Abstract. Background. In 2018 NICE produced their guidelines with regards to the prevention of hospital-acquired thrombosis which extended the age range to include 16- and 17-years old patients, suggesting that these patients are risk assessed and receive thromboprophylaxis if indicated. We analysed the incidence of VTE in this age group in our institution and found it to be extremely low and often not related to risk factors commonly included in adult risk assessment tools. Methods. We retrospectively reviewed the data of 13,951 patients aged 16- and 17-years of age in our admission database at the University Hospitals of Leicester (UHL) over a period of 7 years between 2013 and 2019. This was cross-referenced with our imaging database which identified scans carried out for suspected Venous Thromboembolism (VTE). Results. There were 1,275 admissions and 12,676-day-case attendances over the study period. Of these, 145 patients had scans for suspected VTE. 13 patients had positive scans and fulfilled the inclusion criteria. Of the 13 positive scans, 10 were excluded and 3 patients were included in the study. Conclusion. This study shows that the risk of VTE in the 16- and 17-year-old age group is extremely low in patients attending hospital (0.1% in admitted patients and 0.007% in day attenders). We question whether routine risk assessment for VTE in this age group, especially using existing adult tools, is efficacious. The guidance acknowledges the evidence for prescribed drugs is both lacking and the prescription for such agents being outside their Licencing Authorisation

Falls and fall-related injuries can have devastating health consequences and form a growing economic burden for the healthcare system. To identify individuals at risk for preventive measures and therapies, fall risk assessment scores have been developed. However, they are costly in terms of time and effort and rely on the subjective interpretation of a skilled professional making them less suitable for frequent assessment or in a screening situation. Small wearable sensors as activity monitor can objectively provide movement information during daily-life tasks. It is the aim of this study is to evaluate whether the activity parameters from wearable monitors correlate with fall risk scores and may predict conventional assessment scores. Physical activity data were collected from nineteen home-dwelling frail elderly (n=19, female=10; age=81±5.6 years, GFI=5.4±1.9, MMSE=27.4±1.5) during waking hours of 4 consecutive days, wearing a wearable 9-axis activity monitor (56×40×15mm, 25g) on the lateral side of the right thigh. The signal was analysed using self-developed, previously validated algorithms (Matlab) producing the following parameters: time spent walking, step count, sit-stand-transfer counts, mean cadence (steps/min), count of stair uses and intensity counts >1.5G. Conventional fall risk assessment was performed using the Tinetti sore (range: 0–28=best), a widely used tool directly determining the likelihood of falls and the Short Physical Performance Battery (SPPB, range: 0–12=best) which measures lower extremity performance as a validated proxy of fall risk. The anxiety to fall during activities of daily living was assessed using the self-reported Short Falls Efficacy Scale-International (FES-I, range: 7–28=worst). Correlations between activity parameters and conventional scores were tested using Pearson's r. The activity parameters (daily means) for the 19 participants were 70.8min (SD=28.7; min-max= 22.8–126.6) of walking, 4427 steps (SD=2344; min-max= 1391–8269) with a cadence 79.3 steps per minute (SD=17.1; min-max=52.8–103.9) and 33.3 sit-stand transfers (SD=9.7; min-max=8.8–48.0). The average Tinetti score was 21.2 (SD=5.1; min-max=10.0–27.0), with SPPB scoring 7.8 (SD=2.4; min-max=3.0–12.0), and FES-I 4.6 (SD=5.1; min-max=7.0–23.0). Strong (r≥0.6) and significant correlations existed between the walking cadence and the Tinetti (r=.60, p=<.01) and SPPB (r=.71, p=<.01) scores. No other correlations were found between the activity parameters and the Tinetti, SPPB and none with the psychological FES-I questionnaire. Conventional fall risk scores and activity data are comparable to literature values and thus representative of home-dwelling frail elderly including a wide range covered for both dimensions. No quantitative activity measure had a predictive value for fall risk assessment. Strongly correlated with Tinetti and SPPB, objectively measured cadence as a qualitative parameter seems a useful parameter for remotely identifying fall risk in frail elderly. The perceived anxiety to falls was not correlated to quantitative and qualitative activity parameters suggesting that this psychological aspect hardly affects activity. Wearable activity monitors seem a valid tool to assess fall risk remotely and thus allow low cost, frequent and large group screening of frail elderly towards a health economically viable tool for a growing societal need. The predictive quality of activity monitored data may be increased by deriving additional qualitative measures from the activity data

