1
|
Wei Z, Yu M, Xu Y, Weng X, Feng B. Impact of intraosseous regional administration of tranexamic acid in total knee arthroplasty on perioperative blood loss: a protocol for a randomised controlled trial. BMJ Open 2024; 14:e077393. [PMID: 38346881 PMCID: PMC10862301 DOI: 10.1136/bmjopen-2023-077393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 01/16/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Total knee arthroplasty (TKA) is a common surgical intervention to treat joint diseases. However, TKA is associated with significant blood loss. Tranexamic acid (TXA) has been used to reduce perioperative bleeding and postoperative blood transfusion. This study aims to explore the effectiveness and safety of intraosseous regional administration (IORA) of TXA in TKA and compare differences in perioperative blood loss between IORA of TXA, intravenous infusion of TXA, and combined IORA and intravenous infusion of TXA. METHODS AND ANALYSIS This randomised controlled trial will enrol 105 patients with osteoarthritis who meet the inclusion criteria for unilateral TKA. Patients were randomly divided into three groups using the random number table method. Group A received 1.0 g of TXA via IORA, group B received 1.0 g of TXA via intravenous infusion 15 min prior to the tourniquet release, and group C received both IORA of 1.0 g of TXA and intravenous infusion of 1.0 g of TXA. The primary outcome measure is perioperative total blood loss. Secondary outcomes include bleeding events, venous thromboembolism events, inflammation reactions, other complications and knee function assessments. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Peking Union Medical College Hospital and registered in the Chinese Clinical Trial Registry. Informed consent will be obtained from all the patients before enrolment. The trial will be conducted in accordance with the principles of the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. The results of this study will be disseminated through peer-reviewed publications, conference presentations and social media platforms. The findings will provide valuable insights into the use of IORA of TXA in TKA and may lead to the development of new strategies for perioperative blood management in joint replacement surgery. TRIAL REGISTRATION NUMBER The Ethics Committee of Peking Union Medical College Hospital (approval number: K2371); Chinese Clinical Trial Registry (trial registration number: ChiCTR2200066293).
Collapse
Affiliation(s)
- Zhanqi Wei
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Muyang Yu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiming Xu
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xisheng Weng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Feng
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
2
|
Lu W, Liu D, Cai Z, Pan L, Xie W, Jin H, Liu X, Li Y, Xiao W. Internal brace augmentation reconstruction versus standard anterior cruciate ligament reconstruction: a randomised controlled clinical trial study protocol. BMJ Open 2023; 13:e065254. [PMID: 38114287 DOI: 10.1136/bmjopen-2022-065254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION Anterior cruciate ligament (ACL) rupture is one of the most common knee injuries in sports, and the gold standard for treating ACL rupture is tendon graft reconstruction. Internal brace technology is being used nowadays for ligament repair; however, more relevant in vivo clinical evidence is required for using internal brace technology in ACL reconstruction (ACLR). We conducted a randomised controlled trial to investigate the clinical efficacy of internal brace technology in ACLR. METHODS AND ANALYSIS This randomised, parallel-controlled trial included patients with ACL rupture who underwent inpatient surgery at the Department of Orthopaedics, Xiangya Hospital, Central South University. Random number table method was used to assign the participants to either the test or the control group. The test group underwent ACLR using the internal brace technique, whereas the control group underwent standard ACLR. Uniform postoperative rehabilitation protocol was used for both the groups. Patient-reported outcomes included preoperative baseline and postoperative recovery at 1, 3, 6, 12 and 24 months. The primary outcome was International Knee Documentation Committee function from baseline (ACL rupture) to 6 months postoperatively. Secondary outcomes included (1) other patient outcome reporting metrics, Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score and Visual Analog Scale; (2) the use of Kneelax3 knee stabiliser to assess knee stability; (3) occurrence of adverse events, such as graft refraction or symptomatic instability, postoperative infection and contralateral injury and (4) magnetic resonance images at 12 and 24 months after ACLR. ETHICS AND DISSEMINATION This trial was approved by the Medical Ethics Committee of the Xiangya Hospital of Central South University on 26 October 2021. Data will be published in peer-reviewed journals and presented at national and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2200057526.
Collapse
Affiliation(s)
- Wenhao Lu
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Di Liu
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Zijun Cai
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Linyuan Pan
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Wenqing Xie
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Hongfu Jin
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Xu Liu
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
| | - Yusheng Li
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, China
| | - Wenfeng Xiao
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, China
- Xiangya Hospital, Central South University, National Clinical Research Center for Geriatric Disorders, Changsha, Hunan, China
| |
Collapse
|
3
|
Goodon H, Czyrnyj C, Comaskey B, Gawaziuk J, Logsetty S, Spiwak R. Social determinants of alcohol-related traumatic injury in young adults: a scoping review protocol. BMJ Open 2023; 13:e074653. [PMID: 37989375 PMCID: PMC10668285 DOI: 10.1136/bmjopen-2023-074653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/02/2023] [Indexed: 11/23/2023] Open
Abstract
INTRODUCTION Limited research examines alcohol-related injury in the context of social determinants of health (SDoH) to guide effective intervention and prevention programmes. SDoH are non-medical factors that impact health such as income, housing and childhood environment. This scoping review aims to explore the role SDoH in childhood have in alcohol-related injury in young adults. METHODS AND ANALYSIS The scoping review process will be guided by the methodology framework of Arksey and O'Malley and the Preferred Reporting Items for Systematic Reviews and Meta-analysis Protocols Extension for Scoping Reviews Guidelines (PRISMA-ScR). The PubMed and SCOPUS databases will be systematically searched. Studies of various designs and methodologies (published in English since 1 January 2000) that examine certain SDoH of interest in relation to alcohol-related injury in adults aged 18-25 years old will be considered for inclusion in this review. Two reviewers will screen all articles identified from the databases independently. Titles and abstracts will be reviewed based on the initial search and included if eligibility criteria are met. Duplicate articles will be removed and full texts will be examined to create a final list of included studies. Any disagreements on the inclusion of any articles will be resolved through discussion and consultation with a third reviewer if necessary. ETHICS AND DISSEMINATION As this research does not involve human subjects, ethics approval is not required. The results of this study will be summarised quantitatively through numerical counts and qualitatively through a narrative synthesis. The results from this review will address an important literature gap and inform the development of targeted prevention programmes for alcohol-related injury. REGISTRATION NUMBER This protocol is registered with Open Science Framework (https://doi.org/10.17605/OSF.IO/MYEXA).
Collapse
Affiliation(s)
- Hunter Goodon
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Cameron Czyrnyj
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brenda Comaskey
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Justin Gawaziuk
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarvesh Logsetty
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rae Spiwak
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
4
|
Canizares M, Power JD, Perruccio AV, Veillette C, Mahomed N, Rampersaud YR. Time trends and patterns in opioid prescription use following orthopaedic surgery in Ontario, Canada, from 2004/2005 to 2017/2018: a population-based study. BMJ Open 2023; 13:e074423. [PMID: 37963700 PMCID: PMC10649703 DOI: 10.1136/bmjopen-2023-074423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/26/2023] [Indexed: 11/16/2023] Open
Abstract
OBJECTIVES Increased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective orthopaedic surgery. DESIGN Population-based study. SETTING Ontario, Canada. PARTICIPANTS Ontario residents aged 66+ years who had elective orthopaedic surgery from April 2004 to March 2018. PRIMARY AND SECONDARY OUTCOME MEASURES Postoperative opioid use (short term: within 90 days of surgery, prolonged: within 180 days and chronic: within 1 year), specific opioids prescribed, average duration (days) and amount (morphine milligram equivalents) of the initial prescription by year of surgery. RESULTS We included 464 460 elective orthopaedic surgeries in 2004/2005-2017/2018: 80% of patients used opioids within 1 year of surgery-25.1% were chronic users. There was an 8% increase in opioid use within 1 year of surgery, from 75.1% in 2004/2005 to 80.9% in 2017/2018: a 29% increase in short-term use and a decline in prolonged (9%) and chronic (22%) use. After 2014/2015, prescribed opioid amounts initially declined sharply, while the duration of the initial prescription increased substantially. Across categories of use, there was a steady decline in coprescription of benzodiazepines and opioids. CONCLUSIONS Most patients filled opioid prescriptions after surgery, and many continued filling prescriptions after 3 months. During a period of general increase in awareness of opioid harms and dissemination of guidelines/policies aimed at opioid prescribing for chronic pain, we found changes in prescribing practices following elective orthopaedic surgery. Findings illustrate the potential impact of guidelines/policies on shaping prescription patterns in the surgical population, even in the absence of specific guidelines for surgical prescribing.
Collapse
Affiliation(s)
- Mayilee Canizares
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - J Denise Power
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, University Health Network, Toronto, Ontario, Canada
| | - Christian Veillette
- Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Nizar Mahomed
- Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
| | - Y Raja Rampersaud
- Department of Orthopaedic Surgery, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
5
|
McKibben NS, Marchand LS, Demyanovich HK, Healey KM, Zingas N, O'Connor K, Slobogean GP, O'Toole RV, O'Hara NN. Patient preferences for physical therapy programs after a lower extremity fracture: a discrete choice experiment. BMJ Open 2023; 13:e072583. [PMID: 37798021 PMCID: PMC10565336 DOI: 10.1136/bmjopen-2023-072583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To quantify patients' preferences for physical therapy programmes after a lower extremity fracture and determine patient factors associated with preference variation. DESIGN Discrete choice experiment. SETTING Level I trauma centre. PARTICIPANTS One hundred fifty-one adult (≥18 years old) patients with lower extremity fractures treated operatively. INTERVENTION Patients were given hypothetical scenarios and asked to select their preferred therapy course when comparing cost, mobility, long-term pain, session duration, and treatment setting. MAIN OUTCOME MEASURES A multinomial logit model was used to determine the relative importance and willingness to pay for each attribute. RESULTS Mobility was of greatest relative importance (45%, 95% CI: 40% to 49%), more than cost (23%, 95% CI: 19% to 27%), long-term pain (19%, 95% CI: 16% to 23%), therapy session duration (12%, 95% CI: 9% to 5%) or setting (1%, 95% CI: 0.2% to 2%). Patients were willing to pay US$142 more per session to return to their preinjury mobility level (95% CI: US$103 to US$182). Willingness to pay for improved mobility was higher for women, patients aged 70 years and older, those with bachelor's degrees or higher and those living in less-deprived areas. Patients were willing to pay US$72 (95% CI: US$50 to US$93) more per session to reduce pain from severe to mild. Patients were indifferent between formal and independent home therapy (willingness to pay: -US$12, 95% CI: -US$33 to US$9). CONCLUSIONS Patients with lower extremity fractures highly value recovering mobility and are willing to pay more for postoperative physical therapy programmes that facilitate returning to their pre-injury mobility level. These patient preferences might be useful when prescribing and designing new techniques for postoperative therapy.
Collapse
Affiliation(s)
- Natasha S McKibben
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lucas S Marchand
- Orthopaedics, University of Utah Health, Salt Lake City, Utah, USA
| | - Haley K Demyanovich
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kathleen M Healey
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nicolas Zingas
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Katherine O'Connor
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Gerard P Slobogean
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Robert V O'Toole
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Nathan N O'Hara
- Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
6
|
Yoganandan N, Moore J, Humm JR, Baisden JL, Banerjee A, Pintar FA, Barnes DR, Loftis KL. Human pelvis injury risk curves from underbody blast impact. BMJ Mil Health 2023; 169:436-442. [PMID: 34711674 DOI: 10.1136/bmjmilitary-2021-001863] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/07/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Underbody blast loading can result in injuries to the pelvis and the lumbosacral spine. The purpose of this study was to determine human tolerance in this region based on survival analysis. METHODS Twenty-six unembalmed postmortem human surrogate lumbopelvic complexes were procured and pretest medical images were obtained. They were fixed in polymethylmethacrylate at the cranial end and a six-axis load cell was attached. The specimens were aligned in a seated soldier posture. Impacts were applied to the pelvis using a custom vertical accelerator. The experimental design consisted of non-injury and injury tests. Pretest and post-test X-rays and palpation were done following non-injury test, and after injury test medical imaging and gross dissections were done. Injuries were scored using the Abbreviated Injury Scale (AIS). Axial and resultant forces were used to develop human injury probability curves (HIPCs) at AIS 3+ and AIS 4 severities using survival analysis. Then ±95% CI was computed using the delta method, normalised CI size was obtained, and the quality of the injury risk curves was assigned adjectival ratings. RESULTS At the 50% probability level, the resultant and axial forces at the AIS 3+ level were 6.6 kN and 5.9 kN, and at the AIS 4 level these were 8.4 kN and 7.5 kN, respectively. Individual injury risk curves along with ±95% CIs are presented in the paper. Increased injury severity increased the HIPC metrics. Curve qualities were in the good and fair ranges for axial and shear forces at all probability levels and for both injury severities. CONCLUSIONS This is the first study to develop axial and resultant force-based HIPCs defining human tolerance to injuries to the pelvis from vertical impacts using parametric survival analysis. Data can be used to advance military safety under vertical loading to the seated pelvis.
