bluuebunny/crossref_metadata_2025 huggingface dataset:
IMPACTS OF CLIMATE CHANGE, FORMS, AND EXCESS OF NITROGEN FERTILIZERS ON THE DEVELOPMENT OF WHEAT FUNGAL DISEASES
Authors: Diakite Simbo , Pakina Elena N. , Behzad Abdullah , Zargar Meisam , Saquee Francess Sia , Kalabashkina Elena V. , Tsymbalova Vitaliya A. , Astarkhanova Tamara S.
Published: August 2023

Background. Global climate change and excessive nitrogen application has become a significant issue and inevitably threatens sustainable wheat production, not only with direct negative effects on crop growth but also with profound impacts on biology and pest and disease management.

Purpose. This review addresses the current challenges, namely the negative effects of climate change and the forms and excess of nitrogen-rich fertilizers on the development of fungal diseases in wheat, as well as management strategies.

Materials and methods. To achieve the stated objective of the study, the scientific literature published during the last 20 years on the impacts of climate change and the forms and excesses of nitrogen fertilizers on the development of fungal diseases and on the yield of wheat were reviewed.

Results. Thus, in mitigating these challenges, it is necessary to optimize the dose of nitrogen fertilizers, apply nitrogen in the form of nitrate, ammonium sulphate, ammonium nitrate, and coated urea fertilizers, to use silicate fertilizers such as calcium, magnesium, and potassium silicate, and to perform a long rotation of wheat through perennial legumes and leguminous crops, as well as to develop, through genome editing, varieties with high yield potential, resistant to biotic and abiotic stresses, and of good end-use quality, or plant new cereals that have needs for heat and a longer reproductive growth period.

Conclusion. To develop an effective agricultural management strategy, future research should be based on the study of the interactions among crops, pests, pathogens and farming system under climate change, taking into account all parameters such as temperature increase and CO2, extreme precipitation, etc. A sufficient number of results must be published to be able to draw meaningful conclusions.
CHOLINE PREPARATIONS IN THE TREATMENT OF ASTHENIC STATES: MODERNITY AND PERSPECTIVES (A LITERATURE REVIEW WITH A CLINICAL CASE PRESENTATION)
Authors: Magomedova Kamila Sh. , Bykov Yuriy V. , Bekker Roman A.
Published: August 2023

Purpose. To provide the reader with a detailed description of the biochemical and physiological effects of choline, which make it an indispensable component of our daily food. Then to thoroughly review all the relevant clinical data on the use of choline preparations for the treatment of asthenic and astheno-depressive conditions and cognitive impairments. Then, to present the reader with a clinical case from our own practice, illustrating the effectiveness of the use of choline alfoscerate as part of the combination therapy of a mild form of post-COVID astheno-depressive syndrome in a 19-year-old man who have refused to take antidepressants, as well as any other psychotropic drugs, but instead wanted some form of pharmacotherapy based exclusively on «natural components».

Methodology. We have searched PubMed, Google Scholar, Web of Science databases for keywords such as «choline biochemistry», «choline and phospholipids», «choline and betaine», «arsenolipids», «nitrolipids», «choline and cognition», «choline and asthenia». Then we filtered the data we had found by their relevance. Then we summarized and presented the relevant data in the theoretical part of this article. Then we described in detail the clinical case of the effective use of choline alfoscerate in the complex therapy of post-COVID asthenic-depressive state which we have encountered in our own practice.

Results. The results we have obtained during compilation of this review, in our opinion, may allow us to draw preliminary conclusions about the possible prospects for the use of choline preparations (and, in particular, choline alfoscerate preparations) in monotherapy or as part of combination therapy of asthenic and / or astheno-depressive states (especially if those states are accompanied by impaired memory, concentration, increased mental fatigue), including those states that were caused by a recent history of COVID-19 (that is, asthenic or astheno-depressive states developed as part of the post-covid syndrome).

To be able to make any further, more firm conclusions regarding the efficacy and safety of the use of choline-containing preparations in this context, it will be necessary to organize and conduct large, multicenter, methodologically sound, double-blind, placebo-controlled, randomized clinical trials (RCTs), with clinically meaningful and relevant outcomes in the treatment of asthenia clearly defined as trial endpoints in advance (before starting the trial itself).

Practical implications. We believe that the results we have presented in this review justify the need to further study the efficacy and safety of the use of choline preparations, both as monotherapy and as a part of combination therapy of asthenic and astheno-depressive conditions, preferably in the format of large, multicenter, well organized, methodologically sound, double-blind, placebo-controlled RCTs with clearly pre-defined clinically meaningful and relevant endpoints.
ENSURING FOOD SECURITY THROUGH TRADE AND ECONOMIC COOPERATION BETWEEN SIBERIA AND THE EURASIAN ECONOMIC UNION
Authors: Bykov Alexander A. , Borisov Dmitrii V. , Ryumkin Sergey V.
Published: August 2023

