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What is the most effective treatment for basal osteoarthritis of the thumb?Basal osteoarthritis of the thumb is extremely common and causes pain and difficulty with essential 'pinching' tasks such as writing and dressing. It has been shown, in high-quality studies, that physiotherapy can result in clinically important improvements in pain and function, but the delivery of nonoperative treatment currently varies considerably throughout the NHS in the UK. Trapeziectomy is an effective, simple, and low-cost procedure, and the most common of surgical treatment for basal osteoarthritis of the thumb in the UK. However, recovery can be lengthy and complications include subsidence of the thumb metacarpal, instability, and weakness. New designs of thumb carpometacarpal joint arthroplasty (CMCJA) show promising early results with low complication rates and a quick return to function, but the implants are expensive and high-quality evidence about the outcome is lacking. The Surgery versus Conservative OsteOarthritis of Thumb Trial (SCOOTT) is a multicentre, three-arm, randomized controlled trial which is currently being undertaken, comparing the clinical outcomes and cost-effectiveness of an enhanced package of non-surgical management, trapeziectomy, and thumb CMCJA.
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Impact of Rheumatoid Arthritis on Postoperative Outcomes Following Lumbar Spine Surgery: A Systematic Review and Meta-Analysis.This systematic review and meta-analysis critically evaluated the impact of rheumatoid arthritis (RA) on postoperative outcomes following lumbar spine surgery. A comprehensive literature search was performed across multiple electronic databases from January 2010 to October 2025. Studies involving adult patients with confirmed RA undergoing lumbar spine surgery with comparator groups were included. Eight retrospective cohort studies representing diverse populations were analyzed. Pooled analysis revealed that patients with RA had a significantly higher risk of reoperation compared to non-RA patients, with a relative risk (RR) of 1.34 and a 95% confidence interval (CI) of 1.15-1.57, though high heterogeneity was noted. Surgical site infection analysis demonstrated a 45% increased risk in RA patients with an RR of 1.45 and a 95% CI of 1.28-1.65, with no heterogeneity observed. Other clinical outcomes, including mortality, pneumonia, acute kidney injury, and sepsis, showed no statistically significant differences between the groups. Patients with RA face significantly elevated risks of reoperation and surgical site infection following lumbar spine surgery, likely due to compromised bone quality, impaired healing capacity, and immunosuppressive medications. These findings have important implications for preoperative counseling and perioperative risk stratification. Future prospective research with detailed characterization of disease activity and medication use is needed to facilitate individualized risk assessment.
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The Impact of Preoperative Biliary Drainage on Postoperative Outcomes Following Pancreaticoduodenectomy: A Systematic Review.Pancreaticoduodenectomy (PD) is the standard procedure for periampullary and pancreatic head malignancies, often performed in the context of obstructive jaundice. Preoperative biliary drainage (PBD) is used to alleviate jaundice, but its impact on postoperative outcomes remains controversial due to conflicting evidence regarding its risks and benefits. This systematic review aims to synthesize the most recent evidence on the impact of PBD on postoperative outcomes following PD. A systematic literature search was conducted across five electronic databases (PubMed, Scopus, Web of Science, Embase, CINAHL) for studies published between 2020 and 2025. Twelve studies, comprising retrospective cohort analyses, were included after a rigorous screening process. Data on study characteristics, patient populations, and postoperative outcomes were extracted. The risk of bias was assessed using the ROBINS-I tool, and a qualitative synthesis was performed due to the heterogeneity of the included studies. The evidence indicates a dualistic impact of PBD. It is consistently associated with a higher risk of infectious complications, including surgical site and intra-abdominal infections. However, the preoperative bilirubin level is a critical effect modifier; in patients with severe hyperbilirubinemia, PBD appears to mitigate the high risks of overall morbidity and mortality associated with profound jaundice. The effect of PBD on specific complications like postoperative pancreatic fistula and delayed gastric emptying was ambiguous. The timing of PBD also influences outcomes, with shorter intervals potentially reducing infectious risks. The overall methodological quality of the included studies was predominantly low to moderate risk of bias. The decision to implement PBD should not be universal but individualized. While PBD introduces a significant risk of infectious morbidity, it may be a crucial risk-mitigation strategy in severely jaundiced patients. The procedure's benefits are likely contingent on specific bilirubin thresholds and careful consideration of drainage timing. Future research should focus on validating these thresholds and optimizing perioperative protocols.
