Purpose. Total and partial joint arthroplasty has been clinically proven to successfully relieve pain and improve function in patients with hip and knee degenerative arthrosis. It has been shown that early return to ambulation correlates well with functional scores. Moreover, the benefits of reduced narcotic use are multi-fold and range from reduced risk of addiction, gastrointenstinal and cardiopulmonary side effects. Establishing realistic pre-operative expectations regarding functional improvement and pain control will nevertheless impact patient satisfaction. Thus, the purpose of this study was to establish safe, achievable and data-driven benchmarks for post-operative ambulation and pain control in patients undergoing elective total joint arthroplasty. Methods. A retrospective chart review was performed for of all patients who underwent elective primary total or partial joint replacement by a single fellowship trained academic joint replacement surgeon from 2/1/2015 to 2/29/16. Patients under the age of 18 as well as those who underwent arthroplasty to treat a traumatic injury or to revise an arthroplasty were excluded. Charts were reviewed for the method of ambulation (no ambulation, wheelchair, assistive devices, no devices) and use of prescription pain medications by 6 weeks post-operatively. Results. 82 patient undergoing elective primary arthroplasty were identified and included in the analysis. 38% of patients underwent TKA (31 of 82) and 62% of patients (51 of 82) underwent THA via the direct anterior approach. Post-operatively 63% (52 of 82) patients were ambulating without assist device. An additional 24% (20 of 82) of patients were ambulating with a single point assist device by 6 weeks. 77% (63 of 82) of patients were pain free by 6 weeks post operatively and denied taking any prescription pain medications. Conclusions. Our analysis demonstrates that approximately 80% of patients undergoing elective total joint arthroplasty can be pain free without a need for prescription pain medication by 6 weeks post operatively. Moreover, while close to 90% of patients can expect to ambulate with at most, a single point assist, the majority (62%) can reliably expect to ambulate freely just 6 weeks after surgery. These results aid our understanding of post-operative return to function, and pain control. What is more, these data can inform a clinician in setting realistic, data-driven goals and expectations with patients undergoing elective total joint arthroplasty, thereby ultimately improving patient satisfaction with these commonly performed procedures

Objective. Wearable sensors have enabled objective functional data collection from patients before total knee replacement (TKR) and at clinical follow-ups post-surgery whereas traditional evaluation has solely relied on self-reported subjective measures. The timed-up-and-go (TUG) test has been used to evaluate function but is commonly measured using only total completion time, which does not assess joint function or test completion strategy. The current work employs machine learning techniques to distinguish patient groups based on derived functional metrics from the TUG test and expose clinically important functional parameters that are predictive of patient recovery. Methods. Patients scheduled for TKR (n=70) were recruited and instrumented with a wearable sensor system while performing three TUG test trials. Remaining study patients (n=68) also completed three TUG trials at their 2, 6, and 13-week follow-ups. Many patients (n=36) have also participated up to their 26-week appointment. Custom developed software was used to segment recorded tests into sub-activities and extract 54 functional metrics to evaluate op/non-operative knee function. All preoperative TUG samples and their standardized metrics were clustered into two unlabelled groups using the k-means algorithm. Both groups were tracked forward to see how their early functional parameters translated to functional improvement at their three-month assessment. Test total completion time was used to estimate overall functional improvement and to relate findings to existing literature. Patients that completed their 26-week tests were tracked further to their most recent timepoint. Results. Preoperative clustering separated two groups with different test completion times (n=46 vs. n=22 with mean times of 13s vs. 22s). Of the faster preoperative group, 63% of patients maintained their time, 26% improved, and 11% worsened whereas of the slower preoperative group, 27% maintained, 64% improved, and 9% worsened. The high improvement group improved their times by 4.9s (p<0.01) between preoperative and 13-week visits whereas the other group had no significant change. Test times were different between both groups preoperatively (p<0.001) and at 6 (p=0.01) and 13 (p=0.03) weeks but not at 26 weeks (p=0.67). The high improvement group reached an overall improvement of 9s (p<0.01) at 26 weeks whereas the low improvement group still showed no improvement greater than the TUG minimal detectable change of 2.2s (1.8s, p<0.01)[1]. Test sub-activity times for both groups at each timepoint can be seen in Figure 1. Conclusions. This work has demonstrated that machine learning has the potential to find patterns in preoperative functional parameters that can predict functional improvement after surgery. While useful for assigning labels to the distinguished clusters, test completion time was not among the top distinguishable metrics between groups at three months which highlights the necessity for these more descriptive performance metrics when analyzing patient recovery. It is expected that these early predictions will be used to realistically adjust patient expectations or highlight opportunities for physiotherapeutic intervention to improve future outcomes. For any figures or tables, please contact the authors directly

