Project

Edinburgh Orthopaedic Research Database

Goal: 1) Patient reported outcome and experience following orthopaedic surgery at the Royal Infirmary of Edinburgh. 2) A repository of Edinburgh orthopaedic and trauma research papers

Date: 1 January 2000 - 31 December 2031

Updates
0 new
32
Recommendations
0 new
6
Followers
0 new
45
Reads
4 new
984

Project log

Deborah Jane Macdonald
added an update
This 10 week course starts on Wednesday 21st via the University of Edinburgh Business School. I am very happy to have been accepted as a participant and will be using the new Edinburgh Orthopaedic Relational Research Database as my implemented project.
 
Deborah Jane Macdonald
added an update
Welcome aboard Alex! We are very happy to announce our newest recruit to the EOR Database. Alex will be taking over as database manager and research co-ordinator from the 3rd of October.
 
Deborah Jane Macdonald
added an update
Managing and leading data-driven innovation: Managing and Leading - work based course - 10 weeks starting 19th September!
 
Deborah Jane Macdonald
added an update
Such a great course - I learnt a lot! Managed 78% for my final presentation using our Clinical Director, Gavin Macpherson, as my Leadership role model.
 
Chris Oliver
added a research item
Purpose Positive ulnar variance following a distal radius malunion can lead to ulnar-sided wrist pain, loss of grip strength, and distal radioulnar joint impingement. The primary aim of this study is to describe upper limb-specific functional outcomes following ulnar shortening osteotomy (USO) for ulnar-sided wrist pain associated with malunion of the distal radius. Methods We retrospectively identified 40 adult patients from a single centre over a 9-year period that had undergone an USO for symptomatic malunion of the distal radius. The primary outcome was the patient-rated wrist evaluation (PRWE). Secondary outcomes were the QuickDASH, EQ-5D-5L, complications, and net promoter score (NPS). Results Outcomes were available for 37 patients (93%). The mean age was 56 years and 25 patients were female (68%). At a mean follow-up of 6 years (range 1–10 years) the median PRWE was 11 (IQR 0–29.5), the median QuickDASH 6.8 (IQR 0–29.5), and the median EQ-5D-5L index was 0.88 (IQR 0.71–1). The NPS was 73. Complications occurred in nine patients (24%) and included non-union (n = 4), early loss of fixation requiring revision surgery (n = 1), superficial wound infection (n = 2), neurological injury (n = 1), and further surgery for symptomatic hardware removal (n = 1). Conclusions For patients with a symptomatic distal radius malunion where the predominant deformity is ulnar positive variance, this study has demonstrated that despite 1 in 4 patients experiencing a complication, USO can result in excellent patient reported outcomes with high levels of satisfaction. Level of Evidence III (Cohort Study).
Chris Oliver
added 2 research items
The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. A trauma database was searched to identify all skeletally-mature patients with an undisplaced or minimally-displaced scaphoid waist fracture managed with early percutaneous retrograde screw fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5 L), and complications. During the study period 114 patients underwent this procedure. The mean age was 28 years (range, 17–62) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range, 1–27). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one early revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range, 6.4–19.8). The median PRWE was 0 (IQR 0–7.5), median QuickDASH 0 (IQR 0–4.5) and median EQ-5D-5 L 1.0 (IQR 0.837–1.0). There were 97% (n = 74) patients satisfied with their outcome. Early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health-related quality of life. Although comparable with previous studies, the overall surgical reintervention rate is notable and can result in inferior outcomes. Level of evidence Therapeutic level III (Retrospective Cohort Study).
Background The distribution of professional golfing injuries is poorly understood. Objective The aim of the study was to perform a systematic review to describe the epidemiology of musculoskeletal injuries in professional golfers. Design A systematic review using Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The databases used were Pubmed, SportDiscus and Embase. The inclusion criteria was published observational research articles relating to the incidence or prevalence of musculoskeletal injuries in professional golfers, which were written in the English language and not restricted by age or gender. Setting Professional golf. Main Outcome Measurements Data collected included age, sex, data collection methods, diagnosis, region of injury, side of injury, incidence/prevalence of injury, definition of injury, nature of injury, severity of injury, mechanism of injury, risk factors, length of golfing career, injury management and time to return to sport. Results Of the 1863 studies identified on the initial search, five studies were found to satisfy the inclusion criteria for analysis. The mean age of the golfers in these studies was 34.8 (± 3.6) years. The gender of patients in included studies compromised 72% males and 28% females. Four studies reported that lumbar spine injuries were the most common (range 22–34%). Excluding injuries to the spine (lumbar, thoracic and cervical), the hand/wrist was the next most common region of injury (range 6–37%). The quality of the studies was relatively poor with no study satisfying >50% of the quality assessment tool questions and only one study giving a clear definition of how they defined injury. Conclusions There is a paucity of well-designed epidemiological studies evaluating musculoskeletal injuries affecting professional golfers. Injuries to the spine are the most frequently affected region, followed by the hand/wrist. This study has identified targeted areas of future research that aims to improve the management of injuries among professional golfers.
Deborah Jane Macdonald
added a research item
The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates. Methods A prospective cohort study of patients planned to undergo hip arthroplasty (n = 713) and knee arthroplasty (n = 737) at a UK university teaching hospital who had completed preop-erative PROMs questionnaires, including the EuroQol five-dimension health-related quality of life score, and Oxford Hip Score (OHS) and Oxford Knee Score (OKS). Follow-up questionnaires were sent by post at one year, including satisfaction scoring. Attempts were made to contact patients who did not initially respond. Univariate, logistic regression, and receiver operator curve analysis was performed. Results At one year, 667 hip patients (93.5%) and 685 knee patients (92.9%) had undergone surgery and were alive. No response was received from 151/667 hip patients (22.6%), 83 (55.0%) of whom were ultimately contacted); or from 108/685 knee patients (15.8%), 91 (84.3%) of whom were ultimately contacted. There was no difference in satisfaction after arthroplasty between initial non-responders and responders for hips (74/81 satisfied vs 476/516 satisfied; p = 0.847) or knees (81/93 satisfied vs 470/561 satisfied; p = 0.480). Initial non-response and persistent non-response was associated with younger age, higher BMIs, and worse preopera-tive PROMs for both hip and knee patients (p < 0.050). Being in employment was associated with persistent non-response for hip patients (p = 0.047). Multivariate analysis demonstrated that younger age (p < 0.038), higher BMI (p = 0.018), and poorer preoperative OHS (p = 0.031) were independently associated with persistent non-response to hip PROMs. No independent associations were identified for knees. Using a threshold of > 66.4 years predicted a preference for contact by post (area under the curve 0.723 (95% confidence interval (CI) 0.647 to 0.799; p < 0.001, though this CI crosses the 0.7 limit considered reliable). Conclusion The majority of initial non-responders were ultimately contactable with effort. Satisfaction rates were not inferior in patients who did not initially respond to PROMs.
Deborah Jane Macdonald
added an update
Data Skills Workforce Development (PG ProfDev) (Online Learning) (ICL) - 2 Years .
Managing and Leading Data-Driven Innovation.
Just about to start this course, excited - I'll keep you posted!
 