The paper focuses on a critical issue of ensuring food security for countries that are members of the Eurasian Economic Union (EAEU), which is especially important given the transformation of the global food market in the context of the COVID-19 pandemic. The research aims (1) to assess the possibility of creating a single food market of the EAEU and (2) to identify the difficulties faced by the Siberian agricultural sector in addressing food security issues and export development. The paper presents the results of the study concerning the development of trade and economic cooperation between the Siberian Federal District (SFD) of the Russian Federation and the EAEU countries with regard to the agricultural market. Based on the statistical analysis of national data, we examined the particular aspects of Siberian agricultural export development. We were able to identify the largest trading partners among the EAEU member states and study the particular aspects of their food imports based on the Russian database indicators. According to the analysis results, we concluded that exports are dominated by food products, namely intermediate and final products, which correspond to the objectives of the Russian Federation National Project International Cooperation and Exports. Market research on the breakdown of imports to the EAEU showed that it imported dairy products, fruits, vegetables, and processed foods. We identified the most promising areas of export development for the SFD based on a review of the scientific studies on economic integration and food security issues. The scientific novelty of this research lies in proving the need to develop exports of finished food products with a high level of processing, which requires the integrated development of the food processing industry in the SFD by means of regional strategic programs for introducing innovative biotechnologies in deep processing of agricultural raw materials. The research findings might be of great interest to members of the academic community and undergraduate and graduate students pursuing similar research agendas.
Rising Temperatures, Falling Ratings: The Effect of Climate Change on Sovereign Creditworthiness
Authors: Klusak Patrycja , Agarwala Matthew , Burke Matt , Kraemer Moritz , Mohaddes Kamiar
Published: August 2023

Enthusiasm for “greening the financial system” is welcome, but a fundamental challenge remains: financial decision makers lack the necessary information. It is not enough to know that climate change is bad. Markets need credible, digestible information on how climate change translates into material risks. To bridge the gap between climate science and real-world financial indicators, we simulate the effect of climate change on sovereign credit ratings for 109 countries, creating the world’s first climate-adjusted sovereign credit rating. Under various warming scenarios, we find evidence of climate-induced sovereign downgrades as early as 2030, increasing in intensity and across more countries over the century. We find strong evidence that stringent climate policy consistent with limiting warming to below 2 °C, honoring the Paris Climate Agreement and following representative concentration pathway (RCP) 2.6, could nearly eliminate the effect of climate change on ratings. In contrast, under higher emissions scenarios (i.e., RCP 8.5), 59 sovereigns experience climate-induced downgrades by 2030, with an average reduction of 0.68 notches, rising to 81 sovereigns facing an average downgrade of 2.18 notches by 2100. We calculate the effect of climate-induced sovereign downgrades on the cost of corporate and sovereign debt. Across the sample, climate change could increase the annual interest payments on sovereign debt by US$45–$67 billion under RCP 2.6, rising to US$135–$203 billion under RCP 8.5. The additional cost to corporations is US$10–$17 billion under RCP 2.6 and US$35–$61 billion under RCP 8.5.

This paper was accepted by Colin Mayer, Special Section of Management Science on Business and Climate Change.

Funding: M. Agarwala, P. Klusak, and M. Burke acknowledge funding from the International Network for Sustainable Financial Policy Insights, Research and Exchange (INSPIRE). M. Agarwala also acknowledges funding from The Wealth Economy Project.

Supplemental Material: The data files and online appendix are available at https://doi.org/10.1287/mnsc.2023.4869 .
NO CLINICAL ADVANTAGE WITH CUSTOMIZED INDIVIDUALLY MADE IMPLANTS OVER CONVENTIONAL OFF-THE-SHELF IMPLANTS IN TOTAL KNEE ARTHROPLASTY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Khaleeq Tahir , Saeed Abu Zer , Ahmed Usman , Ajula Randeep , Boutefnouchet Tarek , D'Alessandro Peter , Malik Shahbaz
Published: August 2023

Customised individually made implants(CIM) total knee arthroplasty(TKA) are custom-made to better fit patients native anatomy and aim to improve outcomes which can be variable with conventional off-the-shelf(OTS).

A systematic review and meta-analysis was conducted searching the MEDLINE and Embase databases. Studies reporting on patient reported outcome measures, clinical or radiological outcomes were included.

23 studies satisfied the search criteria (case-control studies14, case series8, cross-sectional studies1). There were 2,856(CIM) and 1,877(OTS) implants. The overall revision-rate was higher in CIM 5.9%vs3.7%OTS [OR 1.46(95% CI 0.82–2.62)]. MUA was higher in the CIM group 2.2%vs.1.1%OTS [OR 2.95(95% CI 0.95–9.13)] and overall complications rate was also higher in the CIM group 5% vs. 4.5%OTS [OR 1.45(95% CI 0.53–3.96)]. LOS was significantly shorter in the CIM group 2.9 days vs. 3.5 days [MD −0.51(95% CI −0.82–0.20)]. Pooled analysis for KSS showed no difference between CIM and OTS groups(Knee=90.5 vs. 90.6 [MD-0.27,(95% CI −4.27–3.73)] and Function=86.1 vs. 90.6[MD 1.51 (95% CI −3.69–6.70)] component of the scores. There was no significant difference in post-operative ROM between CIM and OTS groups 117.3° vs. 115.0° [MD 0.02,(95% CI −1.70–1.74)].

CIM TKAs has theoretical benefits over OTS TKAs however in this review they were associated with higher complication, MUA and revision rates with no difference in outcome scores and no improvement in target alignment. The findings of this review does not support the use of CIM over OTS prosthesis in total knee arthroplasty.
EVALUATING BASIC KNEE ARTHROSCOPY SKILLS IN ORTHOPAEDIC TRAINEES IN A LIMITED RESOURCE SETTING
Authors: Berry Kirsty , Von Bormann Richard , Roche Stephen , Laubscher Maritz , McCollum Graham , Held Michael
Published: August 2023

Background

Orthopaedic training in Southern Africa is largely focused on trauma, although elective procedures, such as knee arthroscopy are increasing. This is especially true in the private sector where most trainees will practice. The primary aim of this study was to assess the arthroscopic competency of orthopaedic trainees in a setting of limited resources.