Introduction

Schoulder function in the rheumatoid patient is often restricted by pain and the decrease of range of motion, muscle strength and coordination. The aim of treatment in particular joint replacement is to improve one or more of these factors to enhance shoulder function. It is unknown how much range of motion of the shoulder and the glenohumeral joint is actually needed after shoulder replacement for a reasonable function.

Methods

The shoulder function of 114 rheumatoid patients (28 male and 86 female) with a shoulder replacement was pre- and post-operatively scored at regular intervals with the Constant scale and the HSS scoring system. These scoring systems measure the ROM and daily functioning. Activities of daily living used were: dress, comb hair, wash opposite axilla and use toilet and these items were scored numerically (5=normal, 0=impossible). These items were correlated with the active ROM of the shoulder and the passive ROM of the glenohumeral joint. The passive ROM of the glenohumeral joint included the ab/adduction movement in the frontal plane, the rotation in resting position and the exorotation in 90° anteflexion. 54 Patients had a hemi-arthroplasty and 60 patients had a total shoulder prosthesis. The average follow-up was 5 years.

Results

The average active ROM measured at follow-up was: flexion 81°±36; abduction 70°±27; exorotation 21°±23. The average passive glenohumeral motion was: exorotation in 90° flexion 42°±33; ab/adduction 51°±21; rotation 61°±30. The average functional score of the activities of daily living measured were: comb hair 2. 8±1. 9; toilet use 3. 9±1. 6 and wash opposite axilla 4±1. 5. There was a significant relationship between flexion/rotation and the functional task comb hair. The other activities of daily living were not significantly related with ROM of the shoulder. The minimal range of motion for optimal functioning of the shoulder was calculated.

Discussion

Exorotation of the 90° flexed shoulder appears to be the most important parameter for an optimal functioning after shoulder prosthesis.

Introduction: Anterior lumbar interbody fusion (ALIF) with posterior stabilisation is an established treatment for degenerative disc disease.¹ Some previous reports have advocated a goal of 360 degree fusion, and condemned posterior stabilisation as it does not achieve fusion of the posterior facet joints.² Others have claimed that the concept of a ‘locked pseudarthrosis’ gives satisfactory clinical results.³ There is also a contention that private or self-funding patients achieve better results after spinal fusion compared to those treated under compensation or Dept. Veterans Affairs (DVA) schemes.

Methods: Twenty patients who had undergone an ALIF with posterior stabilisation were retrospectively reviewed. All had a follow-up greater than 12 months. 13 patients were private and 7 non-private. The groups were aged and sex matched. Radiological assessment of fusion was made with reconstruction CT scans. Oswestry Disability Index (ODI) scores were recorded preoperatively, 6 months and 12 months post operation.

Results: Patients with locked pseudarthrosis showed no significant difference in outcome compared to those with radiological fusion. Both groups showed signifi cant improvement in ODI scores after ALIF (mean preop. = 52 – range 16-74; mean postop. = 18 – range 0-52; p< 0.01). There was a significantly greater improvement (p< 0.02) in ODI scores in private patients (mean reduction = 41 points) compared to worker’s compensation or DVA patients (mean reduction = 22 points).

Discussion: The results indicate that ALIF with posterior stabilisation can achieve good clinical results even with a ‘locked pseudarthrosis’. While there is no significant difference between outcomes in different health funding groups shown in the study, carefully patient select for this treatment is the key to success.