Deborah Jane Macdonald
added 2 research items
Aims The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates. Methods A prospective cohort study of patients planned to undergo hip arthroplasty (n = 713) and knee arthroplasty (n = 737) at a UK university teaching hospital who had completed preoperative PROMs questionnaires, including the EuroQol five-dimension health-related quality of life score, and Oxford Hip Score (OHS) and Oxford Knee Score (OKS). Follow-up questionnaires were sent by post at one year, including satisfaction scoring. Attempts were made to contact patients who did not initially respond. Univariate, logistic regression, and receiver operator curve analysis was performed. Results At one year, 667 hip patients (93.5%) and 685 knee patients (92.9%) had undergone surgery and were alive. No response was received from 151/667 hip patients (22.6%), 83 (55.0%) of whom were ultimately contacted); or from 108/685 knee patients (15.8%), 91 (84.3%) of whom were ultimately contacted. There was no difference in satisfaction after arthroplasty between initial non-responders and responders for hips (74/81 satisfied vs 476/516 satisfied; p = 0.847) or knees (81/93 satisfied vs 470/561 satisfied; p = 0.480). Initial non-response and persistent non-response was associated with younger age, higher BMIs, and worse preoperative PROMs for both hip and knee patients (p < 0.050). Being in employment was associated with persistent non-response for hip patients (p = 0.047). Multivariate analysis demonstrated that younger age (p < 0.038), higher BMI (p = 0.018), and poorer preoperative OHS (p = 0.031) were independently associated with persistent non-response to hip PROMs. No independent associations were identified for knees. Using a threshold of > 66.4 years predicted a preference for contact by post (area under the curve 0.723 (95% confidence interval (CI) 0.647 to 0.799; p < 0.001, though this CI crosses the 0.7 limit considered reliable). Conclusion The majority of initial non-responders were ultimately contactable with effort. Satisfaction rates were not inferior in patients who did not initially respond to PROMs. Cite this article: Bone Jt Open 2022;3(4):275–283.
Aims Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m ² ). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m ² to examine whether this is supported. Methods This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m ² ) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m ² (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m ² in a 1:1 ratio. Demographic data, comorbidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient’s lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. Results All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m ² : 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m ² were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m ² costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m ² . In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m ² and £5,275 in patients with a BMI ≥ 40 kg/m ² . Conclusion Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m ² , suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452–463.
Tom Carter
added a research item
Aims Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m 2). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m 2 to examine whether this is supported. Methods This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m 2) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m 2 (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m 2 in a 1:1 ratio. Demographic data, comor-bidities, and complications to one year were recorded. Preoperative and one-year patient-reported outcome measures (PROMs) were completed: EuroQol five-dimension three-level questionnaire (EQ-5D-3L), OKS, pain, and satisfaction. Using national life expectancy data with obesity correction and the 2020 NHS National Tariff, QALYs (discounted at 3.5%), and direct medical costs accrued over a patient's lifetime, were calculated. Probabilistic sensitivity analysis (PSA) was used to model variation in cost/QALY for each cohort across 1,000 simulations. Results All PROMs improved significantly (p < 0.05) in both groups without differences between groups. Early complications were higher in BMI ≥ 40 kg/m 2 : 34/169 versus 52/169 (p = 0.050). A total of 16 (9.5%) patients with a BMI ≥ 40 kg/m 2 were readmitted within one year with six reoperations (3.6%) including three (1.2%) revisions for infection. Assuming reduced life expectancy in severe obesity and revision costs, TKA in patients with a BMI ≥ 40 kg/m 2 costs a mean of £1,013/QALY (95% confidence interval £678 to 1,409) more over a lifetime than TKA in patients with BMI < 40 kg/m 2. In PSA replicates, the maximum cost/QALY was £3,921 in patients with a BMI < 40 kg/m 2 and £5,275 in patients with a BMI ≥ 40 kg/m 2. Conclusion Higher complication rates following TKA in severely obese patients result in a lifetime cost/QALY that is £1,013 greater than that for patients with BMI < 40 kg/m 2 , suggesting that TKA remains a cost-effective use of healthcare resources in severely obese patients where the surgeon considers it appropriate. Cite this article: Bone Joint J 2022;104-B(4):452-463.
Deborah Jane Macdonald
added a research item
Background Approximately 10% to 20% of patients with joint arthroplasties are golfers. The aim of this study was to assess if being a golfer is associated with functional outcomes, satisfaction or improvement in quality of life (QoL) compared to non-golfers following total knee arthroplasty. Methods All patients undergoing primary total knee arthroplasty (TKA) over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on postoperative function and health-related outcomes. Results The study cohort consisted of a total of 514 patients undergoing TKA. This included 223 (43.3%) male patients and 291 (56.7%) female patients, with an overall mean age of 70 (SD 9.5) years. The preoperative Oxford Knee Score (OKS) was significantly higher in golfers when adjusting for confounders (Diff 3.4 [95% CI 1 to 5.8], p = 0.006). There was no difference in postoperative outcomes between golfers and non-golfers. There was however a trend towards a higher Forgotten Joint Score (FJS) in the golfers (difference 9.3, 95% CI − 0.2 to 18.8, p = 0.056). Of the 48 patients who reported being golfers at the time of their surgery, 43 (89.6%) returned to golf and 88.4% of those were satisfied with their involvement in golf following surgery. Conclusions Golfers had better preoperative and equal postoperative knee specific function compared to non-golfers. The majority of golfers returned to golf by one year and were satisfied with their involvement in the game. Level of evidence III.
Deborah Jane Macdonald
added 7 research items
Background The purpose of this study was to search for changes in functional outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between short and medium-term follow-up. Secondary aims included reporting rates of revision surgery and total hip arthroplasty (THA) at medium-term follow-up. Hypothesis We hypothesised that patients’ functional outcomes would improve between short and medium-term follow-up. Patients and methods Consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement with labral tears between February 2013 and June 2015 were included. Twelve item international hip outcome tool (iHOT-12) and EuroQol 5D-5L (EQ-5D) scores were collected preoperatively, at short-term and medium-term follow-up. Short-term scores were recorded at a minimum of one year postoperatively and medium-term scores at a minimum of five years postoperatively. Survivorship was assessed with Kaplan–Meier analysis. Results Short-term outcome data (at median follow-up 1.6 year, interquartile range [IQR] 1–2.5) was available for 70 of 87 patients (80.5 %) and medium-term outcome data (at median follow-up of 6.5 years, IQR 6–7.1) was available for 68 patients (78.2 %). Median age at the time of surgery was 31 years (IQR 25–37). The median iHOT-12 scores at short- and medium-term follow-up were 72 (IQR 48.75–91.25) and 85.8 (IQR 66.7–96.7) respectively (p < 0.001). Medium-term survivorship was 91.2 %. Survivorship following labral repair was 94.2 %, and 81.3 % following labral debridement (p = 0.09). Discussion Patients undergoing hip arthroscopy for FAI reported continued improvement in iHOT-12 scores between short- and medium-term follow-up. Medium-term survivorship following FAI surgery may be greater when the labrum is repaired, although comparisons are limited by their differing indications. Conversion to THA was low with just 4 patients (4.6 %) undergoing or being listed for THA at final follow-up. Level of evidence IV, case series.
The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation.
Introduction: The aim of this paper is to present validated patient reported outcomes for MIS Distal Metatarsal Metaphyseal Osteotomy (DMMO) in the treatment of metatarsalgia. The study aims to evaluate the DMMO procedure, report patient satisfaction with the operated foot and report any complications of this procedure. Patients and methods: Between 2014 and 2016, patients who had failed conservative treatment for metatarsalgia were identified in the orthopaedic outpatient clinic. Twenty four consecutive patients requiring DMMO plus/minus toe straightening were prospectively studied. Patients requiring additional procedures at the time of surgery were excluded. Patients completed the validated Manchester-Oxford Foot Questionnaire (MOXFQ) three weeks pre-operatively and 1 year postoperatively. The MOXFQ results were analysed using Paired t-tests. A supplementary question was asked regarding patient satisfaction with the operated foot. Results: There were 20 women and 4 men with a mean age of 64 years (sd 8.6). Statistically significant differences were found between the pre and postoperative MOXFQ. The postoperative MOXFQ score demonstrated a poorer result for two patients, no change for two patients and improvement in 20 patients, with four of these patients recording the lowest possible score. There was a 29.5 point improvement in mean metric MOXFQ Index score. Seventy-nine percent (n = 19) of patients were satisfied or very satisfied with the operated foot. The average recoil of the metatarsal heads following DMMO was M2 4.01 mm, M3 4.55 mm, M4 4.16 mm. There was one delayed union and no non-unions. Further reported complications were a gastric bleed, pulmonary embolism (VTE), and one intra operative broken burr. Conclusion: Our study demonstrates a clinically important and statistically significant improvement in patient reported outcomes following DMMO, with 79% of patients satisfied or very satisfied with this procedure. The average recoil of the metatarsal heads following DMMO was M2 4.01 mm, M3 4.55 mm, M4 4.16 mm with one delayed union and no non-unions.
Deborah Jane Macdonald
added a research item
Purpose The primary aim of this study was to determine the cost-effectiveness of total hip arthroplasty (THA) in patients aged 25 years and under by calculating the cost per quality-adjusted life year (QALY) gained at 10 years post-operatively, and over the course of a lifetime. Secondary aims were to describe the change in health-related quality of life (HRQoL), Oxford hip score (OHS), and satisfaction in these patients. Methods From 2000 to 2016, 33 patients undergoing THA aged 25 and under had pre-operative and one-year post-operative EuroQol five-dimensions (EQ-5D) scores and OHS recorded prospectively. Post-operative change in EQ-5D allowed calculation of a health-utility score, which, when combined with life expectancy, gave total QALYs gained. Results The mean age was 20 years (range 13.3-24.9), with 23 females (72.7%). Mean number of QALYs gained was 21.1 (95% CI 14.1-28.2). Total lifetime cost per patient was £14641, giving a mean cost per QALY of £4183 at 10 years post-operatively, and £694 over the total remaining lifetime. Discounting total QALYs gained at a rate of 3.5% and 5% per remaining year of life expectancy increased the mean cost per QALY to £1652 and £2187, respectively. Mean pre- and post-operative EQ-5D index were 0.27 (SD 0.27) and 0.63 (SD 0.29), respectively (p=0.0001). Mean pre-operative and post-operative OHS was 37.5 (SD 7.9) and 19.7 (SD 6.94), respectively (p<0.00001). Conclusion THA remains a cost-effective intervention for patients aged 25 years and under. It is also associated with significant improvement in HRQoL, OHS, and high levels of patient satisfaction in this unique patient group.
Deborah Jane Macdonald
added an update
Coming soon! Our team are getting to grips with the nitty gritty of Health Data Science and making good use of the amazing resources provided by the University of Edinburgh. https://argoshare.is.ed.ac.uk/healthyr_book/about-the-authors.html
 
Deborah Jane Macdonald
added 2 research items
Aims Golf is a popular pursuit among those requiring total hip arthroplasty (THA). The aim of this study was to determine if participating in golf is associated with greater functional outcomes, satisfaction, or improvement in quality of life (QoL) compared to non-golfers. Methods All patients undergoing primary THA over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on outcomes. Results The study cohort consisted of a total of 308 patients undergoing THA, of whom 44 were golfers (14%). This included 120 male patients (39%) and 188 female patients (61%), with an overall mean age of 67.8 years (SD 11.6). Golfers had a greater mean postoperative Oxford Hip Score (OHS) (3.7 (95% confidence interval (CI) 1.9 to 5.5); p < 0.001) and EuroQol visual analogue scale (5.5 (95% CI 0.1 to 11.9); p = 0.039). However, there were no differences in EuroQoL five-dimension score (p = 0.124), pain visual analogue scale (p = 0.505), or Forgotten Joint Score (p = 0.215). When adjusting for confounders, golfers had a greater improvement in their Oxford Hip Score (2.7 (95% CI 0.2 to 5.3); p < 0.001) compared to non-golfers. Of the 44 patients who reported being golfers at the time of their surgery, 32 (72.7%) returned to golf and 84.4% of those were satisfied with their involvement in golf following surgery. Those who returned to golf were more likely to be male (p = 0.039) and had higher (better) preoperative health-related QoL (p = 0.040) and hip-related functional scores (p = 0.026). Conclusion Golfers had a greater improvement in their hip-specific function compared to non-golfers after THA. However, less than three-quarters of patients return to golf, with male patients and those who had greater preoperative QoL or hip-related function being more likely to return to play. Cite this article: Bone Jt Open 2022;3(2):145–151.
Total hip arthroplasty (THA) is a clinically beneficial and cost-effective treatment for patients with end-stage hip arthritis.1 Among patients undergoing lower limb arthroplasty, golf is a popular pursuit.2-4 Hip arthritis can limit patients’ ability to play golf, and this can adversely affect quality of life (QoL).5 However, the effect of being a golfer on functional outcomes and QoL following THA versus a non-golfer are unclear. Furthermore, there is a paucity of studies exploring factors associated with return to golf following THA. Robinson et al6 set out to assess the hip-specific functional outcomes, satisfaction, and improvements in QoL following THA in golfers versus non-golfers. Additionally, the study aimed to determine the rate of return to golf and influencing factors. Overall, 328 patients undergoing primary THA over a one-year period at a single institute were included.6 Of these, 120 patients (39%) were male and 188 (61%) were female, with an overall mean age of 67.8 years (standard deviation (SD) 11.6). There were 44 golfers (14%) within this group. This study found that golfers had significantly higher hip function than non-golfers at one year following surgery (Oxford Hip Score of 43.1 (SD 5.2) vs 39.5 (SD 7.7); p < 0.001, independent-samples t-test). In addition, golfers had a significantly greater EuroQol visual analogue scale score (82.6 (SD 15.2) vs 77.1 (SD 20.6); p = 0.039, independent-samples t-test) indicating a higher perceived QoL following surgery. Of the 44 golfers, 32 (72.7%) returned to golf, and within this group, 27 (84.4%) were satisfied with their involvement in golf since returning from their surgery. Finally, this study found that male sex (p = 0.001, chi-squared test), those with greater preoperative QoL (p = 0.039, independent-samples t-test) or greater preoperative hip function (p = 0.026, independent-samples t-test) are more likely to return to golf. 6 These findings can assist surgeons and patients in shared decision-making for THA.
Deborah Jane Macdonald
added 3 research items
Background: The purpose of this study was to search for changes in functional outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between short and medium-term follow-up. Secondary aims included reporting rates of revision surgery and total hip arthroplasty (THA) at medium-term follow-up. Hypothesis: We hypothesised that patients’ functional outcomes would improve between short and medium-term follow-up. Patients and Methods: Consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement with labral tears between February 2013 and June 2015 were included. Twelve item international hip outcome tool (iHOT-12) and EuroQol 5D-5L (EQ-5D) scores were collected preoperatively, at short-term and medium-term follow-up. Short-term scores were recorded at a minimum of one year postoperatively and medium-term scores at a minimum of five years postoperatively. Survivorship was assessed with Kaplan-Meier analysis. Results: Short-term outcome data (at median follow-up 1.6 year, Interquartile range [IQR] 1-2.5) was available for 70 of 87 patients (80.5%) and medium-term outcome data (at median follow-up of 6.5 years, IQR 6-7.1) was available for 68 patients (78.2%). Median age at the time of surgery was 31 years (IQR 25 – 37). The median iHOT-12 scores at short and medium-term follow-up were 72 (IQR 48.75 – 91.25) and 85.8 (IQR 66.7 – 96.7) respectively (p<0.001). Medium-term survivorship was 91.2%. Survivorship following labral repair was 94.2%, and 81.3% following labral debridement (p=0.09). Discussion: Patients undergoing hip arthroscopy for FAI reported continued improvement in iHOT-12 scores between short and medium-term follow-up. Medium-term survivorship following FAI surgery may be greater when the labrum is repaired, although comparisons are limited by their differing indications. Conversion to THA was low with just 4 patients (4.6%) undergoing or being listed for THA at final follow-up. Level of Evidence: IV, Case series
Aims The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total hip arthroplasty (THA) in a UK population. Methods During a one-year period, 461 patients underwent a primary THA and completed preoperative and six-month FJS, with a mean age of 67.2 years (22 to 93). At six months, patient satisfaction was recorded as very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 31) and satisfied (n = 101) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS. Distribution-based methodology was used to calculate the MDC. Results Using satisfaction as the anchor, the MCID for the FJS was 8.1 (95% confidence interval (CI) 3.7 to 15.9; p = 0.040), which was affirmed when adjusting for confounding. The MIC for the FJS for a cohort of patients was 17.7 (95% CI 13.7 to 21.7) and for an individual patient was 18. The MDC90 for the FJS was eight, meaning that 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS threshold for the FJS was defined as 29. Conclusion The MCID and MIC can be used respectively to assess whether there is a clinical difference between two groups, or whether a cohort or patient has had a meaningful change in their FJS. Both values were greater than measurement error (MDC90), suggesting a real change. The PASS threshold for the postoperative FJS can be used as a marker of achieving patient satisfaction following THA.
Purpose The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient’s hip pathology. The preoperative burden on patients’ mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients’ awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively. Methods A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson’s correlation coefficient was used to assess relationships between continuous variables. Results Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 – 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = − 0.359, p < 0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p < 0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health. Conclusion Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.
Deborah Jane Macdonald
added an update
Not from our project but from our department. Such a great article. Excellent work Hall et al
 
