bluuebunny/crossref_metadata_2025 huggingface dataset:
EARLY OUTCOMES OF HIP ARTHROSCOPY FOR FEMOROACETABULAR IMPINGEMENT: A STUDY OF 7,511 CASES USING THE NAHR DATASET
Authors: Green Justin , Holleyman Richard , Kumar Sunil , Khanduja Vikas , Malviya Ajay
Published: May 2024

This study used a national registry to assess the outcomes of hip arthroscopy (HA) for the treatment femoroacetabular impingement (FAI).

All HAs for FAI recorded in the UK Non-Arthroplasty Hip Registry (NAHR) between January 2012 and September 2023 were identified. Cases were grouped according to the index procedure performed for FAI (cam, pincer, or mixed). Patient outcomes captured included the International Hip Outcome Tool (iHOT)-12.

7,511 HAs were identified; 4,583 cam (61%), 675 pincer (9%), 2,253 mixed (30%). Mean age (34.8) was similar between groups. There was a greater proportion of females in the pincer group (75%) compared to cam (52%) and mixed (50%). A higher proportion of patients had a recorded cartilage injury in association with a cam lesion compared to pincer. The pincer group had poorer mean pre-op iHOT-12 scores (31.6 \[95%CI 29.9 to 33.3\]; n=364) compared to cam (33.7 \[95%CI 32.1 to 34.4\]; n=3,941) and achieved significantly lower scores at 12 months (pincer = 52.6 (50.2 to 55); n=249, cam = 58.3 (57.1 to 59.5); n=1,679).

Overall, significant (p < 0.0001) iHOT-12 and EQ-5D improvement vs baseline pre-operative scores were achieved for all FAI subtypes at 6 months (overall mean iHOT-12 improvement +26.0 \[95%CI 25.0 to 26.9\]; n=2,983) and maintained out to 12 months (+26.2 \[25.1 to 27.2\]; n=2,760) at which point 67% and 48% of patients continued to demonstrate a score improvement greater than or equal to the minimum clinically important difference (>/=13 points) and substantial clinical benefit (>/=28 points) for iHOT-12 respectively.

This study demonstrates excellent early functional outcomes following HA undertaken for FAI in a large national registry.
SHORT-TERM COMPLICATIONS AND REOPERATION RATES AFTER PELVIC OSTEOTOMY: A REVIEW OF 1,348 CASES IN ENGLAND FROM 2010 TO 2023
Authors: Kolhe Shivam , Khanduja Vikas , Malviya Ajay
Published: May 2024

Hip dysplasia is a common cause of hip pain in young adults. Pelvic osteotomy (PO) techniques are the gold standard for treating symptomatic patients, albeit technically demanding. This study aimed to (1) evaluate the 90-day complication rate, and (2) investigate the reasons, frequency and timing of reoperations following primary PO procedures.

We retrospectively analysed the National Hospital Episode Statistics database, examining all patients aged over 14 who underwent PO in NHS England hospitals from 2010 to 2023. We identified index procedures and reoperations using relevant OPCS-4 codes. We analysed patient demographics, 90-day complications, and readmission rates for ipsilateral metalwork removal, revision PO, hip arthroscopy (HA), and THR conversion, and calculated the mean time to reoperations.

This study included 1,348 PO cases (mean age: 28.7±9.1 years, 89.5% female). The mean hospital stay was 5.4±3.9 days, with a 90-day readmission rate of 0.52% at a mean of 51.0±17.2 days. The most common causes were infection (0.22%) and reoperation (0.15%). The 90-day rate of pulmonary embolism and deep vein thrombosis was 0.074%. One patient died within 90 days.

Overall, 810 patients (60.1%) were readmitted for a subsequent hip procedure at a mean of 2.12±1.90 years following their primary PO. Metalwork removal was required in 616 patients (45.7%) at a mean of 1.70±1.19 years. Readmission rates for revision PO, HA, and THR, were 4.23% (mean time: 2.89±0.82 years), 4.15% (mean time: 2.91±2.28 years) and 6.01% (mean time: 5.24±3.08 years) respectively.

This study highlights a low 90-day complication rate following primary PO, but a high reoperation rate, mainly for metalwork removal. We provide the most up-to-date report of revision PO, HA and THR conversion rates in England. These findings provide valuable insight that can facilitate informed decision-making, expectation-setting, and post-operative planning, also establishing a benchmark for future quality improvement.
BEARING SURFACE MATERIALS AND THE RISK OF REVISION FOLLOWING PRIMARY TOTAL HIP ARTHROPLASTY: A COHORT ANALYSIS OF 1,026,481 HIP ARTHROPLASTIES FROM THE NATIONAL JOINT REGISTRY
Authors: Whitehouse Michael , Patel Rita , French Jonathan , Beswick Andrew , Navvuga Patricia , Marques Elsa , Blom Ashley , Lenguerrand Erik
Published: May 2024

Hip bearing surfaces materials are typically broadly reported in national registry (metal-on-polyethylene, ceramic-on-ceramic etc). We investigated the revision rates of primary total hip replacement (THR) reported in the National Joint Registry (NJR) by detailed types of bearing surfaces used.

We analysed THR procedures across all orthopaedic units in England and Wales. Our analyses estimated all-cause and cause-specific revision rates. We identified primary THRs with heads and monobloc cups or modular acetabular component THRs with detailed head and shell/liner bearing material combinations. We used flexible parametric survival models to estimate adjusted hazard ratios (HR).