Background: Feet and lower limb deformities compromise function of children to meet there growing abilities and peer demands. Ilizarov is a known tool in the correction of lower limb deformities.

Purpose: to evaluate the functional outcome of Ilizarov correction of lower limb deformities, and to compare the functional outcome of correction of feet deformity versus other lower limb segments deformity.

Subjects and Methods: 94 Ilizarov corrections of lower limb deformed segments (in 63 children) were performed, of them 43 were feet, 33 were tibial and 18 were femoral deformities. Etiology of deformity was congenital in 72, acquired in 18, and developmental in 4. Functional ability of walking distance, cope with peers, single leg stance, hopping on affected leg, and climbing stairs before and after deformity correction were assessed.

Results: Mean follow was 55.1 ± 30.9 months, mean age at time of operation was 11.1 ± 5.3. At last follow up the corrected deformities of lower limb had a significant increase to full walking distance from 37, to 76 lower extremities (p=0.000). Coping with peers increased from 40, to 68 (p=0.000) extremities. The single stance on the affected extremity increased from 30, to 78(p=0.000). The hopping on affected limb increased from 18, to 41(p= 0.000), climbing stairs increased from 79 and 94(p=0.000) extremities.

Although disability before correction was significantly more pronounced among feet deformities as regards single stance (p=0.001), and hopping on one leg (p=0.023). The improvement to full walking distance, coping with peers, single stance, hoping and climbing stairs was significantly higher among corrected feet (p=0.000), (p=0.000), (p=0.000), (p=0.000), (p=0.000) compared to other corrected lower limb deformities.

Conclusion: Deformity of feet is significantly more disabling functionally than other lower limb deformities. Ilizarov foot correction is significantly more functionally rewarding than Ilizarov correction of other lower limb deformities.

We present a unique prospective study which estimates the median sustained stage related improvement in pain and hand function predicting symptomatic relief period with high accuracy with a single steroid injection.

Patients were grouped into stages, I to IV according to the Eaton and Glickel radiological criteria. The steroid injection contained 40mg triamcelone and 1% lido-caine. The response was assessed by DASH and a visual analogue score before and at six-week interval. We used the Kaplan-Meier method to estimate median length of sustained improvement by grade of disease, with 95% confidence interval. All the patients were injected by an upperlimb physiotherapist (DD). Post injection review was carried out by an independent observer(MK).

Forty patients were studied: 33 females and 7 males. The age ranged from 53 to 81 years, (mean 65years). No patient was lost to follow-up. Mean duration of symptoms were 36 months. Six patients has stage I disease(15%), eighteen patients had stage II disease (45%), ten patients had stage III disease (25%) and six patients has stage IV disease (15%). Pain score ranged from 4 to 9 on visual analogue score. Reduction in pain visual analogue score was noticed in all but 3 patients. With the exception of Grade III patients, DASH scores decreased significantly at 6 weeks (Grade I 14.9, Grade II 19.3, Grade III 6.2 and Grade IV 10.0.). With the exception of Grade IV patients, pain scores decreased significantly at 6 weeks. In Grade II patients, over half had sustained symptomatic relief at 6 months. So on average, we can expect grade I patients to sustain symptomatic relief for an average of 17 weeks. The true average is likely to be between 13 and 21 weeks. For grade II patients, most will still have improved at 6 months. Grade III and IV patients have an identical prognosis of 4 weeks, though the true prognosis may be between 2 and 6 weeks.

In conclusion it is possible to predict the period of symptomatic improvement in each of the four disease stages. This allows the treating clinician to discuss the outcome of treatment with reasonable accuracy.