Methods

A prospective observational cohort study was carried out. Orthopaedic trainees of a Southern African university hospital performed basic arthroscopy on a knee model. Their surgical competency was assessed by two surgeons proficient in arthroscopy using the modified Basic Knee Arthroscopy Skill Scoring System (mBAKSSS).

Results

A total of 16 trainees (12 male) were included (6 junior and 10 senior trainees). The median age of participants was 36 (34.8, 37). The median mBAKSSS was 28.0 (20.3, 32.5) but showed a large variability (12.0–42.5). The overall reliability was excellent with Cronbach's Alpha of 0.91 and interclass correlation of 0.91 [95% CI 0.75, 0.97].

Conclusions

The average knee arthroscopy proficiency of our trainees is comparable to those of international training programs, but there was great variability with inconsistent skills amongst the trainees. This calls for improved and reproducible arthroscopy training and skills transfer, exposure to procedures and ongoing assessment.
CEMENTING TECHNIQUES IN KNEE SURGERY (CETIKS): A UK EXPERT CONSENSUS STUDY
Authors: Hampton Matthew , Balachandar Vivek , Charalambous Charalambos , Sutton Paul
Published: August 2023

Introduction

Aseptic loosening is the most common cause of failure following cemented total knee arthroplasty (TKA) and this has been linked to poor cementation technique. We aimed to develop a consensus on the optimal technique for component cementation in TKA.

Methodology

A UK based, three round, online modified Delphi Expert Consensus Study was completed focussing on cementation technique in TKA. Experts were identified as having a minimum of 5 years Consultant experience in the NHS and fulfilling any one of the following three criteria:

· A ‘high volume’ knee arthroplasty practice (>150 TKA per annum) as identified from the National joint registry (NJR).

· A senior author of at least 5 peer reviewed articles related to TKA in the previous 5 years

· A named trainer for a post CCT fellowship in TKA.

Results

Eighty-one experts (Round 1) and eighty experts (Round 2 and 3) completed the Delphi Study. Four domains with a total of twenty-four statements were identified. 100% consensus was reached within the cement preparation, pressurisation, and cement curing domains. 90% consensus was reached within the cement application domain. Consensus was not reached with only one statement regarding the handling of cement during initial application to the tibial and/or femoral bone surfaces

Conclusion

The CeTIKS expert consensus study presents comprehensive recommendations on the optimal technique for component cementation in TKA. Expert opinion has a place in the hierarchy of evidence and until better evidence is available these recommendations should be considered when cementing a TKA.
ANTERIOR CRUCIATE LIGAMENT INJURY PREVENTION PROGRAMMES IN WELSH NETBALL: SURVEY OF KNOWLEDGE, IMPLEMENTATION, AND BARRIERS AMONG PLAYERS AND COACHES
Authors: Abdul Wahid , Moore Isabel , Robertson Angus
Published: August 2023

Introduction

Perception of ACL injury prevention programs amongst professional netball players and coaches has not been studied. We investigated (1) level of awareness and experience of ACL injury prevention programs; (2) use of ACL injury prevention programs; and (3) barriers to implementing ACL injury prevention program in netball.

Methodology

Female netball players representing Welsh senior and under-21 teams and elite and amateur coaches were invited electronically to this web-based study between 1st May–31st July 2021. Information on ACL injury susceptibility and seriousness, knowledge, experience, and implementation of ACL injury prevention programs were ascertained.

Results

Twenty-eight players (77.8%) and 29 coaches (13.2%) completed the questionnaire. Seventeen (60.7%) players and 15 (51.7%) coaches reported female athletes were at greater risk for sustaining ACL injuries. Over 90% of respondents identified netball as high-risk, whilst 89% of players and 76% of coaches reported these injuries to be preventable. Two (7.1%) players and 6 (20.7%) coaches utilised ACL injury prevention programs with lack of time and engagement from coaches and players identified. Majority of respondents indicated that their club has neither promoted, advocated nor demonstrated exercises for ACL injury prevention. Over 90% of respondents would utilise such programs if it minimised players risk with appropriate training and information.

Conclusion

Study highlights limited knowledge of female athletes’ increased susceptibility of ACL injuries with lack of communication and education of ACL injury prevention programs between sporting associations, coaches and players. Results demonstrate willingness of players and coaches to implement ACL injury prevention programs in Welsh netball.
TRAINING AND VALIDITY OF THE MICROSOFT HOLOLENS, AN AUGMENTED REALITY DEVICE, FOR TOTAL KNEE ARTHROPLASTY: A DOUBLE-BLINDED RANDOMIZED CONTROLLED TRIAL
Authors: Kaka Anaiya , Shah Aishwarya , Yunus Azedah , Patel Arpit , Patel Akash
Published: August 2023

Introduction

Challenges in surgical training have led to the exploration of technologies such as augmented reality (AR), which present novel approaches to teaching orthopaedic procedures to medical students. The aim of this double-blinded randomised-controlled trial was to compare the validity and training effect of AR to traditional teaching on medical students’ understanding of total knee arthroplasty (TKA).

Methodology

Twenty medical students from 7 UK universities were randomised equally to either intervention or control groups. The control received a consultant-led teaching session and the intervention received training via Microsoft HoloLens, where surgeons were able to project virtual information over physical objects. Participants completed written knowledge and practical exams which were assessed by 2 orthopaedic consultants. Training superiority was established via 4 quantitative outcome measures: OSATS scores, a checklist of TKA-specific steps, procedural time, and written exam scores. Qualitative feedback was evaluated using a 5-point Likert scale.