A total of 1,026,481 primary THRs performed between 2003–2019 were included in the primary analysis (Monobloc cups: n=378,979 and Modular cups: n=647,502) with 20,869 (2%) of these primary THRs subsequently undergoing a revision episode (Monobloc: n=7,381 and Modular: n=13,488).

Compared to implants with a cobalt chrome head and highly crosslinked polyethylene (HCLPE) cup, the overall risk of revision for monobloc acetabular implant was higher for patients with cobalt chrome or stainless steel head and non-HCLPE cup. The risk of revision was lower for patients with a delta ceramic head and HCLPE cup implant, at any post-operative period.

Compared to patients with a cobalt chrome head and HCLPE liner primary THR, the overall risk of revision for modular acetabular implant varied non-constantly. THRs with a delta ceramic or oxidised zirconium head and HCLPE liner had a lower risk of revision throughout the entire post-operative period.

The overall and indication-specific risk of prosthesis revision, at different time points following the initial implantation, is reduced for implants with a delta ceramic or oxidised zirconium head and a HCLPE liner/cup in reference to THRs with a cobalt chrome head and HCLPE liner/cup.
WHAT RANGE OF MOTION (ROM) DOES A HIP ARTHROPLASTY ACTUALLY NEED? A CT-BASED METHOD TO PREDICT AN INDIVIDUAL'S HIP ROM PREOPERATIVELY
Authors: Palit Arnab , Kiraci Ercihan , Seemala Vineet , Gupta Vatsal , Williams Mark , King Richard
Published: May 2024

Ideally the hip arthroplasty should not be subject to bony or prosthetic impingement, in order to minimise complications and optimise outcomes. Modern 3d planning permits pre-operative simulation of the movements of the planned hip arthroplasty to check for such impingement. For this to be meaningful, however, it is necessary to know the range of movement (ROM) that should be simulated. Arbitrary “normal” values for hip ROM are of limited value in such simulations: it is well known that hip ROM is individualised for each patient. We have therefore developed a method to determine this individualised ROM using CT scans.

CT scans were performed on 14 cadaveric hips, and the images were segmented to create 3d virtual models. Using Matlab software, each virtual hip was moved in all potential directions to the point of bony impingement, thus defining an individualised impingement-free 3d ROM envelope. This was then compared with the actual ROM as directly measured from each cadaver using a high-resolution motion capture system.

For each hip, the ROM envelope free of bony impingement could be described from the CT and represented as a 3d shape. As expected, the directly measured ROM from the cadaver study for each hip was smaller than the CT-based prediction, owing to the presence of constraining soft tissues. However, for movements associated with hip dislocation (such as flexion with internal rotation), the cadaver measurements matched the CT prediction, to within 10°.

It is possible to determine an individual's range of clinically important hip movements from a CT scan. This method could therefore be used to create truly personalised movement simulation as part of pre-operative 3d surgical planning.
TOTAL FEMORAL ARTHROPLASTY FOR NON-ONCOLOGICAL INDICATIONS
Authors: Logishetty Kartik , Whitwell Duncan , Palmer Antony , Gundle Roger , Gibbons Max , Taylor Adrian , Kendrick Ben
Published: May 2024

There is a paucity of data available for the use of Total Femoral Arthroplasty (TFA) for joint reconstruction in the non-oncological setting. The aim of this study was to evaluate TFA outcomes with minimum 5-year follow-up.

This was a retrospective database study of TFAs performed at a UK tertiary referral revision arthroplasty unit. Inclusion criteria were patients undergoing TFA for non-oncological indications. We report demographics, indications for TFA, implant survivorship, clinical outcomes, and indications for re-operation.

A total of 39 TFAs were performed in 38 patients between 2015–2018 (median age 68 years, IQR 17, range 46–86), with 5.3 yearsâ€™ (IQR 1.2, 4.1–18.8) follow-up; 3 patients had died. The most common indication (30/39, 77%) for TFA was periprosthetic joint infection (PJI) or fracture-related infection (FRI); and 23/39 (59%) had a prior periprosthetic fracture (PPF). TFA was performed with dual-mobility or constrained cups in 31/39 (79%) patients. Within the cohort, 12 TFAs (31%) required subsequent revision surgery: infection (7 TFAs, 18%) and instability (5 TFAs, 13%) were the most common indications. 90% of patients were ambulatory post-TFA; 2 patients required disarticulation due to recurrent PJI. While 31/39 (79%) were infection free at last follow-up, the remainder required long-term suppressive antibiotics.

This is the largest series of TFA for non-oncological indications. Though TFA has inherent risks of instability and infection, most patients are ambulant after surgery. Patients should be counselled on the risk of life-long antibiotics, or disarticulation when TFA fails.
A RANDOMIZED CONTROLLED TRIAL ASSESSING TRADITIONAL VERSUS DYNAMIC REHABILITATION REGIMES FOLLOWING SURGICAL REPAIR OF A PROXIMAL HAMSTRING TENDON AVULSION
Authors: Ajula Randeep , Mayne Alistair , Cecchi Steve , Ebert Jay , Edwards Peter , Davies Peter , Ricciardo Brendan , Annear Pete , D'Alessandro Peter
Published: May 2024

Proximal hamstring tendon avulsion from the ischial tuberosity is a significant injury, with surgical repair shown to have superior functional outcomes compared to non-surgical treatment. However, limited data exists regarding the optimal rehabilitation regime following surgical repair. The aim of this study was to investigate patient outcomes following repair of proximal hamstring tendon avulsions between a conservative (CR) versus an accelerated rehabilitation (AR) regimen.