Aims: To evaluate the impact of etoricoxib, a cyclo-oxygenase (COX)-2 inhibitor on functional status of chronic low back pain (LBP) patients using the 24 question Roland-Morris Disability Questionnaire (RMDQ). Methods: 644 patients were assigned to receive etori-coxib (60 mg/d [n=212] or 90 mg/d [n=213]) or placebo (n=219) in two identically designed, randomized 3 month studies. Patients completed the RMDQ prior to randomization, at baseline, and 1, 2, 4, 8, and 12 weeks. The global score was analyzed as a time weighted average ranging from 0 (no pain) to 24 (unbearable pain). An exploratory analysis of patientñs response to the individual RMDQ questions at Week 12 relative to baseline was also performed for etoricoxib 60 mg versus placebo. Results: Demographics were evenly distributed between groups and studies. The average duration of LBP was 12 years. Reduction in RMDQ score over the 12 week study was greater with etoricoxib 60 mg (−6.85) and 90 mg (−6.43) than with placebo (−4.21). Treatment difference from placebo was signiþcant (P< 0.001) for etoricoxib 60 mg [−2.63 (CI: −3.6, −1.67)] and 90 mg [−2.22 (CI: 3.18, –1.26)]. Signiþcant improvement (p-values < 0.05) with etoricoxib 60 mg compared to placebo was observed on 15 of the 24 individual questions from baseline to Week 12. A strongly signiþcant improvement (p-values ≤0.003) with etoricoxib 60 mg compared to placebo was observed on nine of the 24 questions. Conclusions: Etoricoxib provided signiþcant improvement in functional status assessed with the Roland-Morris Disability Questionnaire. The activities with the most signiþcant level of improvement with etoricoxib included: pain/discomfort, standing/walking, getting out of a chair, getting dressed, and walking up steps

We investigated the clinical response to arthroscopic synovectomy in patients with undifferentiated chronic monoarthritis (UCMA) of the wrist. Arthroscopic synovectomy was performed on 20 wrists in 20 patients with UCMA of the wrist who had not responded to non-steroidal anti-inflammatory drugs. The mean duration of symptoms at the time of surgery was 4.3 months (3 to 7) and the mean follow-up was 51.8 months (24 to 94). Inflamed synovium was completely removed from the radiocarpal, midcarpal and distal radioulnar joints using more portals than normal. After surgery, nine patients had early remission of synovitis and 11 with uncontrolled synovitis received antirheumatic medication. Overall, there was significant improvement in terms of pain relief, range of movement and Mayo score. Radiological deterioration was seen in five patients who were diagnosed as having rheumatoid arthritis during the follow-up period. Lymphoid follicles and severe lymphocyte infiltration were seen more often in synovial biopsies from patients with uncontrolled synovitis. These results suggest that arthroscopic synovectomy provides pain relief and functional improvement, and allows rapid resolution of synovitis in about half of patients with UCMA of the wrist

Wide resection, with or without adjuvant therapy, is the mainstay of treatment for soft tissue sarcoma of the extremities. The surgical treatment of soft tissue sarcoma can portend a prolonged course of recovery from a functional perspective. However, data to inform the expected course of recovery following sarcoma surgery is lacking. The purpose of this study was to identify time to maximal functional improvement following sarcoma resection and to identify factors that delay the expected course of recovery. A retrospective chart review was performed of all patients undergoing surgical treatment of a soft tissue sarcoma of the extremities between January 1st, 1985 and November 15, 2020 with a minimum of 1 follow up. The primary outcome measure was time to maximal functional improvement, defined as failure to demonstrate improvement on two consecutive follow up appointments, as defined by the functional outcome measures of Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) Score or by achieving 90% of maximum outcome score. We identified 1188 patients who underwent surgical resection of a soft tissue sarcoma of the extremities. Patients typically achieved a return to their baseline level of function by 1 year and achieved “maximal” functional recovery by 2 year's time postoperatively. Patient and tumor factors that were associated with worse functional outcome scores and a delayed return to maximal functional improvement included older age (p=0.007), female sex (p-0.004), larger tumor size (p < 0 .001), deep tumor location (p < 0 .001), pelvic location (p < 0 .001), higher tumor grade (p < 0 .001). Treatment factors that were associated with worse functional outcome scores and a delayed return to maximal functional improvement included use of radiation therapy (p < 0 .001), perioperative complications (p < 0 .001), positive margin status (p < 0 .001) and return of disease, locally or systemically (p < 0 .001). Most patients will recover their baseline function by 1 year and achieve “maximal” recovery by 2 years’ time following surgical resection for soft tissue sarcoma of the extremities. Several patient, tumor and treatment factors should be used to counsel patients as to a delayed course of recovery