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Systematic review and meta-analysis of the role of machine learning in predicting postoperative complications following colorectal surgery: how far has machine learning come?BACKGROUND: To systematically evaluate the clinical utility of machine learning in predicting postoperative outcomes following colorectal surgery. METHODS: A systematic literature search was conducted using PubMed, MEDLINE, Embase, and Google Scholar. Clinical studies investigating the role of machine learning models in predicting postoperative complications following colorectal surgery were included. Outcome measure was area under the curve for the model under investigation. The area under the curve and standard error were pooled using a random effects model to estimate the overall effect size. Statistical analyses were performed using the MedCalc (version 23) software, and the results presented as forest plots. RESULTS: Eighteen eligible articles were included. These reported outcomes on postoperative complications, namely anastomotic leak, mortality, prolonged length of hospitalization, re-admission rates, risk of bleeding, paralytic ileus occurrence, and surgical site infection. Pooled area under the curve for anastomotic leak was 0.813 [standard error: 0.031, 95% confidence interval (0.753-0.873)]; mortality 0.867 [standard error: 0.015, 95% confidence interval (0.838-0.896)]; prolonged length of stay 0.810 [standard error: 0.042, 95% confidence interval (0.728-0.892)]; and surgical site infection 0.802 [standard error: 0.031, 95% confidence interval (0.742-0.862)], respectively. CONCLUSION: Machine learning methods and techniques are displaying promising clinical utility and applicability in accurately predicting the risk of developing complications following colorectal surgery. Future well-designed, adequately powered, multi-center studies are needed to investigate the usefulness and generalizability of these novel approaches in optimizing peri-operative surgical care.
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Bechterew's Disease and the Risk of Spinal Fractures: Clinical Patterns, Imaging Correlation, and Outcomes.Bechterew's disease, or ankylosing spondylitis (AS), is a chronic inflammatory spondyloarthropathy that causes spinal rigidity and increases the risk of unstable fractures, often after low-energy trauma. This systematic review included seven studies encompassing 672 patients with ankylosed spines who sustained spinal fractures. Clinical presentation commonly involves sudden back or neck pain, kyphotic deformity, limited spinal mobility, and neurological deficits, which may be subtle and easily overlooked. Fractures predominantly affect the cervical spine (C5-C7) and thoracolumbar junction (T11-L2), often extending through all three spinal columns, resulting in high instability and risk of spinal cord injury. Accurate imaging is critical; computed tomography delineates bony injuries, while magnetic resonance imaging identifies spinal cord damage, ligamentous disruption, and epidural hematomas. Nonoperative management carries a high risk of secondary displacement and neurological deterioration, whereas early surgical stabilization, typically via posterior or combined anterior-posterior fixation, improves outcomes. Multidisciplinary care involving orthopedic, neurosurgical, and critical care teams is essential for optimizing recovery. Limitations of the current literature include small sample sizes and heterogeneous study designs. Future research should focus on prospective multicenter studies, standardized imaging and management protocols, and long-term functional outcomes to reduce fracture risk and improve care in this high-risk population.