Collapse
Affiliation(s)
- Narayan Yoganandan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - J Moore
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - J R Humm
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - J L Baisden
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - A Banerjee
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - F A Pintar
- Joint Department of Biomedical Engineering, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - D R Barnes
- SURVICE Engineering, Belcamp, Maryland, USA
| | - K L Loftis
- DEVCOM, Aberdeen Proving Ground, Maryland, USA
| |
Collapse
|
7
|
Abedi AA, Varnum C, Pedersen AB, Gromov K, Hallas J, Iversen P, Jakobsen T, Jimenez-Solem E, Kidholm K, Kjerulf A, Lange J, Odgaard A, Rosenvinge FS, Solgaard S, Sperling K, Stegger M, Christensen R, Overgaard S. Effect of single versus multiple prophylactic antibiotic doses on prosthetic joint infections following primary total hip arthroplasty in patients with osteoarthritis at public and private hospitals in Denmark: protocol for a nationwide cross-over, cluster randomised, non-inferiority trial [The Pro-Hip-Quality Trial]. BMJ Open 2023; 13:e071487. [PMID: 37604637 PMCID: PMC10445366 DOI: 10.1136/bmjopen-2022-071487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 06/21/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION A feared complication after total hip arthroplasty (THA) is prosthetic joint infection (PJI), associated with high morbidity and mortality. Prophylactic antibiotics can reduce the risk of PJI. However, there is no consensus on the dosages and current recommendations are based on a low evidence level. The objective is to compare the effect of a single versus multiple doses of prophylactic antibiotics administered within 24 hours on PJI. METHODS AND ANALYSIS The study is designed as a cross-over, cluster randomised, non-inferiority trial. All clinical centres use both antibiotic practices (1 year of each intervention). All Danish orthopaedic surgery departments will be involved: Based on quality databases, 2-year cohorts of approximately 20 000 primary THAs conducted at 39 public and private hospitals, will be included. INCLUSION CRITERIA age ≥18 years, all indications for THA except patients operated due to acute or sequelae from proximal femoral or pelvic fractures or bone tumour or metastasis. The primary outcome is PJI within 90 days after primary THA. Secondary outcomes include (1) serious adverse events, (2) potential PJI, (3) length of hospitalisation stay, (4) cardiovascular events, (5) hospital-treated infections, (6) community-based antibiotic use, (7) opioid use and (8) use of acetaminophen and non-steroidal anti-inflammatory drugs. All outcome measures will be extracted from national databases. Analyses will be based on the intention-to-treat population. Non-inferiority will be shown if the upper limit of the two-sided 95% CI for the OR is less than 1.32 for the single dose as compared with multiple doses. The results will establish best practice on antibiotic prophylaxis dosages in the future. ETHICS AND DISSEMINATION This study has been approved by Committees on Health Research Ethics for The Capital Region of Denmark (21069108) and The Danish Medicines Agency (2021091723). All results will be presented in peer-reviewed medical journals and international conferences. TRIAL REGISTRATION NUMBER NCT05530551.
Collapse
Affiliation(s)
- Armita Armina Abedi
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Claus Varnum
- Department of Orthopedics, Lillebaelt Hospital - University Hospital Southern Denmark, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Alma Becic Pedersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Jesper Hallas
- Department of Public Health, Clinical Pharmacology, Pharmacy, and Environmental Medicine, University of Southern Denmark, Odense, Denmark
| | - Pernille Iversen
- The Danish Clinical Quality Program- National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Thomas Jakobsen
- Department of Orthopedics, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Espen Jimenez-Solem
- Department of Clinical Pharmacology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Kristian Kidholm
- Centre for Innovative Medical Technology, Odense Universitetshospital, Odense, Denmark
| | - Anne Kjerulf
- Infectious Disease Epidemiology & Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Jeppe Lange
- Department of Orthopedic Surgery, Regional Hospital Horsens, Horsens, Denmark
- Department of Clinical Medicine, Århus Universitet Klinisk Institut, Aarhus, Denmark
| | - Anders Odgaard
- Department of Orthopaedic Surgery, Rigshospitalet, Copenhagen, Denmark
| | | | - Søren Solgaard
- Department of Hip and Knee Surgery, Copenhagen University Hospital, Herlev-Gentofte University Hospital, Hellerup, Denmark
| | - Kim Sperling
- Department of Orthopedic Surgery, Nastved Hospital, Nastved, Denmark
| | - Marc Stegger
- Department of Microbiological Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Robin Christensen
- Parker Institute, Frederiksberg and Bispebjerg Hospital, Copenhagen, Denmark
| | - Søren Overgaard
- Department of Orthopedic Surgery and Traumatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| |
Collapse
|
8
|
Singh S, Thiagarajah V, Banerjee R, Iyenger K, Garg S, Singh B, Ahluwalia R. Delivering surgical education: a specialist surgical society and undergraduate student collaboration. Postgrad Med J 2023; 99:639-643. [PMID: 37319155 DOI: 10.1136/postgradmedj-2021-140849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/15/2022] [Indexed: 11/03/2022]
Abstract
Currently, the delivery of the undergraduate medical curriculum includes various teaching, learning and assessment strategies. Self-directed learning is an important aspect of this mix and includes the use of resources, sometimes not provided by the parent University, in the student's own time to enhance the student's knowledge, skills and professional practice. Societies aimed at a particular specialty contain a pool of professionals that can provide undergraduate students with opportunities for further self-directed learning, development of specialty-specific core skills and exploration of research interests. This may then enhance and enlighten the students' approach to a particular orthopaedic problem and reinforce the curriculum they are studying while providing an understanding of current areas of debate that are not part of the curriculum at present. The collaboration of postgraduate societies with undergraduate students in developing and implementing undergraduate engagement strategies is of benefit to undergraduate education, the specialty society and the collaborating students. We explore the planning and implementation of an interactive webinar series run by the British Indian Orthopaedic Society in collaboration with undergraduate students. We provide a case study of a surgical specialty society engaging with undergraduate students with synergistic effect. We pay particular attention to the benefits accrued by the specialty society and the student collaborators by this joint effort.
Collapse
Affiliation(s)
- Shashwat Singh
- The Medical School, The University of Edinburgh, Edinburgh, UK
| | - Viswan Thiagarajah
- Faculty of Medicine, Imperial College of Science & Technology and Medicine, London, UK
| | - Rishi Banerjee
- Faculty of Medicine, Imperial College of Science & Technology and Medicine, London, UK
| | - Kartik Iyenger
- Faculty of Medicine, Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, Sefton, UK
| | - Sunil Garg
- Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
| | | | - Raju Ahluwalia
- Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
9
|
Griffin J, Davis ET, Parsons H, Gemperle Mannion E, Khatri C, Ellard DR, Blyth MJ, Clement ND, Deehan D, Flynn N, Fox J, Grant NJ, Haddad FS, Hutchinson CE, Mason J, Mohindru B, Scott CEH, Smith TO, Skinner JA, Toms AD, Rees S, Underwood M, Metcalfe A. Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial (RACER-knee): a study protocol. BMJ Open 2023; 13:e068255. [PMID: 37295832 PMCID: PMC10277111 DOI: 10.1136/bmjopen-2022-068255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Robotic-assisted knee replacement systems have been introduced to healthcare services worldwide in an effort to improve clinical outcomes for people, although high-quality evidence that they are clinically, or cost-effective remains sparse. Robotic-arm systems may improve surgical accuracy and could contribute to reduced pain, improved function and lower overall cost of total knee replacement (TKR) surgery. However, TKR with conventional instruments may be just as effective and may be quicker and cheaper. There is a need for a robust evaluation of this technology, including cost-effectiveness analyses using both within-trial and modelling approaches. This trial will compare robotic-assisted against conventional TKR to provide high-quality evidence on whether robotic-assisted knee replacement is beneficial to patients and cost-effective for healthcare systems. METHODS AND ANALYSIS The Robotic Arthroplasty Clinical and cost Effectiveness Randomised controlled trial-Knee is a multicentre, participant-assessor blinded, randomised controlled trial to evaluate the clinical and cost-effectiveness of robotic-assisted TKR compared with TKR using conventional instruments. A total of 332 participants will be randomised (1:1) to provide 90% power for a 12-point difference in the primary outcome measure; the Forgotten Joint Score at 12 months postrandomisation. Allocation concealment will be achieved using computer-based randomisation performed on the day of surgery and methods for blinding will include sham incisions for marker clusters and blinded operation notes. The primary analysis will adhere to the intention-to-treat principle. Results will be reported in line with the Consolidated Standards of Reporting Trials statement. A parallel study will collect data on the learning effects associated with robotic-arm systems. ETHICS AND DISSEMINATION The trial has been approved by an ethics committee for patient participation (East Midlands-Nottingham 2 Research Ethics Committee, 29 July 2020. NRES number: 20/EM/0159). All results from the study will be disseminated using peer-reviewed publications, presentations at international conferences, lay summaries and social media as appropriate. TRIAL REGISTRATION NUMBER ISRCTN27624068.
Collapse
Affiliation(s)
- James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Edward T Davis
- Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Helen Parsons
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Elke Gemperle Mannion
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chetan Khatri
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark J Blyth
- Orthopaedic Research Unit, Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Nicholas David Clement
- Orthopaedics and Trauma, Royal Infirmary of Edinburgh, Edinburgh, UK
- Department of Orthopaedics, University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - David Deehan
- Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
| | | | | | | | - Fares S Haddad
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles E Hutchinson
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - James Mason
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Bishal Mohindru
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Chloe E H Scott
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- University of Edinburgh Division of Clinical and Surgical Sciences, Edinburgh, UK
| | - Toby O Smith
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - John A Skinner
- Royal National Orthopaedic Hospital NHS Trust, Stanmore, UK
| | - Andrew D Toms
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Sophie Rees
- Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Martin Underwood
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Andrew Metcalfe
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
10
|
Mousoulis C, Karantana A, Trickett RW, Thomas KS, Leighton P. 'It's just a finger isn't it…': patients' perspectives of recovery following finger fractures and participation in surgical trials - a qualitative interview study. BMJ Open 2023; 13:e065185. [PMID: 37173108 DOI: 10.1136/bmjopen-2022-065185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
OBJECTIVES To (1) generate detailed, person-centred data about the experience of finger injury and treatment and (2) understand the patients' perspectives of research involvement with a view to informing better designed future studies in hand injury. DESIGN Qualitative study using semistructured interviews and framework analysis. PARTICIPANTS 19 participants who were part of the Cohort study of Patients' Outcomes for Finger Fractures and Joint Injuries study in a single secondary care centre in the UK. RESULTS The results of this study showed that although finger injuries are frequently seen as minor by patients and healthcare professionals, their effects on peoples' lives are possibly greater than first anticipated. The relative importance of hand functioning means that the experience of treatment and recovery varies and is shaped by an individual's age, job, lifestyle and hobbies. These factors will also inform an individual's perspective on and willingness to participate in, hand research. Interviewees showed reluctance to accept randomisation in surgical trials. Interviewees would be more likely to participate in a study testing two variants of the same treatment modality (eg, surgery vs surgery), rather than two different modalities, (eg, surgery vs splint). The Patient-Reported Outcome Measure questionnaires that were used in this study were seen as less relevant by these patients. Pain, hand function and cosmetic appearance were considered important, meaningful outcomes. CONCLUSIONS Patients with finger injuries need more support from healthcare professionals as they may experience more problems than first anticipated. Good communication by clinicians and empathy can help patients engage with the treatment pathway. Perceptions of an 'insignificant' injury and/or need for quick functional recovery will influence recruitment to future hand research (both positively and negatively). Accessible information about the functional and clinical consequences of a hand injury will be important in enabling participants to make fully informed decisions about participation.
Collapse
Affiliation(s)
- Christos Mousoulis
- Centre for Evidence Based Hand Surgery, University of Nottingham, Nottingham, UK
| | - Alexia Karantana
- Centre for Evidence Based Hand Surgery, University of Nottingham, Nottingham, UK
| | - Ryan W Trickett
- Trauma and Orthopaedics, Cardiff and Vale University Health Board, Cardiff, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Paul Leighton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| |
Collapse
|
11
|
Wang N, Hao J, Zhang J, Du J, Luo Z. Risk factors for emergence agitation during the awakening period in elderly patients after total joint arthroplasty: a retrospective cohort study. BMJ Open 2023; 13:e068284. [PMID: 37164475 PMCID: PMC10174031 DOI: 10.1136/bmjopen-2022-068284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES This study aimed to explore the incidence and risk factors for emergence agitation (EA) in elderly patients who underwent total joint arthroplasty (TJA) under general anaesthesia, and to assess their predictive values. DESIGN Single-centre retrospective cohort study. SETTING A 1600-bed general tertiary hospital in China. PARTICIPANTS This study enrolled 421 elderly patients scheduled for elective primary TJA under general anaesthesia. PRIMARY AND SECONDARY OUTCOME MEASURES EA was assessed using the Richmond Agitation Sedation Scale during the awakening period after surgery in the post-anaesthesia care unit. Risk factors for EA were identified using univariate and multivariable logistic analyses. The receiver operating characteristic (ROC) curve was used to assess the predictive values of the risk factors for EA. RESULTS The incidence of EA in elderly patients who underwent TJA was 37.6%. According to the multivariable logistic analysis, postoperative pain (95% CI: 1.951 to 3.196), male sex (95% CI: 1.781 to 6.435), catheter-related bladder discomfort (CRBD) (95% CI: 4.001 to 15.392) and longer fasting times for solids (95% CI: 1.260 to 2.301) and fluids (95% CI: 1.263 to 2.365) were independent risk factors for EA. As shown by the ROC analysis, postoperative pain and fasting times for solids and fluids had good predictive values, with areas under the ROC curve equalling 0.769, 0.753 and 0.768, respectively. CONCLUSIONS EA is a common complication after TJA in elderly patients. Some risk factors, including postoperative pain, male sex, CRBD and longer fasting times, can increase the incidence of EA. These risk factors may contribute to identifying high-risk patients, which facilitates the development of effective strategies to prevent and treat EA. TRIAL REGISTRATION NUMBER ChiCTR1800020193.
Collapse
Affiliation(s)
- Naigeng Wang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jianhong Hao
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jie Zhang
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Jing Du
- Second Clinical Medical College, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, China
| | - Zhenguo Luo
- Department of Anesthesiology, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| |
Collapse
|
12
|
Parker W, Despain RW, Bailey J, Elster E, Rodriguez CJ, Bradley M. Military experience in the management of pelvic fractures from OIF/OEF. BMJ Mil Health 2023; 169:108-111. [PMID: 32938710 DOI: 10.1136/bmjmilitary-2020-001469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/22/2020] [Accepted: 07/01/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures. METHODS We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined. RESULTS Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy. CONCLUSIONS Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.
