bluuebunny/crossref_metadata_2025 huggingface dataset:
553 Does Patella Implant Design Affect Outcomes? Patella Resurfacing in Total Knee Arthroplasty: A Systematic Review and Meta-Analysis
Authors: Yap NJ , Simpson C , Ng N , Ndou S , Wright E , Scott C , Clement N
Published: November 2022

Aim

To investigate whether implant design affect (1)incidence of anterior knee pain, (2)patient reported outcomes and (3)reintervention rates in a resurfaced vs non-resurfaced Total Knee Arthroplasty (TKA).

Method

MEDline, pubmed and google scholar studies were evaluated using SIGN assessment tool and data analysis was conducted using Review Manager 5.2 on only randomised controlled trials. Search terms: arthroplasty, replacement, knee (Mesh), TKA, prosthesis, patella, patellar resurfacing, patellar retaining.

Results

33 randomised controlled studies were identified. A total of 11 used the modern “patella-friendly” implants and 22 used the older “patella non-friendly” implants.

There was no significant difference in anterior knee pain rates for either surgical option. When using patella-friendly implant, patella resurfacing results in a statistically higher clinical (P 0.007, MD -0.77) and functional (P < 0.0001, MD -1.87) KSS than the non-resurfaced counterparts, but scores were not clinically significant. When the patella was not resurfaced, there was a significant increased risk of reoperation with “non-patella friendly” implant (p=0.04, OR 1.42, CI 1.01, 2.00), whilst there was no significant difference between reoperation rates for the “patella friendly” implants (OR 1.17, CI 0.59,2.30).

Conclusions

Patella implant design has been shown to significantly improve KSS scores but with no clinical significance. Risk of further procedures was significantly higher in non-resurfaced patella TKAs with “non-friendly” implants, likely due to increased rates of anterior knee pain in these older generation implants leading to secondary resurfacing. However, when utilising “patella-friendly” implants, resurfacing does not lower reintervention rates. This meta-analysis finds no clinical indication to resurface the patellar whilst performing a TKA.
562 Midline Versus Off Midline Extraction Site in Laparoscopic Left Sided Colorectal Resections for Colorectal Malignancy: A Systematic Review and Meta-Analysis
Authors: Bhattacharya P , Hussain MI , Mohamedahmed AYY , Faiz N , Peravali R
Published: November 2022

Method

To evaluate comparative outcomes of off-midline and midline extraction sites in laparoscopic left sided colorectal resections.

Method

A systematic search of electronic databases and bibliographic reference lists was conducted, and a combination of free text and controlled vocabulary search was adapted to thesaurus headings, search operators and limits in electronic databases were applied. Studies comparing the outcomes of Off Midline and Midline incisions for specimen extraction in laparoscopic left sided colorectal resections were included. Incisional hernias, surgical site infections, operative time, estimated blood loss, anastomotic leak and length of hospital stay were the evaluated outcome parameters.

Results

We identified 5 comparative studies reporting a total of 1187 patients comparing outcomes of off-midline (n=486) and midline (n=701) incisions for specimen extraction in laparoscopic left colorectal resections. The off-midline approach was associated with lower post operative surgical site infection (OR 0.71, P=0.68), anastomotic leak (OR 0.76,P=0.66), and incisional hernia (MD: 0.65,P=0.64) compared to midline approach, however it was not statistically significant. There was no significant difference in operative time (MD: 0.10, P=0.99), intra-operative blood loss (MD 2.31, P=0.91), and post-operative hospital stay (MD : 0.78, P=0.18) between the two groups.

Conclusions

Off-midline extraction site for left sided colorectal resections have no significant difference in rates of post operative surgical site infection and incisional hernias when compared to midline extraction site. No significant difference was found in operative time, intra-operative blood loss, anastomotic leak and post operative hospital stay in this study. Future higher-level research is required to further evaluate the clinical outcomes.
653 The Impact of Preoperative Screening for Venous Pathology on Lower Limb Free Flap Reconstruction
Authors: Adeboye T , Hagiga A , Dheansa B
Published: November 2022

Aim

Lower limb reconstruction free flap failure rate is 8.5% and is contributed to by venous thrombosis and congestion. Mapping of free flaps and the recipient site to identify venous pathology is not standard and often pathology is only found intraoperatively leading to changes in reconstructive plans. There are no guidelines on preoperative venous assessment. We aimed to review available evidence to delineate the impact preoperative venous imaging has on flap outcomes

Method

A systematic review of MEDLINE, Scopus, Web of Science, Cochrane Library and Embase were searched in August 2021. The reference lists of retrieved publications were checked manually and backward searched using Web of Science and Google Scholar. Data was reviewed by two researchers independently and compared.

Results

Eleven articles were eligible for inclusion encompassing 99 patients and 107 flaps with lower limb pathology at either the donor or recipient vein. Venous pathology was detected preoperatively in 69 veins using USS duplex scanning or CT angiography. Interventions included using another vein, intraoperative thrombectomy, and preoperative anticoagulation. 3 out of 69 (4.34%) of these free flaps resulted in failure.

38 veins diagnosed with venous pathology intraoperatively were managed by using an alternative vein, venotomy, thrombectomy, embolectomy or heparinising the vein. 5 out of 38 flaps failed (13.15%).

