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Bone & Joint Open
Vol. 4, Issue 8 | Pages 621 - 627
22 Aug 2023
Fishley WG Paice S Iqbal H Mowat S Kalson NS Reed M Partington P Petheram TG

Aims

The rate of day-case total knee arthroplasty (TKA) in the UK is currently approximately 0.5%. Reducing length of stay allows orthopaedic providers to improve efficiency, increase operative throughput, and tackle the rising demand for joint arthroplasty surgery and the COVID-19-related backlog. Here, we report safe delivery of day-case TKA in an NHS trust via inpatient wards with no additional resources.

Methods

Day-case TKAs, 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.


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 20 - 20
7 Aug 2023
Fishley W Paice S Iqbal H Mowat S Kalson N Reed M Partington P Petheram T
Full Access

Abstract

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.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_8 | Pages 100 - 100
1 Apr 2017
Al-Azzani W Iqbal H Thayaparan A White S
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Background

The incidence of bleeding following primary TKR has increased with the use of chemical thromboprophylaxis. Our aim was to compare Clexane, Apixaban and Rivaroxaban in terms of frequency and volume of bleeding episodes, need for blood transfusion, return to theatre and incidence of VTE events.

Methods

Between February and May 2014, a consecutive series of 132 primary TKRs were studied prospectively. The wound dressings of these patients were assessed daily to look for signs of bleeding and classified into: Mild (< 50p size coin), moderate (> 50p size coin) or Severe (blood seeping through the dressing). Follow up was up to minimum of 30 days post discharge.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_8 | Pages 101 - 101
1 Apr 2017
Al-Azzani W Iqbal H Al-Soudaine Y Thayaparan A Suhaimi M Masud S White S
Full Access

Background

Increasing number of studies investigating surgical patients have reported longer length of stay (LOS) in hospital after an operation with higher ASA grades. However, the impact of Body Mass Index (BMI) on LOS in hospital post Total Knee Replacement (TKR) remains a controversial topic with conflicting findings in reported literature. In our institution, we recently adopted a weight reduction program requiring all patients with raised BMI to participate in order to be considered for elective TKR.

Objectives

This has prompted us to investigate the impact BMI has on LOS compared to the more established impact of ASA grade on patients following Primary TKR.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_13 | Pages 10 - 10
1 Jun 2016
Iqbal H Al-Azzani W Al-Soudaine Y Suhaimi M John A
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A number of studies have reported longer length of hospital stay (LOS) after surgery in patients with higher ASA grades. The impact of Body Mass Index (BMI) on LOS after Total Hip Replacement (THR) remains unclear with conflicting findings in reported literature. In our hospital we strongly encourage all patients with a raised BMI to participate in a weight reduction programme prior to surgery. This prompted us to investigate the impact BMI has on LOS compared to the more established impact of ASA grade.

A retrospective analysis was conducted on all elective primary THR patients between 11/2013 to 02/2014. LOS in BMI groups <30, 30–39 and ≥40 and ASA grades 1–2 and 3–4 was compared. Where appropriate, independent t-test and non-parametric Mann-Whitney test were used to predict significance.

122 THR were analysed. Mean LOS in BMI groups <30, 30–39 and ≥40 were 5.6, 6.2 and 8.0 days, respectively. This was not predicted significant (p=0.7). Mean LOS in ASA groups 1–2 and 3–4 were 5.2 and 9.3, respectively. This was predicted significant (p-value < 0.01).

In patients undergoing primary THR, ASA grade is a better predictor of LOS than BMI. Our data adds to the evidence that high BMI alone is not a significant factor in prolonging LOS after a primary THR. This should be taken into account when allocating resources to optimise patients for surgery.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_1 | Pages 17 - 17
1 Jan 2014
Iqbal H Srivastava P Davies R Saville S Bruce C Garg N
Full Access

Aims:

To assess the success rate of closed reduction after failing Pavlik harness for treatment of DDH.

Methods:

It was a retrospective review of prospectively collected data. Patient's notes/computerised records were reviewed. Radiological investigations were also reviewed. Microsoft excel used for descriptive stats.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_19 | Pages 3 - 3
1 Apr 2013
Iqbal H Khan Y Pidikiti P
Full Access

Introduction

We conducted an audit on hip fractures to analyse the accuracy of coding and payment by results in our institution.

Materials/Methods

The initial audits analysed hip fracture over a period of four months at two different trusts. Case notes were reviewed to extract data regarding diagnosis, comorbidities and operative procedures. The findings were compared with the data from clinical coding department and difference in the tariff was analysed. A re-audit was performed at Trust B after implementation of changes to assess improvement.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 8 - 8
1 Jan 2013
Khan Y Stables G Iqbal H Barnes S
Full Access

Background

A large number of Tendo-Achilles (TA) injuries occur during sporting activity. Typically occurring in males aged 30–50, whom occasionally undertake sporting activities, the so called ‘weekend warriors’.

Aims

To assess the impact of TA rupture on return to sporting activity in the non-elite athlete.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 270 - 270
1 Sep 2012
Iqbal H Iqbal S Barnes S
Full Access

INTRODUCTION

Hallux Valgus is a common foot condition, which may affect mobility and lifestyle. Corrective surgery is performed as a day case procedure, however, post-operatively; patients remain limited in their ability to drive for a variable period. In the laboratory settings, emergency brake response time after first metatarsal osteotomy has been studied but there is no published study of patients’ experience of driving after this surgery. This study was aimed at assessing patients’ driving ability and comfort after Hallux Valgus corrective surgery.

METHODS

Fifty consecutive patients who underwent first metatarsal corrective osteotomy from January 2009 to July 2010 were reviewed. The operation type, foot side operated, postoperative complications and other conditions affecting driving were recorded from charts and operation notes. A telephonic survey was then conducted and information was recorded in a predesigned questionnaire. The questions included driving advice given by the medical staff, time interval to begin driving postoperatively, and how long the patient took to gain full confidence at driving. It was also noted whether patients required changing the type of car from manual to automatic.


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_II | Pages 403 - 403
1 Jul 2008
Sivardeen K Iqbal H Abudu A
Full Access

Background: The dorsal wrist ganglion is one of the commonest tumours to be found in the upper limb. Aims: We aimed to find out how specialist upper limb surgeons managed this common condition, and to propose best practice guidelines.

Methods: We sent a standard questionnaire by email to 100 hand surgeons who were members of the British Society for Surgery of the Hand.

Results: 62% returned the completed questionnaire. 93% routinely used a tourniquet, 73% used general anaesthetic. 83% would not use Xray or further imaging. 62% would operate on less than 10 a year or as few as possible. Only 42% routinely sent tissue for histology and 71% used a transverse incision.

Discussion and Conclusions: Most upper limb surgeons diagnose a ganglion clinically, use a transverse incision for excision and do not routinely send tissue for histology. We believe that ganglia should be treated like other neoplasms and excised via a longitudinal incision and tissue sent for histology. We present a series of cases which were thought to be simple ganglia, but histology revealed different pathology. The use of a transverse incision, may compromise definitive excision at a later date, if histology revealed a malignant neoplasm. A transverse incision has not been shown to give superior results in terms of cosmesis, and is also associated with an increased risk of painful neuroma formation after damage to the superficial radial nerve.