The ATTUNE™ Knee System (DePuy Synthes) comprises of a tibial insert that is made from AOX™, an antioxidant-stabilized polyethylene. The antioxidant used in AOX is pentaerythritol tetrakis [3-(3, 5-di-tertiary butyl-4-hydroxyphenyl)] propionate (PBHP). A biological risk assessment of the degradation products arising from PBHP has been performed. This assessment focuses on the requirements of ISO 10993–1:2009, ISO 14971:2007, and the Medical Device Directive 93/42/EEC. Because the orthopedic implant is a permanent implant, consideration has been given to all relevant endpoints defined by ISO 10993–1 Biological evaluation of medical devices – Part 1: Evaluation and testing within a risk management process. Comprehensive biocompatibility testing including long-term (26 weeks) subcutaneous implantation has been conducted which confirms the biosafety of the polyethylene compound[1]. In addition to the biological safety testing completed, the overall safety and the associated toxicological risk of exposure to degradation products of PBHP has been given due consideration. The guidelines for the Threshold for Toxicological Concern (TTC) provided by The Product Quality Research Institute (PQRI) Leachables and Extractables Working Group were used in the assessment[2]. This working group is a collaboration of chemists and toxicologists from the U.S. Food and Drug Administration (FDA), industry, and academia. The TTC principle allows safety assessment in the absence of substance-specific hazard data, based on very low levels of exposure to that substance. A Margin of Safety (MOS) is calculated as the ratio of the threshold safety value to the actual exposure quantities determined and used in the assessment. A MOS value greater than 1 is typically judged by risk assessors and regulatory bodies to be unlikely to cause harm and the risk may be considered low. The identity of the degradation products as well as the corresponding 30-day leachable quantities from a water:acetone extraction media has been previously reported [3] and provided here (Table 1). The amount of leachables determined from Table 1 for all products were well below the TTC of 150 ng/device and hence no toxicological risks were identified for these compounds. In order to further examine the toxicological risk assessment, aggressive extraction using Dynamic Head Space (DHS) extraction was done and analytical testing was performed on the degradation products of PBHP using gas chromatography/mass spectrometry (GC /MS). These estimated quantities along with literature information from biological safety studies of the chemicals that were identified from the quantitative GC/MS analysis of degradation products of PBHP were used in the review and toxicological assessment per the methodology described in ISO 14971 and ISO 10993–18. The extraction and analysis confirmed the same sixteen compounds previously identified. The quantities and the calculated margins of safety are summarized (Table 2). In conclusion, upon review of actual test results of PBHP degradation products (Table 1), there is little probability that these organic degradation products would cause a systemic reaction and not be safe. Thus, the potential biological hazards identified in ISO 10993–1:2009 due to the quantified leachables have been verified to be minimal with a high Margin of Safety relative to the Threshold of Toxicological Concern

Aim: to determine the proportion of patients with fragility fractures who underwent risk assessment for osteoporosis as a result of their fracture clinic attendance prior to and following reinforcement of guidelines. Methods: The inclusion criteria were defined as: new patients fifty years of age or over sustaining a fragility fracture of their distal radius presenting during two three month periods in 2004 (April to June and October to December). Guidelines for osteoporosis risk assessment (the Northumberland guidelines) were reinforced during the interim period. Patients were identified from hospital records and the notes obtained to confirm the fracture type as fragility. The number assessed during each period was determined from outpatient referral for DEXA records and compared. Patients who had undergone DEXA scanning in the year prior to their fracture clinic attendance were excluded from the analysis. Results: from April to June there were forty-six patients (39 women and 7 men) with a mean age of 73 years while between October and December there were fifty-four patients (48 women and 6 men) with an average age of 68 years. In the April to June cohort 3 patients had already had a DEXA scan prior to fracture clinic attendance. Of the 43 remaining patients 3 were risk assessed for osteoporosis (7%). Within the October to December group two patients had previously undergone DEXA scanning and of the remaining 52 patients 16 (31%) underwent osteoporosis risk assessment. Conclusion: Risk assessment for osteoporosis is still carried out ineffectively by orthopaedic surgeons even following enforcement of guidelines