This prospective randomized controlled trial (RCT) randomised 50 patients undergoing proximal hamstring tendon repair to either a braced, partial weight-bearing rehabilitation regime (CR=25) or an accelerated, unbraced regime, that permitted full weight-bearing as tolerated (AR=25).

Patients were evaluated pre-operatively and at 3 and 6 months post-surgery, via patient-reported outcome measures (PROMs) including the Lower Extremity Functional Scale (LEFS), Perth Hamstring Assessment Tool (PHAT) and 12-item Short Form Health Survey (SF-12). Primary analysis was per protocol and based on linear mixed models.

Both groups were matched at baseline with respect to patient characteristics. All PROMs improved (p>0.05) and, while the AR group reported a significantly better Physical Component Score for the SF-12 at 3 months (p=0.022), there were no other group differences. Peak isometric hamstrings strength and peak isokinetic quadriceps and hamstrings torque symmetry were all comparable between groups (p>0.05). Three re-injuries have been observed (CR=2, AR=1).

After proximal hamstring repair surgery, post-operative outcomes following an accelerated rehabilitation regimen demonstrate comparable outcomes to a traditionally conservative rehabilitation pathway, albeit demonstrating better early physical health-related quality of life scores, without an increased incidence of early re-injury.
INCIDENTAL FINDINGS AND CLINICAL SIGNIFICANCE OF PREOPERATIVE CT IMAGING FOR THE PLANNING OF ROBOTIC ARTHROPLASTY
Authors: Jones Robin , Phillips Jonathan , Panteli Michalis
Published: May 2024

Total joint arthroplasty (TJA) is one of the commonest and most successful orthopaedic procedures used for the management of end-stage arthritis. With the recent introduction of robotic-assisted joint replacement, Computed tomography (CT) has become part of required pre-operative planning.

The aim of this study is to quantify and characterise incidental CT findings, their clinical significance, and their effect on the planned joint arthroplasty.

All consecutive patients undergoing an elective TJA (total joint arthroplasty; hip or knee) were retrospectively identified, over a 4-year period (December 2019 and November 2023). Data documented and analysed included patient demographics, type of joint arthroplasty, CT findings, their clinical significance, as well as potential delays to the planned arthroplasty because of these findings and subsequent further investigation.

A total of 987 patients (female: 514 patients (52.1%)) undergoing TJA were identified (THA: 444 patients (45.0%); TKA: 400 patients (40.5%); UKA: 143 patients (14.5%)). Incidental findings within imaged areas were identified in 227 patients (23.0%). Of these findings, 74 (7.5%) were significant, requiring further investigation or management, 40 (4.1%) of which represented potential malignancy and 4 (0.4%) resulting in a new cancer diagnosis. A single patient was found to have an aneurysm requiring urgent vascular intervention. Surgery was delayed for further investigation in 4 patients (0.4%). Significant findings were more frequent in THA patients (THA: 43 (9.7%) TKA/UKA: 31 (5.7%)

Within our cohort, 74 (7.5%) patients had significant incidental findings that required further investigations or management, with 4 (0.4%) having a previously undiagnosed malignancy. We strongly advocate that all robotic arthroplasty planning CTs are reviewed and reported by a specialist, to avoid missing undiagnosed malignancies and other significant diagnoses.
REOPERATION-FREE SURVIVAL OF COMMON FEMORAL STEM TYPES IN PRIMARY TOTAL HIP ARTHROPLASTY FROM A LARGE NATIONAL DATASET: TIME TO RETHINK GIRFT GUIDANCE? A NATIONAL COHORT STUDY USING AN INTEGRATED NATIONAL JOINT REGISTRY AND HES DATASET
Authors: Lamb Jonathan , Relton Samuel , Wilkinson Mark , Pandit Hemant
Published: May 2024

Current advice regarding implant choice is based on estimates of cost-benefit derived from implant survival to an endpoint of revision. Current estimates do not account for many implant failures which are treated with non-revision surgery and may not be accurate. The aim of this study was to estimate survival of major stem implant design groups to an endpoint of reoperation.

Primary total hip replacement and linked revision form the National Joint Registry (NJR) and Hospital Episode Statistics (HES) data linked by unique identifier were used. Survival of femoral implant groups (cemented stainless steel polished taper [PTSS], cemented cobalt chrome polished taper [PTCC], cemented composite beam [CB], collarless cementless [NCOL] and collared cementless [COL]) was estimated using Kaplan-Meier method.

809,832 patients with valid NJR and HES data from England, were included. Cumulative failure at ten years for PTSS increased overall from 2.9% (95%CI 2.8–2.9) to 3.6% (95%CI 3.6–3.7) after inclusion of reoperations. Cumulative failure at ten years for PTSS increased from 2.5% (95%CI 2.5–2.6) to 3.3% (95%CI 3.2–3.4), for PTCC increased from 3.8% (95%CI 3.5–4.0) to 5.4% (95%CI 5.1–5.6), for CB increased from 3.1% (95%CI 2.9–3.3) to 4.1% (95%CI 3.8–4.3), for NCOL increased from 3.4% (95%CI 3.3–3.5) to 3.9% (95%CI 3.8–4.0), and for COL increased from 2.5% (95%CI 2.4–2.6) to 3.1% (95%CI 2.9–3.2), after inclusion of reoperations.