Deborah Jane Macdonald
added a research item
Aims Primary aim was to determine survival of a cemented acetabular component with bulk roof autograft with a minimum of 12 years follow-up. The secondary aim was to determine the clinical outcome. Methods A cohort of 62 consecutive patients (74 hips) undergoing cemented total hip arthroplasty with acetabular bulk roof autograft for acetabular dysplasia were retrospectively identified. The group consisted of 57 female patients (67 hips) and 5 male patients (7 hips) with a mean age at operation of 45 years. No patient was lost to follow-up, however 9 patients died had during the study period. The Oxford Hip Score (OHS), Forgotten Joint Score (FJS), EuroQol 5-Dimensional Score (EQ-5D), Short Form (SF-12) physical score and patient satisfaction were used to assess clinical outcome for patients with a surviving prosthesis. Results The median follow-up was 16.6 (13.4–19.1) years. 6 revisions were performed during the follow-up period, all of which were due to aseptic loosening of the acetabular component. The all-cause Kaplan Meier survival rate for the acetabular component was 99% at 10 years, 95% at 15 years and 83% at 20 years. Neither age, gender, femoral osteotomy or polyethylene (UHMW vs. cross-linked) were significant predictors of aseptic revision of the acetabular component. There were no case of graft resorption and all grafts were radiologically incorporated. 45 patients were available for functional assessment at a mean follow-up of 18.2 years. The mean OHS was 37.8, FJS was 55.7, EQ5D was 0.73, and SF-12 physical component was 43.2. No patient was dissatisfied, with 2 patients reporting a neutral satisfaction, 7 stating they were satisfied and the remaining 36 were very satisfied. Conclusions A cemented acetabular component with bulk roof autograft for dysplasia offers excellent survival with good to excellent functional outcome with high patient satisfaction in the medium- to long-term.
Deborah Jane Macdonald
added an update
The future is code. Lots and lots of coding in RStudio and Python for managing our big data. Github is our second home! Interactive Dashboards coming soon. Team members getting to grips with these powerful tools Liam Z Yapp
 
Deborah Jane Macdonald
added an update
The Royal College of Surgeons has honoured our very own Chloe with The Hunter Doig Medal. The Hunter Doig Medal is offered to a female Member or Fellow of the College who is specially selected by the College Council for demonstrating outstanding career potential and ambition.
We are very proud and bathe in Chloe's reflected glory https://twitter.com/EdinburghKnee/status/1433840339685609473/photo/1
 