Conclusions

Preoperative screening for venous pathology showed higher flap survival rate. A standardised approach for identifying venous issues in lower limb free flap reconstruction is needed. Future studies should focus on the prognostic validity of preoperative screening tools and management of identified venous pathology.
665 A Systematic Review of Breast Site Associated Complications Following Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction
Authors: Darling A , McLaughlin D , McGarry K
Published: November 2022

Aim

Breast reconstruction with autologous tissue provides durable reconstruction with native tissue. However, perioperative complications impact negatively on patient perception of success and increase the psychological trauma of mastectomy. The Deep Inferior Epigastric Perforator (DIEP) flap has a recognised low rate of donor site complications. This paper provides the first systematic review focussing on breast site associated complications.

Method

PRISMA guidelines informed a systematic search of Medline, Embase and Web of Science. Studies were screened against set inclusion and exclusion criteria; data was collated regarding demographics, flap characteristics and flap complications.

Results

Twenty-nine studies representing 21,680 flaps were included with the rate of major breast-associated complications ranging between 0 and 55.1% of flaps and 0 to 10.3% of patients; the rate of minor complications ranged between 0 and 48.2% of flaps and 0 to 16.3% of patients. All papers reported major complications including total flap loss (1–17.2% flaps, 0–7.4% patients), partial flap loss (0–44.8% flaps, 0–5% patients) and venous congestion or arterial compromise (1.5–55.1% flaps, 4.3–10.3% patients). Twenty-eight papers reported minor complications and included fat necrosis (1.8–48.2% flaps, 3–16.3% patients); wound problems (1–15.6% flaps, 3.7% patients); skin necrosis (9.2–17.8% flaps, 0.3–7.4% patients; seroma (0–4.9% flaps, 0–5.1% patients); haematoma (0.36–9.3% flaps, 0–8.4% patients) and infection (0.2–20% flaps, 0–6.3% patients).

Conclusions

This systematic review concludes that the DIEP flap has an acceptable level of breast site associated complications and should continue to be considered as gold standard in breast reconstruction. This review can be used in preoperative counselling and to inform consent.
782 Mohs Micrographic Surgery and Patient Satisfaction in Skin Cancer; a Systematic Review
Authors: Said Noor M , Chawla M
Published: November 2022

Aim

Mohs micrographic surgery (MMS) has revolutionised the treatment of skin cancer. It is commonly considered as gold standard, with good cosmesis effect for patients. Patient perception plays an important outcome in skin cancers. This systematic review aims to explore evidence of post-operative patient reported satisfaction after MMS.

Method

We conducted a systematic search using 10 databases including OVID Medline(R), Pubmed, Cochrane (CENTRAL) of all study types between 2000–2021. Studies were appraised for bias and data was tabulated with a narrative synthesis.

Results

The literature search generated 1068 studies. After removing duplicates, 728 were screened and 37 underwent full-text review. Thirteen relevant studies comprising 3046 patients undergoing MMS were included. Patients undergoing MMS expressed higher anxiety pre-operatively compared to conventional excision surgery but post-operatively Mohs was associated with a significantly higher skin cancer index (SCI) score. This was both in the short- and long-term follow up. Patients showed overall very high satisfaction with the technical quality, irrespective of reconstructive complexity or the surgeon's expertise. Patients’ main concerns post-operatively included scar skin thickness, colour, and irregularity. Higher satisfaction was observed in those with better pre-operative quality of life (QOL) including skin quality, co-morbidities, mental health, and age.

Conclusion

Overall patient satisfaction after MMS is high and supports transition to this surgical technique within skin cancer surgery. Higher satisfaction rates are observed in patients with better pre-operative QOL. Post-operatively patients are most concerned of scar thickness, colour, and irregularity. These factors should guide surgeons’ decision-making when aiming to maximise patient satisfaction.
910 Is There a Clinically Significant Advantage to Minimally Invasive Over Standard Surgical Approaches in Total Hip Arthroplasty? a Systematic Review
Authors: Moosavi H , Dandachli W
Published: November 2022

Aim

Conventional surgical approaches in Total Hip Arthroplasty (THA) utilise one long incision to access to the hip joint. Nowadays minimally invasive (MIS) approaches, involving one or more incisions of less than 10cm in length, are being increasingly utilised. This systematic review aims to investigate whether or not there is a statistically significant benefit for the MIS approaches over the conventional ones, and if so, whether a particular approach is superior to the others.

Method

This study was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Following an initial scoping search, six databases were selected in order to search for relevant studies, those being Embase, Medline, PubMed, Science Direct, Scopus and the Cochrane Library for Systematic Reviews, based pre-determined inclusion criteria formulated using the PICO (population, intervention, control, and outcome) format.

Results

10 studies were included for qualitative analysis including 7 randomised control trials, 2 cohort studies and 1 systematic review. There was no agreement in the results, with some studies favouring conventional approaches and other MIS.