Collapse
Affiliation(s)
- William Parker
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - R W Despain
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - J Bailey
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - E Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - C J Rodriguez
- Division of Trauma, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - M Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| |
Collapse
|
13
|
Sudo H, Miyakoshi T, Watanabe Y, Ito YM, Kahata K, Tha KK, Yokota N, Kato H, Terada T, Iwasaki N, Arato T, Sato N, Isoe T. Protocol for treating lumbar spinal canal stenosis with a combination of ultrapurified, allogenic bone marrow-derived mesenchymal stem cells and in situ-forming gel: a multicentre, prospective, double-blind randomised controlled trial. BMJ Open 2023; 13:e065476. [PMID: 36731929 PMCID: PMC9896178 DOI: 10.1136/bmjopen-2022-065476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION In patients with combined lumbar spinal canal stenosis (LSCS), a herniated intervertebral disc (IVD) that compresses the dura mater and nerve roots is surgically treated with discectomy after laminoplasty. However, defects in the IVD after discectomy may lead to inadequate tissue healing and predispose patients to the development of IVD degeneration. Ultrapurified stem cells (rapidly expanding clones (RECs)), combined with an in situ-forming bioresorbable gel (dMD-001), have been developed to fill IVD defects and prevent IVD degeneration after discectomy. We aim to investigate the safety and efficacy of a new treatment method in which a combination of REC and dMD-001 is implanted into the IVD of patients with combined LSCS. METHODS AND ANALYSIS This is a multicentre, prospective, double-blind randomised controlled trial. Forty-five participants aged 20-75 years diagnosed with combined LSCS will be assessed for eligibility. After performing laminoplasty and discectomy, participants will be randomised 1:1:1 into the combination of REC and dMD-001 (REC-dMD-001) group, the dMD-001 group or the laminoplasty and discectomy alone (control) group. The primary outcomes of the trial will be the safety and effectiveness of the procedure. The effectiveness will be assessed using visual analogue scale scores of back pain and leg pain as well as MRI-based estimations of morphological and compositional quality of the IVD tissue. Secondary outcomes will include self-assessed clinical scores and other MRI-based estimations of compositional quality of the IVD tissue. All evaluations will be performed at baseline and at 1, 4, 12, 24 and 48 weeks after surgery. ETHICS AND DISSEMINATION This study was approved by the ethics committees of the institutions involved. We plan to conduct dissemination of the outcome data by presenting our data at national and international conferences, as well as through formal publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER jRCT2013210076.
Collapse
Affiliation(s)
- Hideki Sudo
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Takashi Miyakoshi
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yudai Watanabe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Yoichi M Ito
- Data Science Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Kaoru Kahata
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Khin Khin Tha
- Global Center for Biomedical Science and Engineering, Hokkaido University Faculty of Medicine, Sapporo, Japan
| | - Nozomi Yokota
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroe Kato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Tomoko Terada
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Hospital, Sapporo, Japan
| | - Teruyo Arato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Norihiro Sato
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| | - Toshiyuki Isoe
- Clinical Research and Medical Innovation Center, Institute of Health Science Innovation for Medical Care, Hokkaido University Hospital, Sapporo, Japan
| |
Collapse
|
14
|
Wilson R, Margelyte R, Redaniel MT, Eyles E, Jones T, Penfold C, Blom A, Elliott A, Harper A, Keen T, Pitt M, Judge A. Identification of risk factors associated with prolonged hospital stay following primary knee replacement surgery: a retrospective, longitudinal observational study. BMJ Open 2022; 12:e068252. [PMID: 36526323 PMCID: PMC9764602 DOI: 10.1136/bmjopen-2022-068252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To identify risk factors associated with prolonged length of hospital stay and staying in hospital longer than medically necessary following primary knee replacement surgery. DESIGN Retrospective, longitudinal observational study. SETTING Elective knee replacement surgeries between 2016 and 2019 were identified using routinely collected data from an NHS Trust in England. PARTICIPANTS There were 2295 knee replacement patients with complete data included in analysis. The mean age was 68 (SD 11) and 60% were female. OUTCOME MEASURES We assessed a binary length of stay outcome (>7 days), a continuous length of stay outcome (≤30 days) and a binary measure of whether patients remained in hospital when they were medically fit for discharge. RESULTS The mean length of stay was 5.0 days (SD 3.9), 15.4% of patients were in hospital for >7 days and 7.1% remained in hospital when they were medically fit for discharge. Longer length of stay was associated with older age (b=0.08, 95% CI 0.07 to 0.09), female sex (b=0.36, 95% CI 0.06 to 0.67), high deprivation (b=0.98, 95% CI 0.47 to 1.48) and more comorbidities (b=2.48, 95% CI 0.15 to 4.81). Remaining in hospital beyond being medically fit for discharge was associated with older age (OR=1.07, 95% CI 1.05 to 1.09), female sex (OR=1.71, 95% CI 1.19 to 2.47) and high deprivation (OR=2.27, 95% CI 1.27 to 4.06). CONCLUSIONS The regression models could be used to identify which patients are likely to occupy hospital beds for longer. This could be helpful in scheduling operations to aid hospital efficiency by planning these patients' operations for when the hospital is less busy.
Collapse
Affiliation(s)
- Rebecca Wilson
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruta Margelyte
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emily Eyles
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Jones
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Penfold
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashley Blom
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Alison Harper
- The National Institute for Health Research Applied Research Collaboration South-West Peninsula (PenARC), University of Exeter, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| | - Tim Keen
- North Bristol NHS Trust, Bristol, UK
| | - Martin Pitt
- The National Institute for Health Research Applied Research Collaboration South-West Peninsula (PenARC), University of Exeter, Exeter, UK
- Medical School, University of Exeter, Exeter, UK
| | - Andrew Judge
- Translational Health Sciences, University of Bristol, Bristol, UK
| |
Collapse
|
15
|
Li ADF, Eccleston CT, Abraham V, Balazs GC, Goldman AH. Total hip and knee arthroplasty after lower extremity amputation in a military population. BMJ Mil Health 2022:e002106. [PMID: 35868710 DOI: 10.1136/military-2022-002106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/03/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION The military includes lower extremity amputees requiring arthroplasty; however, there is little literature on this population. The primary aim of this study was to report demographics and clinical factors in amputees who undergo total hip or knee arthroplasty (THA/TKA) in the Military Health System (MHS). Second, patient-reported outcome measures (PROMs) are reported. METHODS The Military Data Repository was queried for patients with lower extremity amputations and TKA or THA between 1 October 2014 and 12 October 2020. The medical records were reviewed and patients were contacted to complete PROMs. Mean follow-up for TKA and THA was 5.5 and 2.5 years, respectively. RESULTS Nineteen TKAs (76%) and eight THAs (28%) were performed in 25 patients. Mean age of TKA and THA patients at the time of arthroplasty was 57 years old. A majority of TKA (68%) and THA (57%) patients underwent amputations secondary to trauma. Nearly all TKAs were performed on the contralateral side to the amputation (95%), while half of THAs were performed on the ipsilateral side (50%). Two THAs (29%) were revised due to periprosthetic fractures, whereas six TKAs (32%) were revised or reoperated on due to infection. Ten TKA patients completed PROMs. The mean score on Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS JR) was 41.8 and Patient-Reported Outcomes Measurement Information System Global-10 (PROMIS-10) was 41.6 (Global Physical Health) and 49.6 (Global Mental Health). CONCLUSIONS Most TKAs were performed on the contralateral limb, suggesting increased demand on the joint. The most common indication for amputation and post-TKA complication was trauma and infection, respectively. KOOS JR may not accurately capture the outcomes of this population, or they simply do worse. However, PROMIS-10 scores were similar to the non-amputee population, suggesting that the PROMIS-10 may be more useful than the KOOS JR.
Collapse
Affiliation(s)
| | - C T Eccleston
- School of Medicine, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - V Abraham
- Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - G C Balazs
- Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| | - A H Goldman
- Orthopaedic Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
- Uniformed Services University of Health Sciences, Bethesda, MD, USA
| |
Collapse
|
16
|
Evans JP, Gibbons C, Toms AD, Valderas JM. Use of computerised adaptive testing to reduce the number of items in patient-reported hip and knee outcome scores: an analysis of the NHS England National Patient-Reported Outcome Measures programme. BMJ Open 2022; 12:e059415. [PMID: 35858721 PMCID: PMC9315912 DOI: 10.1136/bmjopen-2021-059415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Over 160 000 participants per year complete the 12-item Oxford Hip and Knee Scores (OHS/OKS) as part of the NHS England Patient-Reported Outcome Measures (PROMs) programme. We used a modern computational approach, known as computerised adaptive testing (CAT), to simulate individually tailored OHS and OKS assessment, with the goal of reducing the number of questions a patient must complete without compromising measurement accuracy. METHODS We fit the 2018/2019 PROMs data to an item response theory (IRT) model. We assessed IRT model assumptions alongside reliability. We used parameters from the IRT model with data from 2017/2018 to simulate CAT assessments. Two simulations were run until a prespecified SE of measurement was met (SE=0.32 and SE=0.45). We compared the number of questions required to meet each cut-off and assessed the correlation between the full-length and CAT administration. RESULTS We conducted IRT analysis using 40 432 OHS and 44 714 OKS observations. The OHS and OKS were both unidimensional (root mean square error of approximation 0.08 and 0.07, respectively) and marginal reliability 0.91 and 0.90. The CAT, with a precision limit of SE=0.32 and SE=0.45, required a median of four items (IQR 1) and two items (IQR 1), respectively, for the OHS, and median of four items (IQR 2) and two items (IQR 0) for the OKS. This represents a potential 82% reduction in PROM length. In the context of 160 000 yearly assessments, these methodologies could result in the omission of some 1 280 000 redundant questions per year, which equates to 40 000 hours of patient time. CONCLUSION The application of IRT to the OHS and OKS produces an efficient and substantially reduced CAT. We have demonstrated a path to reduce the burden and potentially increase the compliance for these ubiquitous outcome measures without compromising measurement accuracy.
Collapse
Affiliation(s)
- Jonathan Peter Evans
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Christopher Gibbons
- Section of Patient -Centred Analytics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Andrew D Toms
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Jose Maria Valderas
- Health Services and Policy Research Group, University of Exeter Medical School, Exeter, UK
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
17
|
Kowalski KL, Lukacs MJ, Mistry J, Goodman M, Rushton AB. Physical functioning outcome measures in the lumbar spinal surgery population and measurement properties of the physical outcome measures: protocol for a systematic review. BMJ Open 2022; 12:e060950. [PMID: 35667717 PMCID: PMC9171219 DOI: 10.1136/bmjopen-2022-060950] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Low back pain can lead to substantial decline in physical functioning. For disabling pain not responsive to conservative management, surgical intervention can enhance physical functioning. Measurements of physical functioning include patient-reported outcome measures and physical outcome measures using evaluations of impairments, performance on a standardised task or activity in a natural environment. Selecting outcome measures with adequate measurement properties is fundamental to evaluating effectiveness of interventions. The purpose of this systematic review is to identify outcome measures (patient reported and physical) used to evaluate physical functioning (stage 1) and assess the measurement properties of physical outcome measures of physical functioning (stage 2) in the lumbar spinal surgery population. METHODS AND ANALYSIS This protocol aligns with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines and Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. Using a two-staged approach, searches will be performed in MEDLINE, EMBASE, Health and Psychosocial Instruments, CINAHL, Web of Science, Scopus, PEDro and the grey literature from inception until 15 December 2021. Stage 1 will identify studies evaluating physical functioning with patient-reported or physical outcome measures in the lumbar spinal surgery population. Stage 2 will search for studies evaluating measurement properties (validity, reliability, responsiveness) of the physical outcome measures identified in stage 1 in the lumbar spinal surgery population. Two independent reviewers will evaluate studies for inclusion, extract data, assess risk of bias (COSMIN risk of bias tool and checklist) and quality of evidence (modified Grading of Recommendations Assessment, Development and Evaluation approach). Results for each measurement property per physical outcome measure will be quantitatively pooled if there is adequate clinical and methodological homogeneity or qualitatively synthesised if there is high heterogeneity in studies. ETHICS AND DISSEMINATION Ethics approval is not required. Results will be disseminated through peer-reviewed journal publication and conference presentation. PROSPERO REGISTRATION NUMBER CRD42021293880.
Collapse
Affiliation(s)
- Katie L Kowalski
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michael J Lukacs
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jai Mistry
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
- Physiotherapy, St George's Hospital, London, UK
| | - Maren Goodman
- Western Libraries, Western University, London, Ontario, Canada
| | - Alison B Rushton
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| |
Collapse
|
18
|
Smith TO, Parsons S, Ooms A, Dutton S, Fordham B, Garrett A, Hing C, Lamb S. Randomised controlled trial of a behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: the PEP-TALK trial. BMJ Open 2022; 12:e061373. [PMID: 35641012 PMCID: PMC9157340 DOI: 10.1136/bmjopen-2022-061373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To test the effectiveness of a behaviour change physiotherapy intervention to increase physical activity compared with usual rehabilitation after total hip replacement (THR) or total knee replacement (TKR). DESIGN Multicentre, pragmatic, two-arm, open, randomised controlled, superiority trial. SETTING National Health Service providers in nine English hospitals. PARTICIPANTS 224 individuals aged ≥18 years, undergoing a primary THR or TKR deemed 'moderately inactive' or 'inactive'. INTERVENTION Participants received either six, 30 min, weekly, group-based exercise sessions (usual care) or the same six weekly, group-based, exercise sessions each preceded by a 30 min cognitive behaviour discussion group aimed at challenging barriers to physical inactivity following surgery (experimental). RANDOMISATION AND BLINDING Initial 75 participants were randomised 1:1 before changing the allocation ratio to 2:1 (experimental:usual care). Allocation was based on minimisation, stratifying on comorbidities, operation type and hospital. There was no blinding. MAIN OUTCOME MEASURES Primary: University of California Los Angeles (UCLA) Activity Score at 12 months. Secondary: 6 and 12-month assessed function, pain, self-efficacy, kinesiophobia, psychological distress and quality of life. RESULTS Of the 1254 participants assessed for eligibility, 224 were included (139 experimental: 85 usual care). Mean age was 68.4 years (SD: 8.7), 63% were women, 52% underwent TKR. There was no between-group difference in UCLA score (mean difference: -0.03 (95% CI -0.52 to 0.45, p=0.89)). There were no differences observed in any of the secondary outcomes at 6 or 12 months. There were no important adverse events in either group. The COVID-19 pandemic contributed to the reduced intended sample size (target 260) and reduced intervention compliance. CONCLUSIONS There is no evidence to suggest attending usual care physiotherapy sessions plus a group-based behaviour change intervention differs to attending usual care physiotherapy alone. As the trial could not reach its intended sample size, nor a proportion of participants receive their intended rehabilitation, this should be interpreted with caution. TRIAL REGISTRATION NUMBER ISRCTN29770908.