Patients with hip fracture are at high risk of venous thromboembolism (VTE). Chemical thromboprophylaxis with low molecular weight heparin (LMWH) is associated with a risk of major bleeding in certain patient groups, such as those with renal failure. In these patients, unfractionated heparin should be used. Our aim was to determine the practice of VTE risk assessment in patients admitted with hip fracture against the national guidance, which states that all should have VTE risk assessment on admission. We also assessed the impact of introducing the VTE risk assessment form on prescribing practice of chemical thromboprophylaxis in patients with renal failure. Prospective audit of patients of 50 patients admitted with hip fracture from 4/8/10 with re-audit of 50 patients admitted from 17/2/2011 after introducing the VTE risk assessment form into the hip fracture admissions proforma. Retrospective analysis was undertaken to determine chemical thromboprophylaxis prescribing in patients with eGFR <30ml/min/1.73m. 2. . Patient demographics were comparable in both audit loops, with the mean age being equal (84 years) and an equal majority of female patients (76%). There were similar numbers of patients with eGFR <30ml/min/1.73m. 2. in both audit loops with 8% (n=4) in the initial audit, and 10% (n=5) in the re-audit. Frequency of VTE risk assessment significantly increased from 16% to 86% after including the VTE risk assessment form in the hip fracture proforma (p<0.0001). Despite this, there was no significant reduction in prescribing of LMWH in patients with renal failure with eGFR <30ml/min/1.73m. 2. , (P=0.52). Documentation of VTE risk assessment in patients admitted with hip fracture can be improved by simple measures such as inclusion of the VTE risk assessment form in the admissions proforma. However, this did not result in a reduction of LMWH prescribed in patients with significant renal failure and risk of major bleeding

Boys affected by Duchenne Muscular Dystrophy (DMD) often develop significant scoliosis in the second decade of life and require scoliosis surgery. Our aim was to establish whether cardiac MRI (CMR) improves the preoperative risk assessment in DMD patients and evaluate the current risk of surgery. Case records were retrospectively reviewed for 62 consecutive DMD boys who underwent pre-surgical evaluation at a single tertiary neuromuscular centre between 2008–2013. 62 DMD patients aged 7–18 years underwent pre-operative assessment for a total of 70 procedures (45 spinal, 19 foot, 6 gastrostomy). Echocardiography data were available for 68 procedures. Echo revealed a median left ventricular (LV) shortening fraction (SF) of 29% (range: 7–44). 34% of boys (23/68) had abnormal SF <25%, 48% (31/65) showed dyskinesia and 22% (14/64) had LV dilatation. CMR was routinely performed on 35 patients. Of those who underwent CMR, median left ventricular ejection fraction (LVEF) was 52% (range: 27–67%), 71% of boys (25/35) had dyskinesia. Echocardiography shortening fraction (SF) correlated significantly with CMR LVEF (r. s. = 0.67; p<0.001). Increasing severity of dyskinesia on CMR correlated with reduced CMR LVEF (r. s. = −0.64; p<0.001) and reduced echo SF (r. s. = −0.47; p = 0.004). Although functional echocardiography and CMR data tended to correlate in 35 DMD boys who underwent both imaging modalities nine (26%) had discrepant results. Seven (20%) had evidence of dysfunction on CMR (LVEF < 55%) not detected on echocardiography (SF ≥ 27%); in two cases echocardiogram measured worse function than CMR. Based on multi-disciplinary risk assessment, surgery was considered too high risk in 23 out of 67 (34%) cases. In 21 cases (91%) this was due to underlying cardiomyopathy. The highest risk among older boys assessed for spinal surgery; 21 out of 43 (49%). Of 19 boys undergoing spinal surgery, six (32%) experienced complications: two wound infections; three patients required readmission to intensive care; one patient died in the post-operative period with acute heart failure