Re-operation for internal fixation is as significant life event for the patient as revision. When a more inclusive metric is used, the patient and clinician's perspective on what constitutes a GIRFT implant may not be the same. Further work is required to update implant selection guidance in view of the change in implant performance.
EFFICACY OF PERICAPSULAR NERVE GROUP BLOCK AS A MODALITY FOR POSTOPERATIVE PAIN MANAGEMENT IN PATIENTS UNDERGOING ARTHROSCOPIC TREATMENT OF FEMOROACETABULAR IMPINGEMENT
Authors: Mahmoud Mohamed Abdelradi , Sharkawy Essam , Kamel Mahmoud , Metwaly Saeid , Said Hatem , Noaman Safaa
Published: May 2024

The postoperative pain after hip arthroscopy remains a major challenge in the immediate postoperative period. Adequate postoperative analgesia has been associated with increased patient satisfaction and decreased consumption of opioids. We evaluated the efficacy of pericapsular nerve group block (PENG) versus fascia iliaca block (FIB) in reducing post-operative pain and analgesic consumption within the first 24 hours following arthroscopic management of femoroacetabular impingement (FAI).

Thirty-nine patients (17 females and 25 males, ages 18–42 years, mean ± SD (27.9 ± 6.2), and mean BMI of 25.13±5.08 kg/m2 were scheduled for primary arthroscopic management of FAI. Included patients were randomized into two groups according to the block used in each. Group (A) 19 patients were included and had FIB and group (B) 20 patients were included and received PENG block. The efficacy of both techniques was clinically and statistically valuated using VAS score and quadriceps muscle power.

There was a statically significance difference in the mean at rest between the two groups at all measured time points following surgery (6, 12, 18 and 24 h). Also, in dynamic pain scores (with hip flexion) scores were statistically significant at 24 hours post-operative (P = .001). Total opioid consumption in the first 24 hours postoperative was lower in the PENG group with significant difference of mean 16.5 ±9.9 mg for PENG group versus 27.5±9.6 mg for FIB group (P < .005). Five patients (26.31%) in FIB group had weaker quadriceps muscle power while none in PENG group patients had quadriceps weakness.

PENG block might be considered as an ideal regional anesthesia modality for hip arthroscopy. As an alternative to more conventional regional nerve blocks such as a fascia iliaca block. PENG block is easily performed in the preoperative setting, and appears to spare motor function while providing a prolonged sensory pain relief.
DEFINING THRESHOLDS AND CORRELATIONS FOR ACHIEVING MINIMAL CLINICALLY IMPORTANT DIFFERENCE (MCID) AND PATIENT ACCEPTABLE SYMPTOM STATE (PASS) USING IHOT12 IN PATIENTS UNDERGOING PERIACETABULAR OSTEOTOMY (PAO) FOR DYSPLASIA
Authors: Amer Mohammad , Smith Christian , Kumar Karadi H Sunil , Malviya Ajay
Published: May 2024

MCID and PASS are thresholds driven from PROMS to reflect clinical effectiveness. Statistical significance can be derived from a change in PROMS, whereas MCID and PASS reflect clinical significance. Its role has been increasingly used in the world of young adult hip surgery with several publications determining the thresholds for Femoro-acetabular impingement FAI. To our knowledge MCID and PASS for patient undergoing PAO for dysplasia has not been reported.

593 PAOs between 1/2013 and 7/2023 were extracted from the Northumbria Hip Preservation Registry. Patients with available PROMS at 1year and/or 2years were included. PAOs for retroversion, residual Perthes and those combined with FO were excluded. MCID was calculated using the distribution method 0.5SD of baseline score(1). PASS was calculated using anchor method, ROC analysis performed, and value picked maximizing Youden index. A Logistic Regression analysis was performed to determine which independent variables correlated with achieving MCID and PASS.

The MCID threshold for iHOt12 was 8.6 with 83.4 and 86.3 % of patients achieved it at 1 and 2 years respectively. The PASS score at 1 and 2 year follow up was 43 and 44 respectively, with 72.6 and 75.2% achieving it at 1 and 2 year postop. At 2 years a Higher preop iHOT 12 was associated with not achieving MCID and PASS (p<0.05). Preop acetabular version was negatively correlated with achieving MCID and previous hip arthroscopy was negatively correlated with PASS.

The % of patients achieving MCID and PASS mimics that of FAI surgery (2). The negative correlation with preop iHOT12 reaffirms the importance of patient selection. The negative correlation of hip arthroscopy highlights the importance of having a high index of suspicion for dysplasia prior to hip arthroscopy and poorer outcomes of patients with mixed CAM and dysplasia pathology.
CLINICAL FRAILTY IS INDEPENDENTLY ASSOCIATED WITH JOINT-SPECIFIC FUNCTION AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS AWAITING A TOTAL HIP OR KNEE ARTHROPLASTY
Authors: Bayram John M , Wickramasinghe Neil , Scott Chloe EH , Clement Nicholas D
Published: May 2024

The aims were to assess whether preoperative joint-specific function (JSF) and health-related quality of life (HRQoL) were associated with level of clinical frailty in patients waiting for a primary total hip arthroplasty (THA) or knee arthroplasty (KA).

Patients waiting for a THA (n=100) or KA (n=100) for more than six months were prospectively recruited from the study centre. Overall, 162 patients responded to the questionnaire (81 THA; 81 KA). Patient demographics, Oxford score, EuroQol five dimension (EQ-5D) score, EuroQol visual analogue score (EQ-VAS), Rockwood Clinical Frailty Score (CFS), and time spent on the waiting list were collected.