Results

AR training was superior in teaching basic technical proficiency and understanding of TKA, with the intervention group significantly outperforming the control group in 3 metrics [OSATS (38.6%, p=0.021), checklist (33%, p=0.011) and written exam (54.5%, p=0.001)]. Procedural time was equivalent between cohorts (p=0.082). AR was rated as significantly more enjoyable (p=0.044), realistic (p=0.003), easy to understand (p=0.040), and proficient in teaching (p=0.02).

Conclusion

In this adequately powered, double-blinded randomised-controlled trial, AR training demonstrated substantially improved translational technical skills and knowledge needed to understand TKA over traditional learning in medical students. Additionally, the results showed face, content, and transfer validity for AR in surgical training.
DOUBLE LEVEL KNEE OSTEOTOMY IN BIFOCAL (FEMUR AND TIBIA) VALGUS MALALIGNED KNEES: WHAT ARE THE OUTCOMES AND LIMB LENGTH DISCREPANCY?
Authors: Mabrouk Ahmed , Ollivier Matthieu , Pioer Charles
Published: August 2023

Introduction

Double-level knee osteotomy (DLO) is a challenging procedure that requires precision in preoperative planning and intraoperative execution to achieve the desired correction. It is indicated in cases of severe varus or valgus deformities where a single-level osteotomy would yield significantly tilted joint line obliquity (JLO).

Methods

A single-centre, retrospective analysis of prospectively collected data for 26 patients, who underwent DLO by PSCGs for valgus malaligned knees. Post-operative alignment was evaluated and the delta for different lower limb alignment parameters were calculated; HKA, MPTA, and LDFA. At the two-year follow-up, changes in KOOS sub-scores, UCLA scores, lower limb discrepancy, and mean time to return to work and sport were recorded. All intraoperative and postoperative complications were recorded.

Results

The postoperative mean ΔHKA was 0.9 ± 0.9°, the mean ΔMPTA was 0.7 ± 0.7°, and the mean ΔLDFA was 0.7 ± 0.8° (all values with p > 0.05). All KOOS subscores’ mean values were improved to an extent two-fold superior to the reported MCID (all with p < 0.0001). There was a significant increase in the UCLA score at the final follow-up (5.4 ± 1.5 preoperatively versus 7.7 ± 1.4, p < 0.01). The mean time to return to sport and work was 4.7 ± 1.1 and 4.3 ± 2.1 months, respectively. There was an improvement in Lower-limb discrepancy preoperative (LLD = 1.3+/−2cm) to postoperative measures (LLD= 0.3 +/− 0.4 cm) p=0.02.

Conclusion

DLO is effective and safe in achieving accurate correction in bifocal valgus malaligned knees with maintained lower limb length and low complication rate with no compromise of JLO.
OUTCOME OF REVISION PATELLOFEMORAL JOINT REPLACEMENT TO TOTAL KNEE ARTHROPLASTY WHEN COMPARED WITH A MATCHED GROUP OF TOTAL KNEE ARTHROPLASTY OF SAME TOTAL ARTHROPLASTY LIFESPAN
Authors: Jonas Sam , Kumar Abhijeet , White Simon , Agarwal Sanjeev
Published: August 2023

INTRODUCTION

10% of patients with knee osteoarthritis (OA) have disease confined to the patellofemoral joint (PFJ). The main surgical options are total knee replacement (TKR) and PFJ replacement (PFJR). PFJR has advantages over TKR, including being less invasive, bone preserving, allowing faster recovery and better function and more ‘straight forward’ revision surgery. We aim to compare the clinical results of revised PFJR with primary TKR taking into consideration the survival length of the PFJR.

METHODOLOGY

Twenty-five patients (21 female) were retrospectively identified from our arthroplasty database who had undergone revision from PFJR to TKR (2006–2019). These patients were then matched with regards to their age at their primary procedure, sex and total arthroplasty life (primary PFJ survival + Revision PFJ time to follow up) up to point of follow-up with a group of primary TKRs implanted at the same point as the primary PFJR.

RESULTS

Mean survival of the PFJs revised were 4.2 years. In the PFJR revision group (mean arthroplasty life 7.8 years) mean Oxford knee score (OKS) at latest follow up was 27.8. In the primary knee group (mean arthroplasty life 7.5 years) mean OKS was 32.4. This difference was not statistically significant. All PFJR revisions were performed using primary prostheses.

CONCLUSION

PFJR provides comparable clinical outcome even after revision surgery to TKR as primary TKRs at midterm follow up and should be considered in all patients meeting the selection criteria. Given comparable proms and straight forward revisions, staged arthroplasty to preserve bone-stock is a reasonable choice.
SYSTEMATIC REVIEW AND META-ANALYSIS OF TREATMENT OUTCOMES FOR SECONDARY OSTEONECROSIS OF THE KNEE IN YOUNG ADULTS
Authors: Joseph Vinay , Boktor Joseph , Bajada Stefan , Coupe Ben
Published: August 2023

Introduction

Secondary osteonecrosis of the knee affects young population and causes bilateral extensive lesions. Arthroplasty is the last resort in younger population and joint preserving options questionable in pathological bone. Conservative measures have shown failure in multiple studies and hence no gold standard treatment advocated. We aimed at identifying and analysing various treatment options for secondary osteonecrosis with respect to the outcomes and studying features of symptomatic secondary osteonecrosis with regards to demographic pattern, radiological features and causative factors.

Methods

A systematic review of literature was performed in accordance with the Cochrane handbook for systematic reviews and reported according to the PRISMA guidelines.