Conclusions

Minimally invasive surgery is an evolving concept in THA. Based on this study, there is still not enough data in the literature to warrant adopting MIS over conventional approaches as standard practice. The SuperPATH approach appears to be the most promising MIS technique. More research comparing MIS to conventional approaches in the longer term is needed.
517 Composite Surgical Site Infections in Patients Undergoing Kidney Transplantation in a Tertiary Renal Centre
Authors: Chowdhury AM , Khurram MA , Mohamed IH
Published: November 2022

Aim

Surgical Site Infections (SSI) contribute to morbidity and mortality in patients undergoing surgery, especially in high-risk group patients, such as kidney failure patients. Conventional classification and reporting can be inadequate for this group of patients. We developed a composite SSI definition extending the conventional Centres for Disease Control and Prevention criteria to include seromas, lymphoceles, collections, and haematomas specific to kidney transplantation requiring intervention occurring within 21 days. Primary outcomes are incidence; secondary outcomes are length of stay and readmission within 30 days.

Method

A retrospective, single-centre, cohort study was performed of adults who underwent kidney transplantation (01/04/2017–31/03/2018). Pre-, peri- and post-operative data were collected from electronic health records.

Results

130 patients were identified. SSIs occurred in 26% (34/130) of patients (31 organ/retroperitoneal space, 2 superficial and 1 deep). There was no statistically significant difference in age, sex, body mass index, primary pathology, diabetes status, organ donor type, cold ischaemia time, graft function and induction agent in patients with or without SSI. Longer dialysis time was the only factor associated with developing an SSI (7.1 vs 4.0 years; p=0.007). Patients with SSIs were significantly more likely to have >1 week index admission (41% vs 21%, p=0.0249, OR2.660) and readmission within 30 days post-discharge (35% vs 15%, p=0.0118, OR 3.306).

Conclusions

SSI in kidney transplant patients is common and associated with prolonged index admission and higher readmission rates. Strategies to mitigate this such as negative pressure wound therapy should be explored.
531 Less Is More: Extensive Cardiac Investigations Add Little Value in Waitlisting Patients for Kidney Transplantation
Authors: Chow BJ , Khurram MA , Capuano E , Pugliese F , Yaqoob MM , Mohamed IH
Published: November 2022

Aim

Extensive cardiac investigations have long been considered necessary to aid decision-making in waitlisting for kidney transplantation. However, the utility and reliability of such comprehensive tests are not well established. This study assessed the prognostic power of coronary artery calcium scoring (CACS) using computed tomography coronary angiogram (CTCA) and myocardial perfusion scintigraphy (MPS) in predicting major adverse cardiac events (MACE).

Method

We conducted a retrospective study of all ESRD patients considered for kidney transplantation and referred for MPS and/or CTCA for CACS between October 2012 to March 2014 and assessed MACE occurrences (heart failure, cardiac arrest, myocardial infarction, angina, CVA, PVD, and transient ischaemic attack) within a 9-year follow-up period.

Results

Among 131 patients in our study, 91.6% had a MPS (76.7% Negative MPS result, 23.3% Positive MPS result) and 92.4% had a CTCA (75.2% CACS <400 (Low Score), 24.8% CACS>400 (High Score)). Sensitivity, specificity, positive and negative predictive values were poor for CTCA (38.8%, 84.7% 63.3%, 67.0%) and MPS (34.8%, 82.4%, 55.2%, 67.0%). There was no statistical significance in MACE when stratified by CACS and MPS in transplanted patients (log-rank p= 0.155). No statistical difference in MACE was observed when stratified by MPS status (p=0.749) or CACS status (p=0.706) in non-transplanted patients.

Discussion

This challenges the value of extensive cardiac assessments (MPS, CTCA) in predicting MACE. Candidates conventionally considered low-risk by these methods had similar risk of MACE when transplanted against higher-risk groups. Thus, such tests are best used for risk stratification and counselling for shared decision-making.
1036 Gender Equality in Heart Transplantation: A Single Centre Study
Authors: Surendran A
Published: November 2022

Background

International Society for Heart and Lung Transplantation categorises female gender in donor/recipient, as a significant risk factor for mortality after heart transplantation. Further, donor-recipient gender mismatch is also reported to be a determinant of post-transplant morbidity/mortality. To examine the effect of gender in survival outcomes, we conducted a retrospective study.

Method

Population comprised of 298 patients undergoing heart transplantation from 2001 to 2021, divided into four groups on the basis of donor and recipient matching. Group A consisted of men who received male donor-hearts, group B of women who received female donor-hearts, group C of women who received male donor-hearts, and group D of men who received female donor-hearts. Standard heart transplantation protocols were applied to all patient groups for graft preservation, surgical technique, donor-recipient size matching, induction & immunosuppressive-therapy.

Results

The study groups were found to be homogeneous to the major preoperative- risk- factors (aetiology, transplantation status, donor-recipient-age, total ischemic time). Donor gender, recipient gender and donor-recipient gender mismatching did not significantly modify the short and mid-term survivals, functional recovery, and primary graft dysfunction post-surgery.