Collapse
Affiliation(s)
- Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Scott Parsons
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alexander Ooms
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Susan Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Beth Fordham
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Angela Garrett
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Caroline Hing
- Trauma and Orthopaedic Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| |
Collapse
|
19
|
Kamp T, Stevens M, Van Beveren J, Rijk PC, Brouwer R, Bulstra S, Brouwer S. Influence of social support on return to work after total hip or total knee arthroplasty: a prospective multicentre cohort study. BMJ Open 2022; 12:e059225. [PMID: 35623752 PMCID: PMC9150170 DOI: 10.1136/bmjopen-2021-059225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES There is strong evidence that social support is an important determinant of return to work (RTW). Little is known about the role of social support in RTW after total hip or knee arthroplasty (THA/TKA). Objective was to examine the influence of preoperative and postoperative perceived social support on RTW status 6 months postoperatively. DESIGN A prospective multicentre cohort study was conducted. SETTING Orthopaedic departments of four Dutch medical centres; a tertiary university hospital, two large teaching hospitals and a general hospital. PARTICIPANTS Patients planned to undergo THA/TKA, aged 18-63 and employed preoperatively were included. MAIN OUTCOME MEASURES Questionnaires were filled out preoperatively and 3 and 6 months postoperatively and included questions to assess patients' perceived social support targeting three sources of social support: from home (friends, family), from work (coworkers, supervisors) and from healthcare (occupational physician, general practitioner, other caregivers). Control variables included age, gender, education, type of arthroplasty and comorbidities. RTW was defined as having fully returned to work 6 months postoperatively. Univariate and multivariate logistic regression analyses were conducted. RESULTS Enrolled were 190 patients (n=77 THA, n=113 TKA, median age was 56 years, 56% women). The majority returned to work (64%). Preoperatively, social support from the occupational physician was associated with RTW (OR 2.53, 95% CI 1.15 to 5.54). Postoperatively, social support from the occupational physician (OR 3.04, 95% CI 1.43 to 6.47) and the supervisor (OR 2.56, 95% CI 1.08 to 6.06) was associated with RTW. CONCLUSIONS This study underscores the importance of work-related social support originating from the occupational physician and supervisor in facilitating RTW after primary THA/TKA, both preoperatively and postoperatively. Further research is needed to confirm our results and to understand the facilitating role of social support in RTW, as arthroplasty is being performed on a younger population for whom work participation is critical.
Collapse
Affiliation(s)
- Tamara Kamp
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Martin Stevens
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan Van Beveren
- Department of Orthopedics, Röpcke-Zweers Hospital Hardenberg, Hardenberg, The Netherlands
| | - Paul C Rijk
- Department of Orthopedics, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Reinoud Brouwer
- Department of Orthopedics, Martini Hospital Groningen, Groningen, The Netherlands
| | - Sjoerd Bulstra
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sandra Brouwer
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
20
|
Singh S, Thiagarajah V, Banerjee R, Iyenger K, Garg S, Singh B, Ahluwalia R. Delivering surgical education: a specialist surgical society and undergraduate student collaboration. Postgrad Med J 2022:7126394. [PMID: 37068763 DOI: 10.1136/postmj/postgradmedj-2021-140849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 01/15/2022] [Indexed: 04/19/2023]
Abstract
Currently, the delivery of the undergraduate medical curriculum includes various teaching, learning and assessment strategies. Self-directed learning is an important aspect of this mix and includes the use of resources, sometimes not provided by the parent University, in the student's own time to enhance the student's knowledge, skills and professional practice. Societies aimed at a particular specialty contain a pool of professionals that can provide undergraduate students with opportunities for further self-directed learning, development of specialty-specific core skills and exploration of research interests. This may then enhance and enlighten the students' approach to a particular orthopaedic problem and reinforce the curriculum they are studying while providing an understanding of current areas of debate that are not part of the curriculum at present. The collaboration of postgraduate societies with undergraduate students in developing and implementing undergraduate engagement strategies is of benefit to undergraduate education, the specialty society and the collaborating students. We explore the planning and implementation of an interactive webinar series run by the British Indian Orthopaedic Society in collaboration with undergraduate students. We provide a case study of a surgical specialty society engaging with undergraduate students with synergistic effect. We pay particular attention to the benefits accrued by the specialty society and the student collaborators by this joint effort.
Collapse
Affiliation(s)
- Shashwat Singh
- The Medical School, The University of Edinburgh, Edinburgh, UK
| | - Viswan Thiagarajah
- Faculty of Medicine, Imperial College of Science & Technology and Medicine, London, UK
| | - Rishi Banerjee
- Faculty of Medicine, Imperial College of Science & Technology and Medicine, London, UK
| | - Kartik Iyenger
- Faculty of Medicine, Orthopaedics, Southport and Ormskirk Hospital NHS Trust, Southport, Sefton, UK
| | - Sunil Garg
- Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, UK
| | | | - Raju Ahluwalia
- Orthopaedics, King's College Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
21
|
Smith LK, Garriga C, Kingsbury SR, Pinedo-Villanueva R, Delmestri A, Arden NK, Stone M, Conaghan PG, Judge A. UK poSt Arthroplasty Follow-up rEcommendations (UK SAFE): what does analysis of linked, routinely collected national datasets tell us about mid-late term revision risk after knee replacement? BMJ Open 2022; 12:e046900. [PMID: 35264336 PMCID: PMC8915365 DOI: 10.1136/bmjopen-2020-046900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To identify patients at risk of mid-late term revision of knee replacement (KR) to inform targeted follow-up. DESIGN Analysis of linked national datasets from primary and secondary care (Clinical Practice Research Datalink (CPRD GOLD), National Joint Registry (NJR), English Hospital Episode Statistics (HES) and Patient Reported Outcome Measures (PROMs)). PARTICIPANTS Primary elective KRs aged ≥18 years. EVENT OF INTEREST Revision surgery ≥5 years (mid-late term) postprimary KR. STATISTICAL METHODS Cox regression modelling to ascertain risk factors of mid-late term revision. HRs and 95% CIs assessed association of sociodemographic factors, comorbidities, medication, surgical variables and PROMs with mid-late term revision. RESULTS NJR-HES-PROMs data were available from 2008 to 2011 on 188 509 KR. CPRD GOLD-HES data covered 1995-2011 on 17 378 KR. Patients had minimum 5 years postprimary surgery to end 2016. Age and gender distribution were similar across datasets; mean age 70 years, 57% female. In NJR, there were 8607 (4.6%) revisions, median time-to-revision postprimary surgery 1.8 years (range 0-8.8), with 1055 (0.6%) mid-late term revisions; in CPRD GOLD, 877 (5.1%) revisions, median time-to-revision 4.2 years (range 0.02-18.3), with 352 (2.0%) mid-late term revisions.Reduced risk of revision after 5 years was associated with older age (HR: 0.95; 95% CI 0.95 to 0.96), obesity (0.70; 0.56 to 0.88), living in deprived areas (0.71; 0.58 to 0.87), non-white ethnicity (0.58; 0.43 to 0.78), better preoperative pain and functional limitation (0.42; 0.33 to 0.53), better 6-month postoperative pain and function (0.33; 0.26 to 0.41) or moderate anxiety/depression (0.73; 0.63 to 0.83) at primary surgery.Increased risk was associated with male gender (1.32; 1.04 to 1.67); when anticonvulsants (gabapentin and pregabalin) (1.58; 1.01 to 2.47) or opioids (1.36; 1.08 to 1.71) were required prior to primary surgery.No implant factors were identified. CONCLUSION The risk of mid-late term KR revision is very low. Increased risk of revision is associated with patient case-mix factors, and there is evidence of sociodemographic inequality.
Collapse
Affiliation(s)
- Lindsay K Smith
- Department of Health & Applied Sciences, University of the West of England, Bristol, UK
| | - Cesar Garriga
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah R Kingsbury
- NIHR Leeds Biomedical Research Centre, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Rafael Pinedo-Villanueva
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Antonella Delmestri
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Martin Stone
- Orthopaedic Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Andrew Judge
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
22
|
Pellegrini VD, Eikelboom JW, Evarts CM, Franklin PD, Garvin KL, Goldhaber SZ, Iorio R, Lambourne CA, Magaziner J, Magder L. Randomised comparative effectiveness trial of Pulmonary Embolism Prevention after hiP and kneE Replacement (PEPPER): the PEPPER trial protocol. BMJ Open 2022; 12:e060000. [PMID: 35260464 PMCID: PMC8905949 DOI: 10.1136/bmjopen-2021-060000] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION More than 1 million elective total hip and knee replacements are performed annually in the USA with 2% risk of clinical pulmonary embolism (PE), 0.1%-0.5% fatal PE, and over 1000 deaths. Antithrombotic prophylaxis is standard of care but evidence is limited and conflicting. We will compare effectiveness of three commonly used chemoprophylaxis agents to prevent all-cause mortality (ACM) and clinical venous thromboembolism (VTE) while avoiding bleeding complications. METHODS AND ANALYSIS Pulmonary Embolism Prevention after HiP and KneE Replacement is a large randomised pragmatic comparative effectiveness trial with non-inferiority design and target enrolment of 20 000 patients comparing aspirin (81 mg two times a day), low-intensity warfarin (INR (International Normalized Ratio) target 1.7-2.2) and rivaroxaban (10 mg/day). The primary effectiveness outcome is aggregate of VTE and ACM, primary safety outcome is clinical bleeding complications, and patient-reported outcomes are determined at 1, 3 and 6 months. Primary data analysis is per protocol, as preferred for non-inferiority trials, with secondary analyses adherent to intention-to-treat principles. All non-fatal outcomes are captured from patient and clinical reports with independent blinded adjudication. Study design and oversight are by a multidisciplinary stakeholder team including a 10-patient advisory board. ETHICS AND DISSEMINATION The Institutional Review Board of the Medical University of South Carolina provides central regulatory oversight. Patients aged 21 or older undergoing primary or revision hip or knee replacement are block randomised by site and procedure; those on chronic anticoagulation are excluded. Recruitment commenced at 30 North American centres in December 2016. Enrolment currently exceeds 13 500 patients, representing 33% of those eligible at participating sites, and is projected to conclude in July 2024; COVID-19 may force an extension. Results will inform antithrombotic choice by patients and other stakeholders for various risk cohorts, and will be disseminated through academic publications, meeting presentations and communications to advocacy groups and patient participants. TRIAL REGISTRATION NCT02810704.
Collapse
Affiliation(s)
| | | | - C McCollister Evarts
- Orthopaedics and Physical Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Patricia D Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kevin L Garvin
- Orthopaedics and Physical Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Richard Iorio
- Orthopaedics, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Carol Ann Lambourne
- Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jay Magaziner
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Laurence Magder
- Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
23
|
Lin E, Uhler LM, Finley EP, Jayakumar P, Rathouz PJ, Bozic KJ, Tsevat J. Incorporating patient-reported outcomes into shared decision-making in the management of patients with osteoarthritis of the knee: a hybrid effectiveness-implementation study protocol. BMJ Open 2022; 12:e055933. [PMID: 35190439 PMCID: PMC8860037 DOI: 10.1136/bmjopen-2021-055933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is a major clinical and public health concern. The primary surgical treatment of knee OA is total knee replacement (TKR), a procedure that aims to alleviate pain and restore physical function. TKR is expensive, however, and based on professional guidelines, inappropriately performed in up to a third of patients. Patient-reported outcome measures (PROMs) help evaluate treatment options by quantifying health outcomes that matter to patients and can thus inform shared decision-making (SDM) between patients and health professionals. METHODS AND ANALYSIS This is a US-based 2-year, two-site hybrid type 1 study to assess clinical effectiveness and implementation of a machine learning-based patient decision aid (PDA) integrating patient-reported outcomes and clinical variables to support SDM for patients with knee OA considering TKR. Substudy 1: At one study site, a randomised controlled trial is evaluating the clinical effectiveness of the PDA and SDM process on decision quality as measured after the baseline consultation and treatment choice measured 3 and 6 months after the baseline visit among 200 patients with knee OA. Substudy 2: At a second study site, a qualitative assessment using principles of behaviour design and intervention mapping is evaluating the feasibility and acceptability of the PROMs, PDA and SDM process by interviewing seven health professionals and 25 patients before and 25 patients after PDA implementation. ETHICS AND DISSEMINATION Ethics approval has been obtained from The University of Texas at Austin Institutional Review Board (protocol number: 2018-11-0042). Informed consent will be obtained from all participants. Study results will be disseminated through conference presentations, publications and professional societies. TRIAL REGISTRATION NUMBER NCT04805554.
Collapse
Affiliation(s)
- Eugenia Lin
- Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Lauren M Uhler
- Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Erin P Finley
- Research Service, South Texas Veterans Health Care System, San Antonio, Texas, USA
- Center for Research to Advance Community Health, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Division of General and Hospital Medicine, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Prakash Jayakumar
- Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Paul J Rathouz
- Population Health, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Kevin J Bozic
- Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Joel Tsevat
- Center for Research to Advance Community Health, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Division of General and Hospital Medicine, Department of Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Population Health, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| |
Collapse
|
24
|
Huang XM, Yuan FZ, Chen YR, Huang Y, Yang ZX, Lin L, Yu JK. Physical therapy and orthopaedic equipment-induced reduction in the biomechanical risk factors related to knee osteoarthritis: a systematic review and Bayesian network meta-analysis of randomised controlled trials. BMJ Open 2022; 12:e051608. [PMID: 35140149 PMCID: PMC8830256 DOI: 10.1136/bmjopen-2021-051608] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Are physical therapy or orthopaedic equipment efficacious in reducing the biomechanical risk factors in people with tibiofemoral osteoarthritis (OA)? Is there a better therapeutic intervention than others to improve these outcomes? DESIGN Systematic review with network meta-analysis (NMA) of randomised trials. DATA SOURCES PubMed, Web of Science, Cochrane Library, Embase and MEDLINE were searched through January 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We included randomised controlled trials exploring the benefits of using physical therapy or orthopaedic equipment in reducing the biomechanical risk factors which included knee adduction moment (KAM) and knee adduction angular impulse (KAAI) in individuals with tibiofemoral OA. DATA EXTRACTION AND SYNTHESIS Two authors extracted data independently and assessed risk of bias. We conducted an NMA to compare multiple interventions, including both direct and indirect evidences. Heterogeneity was assessed (sensitivity analysis) and quantified (I2 statistic). Grading of Recommendations Assessment, Development and Evaluation assessed the certainty of the evidence. RESULTS Eighteen randomised controlled trials, including 944 participants, met the inclusion criteria, of which 14 trials could be included in the NMA. Based on the collective probability of being the overall best therapy for reducing the first peak KAM, lateral wedge insoles (LWI) plus knee brace was closely followed by gait retraining, and knee brace only. Although no significant difference was observed among the eight interventions, variable-stiffness shoes and neuromuscular exercise exhibited an increase in the first peak KAM compared with the control condition group. And based on the collective probability of being the overall best therapy for reducing KAAI, gait retraining was followed by LWI only, and lower limb exercise. CONCLUSION The results of our study support the use of LWI plus knee brace for reducing the first peak KAM. Gait retraining did not rank highest but it influenced both KAM and KAAI and therefore it was the most recommended therapy for reducing the biomechanical risk factors.