Results

Six studies which included a total of 192 patients with data on 240 knee joints were included in the final review. Follow up period ranged from 1 year to 16 years. The mean age of the patients was 34.7. 3 studies were on arthroplasty and 3 on joint preserving interventions. Majority of patients were in Stage 2 or Stage 4 of osteonecrosis. Steroid induced osteonecrosis was the majority followed by SLE and sickle cell disease. The pooled analysis showed an improvement of pre-operative knee score from 50.47 to 89.21 post-operatively. The pooled effect size for failure rate was 8.7% in joint preserving interventions and 9.2% in joint replacement group.

Conclusion

Joint preserving techniques with bone marrow aspirate infiltration showed promising functional outcome and to a certain extent reversal of the pathological process. For advanced stages with subchondral collapse cemented arthroplasty showed satisfactory functional outcomes.
IS THE HIGH RATE OF TIBIAL TRAY DEBONDING IN POSTERIOR-STABILIZED NEXGEN TOTAL KNEE ARTHROPLASTY ASSOCIATED WITH BACKSIDE DEFORMATION OF POLYETHYLENE INSERTS?
Authors: Langton David , Bhalekar Rohan , Wells Stephen , Nargol Matthew , Waller Susan , Wildberg Linda , Tilley Simon , Nargol Antoni
Published: August 2023

Introduction

At our national explant retrieval unit, we identified an unusual pattern of backside-deformation on polyethylene (PE) inserts of contemporary total-knee-replacements (TKRs). The PE backside's margins were inferiorly deformed in TKRs with central-locking trays. We reported that this backside-deformation appeared to be linked to tray debonding. Moreover, recent studies have shown high-rate of tray debonding in PS NexGen TKRs. Therefore, we hypothesised that backside deformation on PS inserts may be more than on CR inserts.

Methodology

We used peer-reviewed techniques to analyse changes in the bearing (wear rate) and backside surfaces (deformation) of PE inserts using coordinate measuring machines [N=61 NexGen (CR-39 and PS-22) TKRs with non-augmented-trays]. Multiple regression was used to determine which variable had the greatest influence on backside-deformation. The amount of cement cover on trays was quantified as a %of the total surface using Image-J software.

Results

There was no statistically significant difference (p=0.238) in median (IQR) wear rate of the CR PEs 18 (12–28) mm3/year and PS PEs 14 (8–20) mm3/year. The PE backside-deformation median (IQR) of PS [297(242–333) µm] was significantly higher (p=0.011), when compared with CR [241(161–259) µm]. Multiple regression modelling showed that duration in-vivo (p=0.037), central-clearance between insert and tray (p<0.001) and constraint (p=0.003) were significantly associated with PE backside-deformation. 27(69%) of CR and 20(91%) PS exhibited ≤10% of cement cover on tray.

Conclusion

This explant study showed backside-deformation on PS inserts was more than on CR inserts. Therefore, indicating a high-rate of tibial tray debonding in PS compared to CR NexGen TKRs.
LOW READMISSION AND REATTENDANCE RATE FOR 301 CONSECUTIVE DAY-CASE TOTAL KNEE ARTHROPLASTIES DELIVERED IN A NATIONAL HEALTH SERVICE TRUST IN THE UNITED KINGDOM
Authors: Fishley William , Paice Sarah , Iqbal Haaris , Mowat Stephen , Kalson Nicholas , Reed Mike , Partington Paul , Petheram Timothy
Published: August 2023

Introduction

The rate of day-case total knee replacement (TKR) in the UK is currently ~0.5%. Reducing length of stay improves efficiency, increases operative throughput and tackles the rising demand for joint replacement surgery and the COVID-19 related backlog. We report safe delivery of day-case TKR in an NHS Trust via inpatient wards, with no additional resources.

Methodology

Day-case TKRs, defined as patients discharged on the same calendar day as surgery, were retrospectively reviewed with a minimum follow-up of six-months. Analysis of hospital and primary care records was performed to determine readmission and reattendance rates. Telephone interviews were conducted to determine patient satisfaction.

Results

Between 2016 and 2021, 301/7350 (4.1%) TKRs were discharged on the day of surgery. Mean follow-up was 31.4 (6.2–70.0) months. 28 (9.3%) patients attended Accident and Emergency or other acute care settings within 90-days of surgery; six (2.0%) patients were readmitted. No patients underwent a subsequent revision procedure. There were no prosthetic infections. Two patients underwent secondary patella resurfacing, and one patient underwent arthroscopic arthrolysis after previous manipulation under anaesthetic (MUA). Three patients underwent MUA alone. Primary care consultation records, available for 206 patients, showed 16 (7.8%) patients contacted their General Practitioner within two-weeks post-operatively; two (1.0%) were referred to secondary care. 115/121 (95%) patients telephoned stated they would have day-case TKR again.

Conclusion

Day-case TKR can be safely delivered in the NHS with no additional resources. We found low incidence of contact with primary and secondary care in the post-operative period, and high patient satisfaction.
RETURN TO WORK FOLLOWING REVISION KNEE ARTHROPLASTY IN PATIENTS UNDER 65 YEARS OF AGE
Authors: Reason Lucy , Roberton Andrew , Jonas Sam , Phillips Jonathan
Published: August 2023

Introduction

Little is known about employment following revision total knee arthroplasty (RTKA). This study aims to describe factors associated with returning to employment in patients of working age who underwent RTKA surgery.

Methodology

We performed a retrospective assessment of all patients aged ≤65 who underwent RTKA at our NHS institution between 2006 and 2020. All indications and revision procedures were included. Pre-operative demographics, indication for surgery and Oxford Knee Scores (OKS) were recorded. Postal questionnaires were sent to patients including patient reported outcome measures and departmental questionnaire asking patients about employment status pre- and post-operatively.