Conclusions

Even though previous reports suggest that gender negatively affects survival, this proved to have no influence on the outcomes in our study. These results can be explained by a correct donor-recipient size matching. The well-documented female recipients’ tendency to more frequent and fatal rejection was not confirmed in our experience. The patient's age at transplantation, the routine use of induction therapy and an aggressive immunosuppressive regimen may be the substrate of these findings.
3 Establishment of Virtual Fracture Clinic in Princess Royal Hospital Telford; Experience and Recommendations During the First 9 Months
Authors: Khaleeq T , Ahmed U
Published: November 2022

Introduction

Virtual fracture clinics (VFC) have been shown to be a safe and cost-effective way of managing outpatient referrals to the orthopaedic department. During the coronavirus pandemic there has been a push to reduce unnecessary patient contact whilst maintaining patient safety.

Method

A protocol was developed by the clinical team on how to manage common musculoskeletal presentations to A&E prior to COVID as part of routine service development. Patients broadly triaged into 4 categories; discharge with advice, referral to VFC, referral to face to face clinic or discussion with on call team. The first 9 months of data were analysed to assess types of injury seen and outcomes.

Results

In total 2489 patients were referred to VFC from internal and external sources. 734 patients were discharged without follow-up and 182 patients were discharged to physiotherapy. 3 patients required admission. Regarding follow-ups, 431 patients had a virtual follow-up while 1036 of patients required further face to face follow up. 87 patients were triaged into subspecialty clinics. 37 patients were referred inappropriately.

Discussion

BOA guidelines suggest all patients need to be reviewed within 72 hours of their orthopaedic injury. Implementation of a VFC allows this target to be achieved and at the same time reduce patient contact. Almost half the patients were discharged following VFC review, the remaining patients were appropriately followed up. This is especially relevant in the current pandemic where reducing unnecessary trips to hospital will benefit the patient as well as make the most of the resources available.
12 Trends in Neck of Femur Fracture Incidence in EU15+ Countries From 1990–2017
Authors: Ali R , Sugand K , Goodall R , Salciccioli J , Marshall D , Schuster-Bruce J , Abdul-Jabar HB , Shalhoub J
Published: November 2022

Background

Neck of femur fractures (NOFF) pose significant socio-economic costs to society with a high degree of morbidity and mortality. Its incidence rate has been collated within the Global Burden of Disease (GBD) database; however, to date, no comparison across countries has been reported.

Method

NOFF age-standardised incidence rates (ASIR) per 100,000 population were extracted from the GBD database for European Union (EU) 15+ countries over the period 1990 to 2017. Joinpoint regression analysis of the data identified trends in ASIR and associated estimated annual percentage changes (EAPC). These were analysed by specified timeframe, country, and gender.

Results

Of the 19 EU15+ countries, 11 (58%) had overall increases in NOFF ASIRs in 2017 compared to 1990. The median ASIRs were 240/100,000 and 322/100,000 for males and females, respectively, in 1990. By 2017, this had increased to 259/100,000 and 325/100,000, respectively. Females consistently had relatively higher NOFF ASIRs with a median gender fracture gap of 62/100,000 in 2017. Males had a higher percentage change in increasing ASIRs, with a smaller percentage change in decreasing ASIRs for all included countries. The highest national ASIRs was observed in Australia, followed by Finland and Belgium. Conversely the Mediterranean countries demonstrated the lowest ASIRs, closely followed by the USA.

Conclusions

Despite significant advances in primary and secondary hip fracture prevention strategies over the 28-year study period, significant increases in NOFF ASIRs among most EU15+ countries were observed, especially with respect to gender.
35 Medical Complications After Total Ankle Arthroplasty: A Review of the Evidence
Authors: Curlewis K , Leung B , Sinclair L , Chan G , Bendall S , Ricketts D
Published: November 2022

Aim

Total Ankle Arthroplasty (TAA) is increasingly being undertaken globally for the treatment of end-stage ankle arthritis. For each TAA procedure informed consent is required. This requires disclosing all material risks that the patient may find significant. The consent process should include discussion of all relevant complications, both medical and regional. There is a lack of data regarding the medical complications of TAA. This might cause problems in obtaining valid informed consent.

Methods

A literature review was performed. The medical complications and mortality rate of TAA were identified and summarised.

Results

The average rate of systemic medical complications after TAA was 3% (range: 0% - 7%). The average mortality rate following TAA was 0.3% (range: 0% - 0.72%). The following risk factors were identified for medical complications: obesity, diabetes, systemic co-morbidities, preoperative blood transfusion, revision procedures, and long anaesthetic duration.

Conclusions

As part of obtaining informed consent for TAA, the medical complication rate of 3% and mortality rate of 0.3% ought to be included, documented, and conveyed to patients alongside the regional complications.
86 An Emerging Role of Cannabis as an Anti-Nociceptive Agent in the Treatment of Chronic Back Pain
Authors: Damisa J , Richardson M , Adewuyi M
Published: November 2022

Aim

This review aims to provide insight into current research regarding a role for the endocannabinoid signalling pathway as a target in the treatment of chronic pain with particular emphasis on potential use as part of the treatment of lower back pain.

Method

A literature review was conducted using PubMed, Google scholar, and web of science database. The terminologies used were endocannabinoids, cannabis-based medicines, chronic pain, and lower back pain.

Results

The analgesic effect of cannabinoids is produced by stimulating cannabinoid receptors within the endocannabinoid system. Animal studies show cannabinoid type 2 receptors stimulate the release of endogenous opioids, further enhancing anti-nociceptive properties.