There was a significant correlation between CFS and the Oxford score (THA r=ˆ’0.838; p<0.001, KA r=ˆ’0.867; p<0.001), EQ-5D index (THA r=ˆ’0.663, p<0.001; KA r=ˆ’0.681; p< 0.001), and EQ-VAS (THA r=ˆ’0.414; p<0.001, KA r=ˆ’0.386; p<0.001). Confounding variables (demographics and waiting time) where adjusted for using multiple regression analysis. For each 8.5 (THA, 95% CI 7.1 to 10.0; p<0.001) and 9.9 (KA, 95% CI 8.4 to 11.4; p<0.001) point change in the Oxford score, there was an associated change in level of the CFS. For each 0.16 (THA, 95% CI 0.10 to 0.22; p<0.001) and 0.20 (KA, 95% CI 0.12 to 0.27; p<0.001) utility change in EQ-5D, there was an associated change in level of the CFS. EQ-VAS (THA, B=ˆ’11.5; p<0.001, KA B=ˆ’7.9; p=0.005) was also associated with CFS.

JSF and HRQoL in patients awaiting THA or KA for more than six months, were independently associated with level of clinical frailty. With further prospective studies, clinical frailty may prove to be a useful metric to assist in the prioritization of arthroplasty waiting lists.
IMPACT OF REGIONALIZATION OF MAJOR TRAUMA SERVICES ON HIP FRACTURE CARE IN ENGLAND: A COMPARATIVE STUDY
Authors: Potter Matt , Uzoigwe Chika , Azhar Saad , Symes Tom
Published: May 2024

Following the establishment of regional Major Trauma Networks in England in 2012, there were concerns that pressures regarding resource allocation in Major Trauma Centres (MTCs) may have a detrimental impact on the care of patients with hip fractures in these hospitals. This study aimed to compare outcomes in hip fracture care between MTCs and trauma units (TUs).

National Hip Fracture Database data was extracted from 01/01/2015 to 31/12/2022 for all hospitals in England. Outcome measures included perioperative medical and physiotherapy assessments, time to surgery, consultant supervision in theatre, Best Practice Tariff (BPT) compliance, discharge to original residence, and mortality. Data was pooled and weighted for MTCs and remaining hospitals (TUs).

A total of 487,089 patients with hip fractures were included from 167 hospitals (23 MTCs and 144 TUs). MTCs achieved marginally higher rates of orthogeriatrician assessment within 72 hours of admission (91.1% vs 90.4%, p<0.001) and mobilisation out of bed by first postoperative day (81.9% vs 79.7%, p<0.001). A lower proportion of patients underwent surgery by the day after admission in MTCs (65.2% vs 69.7%, p<0.001). However, there was significantly higher consultant surgeon and anaesthetist supervision rates during surgery in MTCs (71.8% vs 61.6%, p<0.001). There was poorer compliance with BPT criteria in MTCs (57.3% vs 60.4%, p<0.001), and proportionately fewer MTC patients were discharged to their original residence (63.5% vs 60.4%, p<0.001). There was no difference between MTCs and TUs in 30-day mortality (6.8% vs 6.8%, p=0.825).

This study demonstrates that MTCs have greater difficulty in providing prompt surgery to hip fracture patients. However, their marginally superior perioperative care outcomes appear to compensate for this, as their mortality rates are similar to TUs. These findings suggest that the regionalisation of major trauma in England has not significantly compromised the overall care of hip fracture patients.
ESTIMATING THE COSTS, HEALTH-RELATED QUALITY OF LIFE, AND REVISION RISK IN THE YEAR AFTER ELECTIVE PRIMARY AND REVISION HIP ARTHROPLASTY PROCEDURES BY IMPLANT BEARING MATERIALS: AN ANALYSIS OF LINKED DATA FROM THE NATIONAL JOINT REGISTRY (NJR), HOSPITAL EPISODE STATISTICS (HES), AND PATIENT-REPORTED OUTCOME MEASURES (PROMS) FOR ENGLISH PATIENTS
Authors: Navvuga Patricia , Lenguerrand Erik , Patel Rita , French Jonathan , Blom Ashley , Whitehouse Michael , Marques Elsa
Published: May 2024

Implants in total hip replacement (THR) are associated with different clinical and cost-effectiveness profiles,. We estimate the costs and outcomes for NHS patients in the year after THR associated with implant bearing materials using linked routinely collected data.

We linked NJR primary elective THR patients for osteoarthritis to HES and National PROMs. We estimated health care costs, health-related quality of life indices, and revision risks, in the year after primary and revision THRs overall. We used generalised linear models adjusting for patient and hospital characteristics and estimated 10-year cumulative probability of revision. We imputed utilities using chained equations for half the sample with missing PROMS.

We linked 577,973 elective primary THRs and 11,812 subsequent revisions. One year after primary THR, patients with the cemented THRs using cobalt chrome or stainless steel head with HCLPE liner/cup cost the NHS, on average, £13,101 (95%CI £13,080,£13,122), had an average quality-of-life score of 0.788 (95%CI 0.787,0.788), and a 10-year revision probability of 1.9% (95%CI 1.6,2.3). Compared to the reference, patients receiving a cemented THR with delta ceramic head and HCLPE liner/cup, hybrid THR with delta ceramic head and HCLPE liner/cup, and hybrid THR with alumina head and HCLPE liner/cup had lower 1-year costs (-£572 \[95% CI -£775,-£385\], -£346 \[-£501,-£192\], -£371 \[-£574,-£168\] respectively), better quality of life (0.007 \[95% CI 0.003,0.011\], 0.013 \[0.010,0.016\], 0.009 \[0.005,0.013\] respectively), and lower 10-year revision probabilities (1.4% \[1.03,2.0\], 1.5 \[1.3,1.7\], 1.6%\[1.2,2.1\] respectively).