Deborah Jane Macdonald
added a research item
The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation.
Chris Oliver
added a research item
Purpose: There is a paucity of literature regarding the long-term outcomes of scaphoid fractures managed with acute percutaneous fixation. The aim of this study was to report the long-term functional outcomes and complication rates following early percutaneous fixation of acute fractures of the scaphoid. Methods: A trauma database was searched to identify all skeletally-mature patients with a scaphoid fracture managed with early percutaneous fixation over a thirteen-year period from 1997-2010. Medical records were retrospectively reviewed, and complications documented. Long-term follow-up was by a questionnaire-based review. The Patient-Rated Wrist Evaluation (PRWE) was the primary outcome measure. Secondary outcomes included the Quick version of the Disability of the Arm, Shoulder and Hand score (QuickDASH), the EuroQol 5-dimensions score (EQ-5D-5L), and complications. Results: During the study period 114 patients underwent this procedure. The mean age was 28 years (SD 9; range 17-62 years) and 97 patients (85%) were male. The median time from injury to surgery was nine days (range 1-27; IQR 5-13 days). The mean time to radiographic union was 13 weeks (SD 7; range 5-40 weeks). Twelve patients (11%) reported a complication, all of whom required repeat surgical intervention (six revision ORIF for non-union, five elective removal of hardware, one acute revision fixation due to screw impingement). Long-term outcome data was available for 77 patients (68%) at mean follow-up of 11.4 years (range 6.4-19.8 years). The median PRWE was 0 (IQR 0-7.5), median QuickDASH 0 (IQR 0-4.5) and median EQ-5D-5L 1.0 (IQR 0.837-1.0). There were 97% (n=74) of patients satisfied with their outcome. Conclusion: This study has demonstrated that early percutaneous fixation of acute non-displaced or minimally displaced scaphoid fractures results in good long-term patient reported outcomes and health related quality of life. High patient satisfaction, along with return to work and physical activities were also observed, with minimal morbidity and low overall pain scores. Program https://simplebooklet.com/otaam21preliminaryprogram1#page=31
Deborah Jane Macdonald
added 3 research items
Bone Joint J 2021;103-B(7):xxx-xxx. KNEE Venous thromboembolism after total knee arthroplasty is associated with a worse functional outcome at one year Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee specific functional outcome (Oxford Knee Score, OKS) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed. Patient demographics, comorbidities, OKS, EuroQol five-dimension (EQ-5D) and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and comparedwith those without. Results In all, A total of 37 patients (1.5%) suffered a VTE, and were significantly more likely to have comorbidities of stroke (p < 0.001), vascular disease (p = 0.03), and kidney disease (p = 0.02). In an unadjusted analysis, patients suffering a VTE had a significantly worse postop-erative OKS (difference in mean (DIM) 4.8, 95% confidence interval (CI) 1.6 to 8.0, p = 0.004) and EQ-5D (DIM 0.146, 95% CI 0.059 to 0.233, p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent pre-dictor associated with a worse postoperative OKS (DIM-5.4, 95% CI-8.4 to-2.4, p < 0.001), and EQ-5D score (DIM-0.169, 95% CI-0.251 to-0.087, p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89, 95% CI 0.35 to 2.07, p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had a clinically significantly worse knee specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):xxx-xxx.
Bone Joint J 2021;103-B(7):xxx-xxx. KNEE Venous thromboembolism after total knee arthroplasty is associated with a worse functional outcome at one year Aims The primary aim of this study was to assess whether non-fatal postoperative venous thromboembolism (VTE) within six months of surgery influences the knee specific functional outcome (Oxford Knee Score, OKS) one year after total knee arthroplasty (TKA). Secondary aims were to assess whether non-fatal postoperative VTE influences generic health and patient satisfaction at this time. Methods A study of 2,393 TKAs was performed. Patient demographics, comorbidities, OKS, EuroQol five-dimension (EQ-5D) and Forgotten Joint Score (FJS) were collected preoperatively and one year postoperatively. Overall patient satisfaction with their TKA was assessed at one year. Patients with VTE within six months of surgery were identified retrospectively and comparedwith those without. Results In all, A total of 37 patients (1.5%) suffered a VTE, and were significantly more likely to have comorbidities of stroke (p < 0.001), vascular disease (p = 0.03), and kidney disease (p = 0.02). In an unadjusted analysis, patients suffering a VTE had a significantly worse postop-erative OKS (difference in mean (DIM) 4.8, 95% confidence interval (CI) 1.6 to 8.0, p = 0.004) and EQ-5D (DIM 0.146, 95% CI 0.059 to 0.233, p = 0.001) compared with patients without a VTE. After adjusting for confounding variables VTE remained a significant independent pre-dictor associated with a worse postoperative OKS (DIM-5.4, 95% CI-8.4 to-2.4, p < 0.001), and EQ-5D score (DIM-0.169, 95% CI-0.251 to-0.087, p < 0.001). VTE was not independently associated with overall satisfaction after TKA (odds ratio 0.89, 95% CI 0.35 to 2.07, p = 0.717). Conclusion Patients who had a VTE within six months of their TKA had a clinically significantly worse knee specific outcome (OKS) and general health (EQ-5D) scores one year postoperatively, but the overall satisfaction with their TKA was similar to those patients who did not have a VTE. Cite this article: Bone Joint J 2021;103-B(7):xxx-xxx.
Introduction There is limited medium-term outcome data regarding the predictors of functional outcome and patient satisfaction after arthroscopic rotator cuff repair. Methods 287 patients that underwent arthroscopic rotator cuff repair under a high-volume single surgeon were contacted at a minimum of 4 years following surgery. Patient demographics, tear size and co-morbidities were pre-operatively recorded. The Oxford shoulder score, EuroQol 5-dimensional score and patient satisfaction were recorded at final follow-up. Results 234 (81.5%) patients completed follow-up at a mean of 5.5 (4–9) years. There were 126 males and 108 females with a mean age of 60 (range 25–83) years. The majority of patients ( n = 211, 90%) were satisfied with their final outcome. Multivariate linear regression analysis ( R ² = 0.64) identified that increasing tear size ( p = 0.04), worsening general health assessed by the EuroQol 5-Dimensional ( p < 0.001), and smoking ( p = 0.049) were associated with a worse Oxford shoulder score. Logistic regression analysis ( R ² = 0.13) identified that worsening general health assessed by the EuroQol 5-Dimensional ( p < 0.001), and smoking ( p = 0.01) were associated with an increased risk of patient dissatisfaction. Conclusion General health status and smoking are independent predictors of functional outcome and patient satisfaction at medium-term follow-up following arthroscopic rotator cuff repair.
Deborah Jane Macdonald
added a research item
Aims: The primary aim was to assess the cost-effectiveness of primary total ankle replacements (PTAR) in the UK. Secondary aim was to identify predictors associated with increased cost-effectiveness of PTAR. Methods: Pre-operative and six-month post-operative data was obtained over a 90-month period across the two centres receiving adult referrals in the UK. The EuroQol general health questionnaire (EQ-5D-3L) measured health-related Quality of Life (HRQoL) and the Manchester-Oxford Foot Questionnaire (MOXFQ) measured joint function. Predictors, tested for significance with QALYs gained, were pre-operative scores and demographic data including age, gender, BMI and socioeconomic status. A cost per QALY of less than £20,000 was defined as cost effective. Results: The 51-patient cohort [mean age 67.70 (SD 8.91), 58.8% male] had 47.7% classed as obese or higher. Cost per QALY gained was £1669, rising to £4466 when annual (3.5%) reduction in health gains and revision rates and discounting were included. Lower pre-operative EQ-5D-3L index correlated significantly with increased QALYs gained (p < 0.01), all other predictors were not significantly (p > 0.05) associated with QALYs gained. Conclusions: PTAR is a cost-effective intervention for treating end-stage ankle arthritis. Pre-operative EQ-5D-3L was associated with QALYs gained. A pre-operative EQ-5D-3L score of 0.57 or more was not cost effective to operate on.
Deborah Jane Macdonald
added 6 research items
Aims It is unclear whether acute plate fixation facilitates earlier return of normal shoulder function following a displaced mid-shaft clavicular fracture compared with nonoperative management when union occurs. The primary aim of this study was to establish whether acute plate fixation was associated with a greater return of normal shoulder function when compared with nonoperative management in patients who unite their fractures. The secondary aim was to investigate whether there were identifiable predictors associated with return of normal shoulder function in patients who achieve union with nonoperative management. Methods Patient data from a randomized controlled trial were used to compare acute plate fixation with nonoperative management of united fractures. Return of shoulder function was based on the age- and sex-matched Disabilities of the Arm, Shoulder and Hand (DASH) scores for the cohort. Independent predictors of an early recovery of normal shoulder function were investigated using a separate prospective series of consecutive nonoperative displaced mid-shaft clavicular fractures recruited over a two-year period (aged ≥ 16 years). Patient demographics and functional recovery were assessed over the six months post-injury using a standardized protocol. Results Data from the randomized controlled trial consisted of 86 patients who underwent operative fixation compared with 76 patients that united with nonoperative treatment. The recovery of normal shoulder function, as defined by a DASH score within the predicted 95% confidence interval for each respective patient, was similar between each group at six weeks (operative 26.7% vs nonoperative 25.0%, p = 0.800), three months (52.3% vs 44.2%, p = 0.768), and six months post-injury (86.0% vs 90.8%, p = 0.349). The mean DASH score and return to work were also comparable at each timepoint. In the prospective cohort, 86.5% (n = 173/200) achieved union by six months post-injury (follow-up rate 88.5%, n = 200/226). Regression analysis found that no specific patient, injury, or fracture predictor was associated with an early return of function at six or 12 weeks. Conclusion Return of normal shoulder function was comparable between acute plate fixation and nonoperative management when union was achieved. One in two patients will have recovery of normal shoulder function at three months, increasing to nine out of ten patients at six months following injury when union occurs, irrespective of initial treatment. Cite this article: Bone Jt Open 2021;2(7):522–529.
Introduction The Olympia femoral stem is a stainless steel, anatomically shaped, polished and three-dimensionally tapered implant designed for use in cemented total hip arthroplasty (THA). The primary aim of this study was to determine the long-term survivorship, radiographic outcome, and patient-reported outcome measures (PROMs) of the Olympia stem. Patients and methods Between May 2003 and December 2005, 239 patients (264 THAs) underwent a THA with an Olympia stem in our institution. Patient-reported outcome measures were assessed using the Oxford Hip Score (OHS), EuroQol-5 dimensions (EQ-5D) score, and patient satisfaction at mean 10 years following THA. Patient records and radiographs were then reviewed at a mean of 16.5 years (SD 0.7, 15.3–17.8) following THA to identify occurrence of complications or revision surgery for any cause following surgery. Radiographs were assessed for lucent lines and lysis according to Gruen’s zones Results Mean patient age at surgery was 68.0 years (SD 10.9, 31–93 years). There were 156 women (65%, 176 THAs). Osteoarthritis was the indication for THA in 204 patients (85%). All cause stem survivorship at 10 years was 99.2% (95% confidence interval [CI], 97.9%–100%) and at 15 years was 97.5% (94.6%–100%). The 15-year stem survival for aseptic loosening was 100%. Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (96.3%–100%) at 10 years and 95.9% (92.4%–99.4%) at 15 years. There were 9 THAs with non-progressive lucent lines in a single Gruen zone and 3 had lines in two zones, and no patient demonstrated signs for lysis. At a mean of 10-year (SD 0.8, 8.7–11.3) follow-up, mean OHS was 39 (SD 10.3, range 7–48) and 94% of patients reported being very satisfied or satisfied with their THA. Conclusions The Olympia stem demonstrated excellent 10-year PROMs and very high rates of stem survivorship at final follow-up beyond 15 years.
Purpose To contextualize the Forgotten Joint Score (FJS-12) by identifying a patient acceptable symptomatic state (PASS) threshold for patients undergoing hip arthroscopy and to investigate factors which correlated with postoperative FJS-12 score. Methods All patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) under the care of a single surgeon between January 2018 and November 2019 were prospectively identified and included. Exclusion criteria were Tönnis classification grade 2 or greater. Data (including FJS-12, EuroQol-5 Dimension-5L [EQ-5D-5L], visual analog scale (VAS), and 12-item International Hip Outcome Tool (iHOT-12) scores) were available before surgery and at a minimum of 1 year after surgery. PASS was calculated using an anchor-based approach and receiver operator characteristic curve analysis. Pearson correlation analysis was used to correlate preoperative and postoperative factors with postoperative FJS-12 score. Results Seventy-seven patients (54 female, 23 male; mean age 30.3 years [standard deviation {SD} 8.2]) were included. Linked longitudinal follow-up data were available for 65 patients (84%) at a mean of 23.8 months (SD 6.4). Six patients required reoperation. Mean postoperative FJS-12 score was 46.5 (SD 33.1) and mean change in score was 27.2 (SD 30.6, P < .001). The PASS threshold for the FJS-12 was 38.5 (sensitivity 80%, specificity 88%), and the area under the curve was 0.852 (95% confidence interval 0.752-0.951). Overall, 53.8% of patients achieved this score. Postoperative FJS-12 score has moderate correlations with preoperative EQ-5D-5L, iHOT-12, and FJS-12 scores, and strong correlations with EQ-5D-5L, iHOT-12 and VAS scores after surgery. Conclusions We report a postoperative PASS threshold of 38.5 points for the FJS-12 after hip arthroscopy for FAI in a United Kingdom population. This value can act as a quantifiable target for clinicians using the FJS-12 to monitor patient outcomes in practice. FJS-12 has strong correlations with EQ-5D-5L, iHOT-12, and VAS at a minimum 12 months after surgery. Level of Evidence Level IV, case series 4.
Chris Oliver
added a research item
Stress fractures of the metacarpals and phalanges are extremely rare injuries. They occur almost universally in adolescents. Metacarpal stress fractures are typically associated with racquet or grip sports, and phalangeal fractures typically occur in rock climbers. Symptoms can be subtle, but magnetic resonance imaging usually reveals the injury. Treatment is nonoperative, with high levels of return to sport, and minimal morbidity.
Deborah Jane Macdonald
added 7 research items
PRIMARY TOTAL KNEE ARTHROPLASTY FACILITATES RETURN TO WORK AT 1 YEAR IN PATIENTS UNDER 65 YEARS OLD K. Al-Hourani, D. MacDonald, S. Breusch, C. Scott The Royal Infirmary of Edinburgh, Edinburgh, United Kingdom Aims: Successful return to work (RTW) is a crucial outcome of primary total knee arthroplasty (TKA) in patients under 65 years. We aimed to determine whether TKA facilitated RTW in patients whose preoperative intention was to return. Methods: Prospective study of 196 patients≤65 years (mean age 58.6 (SD 4.9); mean BMI 31.6kg/m2 (SD 6.7); 51 (46.8%) male) undergoing primary unilateral TKA was performed. Prior to surgery a novel questionnaire covering employment status, nature of employment, ability to work, knee related sick leave and employment intentions following TKA was completed. Oxford knee score, Oxford-APQ, VAS pain/health scores and EQ-5D were assessed preoperatively and at 1 year following surgery. Results: 109 patients (56%) intended to RTW following TKA. Of these patients, 79/109 (73%) returned to work following TKA at mean17.0±17.6 weeks. Significant (pb0.05) associations with 1 year RTW on univariate analysis included young age, lower BMI, knee related sick-leave, better preoperative Oxford-APQ, VAS pain scores, post-operative EQ-5D and VAS pain scores. Only preoperative knee-related sick leave (RTW 7.1 weeks ± 14.4 weeks Vs no RTW 22.8±17.2, p=0.005), and better postoperative VAS pain scores (pb0.001) independently predicted RTW on multivariate analysis (R2=). Conclusion: Primary TKA facilitates return to work by 1 year in 73% of patientsb65 years who intend to return following their surgery. This is independently predicted by the length of sick leave required prior to surgery and the pain relief obtained following TKA.
Background The aim of this study was to compare the outcomes and cost economics of TKA without patella resurfacing in patients with and without patellar cartilage loss. Methods Prospective case control study of 209 consecutive patients undergoing TKA without patella resurfacing. Patella cartilage status was documented intra-operatively: 108 patients had patella cartilage loss (mean age 70 ± 9.7, mean BMI 31 ± 6.2, 72 (67%) female) and 101 control patients did not (age 68 ± 9.2, BMI 31 ± 5.6, 52 (51%) female). The primary outcome measure was Oxford Knee Score (OKS) improvement at one year. Secondary outcomes included OKS, EQ-5D, anterior knee pain (AKP), Kujala scores and reoperation at 2–4 years. The cost to prevent secondary patella resurfacing was calculated. Results There were more women in the patella cartilage loss group (67% Vs 51%, p = 0.037), but no other preoperative characteristics differed. There was no difference in OKS improvement between those with and without patella cartilage loss at 1 year (mean difference −1.03, −3.68 to 1.62 95%CI, p = 0.446) or 2–4 years (mean difference 1.52, −1.43 to 4.45 95%CI, p = 0.310). At 2–4 years there was no difference in AKP (14/87 with vs 17/80 without, p = 0.430) nor Kujala score (mean difference 2.66, −3.82 to 9.13 95%CI, p = 0.418). Routine patella resurfacing would have cost £58,311 to prevent one secondary resurfacing. Conclusion There was no difference in OKS, anterior knee pain, reoperation or Kujala scores up to 2–4 years between patients with and without patellar cartilage loss following TKA without patella resurfacing. Resurfacing for this indication would not have been a cost effective intervention.
Background The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation. Methods A consecutive series of patients over 10-years were retrospectively reviewed using the QuickDASH, Oxford Shoulder Score and EuroQol five-dimension summary index (EQ-5D). These patients were compared to a matched cohort that achieved union after non-operative management using propensity score matching. Results Sixty patients (follow-up 79%, n = 60/76) at 4.1 years post-operative (1.1–10.0 years) had a QuickDASH of 16.5 (95% CI 11.6–21.5), Oxford Shoulder Score 41.5 (39.0–44.1) and EQ-5D 0.7621 (0.6822–0.8421). One in five patients were dissatisfied with their final outcome ( n = 13/60). Functional outcome was inferior following fixation when compared to patients that united with non-operative management (QuickDASH 16.5 vs. 5.5, p < 0.001 and EQ-5D 0.7621 vs. 0.9073, p = 0.001). However, significant improvements were found when compared to pre-operative scores (QuickDASH p < 0.001 and EQ-5D p < 0.001). The cost per QALY for fixation was £5624.62 for the study cohort. Conclusions Clavicle fixation for delayed and non-union is a cost-effective intervention but outcomes are worse compared to patients that unite with non-operative management.
Chris Oliver
added a research item
Invited Gold Medal lecture. "How not to be a surgeon!" Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire, UK. Closed virtual event. 2021. The pdf file is only pictures. The original presentation has sound and video, the file is too big for ResearchGate, contact me for a DropBox Link.
Deborah Jane Macdonald
added an update
Exciting things are happening with the Edinburgh Orthopaedic Database! We are developing our databases with the help of new recruit Dan Osborn.
Dan, a data scientist, is going to help us streamline our datasets into a more user friendly format so watch this space.
 