Pre-clinical studies demonstrated the amount of morphine required to achieve median effective dose was around 3.6 times lower when morphine was administered with cannabinoids compared to morphine alone.

A systematic review of 24 RCT trials and 1334 participants revealed that inhaled cannabis results in improved neuropathic pain symptoms compared to placebo; however, only two studies showed clinical significance.

The medicinal use of cannabis comes with adverse effects. Up to a tenth of users are at risk of developing Cannabis use disorder, characterized by psychosocial problems, increased drug-seeking behaviours including craving, withdrawal, and tolerance.

Conclusions

The use of cannabis is gaining traction as an alternative to opiates despite the ethical and legal considerations.

There is scope for cannabinoids to be successful anti-nociceptive agents in the management of chronic back pain.

The long-term effects and side effect profile of cannabis- based medicines need more research.
114 Bone Transport Using the Monorail External Fixator Over an Intramedullary Nail for Post-Traumatic Femoral Defects
Authors: Lu V , Zhang J , Krkovic M
Published: November 2022

Aim

The management of limb-length discrepancy secondary to traumatic bone loss poses a unique challenge for surgeons. The Ilizarov technique is popular but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail.

Method

Eight patients were included from over a four-year period with post-traumatic femoral defects, that underwent treatment with monorail fixator-assisted intramedullary nailing. Mean follow-up time was 232.83 weeks. Five were open fractures (Gustilo-Anderson type 3A:n=4, 3B:n=1), one had closed fracture. Average bone defect size was 8cm. Primary outcomes were lengthening index, consolidation time and index, external fixator index. Secondary outcomes were time to full weight bearing(FWB), time to union, complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores(OKS), Oxford hip scores(OHS) were recorded after recovery.

Results

Average consolidation time and index were 11.35months and 1.24months/cm, respectively. Mean lengthening and external fixator index were 20.2days/cm and 23.88days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, treated by reamed intramedullary exchange nailing. Two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p=0.104, p=0.238, respectively). Average OKS was 32.17 and OHS was 34.00.

Conclusions

Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time, lowering complication rate, returning patients’ quality of life to a level comparable with the normal population.
122 Outcomes in Young Adult Patients with Intracapsular Femoral Neck Fractures
Authors: Wagner B , Oliver W , Bell K , Scott C , Keating J , White T , Duckworth A
Published: November 2022

Aim

The aim was to evaluate short- and long-term outcomes for young adult patients undergoing fixation for an intracapsular femoral neck fracture.

Method

From 2008–2018, we retrospectively identified 112 consecutive patients (mean age 48yrs [20–60], 54% male). Complication details were determined from medical records and radiographs. Long-term patient-reported outcomes – including Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimension (EQ-5D)/Visual Analogue Scale (EQ-VAS) and UCLA Activity Scale – were obtained via telephone survey.

Results

Union occurred in 77% (n=86/112) at a mean of nine months (3–87). Complications occurred in 23% (n=26/112), including fixation failure (5.4%, n=6/112), nonunion (4.5%, n=5/112) and AVN (14.3%, n=16/112). Alcohol excess (p=0.04), time to surgery >24hrs (p=0.023) and fracture malreduction (p=0.002) were associated with complications. Overall, 35% required further surgery, including metalwork removal (18.8%, n=21/112), total hip replacement (18.8%, n=21/112) and excision arthroplasty (1.8%, 2/112).

Long-term outcomes were obtained for 72% (n=81/112) at a mean of 6.9yrs (2.8–12.8). The mean OHS was 41.4 (4–48), FJS 63.3 (0–100), EQ-5D 0.823 (-0.59–1.0) and EQ-VAS 79.5 (5–100). Mean EQ-5D was significantly lower than population controls (p=0.005). The mean UCLA score fell from 6.8 pre-injury to 6.0 post-injury (p<0.001). Patients with complications had significantly lower OHS (p<0.001), EQ-5D (p=0.001), EQ-VAS (p=0.01) and UCLA scores (p=0.001) compared with those who united uneventfully.

Conclusions

Most young adult patients united following fixation of their fracture. However, one in four experienced a complication, resulting in inferior long-term function and health-related quality of life. Time to surgery and fracture reduction were significantly associated with complications.
164 The Relationship Between Patient Reported Outcome Measures (PROMs) in Patients Undergoing Hip and Knee Joint Replacement Surgery and Social Deprivation on the Wirral
Authors: Gompels B , Donnachie N
Published: November 2022

Aim

This study investigated differences in patient reported outcome measures (PROMs) pre- and post-operatively and socio-economic deprivation in patients on the Wirral. The Wirral is an area s with a diverse socioeconomic spectrum but served by the same Musculoskeletal department.

Method

This was a retrospective cohort study of 1594 adult patients who underwent a hip or knee replacement between 2012–2019. Socioeconomic deprivation was quantified using the Index of multiple deprivation (IMD) Outcomes pre- and post-operatively (Q1 and Q2) were recorded using the Oxford Hip and Knee scores.

Results

The mean Q1 and Q2 score for each IMD decile was found to have a strong positive correlation with PROM score across both hip and knee replacements for both genders. The mean difference between Q1/Q2 score was not strongly correlated with IMD decile. Patients from areas of higher socioeconomic deprivation have lower PROMs pre- and post-operatively.