Abstract. Background. We know that tears of the Triangular fibrocartilage complex (TFCC) can cause DRUJ instability and ulnar sided wrist pain. This study shows the clinical result of patients who had arthroscopic transosseous repair of the TFCC tear with DRUJ instability. Arthroscopic repair of TFCC tear is a promising, minimally invasive surgical technique especially in patients with DRUJ instability. Materials and methods. Fifteen patients who underwent TFCC one tunnel repair form 2018–2021 were reviewed retrospectively in hospital. The proximal component of TFCC was repaired through arthroscopic one- tunnel transosseous suture technique. VAS score for pain, wrist range of motion, grip strength and post operative complications were evaluated and each patient was rated according to the DASH score. Results. The patients had a TFCC tear confirmed on MRI and was confirmed on arthroscopy by doing a hook test. The patients were followed up for 6 months. Twelve patients had normal stability of DRUJ and three patients showed mild laxity compared with the contralateral side. The mean VAS score reduced from 4.7 to 0.8 (P=0.001) and grip strength increased significantly. The quick DASH score (P=0.001)also showed significant functional improvement. No surgical related complications occurred. Conclusions. Arthroscopic one tunnel transosseous TFCC foveal repair can be an excellent and safe method for repair of TFCC tear with DRUJ instability. Its a good treatment option in terms of reliable pain relief, functional improvement and reestablishment of DRUJ stability

The June 2024 Shoulder & Elbow Roundup. 360. looks at: Reverse versus anatomical total shoulder replacement for osteoarthritis? A UK national picture; Acute rehabilitation following traumatic anterior shoulder dislocation (ARTISAN): pragmatic, multicentre, randomized controlled trial; acid for rotator cuff repair: a systematic review and meta-analysis of randomized controlled trials; Metal or ceramic humeral head total shoulder arthroplasty: an analysis of data from the National Joint Registry; Platelet-rich plasma has better results for long-term functional improvement and pain relief for lateral epicondylitis: a systematic review and meta-analysis of randomized controlled trials; Quantitative fatty infiltration and 3D muscle volume after nonoperative treatment of symptomatic rotator cuff tears: a prospective MRI study of 79 patients; Locking plates for non-osteoporotic proximal humeral fractures in the long term; A systematic review of the treatment of primary acromioclavicular joint osteoarthritis

Aims. Internal hemipelvectomy without reconstruction of the pelvis is a viable treatment for pelvic sarcoma; however, the time it takes to return to excellent function is quite variable. Some patients require greater time and rehabilitation than others. To determine if psoas muscle recovery is associated with changes in ambulatory function, we retrospectively evaluated psoas muscle size and limb-length discrepancy (LLD) before and after treatment and their correlation with objective functional outcomes. Methods. T1-weighted MR images were evaluated at three intervals for 12 pelvic sarcoma patients following interval hemipelvectomy without reconstruction. Correlations between the measured changes and improvements in Timed Up and Go test (TUG) and gait speed outcomes were assessed both independently and using a stepwise multivariate regression model. Results. Increased ipsilesional psoas muscle size from three months postoperatively to latest follow-up was positively correlated with gait speed improvement (r = 0.66). LLD at three months postoperatively was negatively correlated with both TUG (r = -0.71) and gait speed (r = -0.61). Conclusion. This study suggests that psoas muscle strengthening and minimizing initial LLD will achieve the greatest improvements in ambulatory function. LLD and change in hip musculature remain substantial prognostic factors for achieving the best clinical outcomes after internal hemipelvectomy. Changes in psoas size were correlated with the amount of functional improvement. Several patients in this study did not return to their preoperative ipsilateral psoas size, indicating that monitoring changes in psoas size could be a beneficial rehabilitation strategy. Cite this article: Bone Joint J 2023;105-B(3):323–330