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Selective Genicular Artery Embolisation for Recurrent Hemarthrosis Following Total Knee Arthroplasty: A Case ReportRecurrent hemarthrosis following total knee arthroplasty (TKA) is an uncommon complication, with an incidence of less than 1%. It can lead to pain, swelling, joint stiffness, and functional impairment. Selective genicular artery embolisation (GAE) has emerged as a minimally invasive treatment for managing such cases. We report the case of a 79-year-old female with recurrent atraumatic hemarthrosis of the left knee following TKA, complicated by long-term anticoagulation with Edoxaban for unprovoked pulmonary embolism. Despite multiple aspirations and arthroscopic washouts, symptoms persisted. Angiography revealed synovial hypervascularity, and GAE was performed to reduce bleeding. Although the procedure initially improved symptoms, recurrence occurred while the patient was maintained on full-dose Edoxaban. Following a multidisciplinary review, the anticoagulant dose was reduced, resulting in complete resolution of haemarthrosis. GAE represents an effective, minimally invasive treatment for recurrent hemarthrosis post-TKA. Anticoagulation management and multidisciplinary coordination are essential to balance bleeding risk and thromboembolic protection in such patients.
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Weighing the impact of evidence in orthopaedic trauma registries: a systematic review of national and international registry data.OBJECTIVES: Worldwide, there are 15 established trauma databases collecting data to better understand the patterns of injury and effectiveness of interventions, but interpreting the information is hampered by the varied approaches. The aim of this study was to determine the impact, practices, evolution in design and methods of analysis that are standardised and comparable within registries. DESIGN: A thematic analysis using a narrative synthesis was used to develop threads for future study and identify the limitations in current practice. DATA SOURCES: PubMed, Ovid, Scopus and EMBASE were searched on the 2 October 2025. At the same time, ChatGPT (Open artificial intelligence) identified the most cited articles in orthopaedic trauma registries, cross-referencing lists as a form of triangulation to aid in snowballing references. ELIGIBILITY CRITERIA: The review included 174 papers from trials and observational studies that analyse data from established trauma orthopaedic registries published in English. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search, screen and code included studies assessing the papers using the Strengthening the Reporting of Observational Studies in Epidemiology checklist to assess the observational and cohort studies and the Downs and Black Quality Criteria for the remaining papers. RESULTS: Outcome measures other than mortality are poorly collected, undermining the value of registries. Trauma patients reported considerable impairment 6 and 12 months after injury. Association between level of trauma care and mortality is evident for major trauma populations, but does not hold for general trauma populations. Level I trauma centres produce improved survival in severely injured, but this association could not be proven for non-fatal outcomes in general populations. There is a disparity between resources allocated to save and salvage cases within major trauma units, and hence, routine cases often have lower priority and delayed care. CONCLUSIONS: There is a need to develop a standardised and reproducible method to evaluate data quality in trauma registries. National performance guidelines and trauma centre audits are integral steps towards optimum results. Routine collection of postinjury outcome measures beyond mortality will enable the development of quality improvement metrics that better reflect patient outcomes.
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Comparative effectiveness of educational interventions in neurological disease for healthcare workers and students: a systematic review.OBJECTIVES: To assess the comparative effectiveness of educational interventions in neurological disease for healthcare workers and students. DESIGN: Systematic review. DATA SOURCES: Medline, Embase and Cochrane through to 1 June 2025. ELIGIBILITY CRITERIA: Studies evaluating neurological disease educational interventions with a comparator group (observational cohort/randomised controlled trial (RCT)) were included. DATA EXTRACTION AND SYNTHESIS: A Preferred Reporting Items for Systematic Reviews and Meta-Analyses-compliant systematic review was conducted (PROSPERO: CRD42023461838). Knowledge acquisition and educational methodologies were collected from each study. Study outcomes were classified using the Kirkpatrick and Kirkpatrick four-level model (learner reaction, knowledge acquisition, behavioural change, clinical outcome).1 Risk of bias was assessed using the Newcastle-Ottawa scale for non-randomised studies and the Cochrane Risk of Bias tool for RCTs.2 3 RESULTS: A total of 67 studies involving 4728 participants were included. Of these, 36 were RCTs, and 31 were observational studies. Virtual interventions were the most common (67.2%, n=45 studies), primarily targeting either medical students (46.3%, n=31 studies) or specialists (40.3%, n=27 studies). Overall, 70.1% (n=47) of studies demonstrated outcomes in favour of the intervention. However, few studies used K&K level 3/4 outcomes, with two studies evaluating behaviour change (level 3) and three assessing clinical outcomes (level 4 combined with other levels). No study exclusively assessed level 4 outcomes. Meta-analysis of 22 RCTs with calculable standardised mean differences (SMDs) (n=1748) showed a significant benefit of interventions (SMD 0.75, 95% CI 0.22 to 1.27, p=0.0056). CONCLUSIONS: This review highlights a growing body of research particularly focusing on virtual techniques, specialist audiences and treatment-oriented content. Few studies assessed changes in practice or patient care. Non-specialists remain underrepresented. Future studies should prioritise assessing the clinical impact of educational interventions within non-specialist audiences.