Collapse
Affiliation(s)
- Xi-Meng Huang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Fu-Zhen Yuan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - You-Rong Chen
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Ying Huang
- Plastic Surgery Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Xi Yang
- Department of Orthopedic, Peking University Third Hospital, Beijing, China
| | - Lin Lin
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| | - Jia-Kuo Yu
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Beijing, China
| |
Collapse
|
25
|
Persson A, Atroshi I, Tyszkiewicz T, Hailer N, Lazarinis S, Eisler T, Brismar H, Mukka S, Kernell PJ, Mohaddes M, Sköldenberg O, Gordon M. EPOS trial: the effect of air filtration through a plasma chamber on the incidence of surgical site infection in orthopaedic surgery: a study protocol of a randomised, double-blind, placebo-controlled trial. BMJ Open 2022; 12:e047500. [PMID: 35115346 PMCID: PMC8814745 DOI: 10.1136/bmjopen-2020-047500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There is controversy regarding the importance of air-transmitted infections for surgical site infections (SSIs) after orthopaedic surgery. Research has been hindered by both the inability in blinding the exposure, and by the need for recruiting large enough cohorts. The aim of this study is to investigate whether using a new form of air purifier using plasma air purification (PAP) in operating rooms (ORs) lowers the SSI rate or not. METHODS AND ANALYSIS Multicentre, double-blind, cluster-randomised, placebo-controlled trial conducted at seven hospitals in 2017-2022. All patients that undergo orthopaedic surgery for minimum 30 min are included. Intervention group: patients operated in OR with PAP devices turned on. CONTROL GROUP patients operated in OR with PAP devices turned off. Randomisation: each OR will be randomised in periods of 4 weeks, 6 weeks or 8 weeks to either have the devices on or off. PRIMARY OUTCOME any SSI postoperatively defined as a composite endpoint of any of the following: use of isoxazolylpenicillin, clindamycin or rifampicin for 2 days or more, International Classification of Diseases codes or Nordic Medico-Statistical Committee codes indicating postoperative infection. In a second step, we will perform a chart review on those patients with positive indicators of SSI to further validate the outcome. Secondary outcomes are described in the Methods section. Power: we assume an SSI rate of 2%, an SSI reduction rate of 25% and we need approximately 45 000 patients to attain a power of 80% at a significance level of 0.05. ETHICS AND DISSEMINATION The study is approved by the Swedish Ethical Review Authority. The interim analysis results from the study will be presented only to the researchers involved unless the study thereafter is interrupted for whatever reason. Publication in a medical journal will be presented after inclusion of the last patient. TRIAL REGISTRATION NUMBER NCT02695368.
Collapse
Affiliation(s)
- Anders Persson
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Isam Atroshi
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden
| | - Thomas Tyszkiewicz
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Orthopaedics, Hässleholm-Kristianstad Hospitals, Kristianstad, Sweden
| | - Nils Hailer
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Stergios Lazarinis
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
- Department of Orthopaedics, Uppsala University Hospital, Uppsala, Sweden
| | - Thomas Eisler
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Harald Brismar
- Department of Clinical Science Intervention and Technology, Karolinska Institute, Huddinge, Sweden
- Department of Orthopaedics and Biotechnology, Karolinska Universitetsjukhuset i Huddinge, Huddinge, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
- Umeå University Hospital, Umeå, Sweden
| | - Per-Juan Kernell
- GHP Ortho Center Stockholm, Löwenströmska Hospital, Upplands Väsby, Sweden
| | - Maziar Mohaddes
- Swedish Hip Arthroplasty Register, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University Of Gothenburg, Gothenburg, Sweden
| | - Olof Sköldenberg
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| | - Max Gordon
- Karolinska Institutet Institutionen för kliniska vetenskaper Danderyds sjukhus, Danderyd, Sweden
| |
Collapse
|
26
|
Spears TM, Harrison JM, Spooner RB, Douglas TJ, Balazs GC. Patient expectations for opioid analgesia following orthopaedic surgery. Postgrad Med J 2022; 98:e64-e65. [PMID: 35105780 DOI: 10.1136/postgradmedj-2020-137957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2020] [Indexed: 11/03/2022]
Affiliation(s)
- Thomas M Spears
- Department of Orthopedics, US Naval Hospital Yokosuka, Yokosuka, Japan
| | - James M Harrison
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Rebecca B Spooner
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - Thomas J Douglas
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| | - George C Balazs
- Bone & Joint Sports Medicine Institute, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
| |
Collapse
|
27
|
Rantalaiho I, Laaksonen I, Launonen AP, Luokkala T, Flinkkilä T, Salmela M, Adolfsson L, Olsen B, Isotalo K, Ryösä A, Äärimaa V. Scandinavian Olecranon Research in the Elderly (SCORE): protocol for a non-inferiority, randomised, controlled, multicentre trial comparing operative and conservative treatment of olecranon fractures in the elderly. BMJ Open 2022; 12:e055097. [PMID: 35105643 PMCID: PMC8808415 DOI: 10.1136/bmjopen-2021-055097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The incidence of olecranon fractures is growing in the elderly population. The traditional operative approach is giving way among the elderly to conservative treatment, which seems to provide a comparable functional outcome with a lower complication burden. However, there is still a lack of reliable evidence to support this shift.The objective of this trial is to investigate whether conservative treatment of displaced olecranon fractures in patients aged 75 or older yields comparable results to those of operative treatment in terms of pain and daily function. METHODS AND ANALYSIS Scandinavian Olecranon Research in the Elderly (SCORE) is a randomised, controlled, multicentre, non-inferiority trial. Eligible patients will be randomised to either conservative or operative treatment. The sample size will be 68 patients and allocation done at a 1:1 ratio (34 patients per group). The randomisation is stratified according to the participating hospital and patient's sex. Both groups will receive the same postoperative physiotherapy and pain management. The primary outcome is Disabilities of the Arm, Shoulder and Hand at 1-year follow-up. Secondary outcomes are pain and satisfaction measured on visual analogue scales, Patient Reported Elbow Evaluation, range of motion of the elbow and extension strength of the elbow compared with the unaffected arm. Radiographs will be taken at each follow-up. Primary analysis of the results will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION The study protocol for this clinical trial has been approved by the Ethics Committee of the Hospital District of Southwest Finland and will be submitted for approval to the Regional Ethics Committees in Linköping, Sweden and Copenhagen, Denmark. Every recruiting centre will apply local research approvals. The results of this study will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04401462. PROTOCOL VERSION This is the second protocol version dated on 16 April 2020.
Collapse
Affiliation(s)
- Ida Rantalaiho
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti P Launonen
- Department of Orthopedics and Traumatology, Tampere University Hospital, Tampere, Finland
| | - Toni Luokkala
- Department of Orthopedics and Traumatology, Central Finland Central Hospital, Jyvaskyla, Finland
| | - Tapio Flinkkilä
- Department of Orthopedics and Traumatology, Oulu University Hospital, Oulu, Finland
| | - Mikko Salmela
- Department of Orthopedics and Traumatology, Helsinki University Hospital, Helsinki, Finland
| | - L Adolfsson
- Institution for Clinical and Experimental Medicine, Division of Orthopaedics, Linköping University, Linkoping, Sweden
| | - Bo Olsen
- Department of Orthopedic Surgery, Herlev and Gentofte Hospital and University of Copenhagen, Copenhagen, Denmark
| | - Kari Isotalo
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Anssi Ryösä
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland
| |
Collapse
|
28
|
Jaconelli T, Auplish S. A rare cause of shoulder pain. Postgrad Med J 2022; 98:e1. [PMID: 37063022 DOI: 10.1136/postgradmedj-2021-141112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 12/31/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Tom Jaconelli
- Department of Emergency Medicine, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Sunil Auplish
- Department of Trauma and Orthopaedics, York Teaching Hospital NHS Foundation Trust, York, UK
| |
Collapse
|
29
|
Duan YJ, Hua XY, Zheng MX, Wu JJ, Xing XX, Li YL, Xu JG. Corticocortical paired associative stimulation for treating motor dysfunction after stroke: study protocol for a randomised sham-controlled double-blind clinical trial. BMJ Open 2022; 12:e053991. [PMID: 35027421 PMCID: PMC8762140 DOI: 10.1136/bmjopen-2021-053991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Stroke survivors can have a high disability rate with low quality of daily life, resulting in a heavy burden on family and society. Transcranial magnetic stimulation has been widely applied to brain injury repair, neurological disease treatment, cognition and emotion regulation and so on. However, there is still much to be desired in the theories of using these neuromodulation techniques to treat stroke-caused hemiplegia. It is generally recognised that synaptic plasticity is an important basis for functional repair after brain injury. This study protocol aims to examine the corticocortical paired associative stimulation (ccPAS) for inducing synaptic plasticity to rescue the paralysed after stroke. METHODS AND ANALYSIS The current study is designed as a 14-week double-blind randomised sham-controlled clinical trial, composed of 2-week intervention and 12-week follow-up. For the study, 42 patients who had a stroke aged 40-70 will be recruited, who are randomly assigned either to the ccPAS intervention group, or to the control group at a 1:1 ratio, hence an equal number each. In the intervention group, ccPAS is practised in conjunction with the conventional rehabilitation treatment, and in the control group, the conventional rehabilitation treatment is administered with sham stimulation. A total of 10 interventions will be made, 5 times a week for 2 weeks. The same assessors are supposed to evaluate the participants' motor function at four time points of the baseline (before 10 interventions), treatment ending (after 10 interventions), and two intervals of follow-up (1 and 3 months later, respectively). The Fugl-Meyer Assessment Upper Extremity is used for the primary outcomes. The secondary outcomes include changes in the assessment of Action Research Arm Test (ARAT), Modified Barthel Index (MBI), electroencephalogram (EEG) and functional MRI data. The adverse events are to be recorded throughout the study. ETHICS AND DISSEMINATION This study was approved by the Medical Ethics Committee of Yueyang Hospital. All ethical work was performed in accordance with the Helsinki declaration. Written informed consent was obtained from all individual participants included in the study. Study findings will be disseminated in the printed media. TRIAL REGISTRATION NUMBER Chinese Clinical Trial Registry: ChiCTR2000036685.
Collapse
Affiliation(s)
- Yu-Jie Duan
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xu-Yun Hua
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mou-Xiong Zheng
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jia-Jia Wu
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang-Xin Xing
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu-Lin Li
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jian-Guang Xu
- School of Rehabilitation Science, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Yueyang Hospital of Integrated Traditional Chinese Medicine and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
30
|
Snowdon DA, Vincent P, Callisaya ML, Collyer TA, Wang YT, Taylor NF. Feasibility of allied health assistant management of people with acute hip fracture: protocol for a feasibility randomised controlled trial. BMJ Open 2021; 11:e054298. [PMID: 34815289 PMCID: PMC8611436 DOI: 10.1136/bmjopen-2021-054298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Guidelines for hip fracture care state that patients with hip fracture should be mobilised on the day after surgery and at least once a day thereafter. However, compliance with these guidelines is poor. One approach that would assist physiotherapists to meet mobility guidelines after hip fracture is to delegate the provision of daily mobilisation to allied health assistants under their supervision. Therefore, we plan to conduct a randomised controlled trial to determine the feasibility of an allied health assistant providing daily inpatient rehabilitation to patients with hip fracture. METHODS AND ANALYSIS Using a parallel group randomised controlled design with one-to-one allocation, participants will be randomly allocated to an experimental group (allied health assistant management) or a comparison group (physiotherapist management). Inclusion criteria are: adult with diagnosis of hip fracture; inpatient in acute hospital; walked independently pre-hip fracture and able to communicate in conversational English. The experimental group will receive routine physiotherapy rehabilitation, including daily mobilisation, from an allied health assistant following initial physiotherapist assessment. The comparison group will receive routine rehabilitation from a physiotherapist. The primary outcome will be the feasibility of allied health assistant management of patients with hip fracture. Feasibility will be determined using the following areas of focus in Bowen's feasibility framework: acceptability (patient satisfaction), demand (proportion of patients who participate), implementation (time allied health assistant/physiotherapist spends with participant, occasions of service) and practicality (cost, adverse events). Staff involved in the implementation of allied health assistant care will be interviewed to explore their perspectives on feasibility. Secondary outcomes include compliance with daily mobilisation guidelines, discharge destination, hospital readmission, falls, functional activity and length of stay. We aim to recruit 50 participants. Descriptive statistics will be used to describe feasibility and mobilisation rates will be calculated using Cox proportional hazards regression to compare compliance with mobilisation guidelines. ETHICS AND DISSEMINATION Ethics approval was obtained from the Peninsula Health human research ethics committee (HREC/63 005/PH-2020). The findings will be disseminated in peer-reviewed journals and conference presentations. TRAIL REGISTRATION NUMBER Australian and New Zealand Clinical Trial Registry; ACTRN12620000877987; Pre-results.
Collapse
Affiliation(s)
- David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Peggy Vincent
- Physiotherapy Department, Peninsula Health, Frankston, Victoria, Australia
| | - Michele L Callisaya
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Taya A Collyer
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
| | - Yi Tian Wang
- Physiotherapy Department, Peninsula Health, Frankston, Victoria, Australia
| | - Nicholas F Taylor
- College of Science Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| |
Collapse
|
31
|
Falotico GG, Moraes VY, Matsunaga FT, Tamaoki MJS, Faloppa F, Belloti JC. Total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fracture: a protocol for an overview of systematic reviews. BMJ Open 2021; 11:e051840. [PMID: 34789493 PMCID: PMC8601070 DOI: 10.1136/bmjopen-2021-051840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Hip arthroplasties for the treatment of displaced femoral neck fractures in adults can be total replacement or hemiarthroplasty. Despite the high prevalence of these fractures and large number of studies on the topic, the best choice of arthroplasty to be used remains unclear. The present study aims to overview the results of systematic reviews of randomised controlled trials (RCTs) comparing outcomes between total hip replacement and hemiarthroplasty for displaced femoral neck fractures in adults. METHODS AND ANALYSIS Four electronic databases (Pubmed, Embase, Cochrane Library and Web of Science) and reference lists from previous reviews will be searched without language limitation. Eligible studies will be systematic reviews of RCT that compare total hip replacement and hemiarthroplasty for treatment of displaced femoral neck fractures in adults. Two reviewers will independently perform study selection, data extraction and quality assessment. Disagreements between reviewers will be resolved by a third reviewer. Comparisons of dichotomous data will report as the OR and 95% CI, and comparisons of functional and health-related quality of life outcomes are reported as the mean difference and 95% CI and as the risk difference, defined as the difference in the proportion achieving the minimum clinically important difference and 95% CI. As this overview will contribute to orthopaedic surgeons and health managers in better decision-making for the treatment of these fractures. The authors plan to complete the searches and analyses by 30 November 2021. ETHICS AND DISSEMINATION Ethical approval was obtained at Federal University of Sao Paulo. Findings will be disseminated through peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42021237885.