Implant bearing materials are associated with varying mean costs and health outcomes after primary THR. Ours is the first study to derive costs and health outcomes from large, linked databases using multiple imputation methods to deal with bias. Our findings are useful for commissioning and procurement decisions and to inform a subsequent cost-effectiveness model with more granular detail on THR implant types.
OPTIMIZING WATER USAGE: THE IMPACT OF ALCOHOL HAND RUBS IN LOWER LIMB PRIMARY ARTHROPLASTY
Authors: Shah Jehan Zaib , Bubak Saad , Sami Wasim Abdus , Quraishi Sohail
Published: May 2024

Alcohol hand rubs, endorsed by WHO and NICE guidelines, are integral to modern surgical practices. Our objective was to assess how different scrubbing methods impact overall water usage by the surgical team, shedding light on variations among team members and their environmental implications.

Over three consecutive arthroplasty lists spanning a week, water usage during scrubbing was observed for the operating team. Blinding all team members, including the anesthetist, consultant surgeon, orthopaedic registrar, orthopaedic SHO, and scrub nurse, during water usage calculations was implemented. Automated taps, using motion sensors, posed a challenge due to variable water quantity, necessitating water flow calculations per sensor movement. The senior surgeon, with over 20 years of experience, follows a traditional approach, starting with a morning prescrub and using an alcohol tub for each case, except when hands are soiled.

We observed a total of 14 cases of lower limb primary arthroplasty. The cumulative water usage for scrubbing by the entire team was 193 liters, yielding a mean of 13.8 liters (±1.85) per case. The anaesthetist demonstrated the most conservative water usage, utilizing a total of 11.85 liters with a mean of 0.84 liters per case. Notably, alcohol rub was employed for half of the observed time, contributing to this efficient use. The senior operating surgeon used a total of 15.6 liters, averaging 1.1 liters per case. In contrast, the SHO and the registrar exhibited the highest water consumption, totaling 121.6 liters and yielding a mean of 5.7 liters per case. The nurses’ collective water usage for scrubbing amounted to 44.8 liters.

Adopting alcohol rub, as endorsed by WHO, results in a remarkable 10-fold reduction in water usage, aligning with global health guidelines. This highlights significant potential for resource conservation in surgical procedures, presenting a practical and environmentally conscious approach to surgical scrubbing practices.
Estimation Model Peak Ground Acceleration at Bedrock and Surface of The Pasaman Barat Earthquake on February 25, 2022 M_w 6.1
Authors: Raharjo Furqon Dawam , Syafriani Syafriani , Ahadi Suaidi
Published: May 2024

The earthquake occured on february 25, 2022 in West Pasaman, Province West Sumatera with momen magnitude Mw6.1, produced strong ground motion so that many several buildings were damaged.  The peak ground  acceleration (PGA) represents its level ground acceleration in bedrock and peak surface acceleration (PGAm) describes the acceleration value on the surface which depends on the amplification factor and the type of soil classification. Information  peak ground acceleration (PGA) and peak surface acceleration (PGAm) values plays an important role in describing the level of damage due to earthquake events. The purpose this study for determine the peak ground  acceleration (PGA) and  peak surface acceleration (PGAm) for West Pasaman earthquake Mw6.1 using boore (1997) attenuation model. In this study using parameter data main earthquake and then peak ground acceleration (PGA) value calculated each grid points and  then analysis peak surface acceleration (PGAm) value is based on the effect of site class from information Vs30 USGS model on peak ground acceleration (PGA) at bedrock from SNI 1726 : 2012. The result in this study showed peak ground acceleration and  peak surface acceleration value  in due West Pasaman earthquake  ranged  between 0.066 - 0.345 g and 0.223 - 0.627 g. The areas affected by heavy damage occured  in Kajai, Rimbo Panti, Malampah and Tigo Nagari Subdistrict with peak ground acceleration and peak surface acceleration value around 0.115 - 0,345 g and 0.423 - 0.627 g respectively and was dominated with type site class moderate soil (SD) based on Vs30 data form USGS model.
Simulation of Boron Dose and Irradiation Time in Lung Cancer Treatment with Boron Neutron Capture Therapy (BNCT) Using MCNP-6
Authors: Handayani Nita , Soelistiyono Kevin Kautsar , Arianto Fajar
Published: May 2024

Boron Neutron Capture Therapy (BNCT) is a cancer radiation treatment. This approach employs a boron carrier agent in the form of a chemical that is injected into the body and then travels to the cancer cells. In a lung cancer case study, BNCT treatment simulation was carried out using Monte Carlo N Particle (MCNP) software version 6.2. The goal of this study was to determine the most effective boron concentration and irradiation duration in lung cancer therapy utilizing the BNCT method. The geometry based on a phantom model created by Oak Ridge National Laboratory (ORNL). The simulated cancer geometry, which is placed in the right lung's middle lobe. The skin, ribs, and right lung are among the organs at risk. The skin, ribs, and right lung are among the organs at risk. The neutron source for the simulation is the collimator output from the Kartini Nuclear Reactor's thermal column. In this simulation, the variations in boron concentrations were 40 g/g, 45 g/g, 50 g/g, 55 g/g, and 60 g/g of cancer tissue at 5 g/g intervals. The researchers discovered a link between boron injection concentration and irradiation time, with higher boron injection concentrations resulting in shorter irradiation times. The volume of boron injected determines the effective dose absorbed by healthy tissue surrounding cancer cells. The effective boron concentration for lung cancer therapy is 60 g/g, with deterministic cell killing in the rib marrow and right lung. When utilizing a boron concentration of 60 g/g, the irradiation time is 20.4 minutes. Boron concentrations of 60 g/g are projected to create an effective irradiation time for BNCT-based lung cancer therapy based on the ALARA principle due to their shorter duration when compared to other concentration variations.
Introduction to the Special Issue: Indigenous Self-determination in Health System Reforms
Authors: Gabel Chelsea , Lavoie Josée
Published: May 2024