Conclusions

The Oxford Hip and Knee scores are widely used for assessing health status. The treating unit does not specify a score that triggers discussion regarding arthroplasty but undertakes a holistic assessment. This study supports this approach as it would appear scores are influenced by IMD decile. NHS Digital publishes PROMs scores using change in PROM score pre- and post-operation rather than absolute PROMs scores; this study supports this as both the pre- and post-operative scores appeared to be strongly correlated to IMD decile but change/improvement in score was poorly correlated and therefore is less influenced by catchment area deprivation.
185 A Review of the Systemic Medical Complications Following Joint Replacement
Authors: Curlewis K , Leung B , Thornhill C , Sinclair L , Chan G , Ricketts D
Published: November 2022

Aim

Arthroplasty procedures are commonly performed in the UK. For each procedure informed consent is required. To obtain informed consent the patient and their surgeon should discuss the risks and benefits of the proposed operation, including complication rates. In the literature the regional complications of arthroplasty are generally well documented. The systemic medical complications are less well described. This lack of accurate data could make it difficult for the treating surgeon to obtain valid consent.

The aim of this paper was to review and compare the literature regarding the rate of systemic medical complications after common arthroplasty procedures.

Method

A literature search was conducted using the PubMed, Cochrane Library and MEDLINE databases. Studies regarding the systemic medical complications and mortality rate of joint replacement published within the last 10 years were included. Any studies focusing purely on regional complications, non-English language or with no full text available were excluded.

Results

We found that systemic complications were more frequent than regional complications following arthroplasty. The systemic complication rates were hip: 5.1%, knee: 6.9%, ankle: 3.0%, shoulder: 11.2%, elbow: 8.5% and wrist: 0%. The most common systemic medical complication following arthroplasty was venous thromboembolism. Pre-operative co-morbidity was the most important risk factor for both post-operative mortality and systemic medical complications following arthroplasty procedures.

Conclusions

We recommend that to obtain informed consent for arthroplasty procedures, the given rates of systemic medical complications of joint replacement should be discussed and documented.
223 Joint Aspirations for Suspected Native Septic Arthritis: A Retrospective Audit of the Diagnostic Accuracy of Aspirations and Clinical Factors Associated with a Diagnosis of Septic Arthritis
Authors: Low JW , Bell KR , Oliver WM , White TO , Duckworth AD
Published: November 2022

Aim

This study aimed to determine the diagnostic accuracy of native joint aspirations for adult septic arthritis (SA), and to determine clinical factors associated with a positive diagnosis of SA.

Method

Retrospective review of adult patients (≥16yrs) undergoing a major joint aspiration at a single centre over a year period (2019) were identified. Patient demographics, clinical and biochemical data, joint aspiration details, post-aspiration diagnosis, management and patient outcomes were recorded. Culture negative SA was defined as Newman's Criteria C or D.

Results

There were 161 native joint aspirations identified. The rate of positive diagnosis of SA was 13.0%, (n=21), with 16 (9.9%) culture positive SA and five (3.1%) culture negative SA. The presence of organisms on gram stain, high synovial white cell count (WCC), history of fever, intravenous drug use (IVDU) and previous SA diagnosis were associated with a diagnosis of SA (all p<0.05). A history of crystal arthropathy made the diagnosis of SA less likely (p=0.025). C-reactive protein (CRP) was not statistically different in the SA and non-SA groups (Area Under Curve of ROC=0.63, p=0.55).

Conclusion

Joint aspiration is still the preferred diagnostic test when it comes to accurately diagnosing native joint SA. However, while synovial culture and gram stain are pending, a high index of suspicion for SA can be based on a combination of patient's presenting symptoms (history of fever), previous SA or IVDU, and a high synovial WCC. These factors can aid the decision as to whether an emergency surgical washout of the joint is indicated.
245 Ankle Fusion with Tibiotalocalcaneal Retrograde Nail for Fragility Ankle Fractures: Outcomes at a Major Trauma Centre
Authors: Lu V , Tennyson M , Zhang J , Thahir A , Zhou A , Krkovic M
Published: November 2022

Aim

Fragility ankles fractures in the geriatric population are challenging to manage, due to fracture instability, soft tissue compromise, and patient co-morbidities. Traditional management options include open reduction internal fixation, or conservative treatment, both of which are fraught with high complication rates. We aimed to present functional outcomes of elderly patients with fragility ankle fractures treated with retrograde ankle fusion nails.

Method

171 patients received a tibiotalocalcaneal nail over a six-year period, but only twenty met the inclusion criteria of being over sixty and having poor bone stock. Primary outcome was mortality risk from co-morbidities according to Charlson co-morbidity index (CCI), and patients’ post-operative mobility status compared to pre-operative mobility. Secondary outcomes include intra-operative and post-operative complications, six-month mortality rate, time to mobilisation and union.

Results

Mean age was 77.82 years old. The average CCI was 5.05. Thirteen patients returned to their pre-operative mobility state. Patients with low CCI are more likely to return to pre-operative mobility status (p=0.16;OR=4.00).