Collapse
Affiliation(s)
| | - Vinicius Ynoe Moraes
- Department of Orthopedics and Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - Fabio Teruo Matsunaga
- Department of Orthopedics and Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | | | - Flavio Faloppa
- Department of Orthopedics and Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| | - João Carlos Belloti
- Department of Orthopedics and Escola Paulista de Medicina, UNIFESP, São Paulo, Brazil
| |
Collapse
|
32
|
Shiomoto K, Babazono A, Harano Y, Fujita T, Jiang P, Kim SA, Nakashima Y. Effect of body mass index on vertebral and hip fractures in older people and differences according to sex: a retrospective Japanese cohort study. BMJ Open 2021; 11:e049157. [PMID: 34753754 PMCID: PMC8578981 DOI: 10.1136/bmjopen-2021-049157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The purpose of this study was to investigate the incidence of vertebral and hip fractures in the older people and to clarify the relationship between these fractures and body mass index (BMI) along with the impact of sex differences.DesignThis was a retrospective cohort study.SettingWe used administrative claims data between April 2010 and March 2018. PARTICIPANTS Older people aged ≥75 years who underwent health examinations in 2010 and were living in the Fukuoka Prefecture, Japan were included in the study. A total of 24 691 participants were included; the mean age was 79.4±4.3 years, 10 853 males and 13 838 females, and an the mean duration of observation was 6.9±1.6 years. PRIMARY AND SECONDARY OUTCOME MEASURES We estimated the incidence of vertebral and hip fractures by BMI category (underweight: <18.5 kg/m2, normal weight: 18.5-24.9 kg/m2, overweight and obese: ≥25.0 kg/m2) using a Kaplan-Meier curve in males and females and determined fracture risk by sex using Cox proportional hazards regression analyses. RESULTS The incidence of vertebral and hip fractures was 16.8% and 6.5%, respectively. The cumulative incidence of vertebral and hip fracture at the last observation (8 years) in each BMI groups (underweight/normal weight/overweight and obese) estimated using the Kaplan-Meier curve was 14.7%/10.4%/9.0% in males and 24.9%/23.0%/21.9% in females, and 6.3%/2.9%/2.4% in males and 14.1%/9.0%/8.1% in females, respectively, and both fractures were significantly higher in underweight groups regardless of sex. Multivariable Cox proportional hazards models showed that underweight was a significant risk factor only in males for vertebral fractures and in both males and females for hip fractures. CONCLUSION Underweight was associated with fractures in the ageing population, but there was a sex difference in the effect for vertebral fractures.
Collapse
Affiliation(s)
- Kyohei Shiomoto
- Artificial Joints and Biomaterials, Faculty of Medical Science, Kyushu University, Fukuoka, Japan
- Orthopaedic Surgery, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
| | - Akira Babazono
- Health Care Administration and Management, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
| | - Yumi Harano
- Health Care Administration and Management, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
- Saga-Ken Medical Center Koseikan, Saga, Japan
| | - Takako Fujita
- Health Care Administration and Management, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Peng Jiang
- Health Care Administration and Management, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
| | - Sung-A Kim
- Health Care Administration and Management, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
| | - Yasuharu Nakashima
- Orthopaedic Surgery, Kyushu University Faculty of Medicine Graduate School of Medical Science, Fukuoka, Japan
| |
Collapse
|
33
|
Battista S, Dell'Isola A, Manoni M, Englund M, Palese A, Testa M. Experience of the COVID-19 pandemic as lived by patients with hip and knee osteoarthritis: an Italian qualitative study. BMJ Open 2021; 11:e053194. [PMID: 34706962 PMCID: PMC8551748 DOI: 10.1136/bmjopen-2021-053194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To examine the experience of the COVID-19 pandemic as lived by people with hip and knee osteoarthritis (OA), in Italy. DESIGN A qualitative study based on semi-structured interviews. SETTING Urban and suburban areas in northern Italy. PARTICIPANTS A total of 11 people with OA were enrolled through a purposeful sampling and completed the study. PRIMARY OUTCOME MEASURE The experience of Italian people with OA during the COVID-19 pandemic. RESULTS Four themes were brought to the forefront from the analysis of the interviews. (1) Being Stressed for the Limited Social Interactions and for the Family Members at High Risk of Infection, as the interviewees were frustrated because they could not see their loved ones or felt a sense of apprehension for their relatives. (2) Recurring Strategies to Cope with the Pandemic such as an active acceptance towards the situation. (3) Being Limited in the Possibility of Undergoing OA Complementary Treatments and Other Routine Medical Visits. (4) Being Unaware of the Importance of Physical Activity as First-Line Interventions which was an attitude already present before the pandemic. CONCLUSION The COVID-19 pandemic and related restrictions impacted the quality of life and the care of individuals with hip and knee OA. The social sphere seemed to be the most hindered. However, the interviewees developed a good level of acceptance to deal with the pandemic. When it came to their care, they faced a delay of routine medical visits not related to OA and of other complementary treatments (eg, physical therapies) to manage OA. Finally, a controversial result that emerged from these interviews was that first-line interventions for OA (ie, therapeutic exercise) was not sought by the interviewees, regardless of the restrictions dictated by the pandemic. Policy-making strategies are thus necessary to support the awareness of the importance of such interventions.
Collapse
Affiliation(s)
- Simone Battista
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mattia Manoni
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Alvisa Palese
- Department of Medical Sciences, University of Udine, Udine, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Savona, Italy
| |
Collapse
|
34
|
Sabah SA, Hedge EA, Abram SGF, Alvand A, Price AJ, Hopewell S. Patient-reported outcome measures following revision knee replacement: a review of PROM instrument utilisation and measurement properties using the COSMIN checklist. BMJ Open 2021; 11:e046169. [PMID: 34675009 PMCID: PMC8532560 DOI: 10.1136/bmjopen-2020-046169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 08/24/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To identify: (1) patient-reported outcome measures (PROMs) used to evaluate symptoms, health status or quality of life following discretionary revision (or re-revision) knee joint replacement, and (2) validated joint-specific PROMs, their measurement properties and quality of evidence. DESIGN (1) Scoping review; (2) systematic review following the COnsensus-based Standards for selection of health status Measurement INstruments (COSMIN) checklist. DATA SOURCES MEDLINE, Embase, AMED and PsycINFO were searched from inception to 1 July 2020 using the Oxford PROM filter unlimited by publication date or language. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting on the development, validation or outcome of a joint-specific PROM for revision knee joint replacement were included. RESULTS 51 studies reported PROM outcomes using eight joint-specific PROMs. 27 out of 51 studies (52.9%) were published within the last 5 years. PROM development was rated 'inadequate' for each of the eight PROMs studied. Validation studies were available for only three joint-specific PROMs: Knee Injury and Osteoarthritis Outcome Score (KOOS), Lower Extremity Activity Scale (LEAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC). 25 out of 27 (92.6%) measurement properties were rated insufficient, indeterminate or not assessed. The quality of supporting evidence was mostly low or very low. Each of the validated PROMs was rated 'B' (potential for recommendation but require further evaluation). CONCLUSION Joint-specific PROMs are increasingly used to report outcomes following revision knee joint replacement, but these instruments have insufficient evidence for their validity. Future research should be directed toward understanding the measurement properties of these instruments in order to inform clinical trials and observational studies evaluating the outcomes from joint-specific PROMs.
Collapse
Affiliation(s)
- Shiraz A Sabah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth A Hedge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Simon G F Abram
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Abtin Alvand
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew J Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sally Hopewell
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
35
|
Domecky P, Rejman Patkova A, Mala-Ladova K, Maly J. Inflammatory blood parameters as prognostic factors for surgical site infection after primary hip or knee arthroplasty: a systematic review protocol. BMJ Open 2021; 11:e046027. [PMID: 34548343 PMCID: PMC8458324 DOI: 10.1136/bmjopen-2020-046027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is a potential complication of surgical procedure. SSI after implant surgery is a disaster both for patients and surgeons. Although predictive tools for SSI are available, none of them estimate early infection based on inflammatory blood parameters. The inflammatory process can be measured using several parameters including interleukin-6, C reactive protein, neutrophil to lymphocyte ratio, white cell count, erythrocyte sedimentation rate or procalcitonin. This systematic review aims to determine whether inflammatory blood parameters could be used as significant predictive factors for SSI after primary hip or knee arthroplasty. METHODS AND ANALYSIS A systematic review of randomised controlled trials, cross-sectional studies, case-control studies and cohort studies, published in English, will be searched in the following electronic bibliographic databases: MEDLINE, Embase, PubMed, Cochrane Central Register of Controlled Trials and Web of Science. Studies performed in adult patients of all ages who underwent knee or hip arthroplasty, studies containing data on the risk/prognostic factors for preknee or postknee or hip arthroplasty SSI and studies with a minimum follow-up of 30 days after surgery will be included. A standardised form will be used to extract data from the included studies comprising study characteristics, participant characteristics, details of the intervention, study methodology and outcomes. Quality Assessment of Diagnostic Accuracy tool, second version, and Standards for Reporting of Diagnostic Accuracy Studies checklist will be used to assess risk of bias. Heterogeneity will be assessed using Cochran χ² statistic and I2 statistics where applicable. Grading of Recommendations Assessment, Development and Evaluation and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance will be used to report findings. ETHICS AND DISSEMINATION No ethics approval is required. The findings will be disseminated at national and international scientific sessions, also to be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42020147925.
Collapse
Affiliation(s)
- Petr Domecky
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Anna Rejman Patkova
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Katerina Mala-Ladova
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Josef Maly
- Department of Social and Clinical Pharmacy, Charles University Faculty of Pharmacy in Hradec Kralove, Hradec Kralove, Czech Republic
| |
Collapse
|
36
|
Barker KL, Room J, Knight R, Dutton S, Toye F, Leal J, Kenealy N, Maia Schlüssel M, Collins G, Beard D, Price AJ, Underwood M, Drummond A, Lamb S. Home-based rehabilitation programme compared with traditional physiotherapy for patients at risk of poor outcome after knee arthroplasty: the CORKA randomised controlled trial. BMJ Open 2021; 11:e052598. [PMID: 34452970 PMCID: PMC8404435 DOI: 10.1136/bmjopen-2021-052598] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/05/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy. DESIGN A prospective, single-blind, two-arm randomised controlled superiority trial. SETTING 14 National Health Service physiotherapy departments in the UK. PARTICIPANTS 621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool. INTERVENTIONS A multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy. MAIN OUTCOME MEASURES The primary outcome was the Late-Life Function and Disability Instrument (LLFDI) at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function), Knee injury and Osteoarthritis Outcome Score Quality of Life subscale, Physical Activity Scale for the Elderly, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance. RESULTS 621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4-7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2-6). The primary outcome, LLFDI function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference=0.49 points; 95% CI -0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions. CONCLUSIONS The CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group. TRIAL REGISTRATION NUMBER ISRCTN13517704.
Collapse
Affiliation(s)
- Karen L Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jonathan Room
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Ruth Knight
- Oxford Clinicial Trials Research Unit (OCTRU), Centre Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Susan Dutton
- Oxford Clinicial Trials Research Unit (OCTRU), Centre Statistics in Medicine, University of Oxford, Oxford, Oxfordshire, UK
| | - Francine Toye
- Nuffield Orthopaedic Centre Physiotherapy Research Unit, Oxford University Hospitals NHS Foundation Trust Nuffield Orthopaedic Centre, Oxford, UK
| | - Jose Leal
- Nuffield Department of Population Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Nicola Kenealy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Michael Maia Schlüssel
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Gary Collins
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | | | - Avril Drummond
- Div of Rehabilitation and Ageing, University of Nottingham, Nottingham, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, Devon, UK
- NDORMS, University of Oxford, Oxford, UK
| |
Collapse
|
37
|
Miettinen M, Rämö L, Lähdeoja T, Sirola T, Sandelin H, Ponkilainen V, Repo JP. Treatment of hallux rigidus (HARD trial): study protocol of a prospective, randomised, controlled trial of arthrodesis versus watchful waiting in the treatment of a painful osteoarthritic first metatarsophalangeal joint. BMJ Open 2021; 11:e049298. [PMID: 34452964 PMCID: PMC8404449 DOI: 10.1136/bmjopen-2021-049298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Hallux rigidus is a common problem of pain and stiffness of the first metatarsophalangeal joint (MTPJ) caused mainly by degenerative osteoarthritis. Several operative techniques have been introduced for the treatment of this condition without high-quality evidence comparing surgical to non-surgical care. In this trial, the most common surgical procedure, arthrodesis, will be compared with watchful waiting in the management of hallux rigidus. METHODS AND ANALYSIS Ninety patients (40 years or older) with symptomatic first MTPJ osteoarthritis will be randomised to arthrodesis or watchful waiting in a ratio of 1:1. The primary outcome will be pain during walking, assessed using the 0-10 Numerical Rating Scale (NRS) at 1 year after randomisation. The secondary outcomes will be pain at rest (NRS), physical function (Manchester-Oxford Foot Questionnaire), patient satisfaction in terms of the patient-acceptable symptom state, health-related quality of life (EQ-5D-5L), activity level (The Foot and Ankle Ability Measure Sports subscale), use of analgesics or orthoses and the rate of complications. Our null hypothesis is that there will be no difference equal to or greater than the minimal important difference of the primary outcome measure between arthrodesis and watchful waiting. Our primary analysis follows an intention-to-treat principle. ETHICS AND DISSEMINATION The study protocol has been approved by the Ethics Committee of Helsinki and Uusimaa Hospital District, Finland. Written informed consent will be obtained from all the participants. We will disseminate the findings of this study through peer-reviewed publications and conference presentations. PROTOCOL VERSION 21 June 2021 V.2.0. TRIAL REGISTRATION NUMBER NCT04590313.