Aims. Obesity is associated with an increased risk of hip osteoarthritis, resulting in an increased number of total hip arthroplasties (THAs) performed annually. This study examines the peri- and postoperative outcomes of morbidly obese (MO) patients (BMI ≥ 40 kg/m. 2. ) compared to healthy weight (HW) patients (BMI 18.5 to < 25 kg/m. 2. ) who underwent a THA using the anterior-based muscle-sparing (ABMS) approach. Methods. This retrospective cohort study observes peri- and postoperative outcomes of MO and HW patients who underwent a primary, unilateral THA with the ABMS approach. Data from surgeries performed by three surgeons at a single institution was collected from January 2013 to August 2020 and analyzed using Microsoft Excel and Stata 17.0. Results. This study compares 341 MO to 1,140 HW patients. Anaesthesia, surgery duration, and length of hospital stay was significantly lower in HW patients compared to MO. There was no difference in incidence of pulmonary embolism, periprosthetic fracture, or dislocation between the two groups. The rate of infection in MO patients (1.47%) was significantly higher than HW patients (0.14%). Preoperative patient-reported outcome measures (PROMs) show a significantly higher pain level in MO patients and a significantly lower score in functional abilities. Overall, six-week and one-year postoperative data show higher levels of pain, lower levels of functional improvement, and lower satisfaction scores in the MO group. Conclusion. The comorbidities of obesity are well studied; however, the implications of THA using the ABMS approach have not been studied. Our peri- and postoperative results demonstrate significant improvements in PROMs in MO patients undergoing THA. However, the incidence of deep infection was significantly higher in this group compared with HW patients. Cite this article: Bone Jt Open 2023;4(5):299–305

Aims. The primary aim was to assess whether robotic total knee arthroplasty (rTKA) had a greater early knee-specific outcome when compared to manual TKA (mTKA). Secondary aims were to assess whether rTKA was associated with improved expectation fulfilment, health-related quality of life (HRQoL), and patient satisfaction when compared to mTKA. Methods. A randomized controlled trial was undertaken, and patients were randomized to either mTKA or rTKA. The primary objective was functional improvement at six months. Overall, 100 patients were randomized, 50 to each group, of whom 46 rTKA and 41 mTKA patients were available for review at six months following surgery. There were no differences between the two groups. Results. There was no difference between rTKA and mTKA groups at six months according to the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) functional score (mean difference (MD) 3.8 (95% confidence interval (CI) -5.6 to 13.1); p = 0.425). There was a greater improvement in the WOMAC pain score at two months (MD 9.5 (95% CI 0.6 to 18.3); p = 0.037) in the rTKA group, although by six months no significant difference was observed (MD 6.7 (95% CI -3.6 to 17.1); p = 0.198). The rTKA group were more likely to achieve a minimal important change in their WOMAC pain score when compared to the mTKA group at two months (n = 36 (78.3%) vs n = 24 (58.5%); p = 0.047) and at six months (n = 40 (87.0%) vs n = 29 (68.3%); p = 0.036). There was no difference in satisfaction between the rTKA group (97.8%; n = 45/46) and the mTKA group (87.8%; n = 36/41) at six months (p = 0.096). There were no differences in EuroQol five-dimension questionnaire (EQ-5D) utility gain (p ≥ 0.389) or fulfilment of patient expectation (p ≥ 0.054) between the groups. Conclusion. There were no statistically significant or clinically meaningful differences in the change in WOMAC function between mTKA and rTKA at six months. rTKA was associated with a higher likelihood of achieving a clinically important change in knee pain at two and six months, but no differences in knee-specific function, patient satisfaction, health-related quality of life, or expectation fulfilment were observed. Cite this article: Bone Joint J 2023;105-B(9):961–970