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Surgical margins in breast conserving surgery for ductal carcinoma in situ of the breast and clinical outcomes: a national audit with long term follow-up.BACKGROUND: Optimal surgical margin width in breast conserving surgery (BCS) for ductal carcinoma in situ (DCIS) is not established. The United Kingdom (UK) Association of Breast Surgery (ABS) recommended a 1 mm margin, whereas a minimum of 2 mm has been recommended in the United States of America (USA). This paper uses precise histological margin width data from UK national datasets to understand the impact of surgical margins on time to recurrence (TTR). METHODS: Patients were included if aged ≥45-years with a new diagnosis of DCIS alone, between 2003 and 2014, within the English National Health Service (NHS) Breast Screening Programme. Primary treatment included BCS and a minimum histological excision margin width recorded. Exclusion criteria included: prior history of DCIS; prior history of invasive cancer or its diagnosis within 3-months of initial surgical treatment for DCIS. Data was extracted from NHS England National Disease Registration Service (NDRS), ABS and Sloane Project audits. FINDINGS: 16,907 patients diagnosed with DCIS having definitive BCS surgery were identified between 2003 and 2014. TTR was found to be significantly shorter for patients with surgical margins <1 mm vs ≥ 1 mm (adjusted hazard ratio (aHR) = 1·32; 95% (confidence interval) CI:1·06-1·63; p = 0·012); <2 mm vs ≥ 2 mm (aHR = 1·19; 95% CI:1·05-1·35; p = 0·0062) and ≥1-<2 mm vs ≥ 2 mm (aHR = 1·18; 95% CI:1·01-1·38; p = 0·032). There was no evidence that increasing the surgical margin width beyond 2 mm significantly improved TTR (aHR = 0·96; 95% CI: 0·86-1·08; p = 0·52 for ≥5 mm vs ≥ 2-<5 mm). The rate of recurrence across 14 years following BCS + radiotherapy was 1·2% per annum, 2129 (13%) patients had a recurrence of which 78% were invasive breast cancers. INTERPRETATION: Patients with DCIS with histological margins of <2 mm, adjusted for other clinical factors, have significantly worse TTR compared to margins ≥2 mm. These findings may inform optimum treatment of patients with DCIS. FUNDING: An ABS grant covered the cost of data extraction by NHS England and medical writing assistance. The latter was provided by Edge Health, supervised by the co-authors.
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Surgical site infections in the head and neck: a multicentre retrospective cohort study.OBJECTIVES: Surgical site infections (SSIs) are one of the most common post-operative complications and can be associated with significant morbidity and mortality. They place a significant burden on healthcare system. Existing guidelines are based on non-head and neck procedures. This study aims to investigate factors affecting SSIs in the head and neck. METHODS: A multi-centre retrospective cohort across otolaryngology departments in Yorkshire (Bradford, Doncaster, Hull, Leeds). All patients undergoing an operation requiring a skin incision in the year 2021 were included. Electronic patient notes were used as the data source. Data on demographics, comorbidities, smoking and alcohol use, operation undertaken, diagnosis, closure material and use of antibiotic prophylaxis were recorded. RESULTS: 827 patients were included. The mean age was 51.4 years. The rate of SSI was 4.2% (n = 34/827). 30-day mortality was 0.6% (n = 5/827). There was no significant difference in development of SSI depending on antiseptic preparation choice. Diabetes significantly increased the risk of SSI. Suture choice did not affect rate of SSI. Intravenous drug use and cardiovascular disease were not significantly associated with 30-day mortality. CONCLUSION: This is the only study that assessed the rate of SSIs in the head and neck region. The NICE guidance for antiseptic preparation choice is not applicable in the head and neck. Absorbable sutures should be used when appropriate. Peri-operative comorbidities should be optimised. For more robust evidence, a larger cohort would be recommended or a randomised controlled trial assessing individual factors can be considered. LEVEL OF EVIDENCE: - Level 3.