Collapse
Affiliation(s)
- Mikko Miettinen
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Lasse Rämö
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Tuomas Lähdeoja
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
- Finnish Centre for Evidence-Based Orthopaedics, FICEBO, Helsinki, Finland
| | - Timo Sirola
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Uusimaa, Finland
| | - Henrik Sandelin
- Department of Orthopaedics and Traumatology, Vaasa Central Hospital and University of Helsinki, Helsinki, Uusimaa, Finland
- Sports Hospital, Mehiläinen, Helsinki, Uusimaa, Finland
| | - Ville Ponkilainen
- Department of Orthopaedics and Traumatology, Central Finland Hospital Nova, Jyväskylä, Central Finland, Finland
| | - Jussi P Repo
- Department of Orthopaedics and Traumatology, University of Tampere and Tampere University Hospital, Tampere, Finland
| |
Collapse
|
38
|
Abstract
OBJECTIVE The treatment effect of orthoses for hallux valgus (HV) is unclear with little interventional studies, the design involves multiple complex factors, and therefore a systematic analysis with meta-analysis is necessary. The objective of this systematic review and meta-analysis is to determine whether current foot orthoses are effective in treating HV. DESIGN Systematic review with meta-analysis. DATA SOURCES Electronic databases (PubMed, Scopus, Cinahl and Medline) are searched up to February 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Interventional studies with content focus on HV orthosis design and any of the outcomes related to effectiveness for treating HV are included. The standardised mean differences are calculated. The risk of bias in included studies is assessed using the Cochrane Collaboration's risk of bias tools. RESULTS In total, 2066 articles are identified. Among them, nine are selected and quality rated, and data are extracted and closely examined. A meta-analysis is conducted, where appropriate. The main causes of potential bias are missing outcome data and outcome measurement error. The results show that orthosis with a toe separator has the best effect of correcting the HV angle (standardised mean difference: 0.50, 95% CI: 0.189 to 0.803). CONCLUSION The orthoses design with a toe separator or an element that allows for the foot anatomic alignment is critical for reducing the HV angle and relieving foot pain. The results contribute to a better selection of treatment for patients. PROSPERO REGISTRATION NUMBER CRD42021260403.
Collapse
Affiliation(s)
- Mei-Ying Kwan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, China
| | - Kit-Lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, China
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, China
| | - Chi-Yung Tse
- Centre for Orthopaedic Surgery, Hong Kong, China
| |
Collapse
|
39
|
Sun Y, Liu W, Hou J, Hu X, Zhang W. Does robotic-assisted unicompartmental knee arthroplasty have lower complication and revision rates than the conventional procedure? A systematic review and meta-analysis. BMJ Open 2021; 11:e044778. [PMID: 34380715 PMCID: PMC8359483 DOI: 10.1136/bmjopen-2020-044778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE We conducted this systematic review and meta-analysis of studies on patients who underwent unicompartmental knee arthroplasty (UKA) to compare the complication rates, revision rates and non-implant-specific complications between robotic-assisted and conventional UKA. DESIGN Systematic review and meta-analysis. DATA SOURCES The PubMed, Embase, Web of Science and Cochrane databases were searched up to 30 June 2020. ELIGIBILITY CRITERIA Case-control studies comparing robotic-assisted and conventional UKA. DATA EXTRACTION AND SYNTHESIS Data from all eligible articles were independently extracted by two authors. We analysed the differences in outcomes between robotic-assisted and conventional UKA by calculating the corresponding 95% CIs and pooled relative risks (RRs). Heterogeneity was assessed using the χ2 and I2 tests. All analyses were performed using the 'metafor' package of R V.3.6.2 software. RESULTS A total of 16 studies involving 50 024 patients were included in the final meta-analysis. We found that robotic-assisted UKA had fewer complications (RR: 0.52, 95% CI: 0.28 to 0.96, p=0.036) and lower revision rates (RR: 0.42, 95% CI: 0.20 to 0.86, p=0.017) than conventional UKA. We observed no significant differences in non-implant-specific complications between the two surgical techniques (RR: 0.80, 95% CI: 0.61 to 1.04, p=0.96). No publication bias was found in this meta-analysis. CONCLUSIONS This study provides evidence that robotic-assisted UKA has fewer complications and lower revision rates than conventional UKA; however, owing to important limitations, the results lack reliability, and more studies are required. PROSPERO REGISTRATION NUMBER CRD42021246927.
Collapse
Affiliation(s)
- Yifeng Sun
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| | - Wei Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| | - Jian Hou
- Emergency Department, Jimo Traditional Chinese Hospital, Qingdao, People's Republic of China
| | - Xiuhua Hu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| | - Wenqiang Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, People's Republic of China
| |
Collapse
|
40
|
Lane JC, Craig R, Rees JL, Gardiner M, Mikhail MM, Riley N, Prieto-Alhambra D, Furniss D. Low rates of serious complications and further procedures following surgery for base of thumb osteoarthritis: analysis of a national cohort of 43 076 surgeries. BMJ Open 2021; 11:e045614. [PMID: 34233971 PMCID: PMC8264901 DOI: 10.1136/bmjopen-2020-045614] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the incidence of further procedures and serious adverse events (SAEs) requiring admission to hospital following elective surgery for base of thumb osteoarthritis (BTOA), and the patient factors associated with these outcomes. DESIGN Population based cohort study. SETTING National Health Service using the national Hospital Episode Statistics data set linked to mortality records over a 19-year period (01 April 1998-31 March 2017). PARTICIPANTS 43 076 primary surgeries were followed longitudinally in secondary care until death or migration on 37 329 patients over 18 years of age. MAIN OUTCOME MEASURES Incidence of further thumb base procedures (including revision surgery or intra-articular steroid injection) at any time postoperatively, and local wound complications and systemic events (myocardial infarction, stroke, respiratory tract infection, venous thromboembolic events, urinary tract infection or renal failure) within 30 and 90 days. To identify patient factors associated with outcome, Fine and Gray model regression analysis was used to adjust for the competing risk of mortality in addition to age, overall comorbidity and socioeconomic status. RESULTS Over the 19 years, there was an increasing trend in surgeries undertaken. The rate of further thumb base procedures after any surgery was 1.39%; the lowest rates after simple trapeziectomy (1.12%), the highest rates after arthroplasty (3.84%) and arthrodesis (3.5%). When matched for age, comorbidity and socioeconomic status, those undergoing arthroplasty and arthrodesis were 2.5 times more likely to undergo a further procedure (subHR 2.51 (95% CI 1.81 to 3.48) and 2.55 (1.91 to 3.40)) than those undergoing simple trapeziectomy. Overall complication rates following surgery were 0.22% for serious local complications and 0.58% for systemic events within 90 days of surgery. CONCLUSIONS The number of patients proceeding to BTOA surgery has increased over the last 19 years, with a low rate of further thumb base procedures and SAEs after surgery overall registered. Arthrodesis and arthroplasty had a significantly higher revision rate. TRIAL REGISTRATION NUMBER NCT03573765.
Collapse
Affiliation(s)
- Jennifer Ce Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Richard Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Jonathan L Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Matthew Gardiner
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
- Department of Plastic Surgery, Wexham Park Hospital, Slough, UK
| | - Mark M Mikhail
- Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Nicholas Riley
- Department of Hand Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| | - Daniel Prieto-Alhambra
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Oxford, UK
- Department of Plastic Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
- Department of Hand Surgery, Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, UK
| |
Collapse
|
41
|
Amajjar I, Malik R, van Wier M, Smeets R, Ham SJ. Transitional care of adolescents with Multiple Osteochondromas: a convergent mixed-method study 'Patients', parents' and healthcare providers' perspectives on the transfer process'. BMJ Open 2021; 11:e049418. [PMID: 34226232 PMCID: PMC8258596 DOI: 10.1136/bmjopen-2021-049418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Multiple osteochondromas (MO) is a rare hereditary disease characterised by numerous benign bone tumours. Its chronic aspect requires a well-organised transition from paediatric care to adult care; however, little is known on organising this care specific for patients with MO. This study aims to gain insight on this topic. DESIGN Convergent mixed-method study. SETTING This study was conducted at the orthopaedic and paediatrics department of an MO-expertise centre in the Netherlands. PARTICIPANTS 12 patients, 10 parents and 10 healthcare professionals were interviewed. An additional survey was completed by 2 young adults. PRIMARY AND SECONDARY OUTCOMES The (1) themes on transition, identified through template analysis and (2) transfer experience and satisfaction assessed by an 18-item On Your Own Feet-Transfer Experience Scale (OYOF-TES, range: 18-90) and by Numeric Rating Scale (NRS, range: 1-10). RESULTS The following three key themes were identified in the qualitative analysis: (1) patient and parent in the lead can be encouraged by self-management tools, (2) successful transfers need interprofessional collaboration and communication and (3) how can we prepare patients for the transitional process? Stakeholders' insights to improve transition were listed and divided into these three themes.Several important aspects were underlined, particularly within the first theme; speaking-up was difficult for patients especially when parents were not directly involved. Moreover, the high psychological impact of the disease requires coaching of self-management and psychological counselling to facilitate stakeholders in their changing roles.Twenty patients completed the quantitative survey. Mean satisfaction score with the transfer process was poor, which was assessed with the NRS (mean=5.7±2.1; range: 1-9) and the OYOF-TES (mean=56.3±14.2; range: 32-85). The OYOF-TES only showed a negative correlation (R2=0.25; p=0.026) with the number of surgical interventions in the past. CONCLUSION Overall, the transfer process was found unsatisfactory. Improvement can be achieved by supporting and guiding the patients to be in the lead of their care. Moreover, preparation for transfer and a multidisciplinary approach may enhance successful transition.
Collapse
Affiliation(s)
- Ihsane Amajjar
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Romana Malik
- Department of Education, OLVG, Amsterdam, The Netherlands
| | - Marieke van Wier
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| | - Rob Smeets
- Department of Rehabilitation Medicine, Research School Functioning, Participation & Rehabilitation, CAPHRI, Maastricht University, Maastricht, The Netherlands
- Department of Rehabilitation Medicine, CIR Revalidatie, Eindhoven, The Netherlands
| | - S John Ham
- Department of Orthopaedic Surgery, Joint Research, OLVG, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Douillet D, Riou J, Thoma M, Moumneh T, Darsonval A, Trinh-Duc A, Hugli O, Chauvin A, Penaloza A, Roy PM. Thromboembolic risk stratification by TRiP(cast) score to rationalise thromboprophylaxis in patients with lower leg trauma requiring immobilisation: a study protocol of the casting stepped-wedge cluster randomised trial. BMJ Open 2021; 11:e045905. [PMID: 34183341 PMCID: PMC8240567 DOI: 10.1136/bmjopen-2020-045905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Patients with lower limb trauma requiring orthopaedic immobilisation may be at risk of venous thromboembolism but opinions differ about who may benefit from thromboprophylactic anticoagulant treatment.The aim of this CASTING study is to demonstrate the safety of thromboprophylaxis based on the Thrombosis Risk Prediction for patients with cast immobilisation (TRiP(cast) score with regards to the 3-month incidence of symptomatic venous thromboembolism events in low-risk patients not receiving thromboprophylaxis, as well as the usefulness of this strategy on the rate of patients receiving anticoagulant treatment in comparison to current practice. METHODS AND ANALYSIS CASTING will be a stepped-wedge cluster randomised controlled clinical trial, performed in 15 emergency departments in France and Belgium. With their informed consent, outpatients admitted to one of the participating emergency departments for a lower limb trauma requiring orthopaedic immobilisation without surgery will be included. All centres will begin the trial with the 'observational period' and, every 2 weeks, 1 centre will be randomly assigned to switch to the 'interventional period' and to apply the TRiP(cast) score, in which only patients with a score ≥7 will receive thromboprophylactic anticoagulant treatment. The primary endpoint is the rate of clinical thromboembolic events within 90 days following the inclusion of low-risk patients not receiving thromboprophylaxis. ETHICS AND DISSEMINATION The protocol has been approved by the Comité de Protection des Personnes Sud I (Ethics Review ID-RCB: 2019-A01829-48) for France and the Comité d'éthique hôpital-facultaire Saint Luc (N° B403201941338) for Belgium. It is carried out in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The findings of this study will be disseminated in peer-reviewed journals and at scientific conferences. TRIAL REGISTRATION NUMBER NCT04064489.
Collapse
Affiliation(s)
- Delphine Douillet
- Emergency Department, University Hospital Centre Angers, Angers, France
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT,UNIV Angers, F-CRIN INNOVTE, Angers, France
| | - Jeremie Riou
- Biostatistics and Methodology Department, University Hospital Centre Angers, Angers, France
- MINT, INSERM UMR 1066, CNRS UMR 6021, Faculté de Santé, UNIV Angers, Angers, France
| | - Maximilien Thoma
- Emergency Department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Thomas Moumneh
- Emergency Department, University Hospital Centre Angers, Angers, France
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT,UNIV Angers, F-CRIN INNOVTE, Angers, France
| | - Astrid Darsonval
- Department of Pharmacy, Angers University Hospital Centre, Angers, France
| | | | - Olivier Hugli
- Emergency Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Anthony Chauvin
- Emergency Department, Hôpital Lariboisière, Assistance Publique - Hôpitaux de Paris APHP, Université de Paris, Paris, France
| | - Andrea Penaloza
- Emergency Department, Cliniques universitaires Saint-Luc, Bruxelles, Belgium
| | - Pierre-Marie Roy
- Emergency Department, University Hospital Centre Angers, Angers, France
- INSERM, CNRS, MITOVASC, Equipe CarMe, SFR ICAT,UNIV Angers, F-CRIN INNOVTE, Angers, France
| |
Collapse
|
43
|
Knifsund J, Niinimaki T, Nurmi H, Toom A, Keemu H, Laaksonen I, Seppänen M, Liukas A, Pamilo K, Vahlberg T, Äärimaa V, Mäkelä KT. Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial. BMJ Open 2021; 11:e046731. [PMID: 34162649 PMCID: PMC8231055 DOI: 10.1136/bmjopen-2020-046731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee. DESIGN Prospective, randomised, 2 years, assessor-blind, multicentre, superiority trial. SETTING The patients were enrolled between December 2015 and May 2018 from the outpatient clinics of three public high-volume arthroplasty hospitals (Finland). PARTICIPANTS We recruited 143 patients with symptomatic-isolated medial osteoarthritis of the knee needing an arthroplasty procedure. All the patients were suitable for both unicompartmental and total knee arthroplasties. Population was selected as the end-stage-isolated medial osteoarthritis. INTERVENTIONS All patients, randomized 1:1, received a medial unicompartmental arthroplasty or a total knee arthroplasty through a similar midline skin incision. Patients were blinded to the type of arthroplasty for the whole 2 years of follow-up. MAIN OUTCOME MEASURES Primary outcome measure was between-group differences in the Oxford Knee Score (OKS) and secondary outcome Knee injury and Osteoarthritis Score (KOOS) at 2 years postoperatively. The changes within and between the groups were analysed with analysis of variance for repeated measurements. RESULTS The primary outcome was comparable for medial unicompartmental arthroplasty and total knee arthroplasty at 2 years. The mean difference in the OKS between the groups was 1.6 points (95% CI -0.7 to 3.9). In the KOOS subscales, the mean difference between the groups was 0.1 points (95% CI -4.8 to 5.0) for pain, 7.8 points (95% CI 1.5 to 14.0) for symptoms, 4.3 points (95% CI -0.6 to 9.2) for function in daily living, 4.3 points (95% CI -3.0 to 11.6) for function in sports, and 2.1 points (95% CI -4.8 to 9.1) for knee-related quality of life. CONCLUSIONS The recovery after unicompartmental knee arthroplasty was faster compared with total knee arthroplasty, but unicompartmental arthroplasty did not provide a better patient-reported outcome at 2 years. TRIAL REGISTRATION NUMBER NCT02481427.
