospital within MLHD. 1,151 patients were included after excluding patients with missing data or underwent emergent surgery.

Within this cohort, 72 of 1,151 patients (6.2%) identified as ATSI. ATSI were younger than non-ATSI population (60.7y v 66.4y). There was no difference between Aboriginal status and ready for care wait time (368.0 v 349.9 days; p=0.116). The rurality of the groups was similar and increasing rurality did not affect total wait time (ATSI 103.1km v 98.6km; p=0.309). There was no difference in total or not-ready-for-care time between the groups (p: 0.68).

Findings suggest equitable access to joint arthroplasty in the MLHD between ATSI and non-ATSI populations, which differs from the national experience. There is no significant difference between rurality and accessibility in the MLHD. This may be a result of the increased focus to ATSI and rural health within the district. A state or national study would be beneficial in identifying high performing regions and reviewing processes that enable equitable and accessible care.

MLHD provides equitable access to arthroplasty surgery between ATSI and non-ATSI, as well as patients from rural areas within the LHD.
EARLY REVISION RATES OF TOTAL HIP ARTHROPLASTY USING INTELLIJOINT HIP® COMPUTER NAVIGATION SYSTEM: A STUDY FROM THE AUSTRALIAN NATIONAL JOINT REPLACEMENT REGISTRY OF 1,911 PROCEDURES
Authors: Lourens E.C. , Kurmis A.P. , Holder C. , de Steiger R. N.
Published: February 2023

Total hip arthroplasty (THA) is an effective treatment for symptomatic hip osteoarthritis (OA). Computer-navigation technologies in total knee arthroplasty show evidence-supported survivorship advantages and are used widely. The aim of this study was to determine the revision outcome of hip commercially available navigation technologies.

Data from the Australian Orthopaedic Association National Joint Replacement Registry from January 2016 to December 2020 included all primary THA procedures performed for osteoarthritis (OA). Procedures using the Intellijoint HIP® navigation were identified and compared to procedures inserted using ‘other’ computer navigation systems and to all non-navigated procedures. The cumulative percent revision (CPR) was compared between the three groups using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazards models, adjusted for age and gender. A prosthesis specific analysis was also performed.

There were 1911 procedures that used the Intellijoint® system, 4081 used ‘other’ computer navigation, and 160,661 were non-navigated. The all-cause 2-year CPR rate for the Intellijoint HIP® system was 1.8% (95% CI 1.2, 2.6), compared to 2.2% (95% CI 1.8, 2.8) for other navigated and 2.2% (95% CI 2.1, 2.3) for non-navigated cases. A prosthesis specific analysis identified the Paragon/Acetabular Shell THAs combined with the Intellijoint HIP® system as having a higher (3.4%) rate of revision than non-navigated THAs (HR = 2.00 (1.01, 4.00), p=0.048).

When this outlier combination was excluded, the Intellijoint® system group demonstrated a two-year CPR of 1.3%. There was no statistical difference in the CPR between the three groups before or after excluding Paragon/Acetabular Shell system.

The preliminary data presented demonstrate no statistical difference in all cause revision rates when comparing the Intellijoint HIP® THA navigation system with ‘other’ navigation systems and ‘non-navigated’ approaches for primary THAs performed for OA. The current sample size remains too small to permit meaningful subgroup statistical comparisons.