Results

132 procedures were performed in 113 patients. Median follow up was 5.5 years (2.4–9.0). Mean age was 58 (5.8) and 50% (57) were male. 62 patients undergoing 74 procedures responded to postal questionnaires and were included in the study. 53% (33) were employed prior to surgery and 61% (38) returned to work at a median of 12 weeks (3–150). Of the 24 who did not return to work, 7 reported intending to return to work. Those patients who returned to work had increased pre-operative OKS (16.9 vs 13.6) and mean improvement (16.5 vs 12.4).

Conclusion

This study is limited by small numbers and its observational nature. In this population the majority of patients who wished to return to work after RTKA were able to do so. This provides some reassurance when counselling patients. Prospective studies to better understand the factors that predict return to work will be important with increasing demands from surgery.
USING THE CAPABILITY, OPPORTUNITY, AND MOTIVATION MODEL OF BEHAVIOUR (COM-B) TO IMPLEMENT A PATHWAY TO REDUCE 30-DAY ELECTIVE EMERGENCY ADMISSIONS
Authors: Wehbe Jad , Womersley Andrew , Jones Samantha , Afzal Irrum , Kader Deiary , Sochart David , Asopa Vipin
Published: August 2023

Introduction

30-day emergency readmission is an indicator of treatment related complication once discharged, resulting in readmission. A board-approved quality improvement pathway was introduced to reduce elective re-admissions.

Method

The pathway involved telephone and email contact details provision to patients for any non-life threatening medical assistance, allowing for initial nurse led management of all issues. A new clinic room available 7 days, and same day ultrasound scanning for DVT studies were introduced. A capability, opportunity and behavior model of change was implemented.

Readmission rates before and six months after implementation were collected from Model Hospital. A database used to document patient communications was interrogated for patient outcomes.

Results

Prior to implementation, readmission rates following elective primary total knee replacement (TKR) at the 1st business quarter of 2021 (April – June 2021), was 8.7%, (benchmark 3.8%). Following implementation, readmission rates decreased to 4.1% (October – December 2021). 54% of patients making contact were managed with telephone advice. 15% of patients required face-to-face clinic. 32% of those required a same day scan to exclude DVT (1/4).

20 out of 684 TKRs performed following protocol introduction were re-admitted within 30 days. Readmissions were 41% surgical, 29% medical. 52% were unaware of the newly implemented protocol. Further improvements have been made to the protocol based on these findings.

Implementation of a suitable pathway can significantly reduce re-admission rates in our center and could be used to reduce readmission rates in other national elective treatment centers.
ROSA ROBOTIC ARM SYSTEM RELIABLY RESTORES JOINT LINE HEIGHT, PATELLA HEIGHT, AND POSTERIOR CONDYLAR OFFSET IN TOTAL KNEE ARTHROPLASTY
Authors: Mayne Alistair , Rajgor Harshadkumar , Munasinghe Chathura , Agrawal Yuvraj , Pagkalos Iosif , Davis Edward , Sharma Akash
Published: August 2023

Introduction

There is growing interest in the use of robotic Total Knee Arthroplasty (TKA) to improve accuracy of component positioning. This is the first study to investigate the radiological accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Tibial Slope, Patella Height and Posterior Condylar Offset. As secondary aims we compared accuracy between image-based and imageless navigation, and between implant designs (Persona versus Vanguard TKA).

Methodology

This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Tibial Slope, Patella Height (using the Insall-Salvati ratio) and Posterior Condylar Offset.

Results

Mean age of patients undergoing ROSA TKA was 70 years (range, 55 to 95 years). Mean difference in joint line height between pre and post-operative radiographs was 0.2mm (range −1.5 to +1.8mm, p<0.05), posterior condylar offset mean change 0.16mm (range −1.4 to +1.3mm, p<0.05), tibial slope mean change 0.1 degrees (p<0.05) and patella height mean change 0.02 (range −0.1 to +0.1 p<0.05). No significant differences were found between imageless and image-based groups, or between implant designs (Persona versus Vanguard).

Conclusion

This study validates the use of the ROSA® knee system in accurately restoring Joint Line Height, Patella Height and Posterior Condylar Offset.
POSTOPERATIVE OUTCOMES AND FEASIBILITY ANALYSIS OF PERFORMING UNICOMPARTMENTAL KNEE ARTHROPLASTY AS A DAY-CASE PROCEDURE
Authors: Saghir Reyan , Aldridge William , Metcalf David , Jehan Shah , Ng Aaron
Published: August 2023

Introduction

Uni-compartmental knee replacement (UKR) has become popularised due to quicker recovery times, reduced postoperative pain, and blood loss. The desire to increase bed capacity and reduce costs, while preserving safety and patient satisfaction, has led to increased interest in day-case arthroplasty. This study observes the feasibility of UKR as a day-case procedure and whether this affects short and long-term postoperative outcomes.

Methodology

Between 2018 and 2021, at a single institution and operated by a single orthopaedic surgeon, seventy-seven patients received a UKR on an elective basis. The patients were divided into two groups: ‘day-case’ for those discharged on the same day, and ‘non day-case’ group.

Results

31 patients were identified as day case procedures with the remaining 46 requiring between one to three days before discharge. Mean age, sex, modal ASA score, BMI, Charlson co-morbidity index, and pre-op oxford knee score showed no statistically significant difference between the two groups (p>0.05). No significant difference between the post-op oxford knee score at 1 year was found for patients treated and discharged as a day case procedure (37.8 +/− 6.88) and those who remained as an inpatient postoperatively (37.8 +/− 10.7); t(df) = −0.0007, p=0.994. No patients in either group suffered any complications beyond the peri-operative period. 30-day and 90-day readmission rates were equal.