Collapse
Affiliation(s)
- Jani Knifsund
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | | | - Heikki Nurmi
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Alar Toom
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Hannes Keemu
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Matti Seppänen
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - Antti Liukas
- Department of Anesthesiology, Turku University Hospital, Turku, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - T Vahlberg
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Ville Äärimaa
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
| | - K T Mäkelä
- Department of Orthopedics and Traumatology, Turku University Hospital, Turku, Finland
- Department of Clinical Medicine, University of Turku, Turku, Finland
- National Institute for Health and Welfare, The Finnish Arthroplasty Register, Helsinki, Finland
| |
Collapse
|
44
|
Farhan-Alanie MM, Lee Y, Underwood M, Metcalfe A, Wilkinson MJ, Price AJ, Warwick J, Wall PDH. Effect of tourniquet use on the risk of revision in total knee replacement surgery: an analysis of the National Joint Registry Data Set. BMJ Open 2021; 11:e045353. [PMID: 34108163 PMCID: PMC8191625 DOI: 10.1136/bmjopen-2020-045353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Tourniquet use in total knee replacement (TKR) is believed to improve the bone-cement interface by reducing bleeding, potentially prolonging implant survival. This study aimed to compare the risk of revision for primary cemented TKR performed with or without a tourniquet. DESIGN We analysed data from the National Joint Registry (NJR) for all primary cemented TKRs performed in England and Wales between April 2003 and December 2003. Kaplan-Meier plots and Cox regression were used to assess the influence of tourniquet use, age at time of surgery, sex and American Society of Anaesthesiologists (ASA) classification on risk of revision for all-causes. RESULTS Data were available for 16 974 cases of primary cemented TKR, of which 16 132 had surgery with a tourniquet and 842 had surgery without a tourniquet. At 10 years, 3.8% had undergone revision (95% CI 2.6% to 5.5%) in the no-tourniquet group and 3.1% in the tourniquet group (95% CI 2.8% to 3.4%). After adjusting for age at primary surgery, gender and primary ASA score, the HR for all-cause revision for cemented TKR without a tourniquet was 0.82 (95% CI 0.57 to 1.18). CONCLUSIONS We did not find evidence that using a tourniquet for primary cemented TKR offers a clinically important or statistically significant reduction in the risk of all-cause revision up to 13 years after surgery. Surgeons should consider this evidence when deciding whether to use a tourniquet for cemented TKR.
Collapse
Affiliation(s)
- Muhamed M Farhan-Alanie
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Yujin Lee
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Martin Underwood
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Andrew Metcalfe
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Mark J Wilkinson
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Andrew James Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jane Warwick
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Peter David Henry Wall
- Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
- Trauma and Orthopaedics, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| |
Collapse
|
45
|
Capella S, Demoulin E, Wilkinson C, Hindle P. Longitudinal study of medical downgrades in the Royal Air Force. BMJ Mil Health 2021; 169:249-255. [PMID: 34035160 DOI: 10.1136/bmjmilitary-2021-001839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/28/2021] [Accepted: 04/29/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION As the focus of the Royal Air Force (RAF) shifts from sustained to contingency operations and the number of personnel is reduced, the burden of retained, medically downgraded personnel may affect operational readiness. The main aims were: to define the prevalence of morbidity leading to permanent medical downgrading; to determine at risk populations and identify areas for improvement. METHOD Database of personnel referred to the RAF Medical Board was analysed from January 2012 to October 2013 and January 2017 to December 2019. Patients were excluded if they did not require a formal medical board; incomplete and duplicate entries were also excluded. The primary reason for medical downgrade was categorised with an ICD-10 code. Further subanalysis compared musculoskeletal disease with age, individual trade groups and anatomic region. RESULTS 2% of RAF service personnel were permanently downgraded annually. Musculoskeletal disease was the leading cause for permanent downgrade across both periods: 58% and 49%. Female personnel were at a greater risk of musculoskeletal downgrade compared with males. Spinal and knee pathology were the leading cause for downgrading among 'high risk' personnel. Personnel downgraded due to musculoskeletal pathology were often retained in a limited role with 10% and 5% retained as medically fully deployable. 14% and 12% of personnel downgraded due to musculoskeletal pathology were medically discharged. CONCLUSION Musculoskeletal disease was the leading cause for permanent medical downgrades in the RAF. A greater proportion of downgraded personnel with musculoskeletal conditions were retained in service with medical limitations rather than medically discharged.
Collapse
Affiliation(s)
| | - E Demoulin
- Trauma and Orthopaedics, Harrogate and District NHS Foundation Trust, Harrogate, North Yorkshire, UK
| | - C Wilkinson
- Department of Occupational Medicine, RAF College Cranwell, Sleaford, Lincolnshire, UK
| | - P Hindle
- Trauma and Orthopaedic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| |
Collapse
|
46
|
Meijering D, Boerboom AL, Gerritsma CLE, The B, van den Bekerom MPJ, van der Pluijm M, Vegter RJK, Bulstra SK, Eygendaal D, Stevens M. Prospective cohort study comparing a triceps-sparing and triceps-detaching approach in total elbow arthroplasty: a protocol. BMJ Open 2021; 11:e046098. [PMID: 33952551 PMCID: PMC8103376 DOI: 10.1136/bmjopen-2020-046098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New surgical approaches have been developed to optimise elbow function after total elbow arthroplasty (TEA). Currently, there is no consensus on the best surgical approach. This study aims to investigate the functional outcomes, prosthetic component position and complication rates after a triceps-sparing and a triceps-detaching approach in TEA. METHODS AND ANALYSIS A multicentre prospective comparative cohort study will be conducted. All patients with an indication for primary TEA will enrol in either the triceps-sparing or the triceps-detaching cohort. Primary outcome measure is elbow function, specified as fixed flexion deformity. Secondary outcome parameters are self-reported and objectively measured physical functioning, including triceps force, prosthetic component position in standard radiographs and complications. DISCUSSION The successful completion of this study will clarify which surgical approach yields better functional outcomes, better prosthetic component position and lower complication rates in patients with a TEA. ETHICS AND DISSEMINATION The Medical Ethics Review Board of University Medical Center Groningen reviewed the study and concluded that it is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO), therefore WMO approval is not needed (METc2019/544). TRIAL REGISTRATION NUMBER NTR NL8488.
Collapse
Affiliation(s)
- Danielle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco van der Pluijm
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopedic Surgery, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
47
|
Fleischmann C, Yanovich R, Milgrom C, Eliyahu U, Gez H, Heled Y, Finestone AS. Utility of preinduction tests as predictors of attrition in infantry recruits: a prospective study. BMJ Mil Health 2021; 169:225-230. [PMID: 33789974 DOI: 10.1136/bmjmilitary-2021-001776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Infantry recruit attrition wastes resources and can affect combat readiness. The purpose of this study was to examine the utility of preinduction tests as a predictor of attrition among conscripts in the first year of infantry training. METHODS 303 infantry conscripted recruits participated in a prospective study. Before their service, recruits received health profile and Quality Group Scores (QGSs). Recruits were screened at induction using questionnaires, by functional movement screening (FMS) and by upper and lower quarter Y-balance, dynamic and anthropometric tests. They were followed for musculoskeletal injuries and attrition during the first year of training. RESULTS 165/303 (54.5%) recruits were diagnosed with musculoskeletal injury or pain during the first year of their training. 15.2% did not complete their first year of service as combatants and 5.9% were discharged. On multivariable binary stepwise logistic regression analysis for attrition, protective factors were higher QGSs (OR 0.78, 95% CI 0.69 to 0.89) and recruits diagnosed with musculoskeletal injuries or pain (OR 0.20, 95% CI 0.09 to 0.48). Pain in the balance test performed at the beginning of training was a risk factor (OR 3.31, 95% CI 1.44 to 7.61). These factors explained only 15.4% of the variance in attrition. CONCLUSIONS FMS was not a significant predictor of infantry attrition. Measuring the three variables found to be associated with infantry attrition would seem to be valuable when the number of infantry candidates greatly exceeds the number of infantry positions. Transferring infantry attriters to non-combatant roles and not discharging them is a way to manage the problem of attrition.
Collapse
Affiliation(s)
- Chen Fleischmann
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - R Yanovich
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - C Milgrom
- Military Medicine, Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - U Eliyahu
- Heller Institute of Medical Research, Sheba Medical Center, Tel Hashomer, Israel
| | - H Gez
- Department of ENT, Lady Davis Carrnel Medical Center, The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Y Heled
- Faculty of Medicine, Kibbutzim College of Education Technology and the Arts, Tel Aviv, Israel
| | - A S Finestone
- Department of Orthopaedic Surgery, Shamir Medical Center, Tel Aviv University Sackler School of Medicine, Tel Aviv, Israel
| |
Collapse
|
48
|
Carpanen D, Masouros SD, Stinner DJ. Biomechanical evaluation of a tool-less external fixator. BMJ Mil Health 2021; 169:e55-e58. [PMID: 33789976 DOI: 10.1136/bmjmilitary-2020-001766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Current external fixator systems used by the US and UK military for stabilising extremity fractures require specialised tools to build a construct. The goal of obtaining and maintaining limb length and alignment is not achieved if these tools are misplaced. An alternative, tool-less system is currently available, namely the Dolphix Temporary Fixation System. The aim of this study was to compare the stiffness of the Dolphix system with the existing Hoffmann III system. METHODS Three Hoffmann III and three Dolphix constructs were assembled on a bone (tibia) surrogate. A 30 mm fracture gap was created to simulate a comminuted proximal tibia or distal femur fracture. The constructs were then tested in cyclic axial compression once daily for 3 consecutive days. RESULTS The length and alignment of the surrogate limb was restored following each testing cycle with both external fixation systems. The stiffness of the constructs was maintained throughout each sequential test, with the Dolphix exhibiting 54% the stiffness of the Hoffmann III construct. CONCLUSION Given the Dolphix's performance in mechanical testing and the unique advantage of having a tool-less manual locking clamp mechanism, this tool-less system should be considered for use in the mobile austere environment.
Collapse
Affiliation(s)
| | - S D Masouros
- Department of Bioengineering, Imperial College London, London, UK
| | - D J Stinner
- Department of Bioengineering, Imperial College London, London, UK.,Department of Orthopaedics and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
49
|
Grandizio LC, Barreto Rocha DF, Holbert JA, Pavis EJ, Hopkins D, Volarich K, Klena JC. Analysis of driving simulator performance for post-call orthopaedic surgery residents. Postgrad Med J 2021; 98:e13. [PMID: 33782204 DOI: 10.1136/postgradmedj-2021-139908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 11/04/2022]
Abstract
PURPOSE Despite the associations between workhours, fatigue and motor vehicle accidents, driving abilities for residents post-call have been infrequently analysed. Our purpose was to compare orthopaedic surgery resident performance on a driving simulator after a night of call compared with their baseline. STUDY DESIGN All residents from a single orthopaedic programme were asked to complete baseline and post-call driving simulator assessments and surveys. The primary outcome measure was brake reaction time (BRT) and secondary outcome measures included lane variance, speed variance and accidents on the driving simulator. RESULTS All 19 orthopaedic residents agreed to participate. Compared with the baseline assessment, residents demonstrated significantly higher levels of sleepiness on the Stanford Sleepiness Scale post-call (1.6 vs 3.4; p<0.0001). Despite higher levels of fatigue post-call, there was no statistically significant differences between baseline and post-call assessments for mean BRT, accidents, lane variation and speed variation. CONCLUSIONS These data suggest that for orthopaedic residents, driving simulator performance does not appear to be worse after a single night of call compared with baseline. Future collaborative, multicentre investigations on post-call driving safety that incorporate different call types and frequencies are necessary to better define the impact of post-call fatigue on driving performance. Recognising that motor vehicle accidents remain the leading cause of death for people under the age of 30 years, these continued areas of study are necessary to truly establish a culture of resident safety.
Collapse
Affiliation(s)
- Louis C Grandizio
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | | | - J Alexander Holbert
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Elizabeth J Pavis
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - David Hopkins
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Kathryn Volarich
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Joel C Klena
- Department of Orthopaedic Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| |
Collapse
|
50
|
Vaishya R, Vaish A, Ansari AH. Acute painful calcific tendonitis of the shoulder. Postgrad Med J 2021; 98:e2. [PMID: 33688070 DOI: 10.1136/postgradmedj-2021-139719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Raju Vaishya
- Orthopaedics, Institutes of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Abhishek Vaish
- Orthopaedics, Institutes of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| | - Aabid Husain Ansari
- Orthopaedics, Institutes of Orthopaedics, Indraprastha Apollo Hospitals, New Delhi, Delhi, India
| |
Collapse
|