Deborah Jane Macdonald
added 2 research items
Purpose: The primary aim of this study was to assess whether there was a clinically significant difference in the mean Oxford knee score (OKS) between 6 and 12 months after total knee arthroplasty (TKA). The secondary aim was to identify variables associated with a clinically significant change in the OKS between 6 and 12 months. Methods: A retrospective cohort study was undertaken using an established arthroplasty database of 1574 primary TKA procedures. Patient demographics, body mass index (BMI), comorbidities, OKS and EuroQoL 5-domain (EQ-5D) score were collected preoperatively and at 6 and 12 months postoperatively. A clinically significant change in the OKS was defined as 5 points or more. Results: There was a 1.1-point increase in the OKS between 6 and 12 months postoperatively, which was statistically significant (95% confidence (CI) 0.8-1.3, p < 0.0001). There were 381 (24.2%) patients who had a clinically significant improvement in their OKS from 6 to 12 months. After adjusting for confounding, patients with a lower BMI (p = 0.028), without diabetes mellitus (p < 0.001), a better preoperative OKS (p < 0.001) or a worse 6-month OKS (p < 0.001) were more likely to have a clinically significant improvement. A 6-month OKS < 36 points was a reliable predictor of a clinically significant improvement in the 6-month to 12-month OKS (area under the curve 0.73, 95% CI 0.70-0.75, p < 0.001). Conclusion: Overall, there was no clinically significant change in the OKS from 6 to 12 months; however, a clinically significant improvement was observed in approximately a quarter of patients and was more likely in those scoring less than 36 points at 6 months. Level of evidence: retrospective diagnostic study, level III.
Chris Oliver
added a research item
Aims: Patient-reported outcomes after corrective osteotomy for a symptomatic malunion of the distal radius aims the primary aim of this study was to describe patient satisfaction and health-related quality of life (HrQoL) following corrective osteotomy for a symptomatic malunion of the distal radius. Methods: We retrospectively identified 122 adult patients from a single centre over an eight-year period who had undergone corrective osteotomy for a symptomatic malunion of the distal radius. the primary long-term outcome was the Patient-rated Wrist Evaluation (PrWE) score. secondary outcomes included the Quick disabilities of the arm, shoulder and Hand (QuickdasH) score, the EQ-5d-5L score, complications, and the net Promoter score (nPs). Multivariate regression analysis was used to determine factors associated with the PrWE score. Results: Long-term outcomes were available for 89 patients (72%). The mean age was 57 years (SD 15) and 68 were female (76%). The median time from injury to corrective osteotomy was nine months (interquartile range (IQR) 6 to 13). At a mean follow-up of six years (1 to 11) the median PRWE score was 22 (IQR 7 to 40), the median QuickDASH score was 11.4 (IQR 2.3 to 31.8), and the median EQ-5D-5L score was 0.84 (IQR 0.69 to 1). The NPS was 69. Multivariate regression analysis showed that the presence of an associated ulnar styloid fracture was the only significant independent factor associated with a worse PRWE score when adjusting for confounding variables (p = 0.004). Conclusion: We found that corrective osteotomy for malunion of the distal radius can result in good functional outcomes and high levels of patient satisfaction. However, the presence of an ulnar styloid fracture may adversely affect function. Level of Evidence: iii (cohort study). Cite this article: Bone Joint J 2020;102-B(11):1542-1548.
Deborah Jane Macdonald
added a research item
Background: A minority of proximal humeral fractures extend into the diaphysis and their optimal treatment remains controversial. We evaluated the outcomes and risk of complications in patients with these injuries, treated by a protocol of open reduction and long locking plate fixation (LPF). Methods: Between 2007 and 2014, all locally resident patients with a proximal humeral fracture extending into the diaphysis were referred to a specialist shoulder clinic. Operative treatment using a protocol of open reduction and LPF was offered to medically fit patients. Those with 2-year radiographic follow-up were included in the study, and standardized assessments of clinical and radiographic outcomes were performed during the first 2 years postoperatively. At a mean of 8.8 years (range, 5 to 12 years) after LPF, the functional outcomes and satisfaction of surviving, cognitively intact patients were assessed with a questionnaire study. Results: One hundred and two patients met the inclusion criteria; the majority were older women who had incurred the injury during a simple fall. Fractures were divided into 2 types depending on the pattern of diaphyseal extension. The pain levels, functional scores, and satisfaction with treatment were satisfactory both at the 2-year follow-up and at the longer-term follow-up at a mean of 8.8 years postsurgery. Complications were predominantly due to postsurgical stiffness (in 7 patients, with 3 undergoing additional surgery) and nonunion or fixation failure (in 7 patients, with 6 undergoing additional surgery). Conclusions: Proximal humeral fractures with diaphyseal extension are rare. The results of our study support the use of LPF in medically stable patients in centers with the expertise to perform these procedures. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Deborah Jane Macdonald
added a research item
Background The aim of this study was to assess the reliability of the Oxford Knee Score (OKS) collected verbally compared with the validated written score, using a population of patients who underwent total knee arthroplasty (TKR). Methods Ninety patients (mean age 70.6; (43–92), 56.7% female) undergoing TKR were prospectively assessed. One group (n = 45) completed written (standard) and verbal (over the telephone) OKS preoperatively, half (n = 23) performed the written questionnaire first followed by the verbal questionnaire, and the other half (n = 22) performed this in reverse. A separate group (n = 45) completed the same regime one year postoperatively. Results A mean difference of 0.63 (95% CI − 0.985–2.23) points between verbal and written OKS was observed preoperatively, and of 1.36 (95% CI − 0.942–3.65) points was observed at one year postoperatively. Excellent reliability was observed using ‘average measures’ intra-class coefficient for the OKS preoperatively (r = 0.848) and at one year postoperatively (r = 0.970) in both groups who had written scores performed first, and those who had verbal scores performed first (preoperative r = 0.780, one year r = 892). Bland and Altman plots demonstrated consistent correlation between patients reporting their preoperative score and one-year postoperative score verbally and written. There was no significant variation between groups who had written scores performed prior to verbal, compared with those who reported verbal scores prior to written. Conclusions Prospective written collection of OKS remains the benchmark. However, verbal recording of OKS is not clinically different to written score, and may be a useful alternative to OKS in patients who are unable to attend or complete written questionnaires.
Deborah Jane Macdonald
added 7 research items
Background: The optimal treatment of complex proximal humeral fractures in adults remains controversial. We evaluated the risk of complications and the long-term outcomes in patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus treated with open reduction and plate fixation (ORIF). Methods: Between 1995 and 2012, 5,897 consecutive patients with a proximal humeral fracture were referred to a specialist shoulder clinic for surgical assessment. Indications for surgery included anterior or posterior fracture-dislocation, substantial tuberosity involvement with >1 cm of displacement in a Neer 3 or 4-part fracture configuration, disengagement of the head from the shaft, or severe varus or valgus deformity of the head. All patients who met the surgical criteria and had been followed for 2 years were included, and standardized clinical and radiographic assessments of outcomes were performed. At a median of 10.8 years (range, 5 to 22 years) after ORIF, all surviving cognitively intact patients completed a patient-reported questionnaire assessing functional outcomes and satisfaction. Results: Three hundred and sixty-eight patients (6.2%) met the inclusion criteria and had the appropriate follow-up. The study population had a high rate of complex fracture configurations; 77.2% had tuberosity involvement, 54.1% had complete head-shaft disengagement, and 44.0% had a dislocated head. Eighty-seven patients (23.6%) had postoperative stiffness, 25 (6.8%) had fixation failure/nonunion, and 16 (4.3%) had late osteonecrosis/posttraumatic osteoarthritis; these complications were the reason for the majority of the reoperations in the cohort. The survivorship until any reoperation was 74% at 10 years, but when reoperations for stiffness were excluded, the survivorship was 90% during the same time period. The patients' mean levels of pain, function, and satisfaction with treatment were good to excellent. Conclusions: Our results support the use of primary ORIF in medically fit patients with a severely displaced fracture or a fracture-dislocation of the proximal part of the humerus in centers where the expertise to carry out such treatment exists. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Background: It is unclear if clinical recovery following a midshaft clavicle fracture can accurately predict fracture-healing. The additional information that can be assessed at 6 weeks after injury may have superior predictive value compared with information available at the time of the injury. Methods: A prospective study of all patients (≥16 years of age) who sustained a fully displaced midshaft clavicle fracture was performed. We assessed patient demographic characteristics, injury factors, functional scores, and radiographic predictors with a standardized protocol at 6 weeks. Conditional stepwise regression modeling was used to assess which factors independently predicted nonunion at 6 months after the injury as determined by computed tomography (CT). The nonunion predictor 6-week model was compared with a previously validated model based on factors available at the time of the injury, which included smoking, comminution, and fracture displacement. Results: At 6 months, 200 patients completed follow-up. The CT-defined nonunion rate was 14% (27 of 200). Of the functional scores, the QuickDASH (the abbreviated version of the Disabilities of the Arm, Shoulder and Hand questionnaire) had the highest accuracy on receiver operator characteristic (ROC) curve analysis with a 39.8-point threshold, above which was associated with nonunion (area under curve [AUC], 76.8%; p < 0.001). Sixty-nine percent of the cohort had a QuickDASH score of <40 points at 6 weeks, and 95% (131 of 138) of these patients had fracture union. On regression modeling, a QuickDASH score of ≥40 points (p = 0.001), no callus on radiographs (p = 0.004), and fracture movement on examination (p = 0.001) were significant predictors of nonunion. If none were present, the predicted nonunion risk was 3%, found in 40% (80 of 200) of the cohort. Conversely, if ≥2 of the predictors were present, found in 23.5% of the cohort, the predicted nonunion risk was 60%. The nonunion predictor model at 6 weeks appeared to have superior accuracy (AUC, 87.3%) when compared with the nonunion predictor model at the time of injury (AUC, 64.8%) for fracture-healing on ROC curve analysis. Conclusions: Delayed assessment at 6 weeks following displaced midshaft clavicle fracture enables an accurate prediction of patients who are likely to have union with nonoperative management. One in 4 patients are at an increased risk of nonunion and may benefit from operative intervention. Level of evidence: Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