We aimed to audit the results of one stop fragility fracture risk assessment service at fracture clinic for non-hip fractures in 50–75 years old patients at Newcastle General Hospital. Currently, fewer than 30% of patients with fragility fractures benefit from secondary prevention in the form of comprehensive risk assessment and bone protection because of multifactorial reasons. We have a fragility fracture risk assessment service staffed by an Osteoporosis Specialist Nurse equipped with a DEXA scanner located at the fracture clinic itself. We carried out a retrospective audit of 349 patients of 50–75 years with suspected non-hip fractures referred from A& E Department from October 2006 to September 2007. Patients over 75 years were excluded because as per NICE guidelines, they should receive bone protection without need of a DEXA scan. Out of these 349 patients with suspected fractures, 171 had fragility fractures. Median age was 64 years. 69 patients had humerus fracture, 65 had forearm fracture and 23 patients had ankle fracture and 14 had metatarsal fractures. Fracture risk assessment was carried out in 120 (70%) patients. Thirty Seven (31%) patients had osteoporosis and bone protection was recommended to GP. 38 (32%) had osteopenia and lifestyle advice was provided. 45 (37%) had normal axial bone densitometry. 90% patients had DEXA scan at the same time of fracture clinic appointment. Patients with male gender, undisplaced fracture and fewer fracture clinic appointments were more likely to miss fracture risk assessment. Our experience suggests that locating fragility fracture risk assessment service co-ordinated by an Osteoporosis Specialist Nurse at fracture clinic is an efficient way of providing secondary prevention for patients with fragility fractures. This can improve team communication, eliminate delay and improve patient compliance because of ‘One Stop Shop’ service at the time of fracture clinic appointment

To explore a novel machine learning model to evaluate the vertebral fracture risk using Decision Tree model and train the model by Bone Mineral Density (BMD) of different compartments of vertebral body. We collected a Computed Tomography image dataset, including 10 patients with osteoporotic fracture and 10 patients without osteoporotic fracture. 40 non-fracture Vertebral bodies from T11 to L5 were segmented from 10 patients with osteoporotic fracture in the CT database and 53 non-fracture Vertebral bodies from T11 to L5 were segmented from 10 patients without osteoporotic fracture in the CT database. Based on the biomechanical properties, 93 vertebral bodies were further segmented into 11 compartments: eight trabecular bone, cortical shell, top and bottom endplate. BMD of these 11 compartments was calculated based on the HU value in CT images. Decision tree model was used to build fracture prediction model, and Support Vector Machine was built as a compared model. All BMD data was shuffled to a random order. 70% of data was used as training data, and 30% left was used as test data. Then, training prediction accuracy and testing prediction accuracy were calculated separately in the two models. The training accuracy of Decision Tree model is 100% and testing accuracy is 92.14% after trained by BMD data of 11 compartments of the vertebral body. The type I error is 7.14% and type II error is 0%. The training accuracy of Support Vector Machine model is 100% and the testing accuracy is 78.57%. The type I error is 17.86% and type II error is 3.57%. The performance of vertebral body fracture prediction using Decision Tree is significantly higher than using Support Vector Machine. The Decision Tree model is a potential risk assessment method for clinical application. The pilot evidence showed that Decision Tree prediction model overcomes the overfitting drawback of Support Vector Machine Model. However, larger dataset and cohort study should be conducted for further evidence

Introduction:. NICE guidelines state that every patient should be assessed for their VTE risk on admission to hospital. The aim of this study was to determine whether currently recommended risk assessment tools (Nygaard, Caprini, NICE and Plymouth) can correctly identify the patients at risk. Methods:. In a consecutive series of over 750 trauma patients treated with cast immobilisation 23 were found to have suffered a VTE. Their notes were retrospectively reviewed to discover how many had been assessed for their VTE risk on admission. Additionally, the 4 most current Risk Assessment Tools were used to retrospectively score the patients for their VTE risk to determine whether they would have been identified as at risk of sVTE, had the RAMs been used at the time. We also identified a matched group of patients in the same cohort who had not suffered a VTE and they were also retrospectively risk assessed. Results:. NICE (2010), Caprini (2001) and Nygaard (2009) identified 100% of the 750 patients as at risk of sVTE but had a specificity of 0% as only 23 went on to develop VTE. The Plymouth Score (2010) was more specific and identified 56.3% patients of the 23 confirmed VTEs as ‘at risk’. However it would not have recommended prophylaxis in the remaining 46.7 & that did in fact go on to developed VTE. Conclusion:. The tools used in this study have no clinical utility in this patient group. Detailed evaluation of the different RAMs is required in order to improve their discriminatory power. A reliance on NICE, Caprini and Nygaard tools would have required all 750 patients in this group to have been treated with thromboprophylaxis and therefore lacked sensitivity. However the Plymouth Score would have failed to recommend thromboprophylaxis in half of the patients who eventually developed VTE