Average time to bone union and mobilisation were 92.5 days and 7.63 days, respectively. Mean post-operative AOFAS ankle-hindfoot and Olerud-Molander scores were 53.0 and 50.9, respectively. There were four cases of superficial infection. Patients with high CCI were more likely to acquire superficial infections (p=0.264,OR=3.857). There were no deep infections, periprosthetic fractures, nail breakages, non-unions. Average follow-up time was 499.3 days.

Conclusions

Tibiotalocalcaneal nailing is an effective and safe option for managing fragility ankle fractures in the elderly. This technique leads to lower complication rates and earlier mobilisation than traditional fixation methods.
298 Liver Disease Is a Risk Factor for Acute Septic Arthritis: Results from a Major Trauma Centre
Authors: Lu V , Zhou A , Thahir A , Krkovic M
Published: November 2022

Introduction

A hot swollen joint is commonly encountered in orthopaedics and rheumatology. With a broad range of differentials, septic arthritis (SA) is perhaps the most concerning, with delayed treatment leading to osteonecrosis, loss-of-joint-function, and mortality. To facilitate clinical decision making, we aimed to determine the risk factors for development of SA.

Method

All patients presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2020 and January 2021 with a hot, swollen joint were retrospectively evaluated.

The frequency of variables of interest in the three-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariate analysis. A multiple logistic regression model was formed for covariates that were significantly associated with SA (p<0.05), which underwent a backwards elimination process to identify a predictive model for SA. Multi-collinearity was assessed between covariates and variables with significant intercorrelation were removed. Statistical significance was set at p<0.05.

Results

221 patients were included (SA: 28; periprosthetic joint infection: 24; pseudogout: 32; gout:26; other conditions: 111). Multivariate analysis showed that RA, skin infection, and liver disease were risk factors for SA, with odds ratios of 2.656 (95%CI:1.090–6.475;p=0.032), 3.162 (95:CI:1.269–7.883;p=0.013), 4.993 (95%CI:1.156–21.559;p=0.031), respectively.

Conclusions

With a high mortality and morbidity rate, early diagnosis of septic arthritis is crucial. This requires understanding what the risk factors are, namely RA, skin infection, and liver disease. We believe that the models in this study are of prognostic value to clinicians who are presented with the common presenting compliant of a hot swollen joint.
335 Motor Sparing Peripheral Nerve Block: A Modern Approach to Total Knee Arthroplasty
Authors: Trivedi R , John J , Ito Y
Published: November 2022

Aim

To maximise postoperative analgesia, whilst minimising opioid use, motor sparing peripheral nerve blocks have been described as an alternative to local infiltration analgesia (LIA) with adductor canal block (ACB) in total knee arthroplasty (TKA). At The Robert Jones and Agnes Hunt Orthopaedic Hospital, we have developed a new technique, involving ten separate injections to the four genicular nerves, saphenous nerve, nerve to the vastus medialis, the popliteal plexus and to the medial, intermediate, and lateral cutaneous nerves of the thigh. The aim was to compare the analgesic effect of this type of motor sparing nerve block against LIA with ACB in TKA.

Method

Two groups were identified retrospectively. The test group included fifty patients who received 5ml each of 0.75% Levobupivacaine to the saphenous nerve and nerve to the vastus medialis, and 40ml of 0.25% Levobupivacaine to the four genicular nerves, the popliteal plexus, and to the cutaneous nerves. A matched control group received standard treatment with ACB and LIA.

The primary outcome was the consumption of opioid analgesics, measured as a total morphine equivalent.

Results

For patients in the test group, the mean amount of IV morphine equivalent administered in the first 48-hours postoperatively was 34mg vs 108mg. This equates to a 68% reduction in opioid consumption compared to the control group.

Conclusions

Motor sparing nerve blocks provide a significant reduction in opioid consumption compared to LIA with ACB in TKA. The results have implications in terms of pain management, reduced opioid-induced side effects and overall, enhanced patient recovery.
428 Ulna Shortening Osteotomy Using a Dorsal DCP Plate Versus Volar Low-Profile Plate: Which Is Superior?
Authors: Manley L , Rabbani M , Gupta N , Macmillan A , McKee A , Norris R , Jones J
Published: November 2022

Aim

There is limited literature comparing differing techniques and equipment used in ulna shortening osteotomy. This study reviewed operative outcomes of ulna osteotomies across one NHS Trust. Our aims were to compare outcomes of two different operative techniques: dorsal-approach DCP plates versus volar-approach low profile plates and to evaluate the impact of plate size on union rates.

Method

We performed a retrospective review of all patients undergoing an ulna shortening osteotomy between 2016–2021 at North West Anglia Foundation Trust. We reviewed patient demographics, surgical technique, plate size, complications, union rates and need for reoperation. Outcomes between two operative techniques were compared using Fisher's exact test.

Results

32 patients were identified. 21 had a dorsally placed DCP plate using the Stanley jig, 11 had a volar low-profile plate using alternative systems. The majority of DCP plates were 6 or 7 holes. One 5-hole plate was used, resulting in the only case of non-union. Overall complication rate was 41%. 38% of patients with a dorsal plate had symptoms of plate irritation post-operatively. 5 needed removals, which was significantly greater than in the volar plate group (rate of 0%, p = 0.03). There were no cases of nerve damage and one case of CRPS in the volar low-profile plate group.