Background The primary aim of this study was to determine the cost-effectiveness of the reverse total shoulder arthroplasty in a prospective cohort of patients over a two-year post-operative period. Methods Patients who underwent reverse total shoulder arthroplasty were prospectively monitored for 24 months post-operatively using the Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand questionnaire and EuroQol 5-dimensional questionnaire. Any complications or use of health care resources were recorded. The incremental cost-effectiveness ratio was used to express the cost per quality-adjusted life year gained. Results Sixty-seven patients were analysed, 46 primary reverse total shoulder arthroplasty for cuff arthropathy and 21 revisions from previous arthroplasty. Both indications had comparable peri-operative shoulder scores without significant difference. Using the mean change of EuroQol 5-dimensional questionnaire at one year, the incremental cost-effectiveness ratio was calculated at £16,827.43 per quality-adjusted life year, decreasing to £8313.48 per quality-adjusted life year at two years. Primary was associated with a lower incremental cost-effectiveness ratio at two years (primary £7596.76 vs. revision £11,748.51). The estimated post-operative life expectancy of the cohort was 6.9 years with a projected cost per quality-adjusted life year of £2438.78. Conclusions Reverse total shoulder arthroplasty provides a cost-effective intervention with excellent patient outcomes at two years post-operatively.
Chris Oliver
added a research item
Antimicrobial resistance presents a major challenge, but simple steps can to minimise the impact. Social media has a role in disseminating information during antibiotic awareness campaigns: information can be shared rapidly, widely, and cheaply. Hashtags are used to identify social media posts on a specific topic. The official hashtag for social media activity during the 2016 world antibiotic awareness week (14 to 20 November 2016) was #AntibioticResistance, with a separate hashtag for the official European campaign on 18 November 2016 (#EAAD or #EAAD2016).
Chris Oliver
added 2 research items
Invited Opinion Platform piece. Edinburgh Evening News. 30th Sept 2019 https://www.edinburghnews.scotsman.com/news/opinion/lower-road-speeds-can-help-to-save-more-cyclists-lives-prof-chris-oliver-1-5013190/amp
AO Surgery Reference is an internet-based resource for the management of fractures, based on current clinical principles, practices and available evidence. It describes the complete surgical management process from diagnosis to aftercare for fractures in a given anatomical region, and also assembles relevant published AO material. Chris Oliver, Florian Gebhard and Phil Kregor prepared the first edition of distal femur and patella. Web https://www2.aofoundation.org/wps/portal/surgery App https://apps.apple.com/us/app/ao-surgery-reference/id403961165?ls=1
Chris Oliver
added a research item
Plenary lecture by Prof Chris Oliver on "Medical issues surrounding vibration exposure & chronic pain". The UK Conference on Human Responses to Vibration #54UKHRV2019 is an opportunity for specialists from the UK and further afield to exchange information, disseminate research findings and get updated on current issues related to human exposure to vibration. Presented papers cover all aspects of hand-transmitted vibration, whole-body vibration and motion sickness. organisations since the first conference in 1968.
Deborah Jane Macdonald
added a research item
Background: Anterior knee pain is the most common complication of total knee arthroplasty (TKA). The purpose of this study was to assess whether sagittal femoral component position is an independent predictor of anterior knee pain after cruciate-retaining single-radius TKA without routine patellar resurfacing. Methods: A prospective cohort study of 297 cruciate-retaining single-radius TKAs performed in 2006 and 2007 without routine patellar resurfacing identified 73 patients (25%) with anterior knee pain and 89 (30%) with no pain (controls) at 10 years. Patients were assessed preoperatively and at 1, 5, and 10 years postoperatively using patient-reported outcome measures (PROMs), including the Short Form-12 (SF-12), Oxford Knee Score (OKS), and satisfaction and expectation questionnaires. Variables that were assessed as predictors of anterior knee pain included demographic data, the indication for the TKA, early complications, stiffness requiring manipulation under anesthesia, and radiographic criteria (implant alignment, Insall-Salvati ratio, posterior condylar offset ratio, and anterior femoral offset ratio). Results: The 73 patients with anterior knee pain (mean age, 67.0 years [range, 38 to 82 years]; 48 [66%] female) had a mean visual analog scale (VAS) score of 34.3 (range, 5 to 100) compared with 0 for the 89 patients with no pain (mean age, 66.5 years [range, 41 to 82 years]; 60 [67%] female). The patients with anterior knee pain had mean femoral component flexion of -0.6° (95% confidence interval [CI] = -1.5° to 0.3°), which differed significantly from the value for the patients with no pain (1.42° [95% CI = 0.9° to 2.0°]; p < 0.001). The patients with and those without anterior knee pain also differed significantly with regard to the mean anterior femoral offset ratio (17.2% [95% CI = 15.6% to 18.8%] compared with 13.3% [95% CI = 11.1% to 15.5%]; p = 0.005) and the mean medial proximal tibial angle (89.7° [95% CI = 89.2° to 90.1°] compared with 88.9° [95% CI = 88.4° to 89.3°]; p = 0.009). All PROMs were worse in the anterior knee pain group at 10 years (p < 0.05), and the OKSs were worse at 1, 5, and 10 years (p < 0.05). Multivariate analysis confirmed femoral component flexion, the medial proximal tibial angle, and an Insall-Salvati ratio of <0.8 (patella baja) as independent predictors of anterior knee pain (R = 0.263). Femoral component extension of ≥0.5° predicted anterior knee pain with 87% sensitivity. Conclusions: In our study, 25% of patients had anterior knee pain at 10 years following a single-radius cruciate-retaining TKA without routine patellar resurfacing. Sagittal plane positioning and alignment of the femoral component were associated with long-term anterior knee pain, with femoral component extension being a major risk factor. Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Tom Carter
added 2 research items
Background: The evidence for treating acute, unreconstructable radial head fractures in unstable elbows with radial head replacement predominantly consists of short- to mid-term follow-up studies with a heterogenous mix of implants and operative techniques. Data on longer-term patient-reported outcomes after radial head replacement is lacking. Questions/purposes: (1) What proportion of patients undergo revision or implant removal after radial head replacement? (2) At a minimum of 8 years follow-up, what are the patient-reported outcomes (QuickDASH, Oxford Elbow Score, and EuroQol-5D)? (3) What factors are associated with a superior long-term patient-reported outcome, according to the QuickDASH? Methods: Between September 1994 and September 2010, we surgically treated 157 patients for acute radial head fractures. We excluded patients where the radial head was excised (n = 21), internally fixed (n = 15), or replaced as a secondary procedure after failed internal fixation (n = 2). A total of 119 patients who underwent radial head replacement surgery for an acute unreconstructable fracture were included, with a mean age of 50 years (range 15 to 93 ± 19 years), and 53% of patients (63) were women. All but two implants were uncemented, loose-fitting, monopolar prostheses, of which 86% (102) were metallic and 14% (17) were silastic. Implants were only cemented if they appeared unstable within the proximal radius. Silastic implants were used in the earlier series and replaced by metallic implants starting in 2000. We reviewed electronic records to document postoperative complications and prosthesis revision and removal. A member of the local research team (THC, CDC) who was not previously involved in patient care contacted patients to confirm complications, reoperations and to obtain long-term patient-reported outcomes scores. Nineteen patients had died at the point of outcome score collection. Of the remaining 100 patients, 80 were contacted (67% of total cohort), at a median of 11 years (range 8 to 24 years) after injury. The primary outcome measure was the QuickDASH score. Results: Of 119 patients, 25% (30) underwent reoperation, with three patients undergoing revision and 27 patients undergoing prosthesis removal at a median of 7 months (range 0 to 125 months). Twenty-one of 30 procedures (70%) occurred within 1 year after implantation. Kaplan-Meier survivorship analysis demonstrated a cumulative implant survival rate of 71%. In the 80 patients contacted, the mean QuickDASH score was 13 ± 14, the mean Oxford Elbow Score was 43 ± 6, and the median EuroQol-5D score was 0.8 (-0.3 to 1.0). After controlling for covariates, we found that prothesis revision or removal (p = 0.466) and prosthesis type (p = 0.553) were not associated with patient-reported outcome, according to the QuickDASH. Conclusions: The management of acute unreconstructable fractures of the radial head in unstable elbow injuries with radial head replacement has a high risk of reoperation. Patients must be counselled regarding this risk of secondary intervention, of which the peak risk appears to be within 1 year after implantation. Despite this, patients report low disability according to the QuickDASH at a minimum follow-up of 8 years. Level of evidence: Level IV, therapeutic study.
Background: Humeral shaft fractures constitute around 1% of adult fractures in the UK, with an annual incidence of approximately 13 per 100,000 population. Historically, these injuries have been primarily managed non-operatively, with operative fixation reserved for specific indications. Although some recent retrospective studies have suggested there are potential benefits of operative fixation over humeral bracing, there is a deficiency in level 1 evidence to support operative management as the primary treatment for humeral shaft fractures. Methods/design: This single-centre prospective randomised controlled trial aims to recruit 70 adult patients with an isolated closed fracture of the humeral diaphysis into one of two treatment arms: operative (n= 35) or non-operative (n= 35). The operative arm will undergo open reduction and internal fixation (ORIF) of the fracture using a standard fixation technique (plate and screws). The non-operative arm will be fitted with a prefabricated humeral brace until fracture union. All patients will be followed up for 1 year post-intervention. The primary outcome measure will be the Disabilities of the Arm, Shoulder and Hand (DASH) score at 3 months post-intervention. Secondary outcome measures will include pain, treatment complications, return to work or sporting activities, shoulder and elbow range of motion, radiographic assessment, EuroQol (EQ-5D) Health Outcome score and 12-item Short Form (SF-12) Health Survey score. A health economic analysis will be performed to compare the cost implications of each treatment strategy. Discussion: This randomised controlled trial will provide level 1 evidence comparing a standard ORIF technique against functional bracing for isolated closed humeral shaft fractures. The investigators hope that the study results will assist surgeons in their decision-making when managing patients with these injuries. Trial registration: ClinicalTrials.gov, NCT03689335. Registered on 28 September 2018 (retrospectively). Keywords: Humerus, Humeral, Shaft, Diaphysis, Fracture, Randomised controlled trial, Operative, Fixation, Non-operative, Bracing, Trauma, Patient outcome
Deborah Jane Macdonald
added 6 research items