Introduction. Reducing readmissions after total joint arthroplasty (TJA) is challenging. Pre-operative risk stratification and optimization pre surgical care may be helpful in reducing readmission rates after primary TJA. Assessment of the predictive value of individual modifiable risk factors without a tool to properly stratify patients may not be helpful to the surgical community to reduce the risk of readmission. We developed a scoring system: Readmission Risk Assessment Tool (RRAT) as part of a Perioperative Orthopaedic Surgical Home model that allows for risk stratification in patients undergoing elective primary TJA at our institution. We analyzed the relationship between the RRAT score and readmission following primary hip or knee arthroplasty. Methods. The RRAT, which is scored incrementally based on the number and severity of modifiable comorbidities was used to generate readmission scores for a cohort of 207 readmitted and 2 cohorts of 234 (random and age-matched) non-readmitted patients each. Regression analysis was performed to assess the strength of association between individual risk factors, RRAT score and readmissions. We also calculated the odds and odds ratio (OR) at each level of RRAT score to identify patients with relatively higher risk of readmission. Results. There were 207(2.08%) 30-day readmissions in 9,930 patients over a 6-year period (2008 to 2013). Surgical site infection was the most common cause of readmission (93 cases, 45%). The median RRAT scores were 3 (IQR: 1, 4) and 1 (IQR: 0, 2) for readmitted group and non-readmitted group respectively. The RRAT score was significantly associated with readmission with odds ratio between 1.5 and 1.9 under various model assumptions. A RRAT score of 3 or higher resulted in higher odds of readmission. Discussion and Conclusion. Population health management, cost-effective care and optimization of outcomes to maximize value are the new maxims for healthcare delivery in the United States. The RRAT has a significant association with readmission following joint arthroplasty and could potentially be a clinically meaningfully tool for risk mitigation

Aim

There is an ongoing controversy whether the observed benefit of infection risk reduction by ALBC outweighs the risk of possible antimicrobial resistance development.

Objectives: The view that patients low back pain presenting with ‘abnormal’ psychometric and poor DRAM scores predict an unsatisfactory surgical outcome is considered controversial. This prospective study was designed to identify if DRAM Scores (Scores of Distress Risk Assessment Method) is a predictive determinant or a reactive instrument in regard to the outcome of Endoscopic Foraminoplasty. Design: Pre- and postoperative assessment of disability and DRAM at two years. Subjects: One hundred and eighty-five patients (86 males and 99 females) underwent an Endoscopic Laser Foraminoplasty between April 1997 and November 1998. Outcome measures: Oswestry Disability Scale, and the Visual Analogue Pain Scale and the DRAM scores. Patients were categorised by their pre-op DRAM score. Kruskal-Wallis analysis of variance and a regression analysis were performed. Results: There was significant improvement in disability and pain scores at two years. (p< 0.05). A significant difference in median DRAM between the preoperative and postoperative score at two years was noted. Conclusion: The DRAM score highlights individuals in distress who may need psychological support and physical treatment for optimum benefit from endoscopic spinal intervention. While the DRAM score predicted the patients’ disability and pain it failed to predict percentage benefit gain in outcome