Across Canada, First Nations, Inuit and Métis peoples and communities live in rural, remote, Northern and reserve places, as well as urban places, and experience health inequities when compared with non-Indigenous peoples. These inequities are founded by pervasive colonial ideologies, policies, systems, and practices, many of which persist today resulting in multiple disparities in health as well as social, political, and economic areas (Adelson 2005; Allan and Smylie 2015).
In Canada, the federal government’s role in the provision of health services is primarily through the limited public health and prevention services offered by the First Nations and Inuit Health Branch (FNIHB), now Indigenous Services Canada (ISC). Services are offered to status (registered) First Nations living on-reserve and to Inuit living in their traditional territories. They provide non-insured health benefits (NIHB) such as prescription drugs, dental, and vision coverage to all status/registered First Nations and Inuit, regardless of where they live; however, non-insured health benefits are not offered to Métis or non-status First Nations. As a result of historical legislative vagueness, and the multiplicity of authorities that has resulted, the First Nations, Inuit and Métis legislation and health policy framework is very complex, which itself results in a great deal of diversity in health service provision across provinces and territories. The framework fails to adequately address the health care needs of the Métis or First Nations and Inuit people who are either not registered or not living on reserve or in their traditional territory (Lavoie and Gervais 2012). [continued in PDF / HTML]
Catholics and the 1980s U.S. Sanctuary Movement
Authors: González Sergio M.
Published: May 2024

Abstract: Most of the scholarship on the 1980s U.S. Sanctuary Movement in support of Central American asylum seekers has emphasized the role of mainline Protestants in the movement’s birth in the U.S.-Mexico borderlands and its spread across the country. This article instead focuses on Catholics’ pivotal role in the movement, which ranged from full support and significant leadership to deep skepticism and overt opposition. It examines sanctuary at both the local and national levels, exploring parish engagement while also assessing debates among clerical leaders on the movement’s legality and whether U.S. Catholics should challenge state power in supporting undocumented asylum seekers. This article illuminates the genealogies of sanctuary that have developed across Catholic, interfaith, and interethnic spaces, demonstrating how they represent one aspect of the Catholic Church’s growing emphasis on Latino immigrant, migrant, and refugee justice.
Prisoner, Sailor, Soldier, Spy: Hobbes on Coercion and Consent
Authors: Luban Daniel
Published: May 2024

Abstract: This article examines Thomas Hobbes’s notorious claim that “fear and liberty are consistent” and therefore that agreements coerced by threat of violence are binding. This view is to a surprising extent inherited from Aristotle, but its political implications became especially striking in the wake of the English Civil War, and Hobbes recast his theory in far-reaching ways between his early works and Leviathan to accommodate it. I argue that Hobbes’s account of coercion is both philosophically safe from the most common objections to it and politically superior to the seemingly commonsensical alternatives that we have inherited from Hobbes’s critics.
Sophie de Grouchy’s Political Thought in the Letters on Sympathy (1798)
Authors: Kim Minchul
Published: May 2024

Abstract: This article proposes a reading of Sophie de Grouchy’s moral, political, and economic thought as embedded in the tradition of natural jurisprudence, adapted to the context of the French First Republic. A close reading of her French translation of Adam Smith’s Theory of Moral Sentiment and her eight Letters on Sympathy confirms that there are points to be made by reading her works in the context of the language of early modern natural law. This sheds light on the important question of how to read revolutionary republicanism emanating from multiple traditions other than the neo-Roman discourse of non-domination.
Neo-Confucianism and the Development of German Idealism
Authors: Hoston Germaine A.
Published: May 2024

Abstract: This article analyzes the influence of Chinese Neo-Confucianism on the development of German idealism. Information obtained by Leibniz from Jesuit missionaries included key concepts in Neo-Confucian philosophy that not only confirmed Leibniz’s belief in the universality of his organic image of the cosmos but also influenced Leibniz’s later writings. Such influence is also exhibited in Kant’s work, especially in his crucial noumenon-phenomenon distinction, as well as in Hegel’s phenomenology and philosophy of history. Recognition of these influences, unacknowledged by either Kant or Hegel, enhances our assessment of the import of both Neo-Confucianism and German idealism in international religio-philosophical discourse.
Queering a Trans Life Story: The Unnatural Potential of Weak Narrativity in succubus in my pocket
Authors: Säntti Joonas
Published: May 2024

ABSTRACT: Discussing similarities between antimimetic and queer/trans narratives, as well as interlacing subjects of interest in the respective fields of unnatural and queer/trans narratology, this article suggests the importance of experimental texts for theorizing trans narratives. It presents its arguments by focusing on one case study, a mixed genre manuscript written in 2004 and published in 2015, succubus in my pocket by the late trans poet kari edwards (1954–2006). My approach mines queer narratology (Susan Lanser), trans poetics (Trace Peterson), unnatural narratology (Brian Richardson), and the study of narrative poetry (Brian McHale) for conceptual tools to discuss how an extremely antimimetic narrative entwines transgressions of narrative expectations with transgressions of expectations about sex and gender. The work invites narrative interpretations of sequential events based on causal expectations while consistently refuting default interpretive strategies. This article shows how weak narrativity can be deployed as a critique of narrative sense-making processes in general and, more particularly, of conventional progression in narratives about trans lives.
The Crisis in World Trade Law: How the Dust Is Settling
Authors: Pomfret Richard
Published: May 2024