Objectives: To identify risk factors for fixation failure, report patient outcomes and advise on modifications to the surgical technique for fibula nail stabilisation of unstable ankle fractures. Design: Retrospective review. Setting: Academic orthopaedic trauma unit. Patients: All 342 patients were identified retrospectively from a prospectively collected single-centre trauma database over a nine-year period. Intervention: Unstable ankle fractures managed surgically with a fibula nail. Main Outcome Measurements: The primary short-term outcome was failure, defined as any case that required revision surgery due to an inadequate mechanical construct. The mid-term outcomes included the Olerud-Molander Ankle Score (OMAS) and the Manchester-Oxford Foot Questionnaire (MOXFQ). Results: Twenty failures occurred (6%), of which seven (2%) were due to device failure and 13 (4%) due to surgeon error. Of the surgeon errors, eight consisted of inappropriate weight bearing after syndesmotic diastasis and five were due to inadequate fracture reduction or poor nail placement. Proximal locking screw (PLS) pull-out was the cause of all device failures. Positioning the PLS >20mm above the plafond significantly increased failure risk (p=0.003). At a mean follow-up of 5.1 years (range, 8 months – 8 years) the median OMAS and MOXFQ were 80 (interquartile range, 45) and 10.94 (interquartile range, 44.00) respectively. Patient outcome was not negatively affected by the requirement for revision surgery. Conclusion: The fibula nail offers secure fixation and good patient reported outcomes for unstable ankle fractures. Appropriate post-operative management and surgical technique, including careful placement of the PLS is essential to minimise construct failure risk. Level of Evidence: III – Retrospective cohort study.
Introduction Revision knee arthroplasty surgery can range from patella resurfacing or polyethylene exchange, to staged revision and revision to a more constrained implant. Subsequently, the ability to elicit outcomes becomes difficult to obtain and hence information on functional outcome and survivorship for all modes of failure with a single revision system is valuable. Methods We retrospectively assessed 100 consecutive revision knee replacements that were converted from a primary knee replacement to a Triathlon total stabilizer (TS) knee system (Stryker Orthopaedics, Mahwah, NJ). Inclusion criteria included failure of a primary knee replacement of any cause converted to a Stryker TS knee system. Midterm outcome of at least 5 years was required. Implants survivorship, Oxford Knee Score (OKS), Forgotten Joint Score (FJS-12), Short Form (SF-) 12, reported patient satisfaction and radiographic analysis were recorded. Results The all-cause survival rate at 5 years was 89.0% [95% confidence interval (CI) 87.3 to 90.7]. The all-cause survival rate was generally static after the first 4 years. The mean OKS was 27 (SD 11.9, range 0 to 46), FJS was 32.3 (SD 30.4, range 0 to 100), SF-12 physical component summary was 40.6 (SD 17.6, range 23.9 to 67.1), and mental component summary was 48.3 (SD 15.5, range 23.9 to 69.1). Reported patient satisfaction in patients who were not re-revised was 82%. Conclusion The midterm survivorship of cemented Stryker Triathlon TS knee revision for all-cause mode of failure is good to excellent; however, future follow-up is required to ensure this survivorship is observed into the long term. Despite limited functional outcome, overall patient satisfaction rates are high.
Aims The aim of this study was to investigate the influence of age on the cost-effectiveness of arthroscopic rotator cuff repair. Patients and Methods A total of 112 patients were prospectively monitored for two years after arthroscopic rotator cuff repair using the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), the Oxford Shoulder Score (OSS), and the EuroQol five-dimension questionnaire (EQ-5D). Complications and use of healthcare resources were recorded. The incremental cost-effectiveness ratio (ICER) was used to express the cost per quality-adjusted life-year (QALY). Propensity score-matching was used to compare those aged below and above 65 years of age. Satisfaction was determined using the Net Promoter Score (NPS). Linear regression was used to identify variables that influenced the outcome at two years postoperatively. Results A total of 92 patients (82.1%) completed the follow-up. Their mean age was 59.5 years (sd 9.7, 41 to 78). There were significant improvements in the mean DASH (preoperative 47.6 vs one-year 15.3; p < 0.001) and OSS scores (26.5 vs 40.5; p < 0.001). Functional improvements were maintained with no significant change between one and two years postoperatively. The mean preoperative EQ-5D was 0.54 increasing to 0.81 at one year (p < 0.001) and maintained at 0.86, two years postoperatively. There was no significant difference between those aged below or above 65 years of age with regards to postoperative shoulder function or EQ-5D gains. Smoking was the only characteristic that significantly adversely influenced the EQ-5D at two years postoperatively (p = 0.005). A total of 87 were promoters and five were passive, giving a mean NPS of 95 (87/92). The total mean cost per patient was £3646.94 and the mean EQ-5D difference at one year was 0.2691, giving a mean ICER of £13 552.36/QALY. At two years, this decreased further to £5694.78/QALY. This was comparable for those aged below or above 65 years of age (£5209.91 vs £5525.67). Smokers had an ICER that was four times more expensive. Conclusion Arthroscopic rotator cuff repair results in excellent patient satisfaction and cost-effectiveness, regardless of age. Cite this article: Bone Joint J 2019;101-B:860–866.
Deborah Jane Macdonald
added an update
Chris Oliver
added a research item
King James IV Professorial Lecture. Prof Chris Oliver shares insights into improving data visualisation and knowledge transfer. Publication in Surgeons News. Royal College of Surgeons of Edinburgh. https://www.rcsed.ac.uk/news-public-affairs/surgeons-news/september-2019 pages 28-32
Chris Oliver
added a research item
Published in The Scotsman newspaper as an platform opinion piece 8th May 2019. With the declaration by Nicola Sturgeon of a "climate emergency" we outline why sustainable transport must be understood as critical in any strategy for Scotland to go "further and faster" in tackling climate change. The Scottish Government must achieve net-zero greenhouse gas emissions by 2045. Net-zero is the point where the same volume of greenhouse gases is being emitted as is being absorbed through offsetting techniques like forestry. Although Scotland has been innovative in carbon reduction, transport remains an Achilles heel. Sustained and strong political leadership in delivering nothing less than transformational change is required. Drawing on robust international evidence a study out this week for Sport England says that town and city-wide active travel interventions are the most effective at increasing walking, cycling and overall physical activity. Taking a UK example from the study, the Sustainable Travel Towns (2004-09 in Peterborough, Darlington and Worcester/Redditch), all three towns put in place a range of initiatives aiming to encourage more use of non-car options-in particular, bus use, cycling and walking-and to discourage single-occupancy car use. Cycle trips per head across the three towns increased by 26-30% and walking between 13-18%. Between 2008-09 and 2013, both the higher cycling and walking levels were maintained. Key to this success was scale and funding: these programmes were funded at a level that enabled significant changes to be made to the physical environment for walking and cycling supported by behaviour change programmes. This created a synergistic effect of the wide range of interventions. Critically, there was a 7-10% reduction in the number of car driver trips per resident. And all for £10Million shared across the three towns-roughly equivalent to a mile of a new road scheme. We are about to see more car free days in our Scottish cities, increased pedestrianisation and businesses being supported to transport goods by cargo bikes. This and much more is needed including low speed streets with safe routes to school for children. Bus lanes, signal priority, park and ride and Workplace Parking Levies in Low Emission Zones, also form part of a synergetic package. So fund what we want to see delivered: although the Active Travel budget was doubled from £40 to 80 million in 2017 this funding needs redoubling in gearing up to achieve the 2045 carbon emission reductions target. The major mode share for sustainable travel across much of continental Europe is not culturally driven. It is because decade in, decade out funding has been at over £10 per head of population.
Deborah Jane Macdonald
added 3 research items
Objectives To assess a targeted ‘therapy as required’ model of post-discharge outpatient physiotherapy provision. Specifically, we investigated what proportion of patients accessed post-discharge physiotherapy following total hip arthroplasty (THA) and total knee arthroplasty (TKA), whether accessing therapy was associated with post-arthroplasty patient reported outcomes and whether it was possible to predict which patients would access post-discharge physiotherapy from pre-operative data. Design Prospective, observational, longitudinal cohort study. Setting Single National Health Service orthopaedic teaching hospital in the UK. Participants 1395 patients undergoing total hip arthroplasty and 1374 patients undergoing total knee arthroplasty. Primary and secondary outcome measures Self-reported access of post-discharge physiotherapy, the Oxford Hip or Knee Score, EuroQol 5-dimension questionnaire and post-operative surgical episode satisfaction metric. Results 662 (48.2%) patients with TKA and 493 (35.3%) patients with THA accessed additional post-discharge physiotherapy. Patient-reported outcomes (p<0.001) and surgical episode satisfaction (p=0.001) in both THA and TKA were higher in patients that did not participate in post-discharge physiotherapy. Regression models using pre-operative symptom burden and demographic data predicted post-discharge therapy access with an accuracy of only 17% greater than chance in patients with THA and 7% greater than chance in patients with TKA. Conclusions In a choice-based service model of ‘therapy as required’ following hip and knee arthroplasty only a third of THA and half of TKA patients accessed post-discharge therapy. Patients who did not access physiotherapy reported greater post-operative outcomes. This variation in the need for post-discharge physiotherapy suggests that targeting of rehabilitation may be a cost-effective model, however it was not possible to reliably predict which patients would access post-discharge physiotherapy from pre-operative data.
Background Whilst the lateral malleolus appears to be crucial in controlling anatomical reduction of the talus, the role of the medial malleolus is less clear. Medial sided complications including infection, damage to local structures and symptomatic hardware are not without morbidity. This study compares the outcomes of patients with bimalleolar or trimalleolar ankle fractures who underwent fibular nail stabilisation with or without medial malleolar fixation. Methods From a prospective single-centre trauma database, we identified 342 patients over a nine-year period who underwent fibular nail insertion to stabilise a bimalleolar or trimalleolar ankle fracture. Isolated lateral malleolar fractures were excluded. Demographic data, clinical outcomes, radiographic evaluation, return to work and sport, and patient reported outcomes, including Olerud-Molander Ankle Score (OMAS), EuroQol-5D (EQ-5D) and Manchester-Oxford Foot Questionnaire (MOXFQ) were collected. Results This study included 247 patients with a mean age of 66.7 years (range, 25 – 96 years), of whom 200 were female (81%). Medial malleolar fixation was not performed in 54 cases (22%). There was no significant difference between groups with respect to failure of fixation (p = 0.634) or loss of talar reduction (p = 0.157). No patient required surgery for a symptomatic medial malleolar non-union. Medial sided complications occurred in 32 (16%) of the fixation group, of whom 20 (10%) required further surgery. At a mean mid-term follow-up of 4.8 years (range, 8 months – 9 years) there was no significant difference between the non-fixation and fixation groups with respect to the median OMAS (85 vs 80; p = 0.885) or median EQ-5D (0.80 vs 0.81; p = 0.846). Patient satisfaction was not significantly different between the two groups (85/100 vs 87/100; p = 0.410). Conclusion Non-operative management of the medial malleolar component of an unstable ankle fracture treated with a fibular nail may reduce the rate of post-operative complications without compromising the patient reported outcome. Keywords ankle fractures; trauma; medial malleolus; patient outcome
Tom Carter
added a research item