Conclusions

With no significant differences in post-op knee scores, complication, and readmission rates, we feel UKR can be performed as a viable day case procedure in a planned elective setting. This will result in significant cost savings.
TOTAL KNEE ARTHROPLASTY IN PATIENTS WITH SKELETAL DYSPLASIA
Authors: Mudiganty Srikanth , Jayadev Chethan , Carrington Richard , Miles Jonathan , Donaldson James , Mcculloch Robert
Published: August 2023

Introduction

Total knee replacement (TKR) in patients with skeletal dysplasia is technically challenging surgery due to deformity, joint contracture, and associated co-morbidities. The aim of this study is to follow up patients with skeletal dysplasia following a TKR.

Methodology

We retrospectively reviewed 22 patients with skeletal dysplasia who underwent 31 TKRs at our institution between 2006 and 2022. Clinical notes, operative records and radiographic data were reviewed.

Results

Achondroplasia was the most common skeletal dysplasia (8), followed by Chondrodysplasia punctata (7) and Spondyloepiphyseal dysplasia (5). There were fourteen men and eight women with mean age of 51 years (28 to 73). The average height of patients was 1.4 metres (1.16–1.75) and the mean weight was 64.8 Kg (34.3–100). The mean follow up duration was 68.32 months (1–161). Three patients died during follow up. Custom implants were required in twelve patients (38.71%). Custom jigs were utilised in six patients and two patients underwent robotic assisted surgery. Hinged TKR was used in seventeen patients (54.84%), posterior stabilised TKR in nine patients (29.03%), and cruciate retaining TKR in five patients (16.13%). One patient underwent a patella resurfacing for persistent anterior knee pain and another had an intra-operative medial tibial plateau fracture which was managed with fixation. No revisions occurred during the follow up period.

Conclusion

Despite the technical challenges and complexity of TKR within this unique patient group, we demonstrate good implant survivorship during the study period. Cross sectional imaging is recommended preoperatively for precise planning and templating.
DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION IS SUCCESSFUL IN THE MANAGEMENT OF ACUTELY INFECTED UNICOMPARTMENTAL KNEE ARTHROPLASTY: A CASE SERIES
Authors: Al-Jabri Talal , Brivio Angela , Martin Jurgen , Barrett David , Maffulli Nicola
Published: August 2023

Background

Infections are rare and poorly studied complications of unicompartmental knee athroplasty (UKA) surgery. They are significantly less common compared to infections after total knee arthroplasties (TKAs). Optimal management of periprosthetic joint infections (PJIs) after a UKA is not clearly defined in the literature. We present the results of a multicentre retrospective series of UKA PJIs treated with Debridement, Antibiotics and Implant Retention (DAIR).

Methodology

Patients presenting between January 2016 and December 2019 with early UKA infection were identified at three specialist centres using the Musculoskeletal Infection Society (MSIS) criteria. All patients underwent a standardized treatment protocol consisting of the DAIR procedure and antibiotic therapy comprising two weeks of intravenous (IV) antibiotics followed by six weeks of oral therapy. The main outcome measure was overall survivorship free from reoperation for infection.

Results

A total of 3225 UKAs (2793 (86.2%) medial and 432 (13.8%) lateral UKAs) were performed between January 2016 and December 2019. Nineteen patients had early infections necessitating DAIR. The mean follow-up period was 32.5 months. DAIR showed an overall survivorship free from septic reoperation of 84.2%, with an overall survivorship free from all-cause reoperation of 78.95%. The most common bacteria were Coagulase-negative Staphylococci, Staphylococcus aureus and Group B Streptococci. Three patients required a second DAIR procedure but remained free from re-infection at follow-up obviating the need for more demanding, staged revision surgery.

Conclusions

In infected UKAs, the DAIR procedure produces a high rate of success, with a high survivorship of the implant.
X-RAY IDENTIFIED LIPO-HAEMARTHROSIS IN THE ACUTELY INJURED KNEE IS A POOR PREDICTOR OF THE PRESENCE OF INTRA-ARTICULAR FRACTURE OR THE NEED FOR URGENT SURGERY
Authors: Lewis Andrew , Bucknall Kristen , Davies Andrew , Evans Abbie , Jones Lisa , Triscott James , Hutchison Anne-Marie
Published: August 2023

Introduction

A lipohaemarthrosis seen on Horizontal beam lateral X-ray in acute knee injury is often considered predictive of an intra-articular fracture requiring further urgent imaging.

Methodology

We retrospectively searched a five-year X-ray database for the term “lipohaemarthrosis”. We excluded cases if the report concluded “no lipohaemarthrosis” or “lipohaemarthrosis” AND “fracture”. All remaining cases were reviewed by an Orthopaedic Consultant with a special interest in knee injuries (AD) blinded to the report. X-rays were excluded if a fracture was seen, established osteoarthritic change was present, a pre-existing arthroplasty present or no lipohaemarthrosis present. Remaining cases were then studied for any subsequent Radiological or Orthopaedic surgical procedures.

Results

136 cases were identified and reviewed by an Orthopaedic Consultant. 31 were excluded for no lipohaemarthrosis (n= 11), for degenerative change (n=9), for fracture (n=4), for existing arthroplasty (n=4) and for data errors (n=3). The remaining 105 patients had a mean age of 32, and range 5–90 years. 66 patients underwent further imaging in the form of MRI scan (n=47), CT Scan (n=9) repeat x-rays (n=9) and ultrasound (n=1). 27 fractures were identified.