Abstract: Reform and extension of world trade law have stalled because of the WTO's consensus rule. The sense of crisis has been exacerbated by the US refusal to approve new members to the WTO Appellate Body, preventing settlement of disputes arising from current world trade law, and by the United States dropping out of the most promising plurilateral approach to extending world trade law. By unilaterally increasing tariffs, the Trump administration further indicated the US disregard for world trade law. After January 2021, President Biden quickly made clear that he would not reverse the US position on the WTO, the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP), or recent tariff increases. Other countries' responses to the blow to enforcing and extending world trade law were hampered by the COVID-19 pandemic that curtailed face-to-face meetings in 2020 and 2021, but the dust began clearing in 2023. In June 2023, the UK became the first new member of the CPTPP; China and Taiwan are next in the queue for accession. In 2023, Japan became the 53rd signatory of the Multi-Party Interim Appeal Arbitration Arrangement (MPIA), whose signatories recognize binding arbitration decisions on WTO rulings; the United States rejects the MPIA. The article ends by drawing conclusions about the future of the world trade system and the US response to initiatives supported by its major allies and other major trading nations.
Localized Multilateralism: Examining the African Development Bank
Authors: Moussavi Sara
Published: May 2024

Abstract: This paper critically examines post-crisis efforts by focusing on the African Development Bank's (AfDB) role in facilitating recovery and poverty reduction across the African continent. Case studies include the COVID-19 crisis, migration, and efforts to battle regional hunger. The analysis contrasts the approaches of the AfDB's strategies with that of the World Bank's Structural Adjustment Programs (SAPs), underscoring the former's unique successes and efficiencies in addressing the specific needs of the continent to reduce poverty. The analysis begins by contextualizing the historical and socio-economic landscape, highlighting African countries' distinct challenges with structural adjustment and debt, and then delves into a detailed assessment of the AfDB's initiatives. This paper suggests that the AfDB's customized strategies could be more effective for Africa's development agenda due to their alignment with the continent's varied cultural, political, and economic landscapes. This approach, prioritizing contextual relevance over a sole focus on economic growth, is argued to be more conducive to addressing Africa's unique developmental challenges.
“Wholesome Utility”: Patriarchy and Black Nationalism in Paradise
Authors: Hooper M. Clay
Published: May 2024

Abstract: This essay examines the relationship between patriarchal culture and Black separatist politics in Toni Morrison’s Paradise . While these two themes are obviously central to the text, they are generally treated as merely contiguous elements of life in Ruby, Morrison’s fictional all-Black town. A close examination of classic Black nationalist discourse, however, reveals that the politics of Black separatism has, from the time of its origin, stemmed from efforts to establish a Black patriarchal order that could stand in opposition to racist institutions and practices that strip the Black man of the patriarchal status enjoyed by white men. I argue that Morrison’s novel exposes this causal relationship between patriarchal culture and Black separatism and the way that it generates within Black nationalist ideology a tendency to hijack, obscure, or even eliminate racial solidarity efforts that are more intersectional, inclusive, and democratic.
Application research on internal prestress monitoring of box girder based on FBG self-sensing steel strand
Authors: Zeng Rong , Zhu Wanxu , Liu Fengrong , Xiong Chengyang , Liu Rong
Published: May 2024

Internal prestressing is an effective prestressing approach in the concrete box girder that ultimately plays a vital role in their construction. In practical engineering, accurate measurement and long-term monitoring are still challenging. FBG-based self-sensing steel strand (FSS) possesses the advantages of quasi-distributed monitoring of internal cable prestress and long-term stable monitoring. To examine its application in monitoring the internal prestressing of the actual box girder project, as well as to reveal the law of prestressing distribution and prestressing loss in the box girder, the self-sensing steel strand is appropriately experimented by using the cyclic tensile test. Precast and cast-in-place beams are then selected to examine the prestressing process and long-term prestressing monitoring of box girders with single-ended and double-ended tensioning processes. The results reveal that the linearity of FSS is 0.84%, the hysteresis is 0.75%, and the repeatability is 1.87%, which exhibits a good prestress monitoring performance. In the comparative application with the Elasto-Magnetic sensor and the reverse tension method, the instantaneous prestress monitoring results are basically consistent with the Elasto-Magnetic sensor. Due to the influence of the friction resistance of the anchorage, it is slightly lower than the measured value of the reverse tension method. Therefore, the FSS exhibits the accuracy of prestress monitoring and consistency of the actual box girder engineering application. In the monitoring of instantaneous prestress loss, such a loss at the tension end of the box girder mostly caused by the internal shrinkage of prestressed tendon, accounting for 81.3 % on average. The mid-span and the fixed end of the box girder, which experience tension under the single-ended tension conditions, are affected by friction and concrete compression loss. Therefore, reducing the amount of shrinkage of steel strands and adopting the double-ended tension method is still the key to reducing the instantaneous prestress loss. In the long-term prestress loss, the measured value exhibits a certain discontinuity. Compared to the theoretical value, the amount of prestress loss of the box girder tensioned at both ends is linearly positively correlated with the magnitude of applied effective prestress, and the amount of loss is negatively correlated with channel curvature.