The medial malleolus, once believed to be the primary stabilizer of the ankle, has been the topic of conflicting clinical and biomechanical data for many decades. Despite the relevant surgical anatomy being understood for almost 40 years, the optimal treatment of medial malleolar fractures remains unclear, whether the injury occurs in isolation or as part of an unstable bi- or trimalleolar fracture configuration. Traditional teaching recommends open reduction and fixation of medial malleolar fractures that are part of an unstable injury. However, there is recent evidence to suggest that nonoperative management of well reduced fractures may result in equivalent outcomes, but without the morbidity associated with surgery. This review gives an update on the relevant anatomy and classification systems for medial malleolar fractures and an overview of the current literature regarding their management, including surgical approaches and the choice of implants. Cite this article: Bone Joint J 2019;101-B:512–521.
Chris Oliver
added a research item
Throughout my career I have extensively supported surgical informatics and have used various and complex methods of data visualisation to research and improve knowledge transfer and outcomes to patients care. This Royal College of Surgeons of Edinburgh King James IV professorial lecture outlines my innovative and lifelong contribution to data visualisation, surgery and patient care. Highlights • Many ways to present complex data and simplify it. • Graphs and charts are pictorial and highlight trends. • Choosing correct data visualisation is crucial. • It’s easy with modern software to make data rich visualisations such as infographics. • Data visualisation give a deeper understanding of both simple and complex data. See also PowerPoint with Speaker Notes and References
Deborah Jane Macdonald
added 5 research items
Introduction: There is a paucity of survival data reporting the medium to long-term survivorship of endo-rotational hinged total knee arthroplasty (EH-TKA). Such information is essential when counseling patients preoperatively, and predictors of survival would help to inform patients of their likely outcome. Methods: Patients were identified retrospectively from an arthroplasty database recorded at the study centre. Inclusion criteria were all patients receiving an EH-TKA, for any reason, with a minimum follow up period of 5 years. Patient demographics, comorbidities and indication (primary/revision) were recorded prospectively in the database. Subsequent follow up data and implant survival were identified from the patient’s notes. Mortality status was obtained from local government. Results: 100 patients underwent an EH-TKA over a 7-year period. There were 66 females and 34 males, with mean ages of 73.8 years and 67.6 years respectively. Indications were classified as either primary (n=41) or revision (n=59) arthroplasty. The median follow up period was 8.2 (range 5 to 12.3) years. 8 patients underwent implant revisions during the follow up period. This resulted in a 92% implant survival at 5 years. 26 patients had a follow up period of 10 years or greater and implant survival was 85% at this time. Cox regression analysis identified male sex to be the only independent predictor of implant failure (hazard ratio 5.7 95% CI 1.0 to 31.8, p=0.04) after adjusting for confounding variables. Discussion: The EH-TKA has a good medium to long-term survival rate but male sex has a significant negative effect on the survival of the implant and these patients should be made aware of this preoperatively.
Aims: The aim of this study was to identify predictors of return to work (RTW) after revision lower limb arthroplasty in patients of working age in the United Kingdom. Patients and methods: We assessed 55 patients aged ≤ 65 years after revision total hip arthroplasty (THA). There were 43 women and 12 men with a mean age of 54 years (23 to 65). We also reviewed 30 patients after revision total knee arthroplasty (TKA). There were 14 women and 16 men with a mean age of 58 years (48 to 64). Preoperatively, age, gender, body mass index, social deprivation, mode of failure, length of primary implant survival, work status and nature, activity level (University of California, Los Angeles (UCLA) score), and Oxford Hip and Knee Scores were recorded. Postoperatively, RTW status, Oxford Hip and Knee Scores, EuroQol-5D (EQ-5D), UCLA score, and Work, Osteoarthritis and Joint-Replacement Questionnaire (WORQ) scores were obtained. Univariate and multivariate analysis was performed. Results: Overall, 95% (52/55) of patients were working before their revision THA. Afterwards, 33% (17/52) RTW by one year, 48% (25/52) had retired, and 19% (10/52) were receiving welfare benefit. RTW was associated with age, postoperative Oxford Hip Score, early THA failure (less than two years), mode of failure dislocation, and contralateral revision (p < 0.05). No patient returned to work after revision for dislocation. Only age remained a significant factor on multivariate analysis (p = 0.003), with 79% (11/14) of those less than 50 years of age returning to work, compared with 16% (6/38) of those aged fifty years or over. Before revision TKA, 93% (28/30) of patients were working. Postoperatively only 7% (2/28) returned to work by one year, 71% (20/28) had retired, and 21% (6/28) were receiving welfare benefits. UCLA scores improved after 43% of revision THAs and 44% of revision TKAs. Conclusion: After revision THA, age is the most significant predictor of RTW: only 16% of those over 50 years old return to work. Fewer patients return to work after early revision THA and none after revision for dislocation. After revision TKA, patients rarely return to work: none return to heavy or moderate manual work. Cite this article: Bone Joint J 2018;100-B:1043-53.
Purpose Over 2 million Triathlon single-radius total knee arthroplasties (TKAs) have been implanted worldwide. This study reports the 10-year survival and patient-reported outcome of the Triathlon TKA in a single independent centre. Methods From 2006 to 2007, 462 consecutive cruciate-retaining Triathlon TKAs were implanted in 426 patients (median age 69 (21–89), 289 (62.5%) female). Patellae were not routinely resurfaced. Patient-reported outcome measures (SF-12, Oxford Knee Scores (OKS), satisfaction) were assessed preoperatively and at 1, 5 and 10 years when radiographs were reviewed. Forgotten Joint Scores (FJS) were collected at 10 years. Kaplan–Meier survival analysis was performed. Results At 10–11.6 years, 123 patients (128 TKAs) had died and 8 TKAs were lost to follow-up. There were four aseptic failures (two cases of tibial loosening, two cases of instability) and four septic failures requiring revision. Symptomatic aseptic radiographic loosening was present in three further cases at 11 years. Four (1%) patellae were secondarily resurfaced. OKS score improved by 17.7 ± 9.7 points at 1 year (p < 0.001), and was maintained at 34.7 ± 9.6 at 10 years with FJS 48.5 ± 31.4. Patient satisfaction was 88% at each timepoint. Ten-year survival was 97.9% (95% confidence interval 96.5–99.3) for revision for any reason, 98.9% (97.7–100) for mechanical failure, and 98.6% (97.4–99.8) for aseptic loosening (symptomatic radiographic or revised). Conclusion The Triathlon TKA continues to show excellent longer-term results with high implant survivorship, low rates of aseptic failure, consistently maintained PROMs and excellent patient satisfaction rates of 88% at 10 years. Level of evidence II, Prospective cohort study.
Deborah Jane Macdonald
added 2 research items
Background: The incidence of revision total knee arthroplasty (TKA) is projected to increase 6-fold worldwide by 2030. As the number of younger, physically active revision TKA patients increases in future, understanding factors influencing postoperative function will be increasingly important to help counsel patients. The primary aim of this study was to examine factors influencing return to physical activity following revision TKA. Methods: Patients who had undergone tibiofemoral revision between 2003 and 2013 at a single UK teaching hospital were retrospectively identified from a prospectively collected arthroplasty database. Preoperative activity level (University of California, Los Angeles [UCLA] score), patient demographics, indication, implant used, and Oxford Knee Scores (OKSs) were recorded in the database. At a mean follow-up of 3.9 years (standard deviation, 2.2), UCLA score, OKS, EuroQol-5 Dimension Score (EQ-5D), satisfaction, complications, and WORQ scores (Work, Osteoarthritis and Joint-Replacement Questionnaire) were sampled via postal questionnaire. Patient experience of complications and related surgery was also identified from healthcare records. Univariate and multivariate analyses were performed. Results: Responses were received from 112 revision TKAs (112 patients; mean age, 71 years). Mean UCLA activity scores improved from preoperative levels (P < .001): activity levels improved in 47% of patients with 58% engaging in moderate or more intensive activities (UCLA score ≥5). Postoperative activity level was independently predicted by male gender (P = .042) and preoperative UCLA score (P < .001). Increasing social deprivation was associated with inferior UCLA (P = .005), EQ-5D (P < .005), and OKS (P = .006) scores. Indication, implant type, and patient body mass index did not affect functional outcome or satisfaction (P > .05). Patients <65 years old were more likely to be dissatisfied (P = .009), and patients aged ≤55 years were more likely to report difficulties with WORQ criteria (P < .05). Conclusion: Although 90% of patients maintain activity levels following revision TKA, less than half increase levels and this is predicted by male sex and pre-revision activity level.
Aims: The primary aim of this study was to compare the knee-specific functional outcome of patellofemoral arthroplasty with total knee arthroplasty (TKA) in the management of patients with patellofemoral osteoarthritis. Patients and methods: A total of 54 consecutive Avon patellofemoral arthroplasties were identified and propensity-score-matched to a group of 54 patients undergoing a TKA with patellar resurfacing for patellofemoral osteoarthritis. The Oxford Knee Score (OKS), the 12-Item Short-Form Health Survey (SF-12), and patient satisfaction were collected at a mean follow up of 9.2 years (8 to 15). Survival was defined by revision or intention to revise. Results: There was no significant difference in the mean OKS (p > 0.60) or SF-12 scores (p > 0.28) between the groups. There was a lower rate of satisfaction at the final follow-up for the TKA group (78% vs 87%) but this was not statistically significant (odds ratio 0.56, p = 0.21). Length of stay was significantly shorter (p = 0.008) for the Avon group (difference 1.8 days, 95% confidence interval (CI) 0.4 to 3.2). The ten-year survival for the Avon group was 92.3% (95% CI 87.1 to 97.5) and for the TKA group was 100% (95% CI 93.8 to 100). This difference was not statistically significant (log-rank test, p = 0.10). Conclusion: Patients undergoing an Avon patellofemoral arthroplasty have a shorter length of stay, and a functional outcome and rate of satisfaction that is equal to that of TKA. The benefits of the Avon arthroplasty need to be balanced against the increased rate of revision when compared with TKA.
Chris Oliver
added 2 research items
First Massive Online Open Course (MOOC) to deliver and evaluate physical activity promotion Goal :To encourage people to sit less and and be more active in various settings (neighbourhood, school, work, home. • Also teaches how to monitor and set physical activity. https://www.coursera.org/learn/get-active
Deborah Jane Macdonald
added an update
2019! Exciting times ahead. Catastrophising,; complications; arthroplasty pre and post-op physical activity and developing a 'predictors of length of stay algorithm' all enhanced by the addition of qualitative data analysis thanks to a new collaboration with the world renowned Usher Institute.
 
Chris Oliver
added a research item
Physical Activity is recognised as a major global pandemic and a modifiable risk factor in several health outcomes. Evidence suggests that medical students lack knowledge of the physical activity guidelines. Limited curriculum space and available staff expertise in medical faculty. To address this, a flipped classroom was used to encourage the students to be familiar with the physical activity guidelines and to appreciate the role that will have as a doctor to prescribe physical activity.
Chris Oliver