The view that patients low back pain presenting with ‘abnormal’ psychometric and poor DRAM scores predict an unsatisfactory surgical outcome is considered controversial. This prospective study was designed to identify if DRAM Scores (Scores of Distress Risk Assessment Method) is a predictive determinant or a reactive instrument in regard to the outcome of Endoscopic Foraminoplasty. One hundred and eighty-five patients (86 males and 99 females) underwent an Endoscopic Laser Foraminoplasty between April 1997 and November 1998. Pre- and postoperative assessment at 2 years was made using the Oswestry Disability Scale, and the Visual Analogue Pain Scale and the DRAM scores. Patients were categorised by their pre-op DRAM score. A Kruskal-Wallis analysis of variance and a regression analysis were performed. There was significant improvement in disability and pain scores at two years. (p< 0.05). A significant difference in median DRAM between the preoperative and postoperative score at two years was noted. While the DRAM score predicted the patients’ disability and pain it failed to predict the change in outcome. The DRAM score highlights individuals in distress who may need psychological support and physical treatment for optimum benefit from endoscopic spinal intervention and not be used to deny a surgical intervention

Background and objectives

The prevention of osteoporotic fractures is a global problem. Key to this strategy is efficient identification of ‘at risk’ patients in order to address the osteoporosis pandemic, including the identification of previously sustained fractures. GP practices are now integrating touch screens as a method of registering patients' attendance for an appointment, so all ages of patients are becoming familiar with this channel of communication. Our touch screen patient administered questionnaire system intends to provide an effective solution.

Aims: The purpose of the study is to evaluate the risk of fractures in long bones with metastases based on intact cortical bone index (ICBI) and functional assessment. Methods: We evaluate radiograms of 36 (25 fractures) and 86 patients (56 fractures) with the upper and lower extremity metastases, respectively. We measured on radiograms intact cortical bone index (ICBI) using the schedule K-G/K-J x100%, where is K-shaft diameter, G-size of destruction, J-bone marrow diameter above or below the metastases. We asses the extremity function by the ability to elevate and abduct it straight. Results: We found that fracture occurs if the ICBI is lower than 46% and 40% in upper and lower extremity, respectively. 7 (5,7%) patients develop fracture despite higher ICBI. If the metastases are located in upper part of the femur and humerus and he/she can not elevate or abduct the extremity the fracture inevitably occurs. Conclusions: Counting the ICBI and simple functional assessment allows to predict fracture in 94,3% of patients with long bone metastases.

Background: ProFaNE is an EC-funded network supporting collaboration between researchers in the field of falls injury prevention. One component of ProFaNE concerns psychosocial aspects of falls prevention, which include assessment of fear of falling and attitudes to falls prevention programmes. Findings from members’ collaborative qualitative research on attitudes to falls prevention will be presented.

Methods: We conducted interviews with older people, assessing their beliefs and attitudes regarding falls prevention programmes. Interviews were structured around the Theory of Planned Behaviour, were carried out in the UK, the Netherlands, Germany, Switzerland, Norway, Greece and Italy. The thematic analysis reported here compares the beliefs of those who had taken part in a falls prevention programme and those who had not been offered this option.

Findings: Whilst many may reject the notion that falls are anything to do with them, participants reported being motivated to take part in programmes that are designed to improve strength and balance chiefly by a desire for, and experiences of, immediate benefits (including improved functioning and mobility, enjoyment and increased self-confidence) rather than by fear of falling. The main reported barriers to participation included lack of familiarity with such programmes, concern about exertion, transport and financial obstacles, and lack of motivation.

Conclusions: Falls prevention has negative connotations for many older people. Participation in falls prevention programmes may be enhanced by maximising and promoting their immediate benefits rather than their potential for reducing falls, by removing practical barriers, and by providing opportunities to sample programmes in order to demonstrate their immediate benefits. A focus on exercise as promoting health, fitness and independence may have wider acceptability.

Introduction

There is a need for a standardised guideline to assist in optimal decision-making in diabetics who have acquired an ankle fracture. Through a critical analysis of the literature, a diagnostic and management algorithm that incorporates a quantitative scoring system is proposed and presented for consideration.

Surgeons must explain the risk of complications to prospective patients and get informed consent. If a complication that occurred was omitted in the process or given the wrong risk level, culpability of the surgeon is judged in court against what a “reasonable patient” would like to know to give or refuse consent.

ObjectivesThe concept “reasonable patient” is widely used, no attempt has been made to define it objectively. We assessed insight of patients, presumed “reasonable”, about risks of certain complications after they underwent one of five orthopaedic procedures.