Introduction. Large osteochondral defects (OCD) of the talus present a difficult management conundrum. We present a series of Maioregen xenograft patches applied through an open approach, early lessons from the technique and good early outcomes, in patients who are otherwise looking at ankle salvage techniques. Results. 16 patients underwent open patch procedures, performed by a single surgeon, over a 30 month period. 12 males, and 4 females with age at presentation from 21–48. The majority were young, male, in physical employment with active sporting interest. MoxFQ, and E5QD were collected preop, 3, 6, 12 month postoperatively. There were significant improvements in ROM, pain, and scores in the cohort. 3 cases returned to Theatre, 1 for a concern about late infection, which settled with good outcome, and a further 2 with metalwork / adhesions. Conclusion. Early results suggest that this patch technique may be useful in prolonging the longevity of the TTJ, where micro fracture has failed, or the lesion is so large that it would likely be futile. Patients rescoped demonstrated good integration of the patch material, with stability and functional improvement. There may be a place for this technique in the management of large lesions, particularly in young patients where preservation is desired over joint salvage

Surgical debridement for medial epicondylitis (ME) is indicated for patients with refractory ME. The clinical efficacy of simple debridement has not been studied sufficiently. Moreover, authors experienced surgical outcome of ME was not as good as lateral epicondylitis. In this regard, authors have combined the atelocollagen injection in the debridement surgery of ME. The purpose of study was to compare clinical outcomes between simple debridement and debridement combined with atelocollagen injection in the ME. Twenty-five patients with refractory ME and underwent surgical debridement were included in the study. Group A (n=13) was treated with isolated debridement surgery, and group B (n=12) was treated with debridement combined with 1.0 mL of type I atelocollagen. Pain and functional improvements were assessed using visual analogue scale, Mayo Elbow Performance Score (MEPS) and quick Disabilities of the Arm, Shoulder and Hand (DASH) scale respectively before surgery, at 3, 6 months after surgery and at the final follow-up. Demographic data did not show significant difference between two groups before surgical procedures. Both groups showed improvement in pain and functional score postoperatively. However, at the 3 months after surgery, group B showed significantly better improvement as compared to group A(VAS 3.1 / 2.0, MEPS 71/82 qDASH 29/23). At the 6 months after surgery and final follow-up, both groups did not show any difference. Surgical debridement combined with atelocollagen is effective treatment option in refractory ME and showed better short-term outcomes compared to isolated surgery

Although day surgery has a good patient satisfaction and safety profile, accurate episode-of-care costs (EOCC) calculation for of this procedure compared to standard same-day admission (SDA), while considering functional outcomes, is not well known. This study assesses the EOCC for patients with a THA while comparing DS and Same Day Admission (SDA) (with a 1-day hospitalization) pathways. The episode-of-care cost (EOCC) of 50 consecutive day surgery and SDA patients who underwent a THA was evaluated. The episode-of-care cost was determined using a bottom-up Time Driven- Activity Based Funding method. Functional outcomes were measured using preoperative and postoperative Harris Hip Score (HHS). Overall, the SDA THA cost 11% more than a DS THA. The mean total EOCC of DS THA was 9 672 CAD compared to 10 911 CAD in the SDA THA group. Both groups showed an improvement in HHS score following the procedure but patients in the DS group had a significantly higher postoperative HHS score and a significantly greater improvement in their HHS score postoperatively. Day surgery THA is cost-effective, safe and associated with high patient satisfaction due to functional improvement. Providing policymakers the information to develop optimal financing methods is paramount for clinicians wishing to develop modern protocols, increase productivity while providing the optimal care for patients