Conclusions

We found that a 5-hole DCP plate should be avoided and dorsally placed DCP plates led to more cases of plate irritation requiring removal. Overall, rates of union and improvements in function and pain scores were acceptable and comparable regardless of surgical technique used.
497 Biomechanics of Fragility Hip Fractures and Its Effect on Fixation Implant Choice
Authors: Leow TW , Massoumi A , Hammouche S
Published: November 2022

Aim

Fragility hip fracture is associated with significant morbidity and mortality. Bone fracture biomechanics are central to orthopaedic surgery as it is vital to optimise patient outcomes. This review aims to provide the relevant biomechanics of hip fracture for clinicians.

Method

The following terms were used in Embase and Medline: biomechanics, hip fracture, proximal femoral fracture, and fragility fracture. Bibliographies of review articles were scrutinised to identify any articles that were not captured. A narrative review is performed to summarise all the relevant articles identified.

Results

Vertical loading of the hip joint results in the upper cortex being stretched and lower cortex being compressed. Consequently, the neck breaks from the upper subcapital border to the lesser trochanter, which is rare in clinical practice. In contrast to vertical loading, sideways impact on the greater trochanter compresses the femoral neck. The resulting fracture are more often basicervical or trochanteric fracture.

Dynamic hip screw (DHS) remains the preferable implant for stable extracapsular fracture. On the other hand, intramedullary nail (IM) is a better choice for unstable extracapsular fracture due to its biomechanical and clinical superiority over DHS. Lag screw placement in the inferior-central position (inferior on anteroposterior and central on lateral radiograph) is thought to provide the greatest stability and outcomes.

Conclusions

Vertical loading often leads to subcapital hip fracture and horizontal impact results in trochanteric or basicervical hip fracture. The choice of implant used to treat hip fracture depends on the specific needs of the implant to counter the different forces that caused the fracture.
523 Effect of the COVID-19 UK Lockdown on Lower Limb Tendon Ruptures
Authors: Yasen Z , Islam Saad , Hasnain Adil , Ali Shahanoor , Raja Hassan , Tsitskaris Konstantinos
Published: November 2022

Aim

Achilles tendon ruptures are known to be prevalent in the ‘weekend warrior’, individuals who are intermittently active on a background of sedentary behaviour. There is minimal literature that looks at whether this impacts the incidence of rupture of other tendons. In the spring of 2020, a ‘lockdown’ was announced in the UK in response to the COVID-19 pandemic. In this study we aim to assess whether the incidence of lower limb tendon rupture had increased compared to other years, and whether the incidence changed as exercise allowance was increased.

Method

A retrospective study was performed at a London district general hospital assessing the incidence of Achilles, patellar and quadricep tendon rupture presenting during the lockdown period, and the corresponding periods in 2019 and 2021.

Results

In 2020 there was a significant increase in incidence of Achilles (2021: 16, 2020: 14, 2019: 8) and patellar (2021: 2, 2020: 7, 2019: 1) tendon ruptures, whereas quadricep (2021: 0, 2020: 2, 2019: 0) tendon ruptures did not differ significantly. There was an increase in the incidence of Achilles tendon rupture as exercise allowance was increased.

Conclusions

This study reinforces the necessity of stepwise return to play protocol for deconditioned athletes as well as the advantages of an active lifestyle for the general population. The results also indicate that patellar rupture may be influenced by the same lifestyle factors as Achilles rupture and should prompt larger studies across multiple sites to confirm this.
588 Incidence and Clinical Significance of Incidental Findings in Major Trauma Patients
Authors: Dixon S , Knight C , Smith S
Published: November 2022

Aim

This study aimed to characterise and demonstrate the clinical importance of incidental findings (IF) for patients presenting to a Major Trauma Centre (MTC).

Method

A prospective review of 941 consecutive patients who were imaged and subsequently admitted to hospital as Major Trauma. IF unrelated to the trauma were analysed from radiological imaging reports and documented management was reviewed.

Results

594 patients (63.1%) received a pan/trauma CT, 225 (23.9%) had isolated CT scans and 122 (13%) had X-Rays only. 365 (38.7%) patients had a total of 647 IF. Of these: 15 (2.3%) were suggestive of malignancy (e.g., colon mass, liver tumour). 41 (6.3%) represented acute pathology requiring urgent intervention (e.g., pulmonary embolism, consolidation). 148 (22.9%) represented likely benign pathology but required further investigation or routine follow-up (e.g., pulmonary nodules, pancreatic cysts). 443 (68.5%) represented benign or chronic pathology not requiring any specific follow-up (e.g., hiatus hernia, diverticular disease). The reporting radiologist advised further investigation or review in 61 (6.5%) cases. This was actioned and documented in 44 (72.1%) cases by the MTC clinician as part of the tertiary survey. 9 patients still lacked adequate documentation, 2 were transferred to a different hospital, 1 self-discharged and 5 were never reviewed by the major trauma team.

Conclusion

The common utilisation of pan/trauma CT scanning in Major Trauma identifies a high volume of IF. Over a quarter represented potentially clinically significant findings that require onward investigation. MTC should ensure they have appropriate systems to capture and document IF including actioning further investigation and follow up.