Questionnaire was administered with procedures: femur IMN, tibia IMN, ankle ORIF, distal radius ORIF and hip arthroplasty. Four common/serious complications were chosen per procedure, and matched against life events with documented risk levels.

There were 230 participants 163 males and 67 females. We found 19.1% of patients above age 40 and 33.3% with tertiary education wouldn't accept nerve injury as reported in literature. With infection risk, 18.1% above 40 and 52.9% with pre-tertiary education would not accept. All patients below 40 and 7.4% pre-tertiary education wouldn't accept the risk of death as reported. However, 37.1% above 40 and 76.9% with pre-tertiary education would accept that risk at a higher level.

It is hard to predict what risk of complication a patient may accept. This study highlights that some patients will not accept risks as reported in literature, even though they need the procedure. Therefore, surgeons need to explain complications fully, so that patients knowingly accepts or refuses consent. The subset of patients who are not willing to accept any level of risk, should be the subject of another study.

The aim of this study was to identify factors independently associated with symptomatic venous thromboembolism (VTE) following acute Achilles tendon rupture (ATR), and to suggest a clinical VTE risk assessment tool for patients with ATR. From 2010–2018, 984 consecutive adults (median age 47yrs, 73% male) sustaining an ATR were retrospectively identified. There were 95% managed non-operatively (below-knee cast 52%, n=507/984; walking boot 44%, n=432/984), with 5% (n=45/984) undergoing primary operative repair (<6wks). VTE was diagnosed using medical records and national imaging archives, reviewed at a mean of 5yrs (1–10) post-injury. Regression was performed to identify factors independently associated with VTE. Incidence of VTE within 90 days of ATR was 3.6% (n=35/984; deep vein thrombosis 2.1% [n=21/984], pulmonary embolism 1.9% [n=19/984]). Age ≥50yrs (adjusted OR [aOR] 2.3, p=0.027), personal history of VTE/thrombophilia (aOR 6.1, p=0.009) and family history of VTE (aOR 20.9, p<0.001) were independently associated with VTE. These non-modifiable risk factors were incorporated into a VTE risk assessment tool. 23% of patients developing VTE (n=8/35) had a relevant personal or family history, but incorporating age into the tool identified 69% of patients with VTE (n=24/35). Non weight-bearing ≥2wks after ATR was also independently associated with VTE (aOR 3.2, p=0.026). Age ≥50 years, personal history of VTE/thrombophilia and a positive family history were independently associated with VTE following ATR. Incorporating age into our suggested VTE risk assessment tool enhanced sensitivity in identifying at-risk patients. Early weight-bearing in an appropriate orthosis may be beneficial in VTE risk reduction

Osteoarthritis (OA) of the hip is the most common indication for total hip replacement (THR). Obesity is a risk factor for the development of OA and has recently resulted in patients requiring THRs at much younger ages to relieve pain at the joint capsule and restore mobility. However, the impact of obesity on THR mortality is not well understood. An updated systematic review was performed to identify whether an obese BMI should influence patient selection for surgery. Specifically, the impact of obesity on short-term mortality, long-term mortality, and peri- and post-operative complications was assessed with a particular focus on BMI classes. A comprehensive literature search of Ovid Medline and EMBASE in November 2022 identified relevant papers in accordance with PRISMA methodology. After removing duplicates, 2988 articles underwent strict inclusion and exclusion criteria, resulting in 12 papers for analysis. There was no statistically significant difference in mortality risk between obese and non-obese populations. Obesity was associated with a lower risk of short-term mortality than in the normal weight control group, however there was an increased mortality risk in obese patients long-term likely due to comorbidities. Obese patients were significantly younger than normal BMI and underweight patients. However, the paper found increased mortality risk in underweight and morbidly obese patients. Obese patients did not have an increased risk of mortality when compared to non-obese patients following THR. Obesity may have a protective effect on mortality up to a BMI of 40kg/m2, although this may be influenced by the obesity paradox which states only the healthiest obese individuals are selected for surgery, which could attribute to a lower mortality risk. The greatest risk of mortality and complication was associated with underweight patients. As a result, a BMI greater than 30kg/m2 may not necessitate a hip replacement contraindication. It is important surgeons apply careful consideration and comprehensive risk assessment on patients who require a THR, especially at the BMI extremes