Total Joint Arthroplasty (TJA) is a successful orthopaedic procedure allowing dramatic clinical and functional improvements. Globally, there's been an increase in demand and performed cases associated with an increase in complications. Subsequently, focus on the prevention of complications has become important worldwide. The incidence of venous-thrombolic events (VTE) despite great attention has not diminished despite much investigation. A balance between efficacy and safety from the available agents is essential. Low molecular weight heparin (LMWH) has been commonly used, but oral anti-coagulants have become more popular. The aim of this study was to assess the adherence LMWH and the effectiveness and safety of preventing VTE in post-operative arthroplasty patients in a South African setting. We conducted a prospective cohort study that included hip and knee, primary and revision, arthroplasty patients who received thromboprophylaxis with one daily injection of LMWH for 14 days post discharge. Patients who omitted 1 or more doses during the follow up period were classified as “non adherent”. A questionnaire was used at follow up visits at least 6 weeks post-operatively. 100 consecutive patients were followed up. The mean age of patients was 63.45 years. There were 68 % female patients. There was a 92% compliance rate. 60 % of patients had the injection administered by a family member, 38 % administered it themselves and 2 % had the injection administered by health professionals. Venous thromboembolic events were confirmed in 5 % at 7.86 days after surgery. Three patients had persistent wound drainage after surgery, however, none required reoperation or readmission. Compliance with LMWH is high and is comparable with oral agents. It is effective in preventing VTE and safe with regards to bleeding and wound complications in a South African setting. Patient education regarding medications may improve compliance of the medication

Higher levels of socioeconomic deprivation have been associated with worse health outcomes. The influence of socioeconomic deprivation on patients undergoing periacetabular osteotomy (PAO) has not previously been investigated. A total of 217 patients (171 female, 46 male; median age 23.4 years) who underwent PAO by a single surgeon were identified. Patients were categorised into three groups according to their New Zealand Deprivation (NZDep) Index: minimal deprivation (NZDep Index 1–3, n=89), moderate deprivation (NZDep Index 4–6, n=94), and maximal deprivation (NZDep Index 7–10, n=34). The three groups were compared with respect to baseline variables, surgical details, complications, and pre-operative and two-year post-operative functional scores (including International Hip Outcome Tool (iHOT-12), EQ-5D quality of life score, and University of California Los Angeles (UCLA) activity score). Multivariate regression was undertaken to assess for the effect of NZDep Index on patient outcomes. Patients in the maximal deprivation group were more likely to be Māori (p<0.001) and have surgery in a public rather than a private hospital (p=0.004), while the minimal deprivation group demonstrated a lower BMI (p=0.005). There were otherwise no other significant differences in baseline variables, surgical details, complications, nor pre-operative or two-year post-operative functional scores between the three groups (all p>0.05). Multivariate analysis identified a higher NZDep Index to be independently predictive of a lower pre-operative UCLA activity score (p=0.014) and a higher two-year iHOT-12 score (p<0.001). Our results demonstrate an inequality in access to PAO, with patients exposed to higher levels of socioeconomic deprivation under-represented in our study population. When provided access to PAO, these vulnerable patients achieve significant functional improvement at least as great as patients with less socioeconomic deprivation. Initiatives to improve access to hip preservation care in socioeconomically deprived populations appear warranted

Abstract. Cemented total hip arthroplasty (THA) in the younger patient has historically been associated with higher wear and revision rates. We carried out a retrospective study of a prospectively collected database of patients at Wrightington hospital undergoing cemented THA under 55 years of age to determine acetabular wear and revision rates. Between August 2005 and December 2021 a cohort of 110 patients, 56 males and 54 females, underwent Cemented Total Hip Replacement through a posterior approach. Mean age at operation was 50yrs (35–55). The mean follow up was 6 years 9 months (0–16 years). 3 patients were lost to follow-up. Of the remaining 107 patients, Conventional and cross lined polyethylene were used in 54 and 53 patients respectively. Ceramic heads were used in 102 patients. 22.225mm and 28mm heads were used in 60 and 47 patients respectively. Clinical outcomes were assessed by Merle d'Aubigne and Postel scores which showed significant functional improvement. Linear wear was measured on plain radiographs using TRAUMA CAD and cup loosening was assessed by classification of Hodgkinson et al. No cases were revised during the observed follow up period. The mean wear rate in conventional and crosslinked polyethylene cups were 2.31mm (0.1–4.6) and 1.02mm (0.1–2.6) respectively. Cemented THA with both conventional and crosslinked polyethylene provides excellent survival rates in adults under the age of 55 years and crosslinked polyethylene may further improve these results due to improved wear rates