Surgery was performed in 12 cases (11%). Two (2%) urgently (One ACL reconstruction plus meniscus repair, one for ORIF of tibial plateau fracture). Ten (10%) had elective surgery (6 for ACL reconstruction, 2 for ACL reconstruction plus meniscus repair, 2 for loose body removal.

Conclusion

The presence of a lipohaemarthrosis on x-ray following acute knee injury was a poor predictor of intra-articular fracture (26%) or need for urgent surgery (2%).
SUPPORT AND TREATMENT AFTER JOINT REPLACEMENT (STAR): TRANSLATING TRIAL FINDINGS INTO NHS PRACTICE
Authors: Bertram Wendy , Wylde Vikki , Woodward Tom , Gooberman-Hill Rachael , Whitehouse Michael , Howells Nick
Published: August 2023

Introduction

Total knee replacement (TKR) aims to reduce pain and functional limitations. Despite a good outcome for many, 15–20% patients report chronic pain three months after TKR.

The STAR Care Pathway is a clinically important and cost effective treatment to improve pain outcomes over 1 year for people with chronic pain at 3 months after total knee replacement surgery. The care pathway is delivered by specially trained Extended Scope Practitioners (ESPs).

There is a gap between research findings and translation into practice. This work shows how the STAR trial findings were implemented into NHS practice at a single centre and the further work required to enable national implementation.

Methodology

Trial findings were presented to NHS managers with a business case for an implementation pilot. Trial documentation was adapted for use in usual care using the COM-B model for behaviour change and evidence-based approaches to increase the return of postal questionnaires. Trial sites were contacted to understand their capacity to implement the intervention locally.

Results

The STAR care pathway was successfully implemented into NHS practice with a screening response rate of 83%. It is now permanently part of usual care at North Bristol NHS Trust. Trial centres indicated that lack of availability of STAR trained ESPs as a barrier to implementation. The trial manual and training session were adapted for online delivery in partnership with Health Education England.

Conclusion

The STAR care pathway has been successfully embedded into NHS care. A toolkit and online clinician training package enables national implementation.
PHYSICAL ACTIVITY AND HEALTH-RELATED QUALITY OF LIFE OF PATIENTS WITH CHRONIC KNEE PAIN AFTER TOTAL KNEE ARTHROPLASTY: ANALYSIS OF THE PEP-TALK TRIAL
Authors: Fabiano Gianluca , Smith Toby , Parsons Scott , Ooms Alex , Dutton Susan , Fordham Beth , Hing Caroline , Pinedo-Villanueva Rafael , Lamb Sallie
Published: August 2023

INTRODUCTION

This study aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after total knee replacement (TKR) for patients with and without post-operative chronic knee pain.

METHODS

83 adults participating in the PEP-TALK, a RCT testing the effectiveness of a behaviour change physiotherapy intervention versus usual rehabilitation post-primary TKR, were analysed. UCLA Activity Score and EQ-5D-5L values for participants with and without chronic knee pain (14 points or lower in the Oxford Knee Score Pain Subscale at six months post-TKR) were compared at six and 12 months post-TKR. We evaluated recovery trajectory those with or without chronic pain at these time points.

RESULTS

Participants with chronic knee pain, UCLA Activity Score remained unchanged between baseline to six months (mean: 3.8 to 3.8), decreasing at 12 months (mean: 3.0). Those without post-operative chronic knee pain reported a improvement in physical activity from baseline to six months (mean: 4.0 vs 4.9), plateauing at 12 months (mean: 4.9). Participants with chronic knee pain reported lower baseline HRQoL, although both groups improved mean health utility over one year. Of participants who were not defined as being in chronic pain at six months, 8.5% returned to a chronic pain categorisation by 12 months.

CONCLUSION

People with chronic knee pain post-TKR report poorer physical activity and HRQoL scores post-operatively. Monitoring outcomes longer than six months may be indicated as those without chronic knee pain initially post-TKR remain at risk of reverting to chronic knee pain 12 months post-TKR.
PATIENT SATISFACTION FOLLOWING DOUBLE-LEVEL OSTEOTOMY: A SUCCESSFUL INTERVENTION FOR KNEE OSTEOARTHRITIS?
Authors: Wright Esther , Andrews Nicole , Thakrar Raj , Chatoo Minhal
Published: August 2023

Introduction

Osteotomy is recognised treatment for osteoarthritis of the knee. Evidence suggests favourable outcomes when compared to arthroplasty, for younger and more active individuals[1]. Double level osteotomy (DLO) is considered when a single level is insufficient to restore both joint line obliquity and adequate realignment[2]. This paper aims to establish the functional outcomes up to two years post operatively for patients undergoing DLO, using patient reported outcome measures (PROMs).

Methodology

All patients who underwent a DLO at either Lister Hospital, Stevenage, or One Hatfield Hospital, Hertfordshire, between 1st January 2018 and 1st October 2020 were identified. DLO were performed by two specialist consultants, independently or in combination. PROMs including pain scores, health score, Oxford knee score (OKS) and knee injury and osteoarthritis outcome score (KOOS) were recorded pre-operatively and at six month, one and two year post operative intervals.

Results

24 patients underwent DLO; a medial opening wedge high tibial osteotomy and lateral closing wedge distal femoral osteotomy. The cohort comprised 21 males, 3 females with an average age of 54.09 (38–77) years. Preoperative pain scores graded from 0–10 improved from 6.86 to 2.0 at 2 years. OKS improved from 23.94 to 47.88, as did KOOS 43.55 to 87.51, over the same duration.

Conclusion

DLO was associated with improvements in pain and functional outcomes, compared to pre-operative levels. In patients for whom arthroplasty may be unfavourable, this provides an alternative to non-operative management, the options for which are frequently exhausted early in the disease process.