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Comparative Effectiveness of the Proximal Femoral Nail and Dynamic Hip Screw Fixation in Intertrochanteric Femur Fractures: A Systematic Review and Meta-Analysis.This systematic review and meta-analysis compared the clinical effectiveness of proximal femoral nail (PFN) versus dynamic hip screw (DHS) fixation in patients with intertrochanteric femur fractures. A comprehensive literature search was conducted across multiple databases from January 2010 to September 2025, identifying studies that directly compared PFN and DHS fixation outcomes. Thirty-three studies met the inclusion criteria, comprising randomized controlled trials, prospective cohorts, and retrospective comparative studies from diverse geographic regions. The pooled analysis demonstrated several significant advantages favoring PFN fixation. Operative time was significantly shorter with PFN compared to DHS (mean difference (MD): -12.30 minutes, 95% confidence interval (CI): -17.33 to -7.28), while intraoperative blood loss was substantially lower (MD: -115.01 mL, 95% CI: -132.05 to -97.98). Patients treated with PFN achieved full weight-bearing significantly earlier than those receiving DHS. Safety outcomes showed PFN was associated with significantly lower total complication rates (risk ratio (RR): 0.46, 95% CI: 0.31-0.68) and reduced infection risk. However, no significant differences were observed between groups regarding implant failure rates, mortality, or long-term functional outcomes, as measured by the Harris Hip Score. High heterogeneity was noted across most outcomes, reflecting variations in study populations and methodologies. These findings suggest that PFN offers superior perioperative outcomes and early recovery advantages compared to DHS, while maintaining comparable long-term functional results and survival rates in patients with intertrochanteric femur fractures
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Is open pyeloplasty still a practical option for pediatric patients in resource-limited settings compared to laparoscopic and robotic approaches?OBJECTIVE: To explore the feasibility of open pyeloplasty (OP) for treating pediatric pelviureteric junction obstruction in resource-limited settings in the era of robot assisted laparoscopic pyeloplasty (RALP) and laparoscopic pyeloplasty (LP). METHODS: A total of 168 patients (56 each) were randomized to receive RALP, LP, or OP, respectively. RESULTS: The operative time for the RALP was significantly higher (P < 0.001) compared to LP and open OP. The length of stay (LOS) for RALP and LP was substantially lower (P < 0.001) compared to the OP, with average stays of 2.8 ± 1.5 days, 3.1 ± 1.2 days, and 6.4 ± 8.1 days, respectively. In the RALP group, 54 (96.4%) had a non-obstructed drainage pattern post-operatively compared to 52 (92.8%) in the LP group, and 53 (94.6%) patients in the OP group (P = 0.363). Only 2 (3.6%) patients in the RALP group and 4 (7.1%) patients in the LP group, and 3 (5.3%) patients in OP group, exhibited obstructed drainage on dynamic nuclear scan. Grade II complications (urine leakage) occurred in 2 patients in the RALP cohort, and in 3 patients in the LP cohort. The leakage typically resolved within 10 days and did not require further intervention. Higher-grade complications (Clavien Grade 3 and 4a), such as hydronephrosis, were identified in both the RALP and OP groups (one case each). CONCLUSION: Due to comparable success rates and minimal complications, OP is a viable alternative to minimally invasive RALP and LP in treating pediatric patients with PUJO, particularly where cost and equipment availability are limiting factors.
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Tailored performance of additively manufactured titanium TPMS bone scaffoldTriply periodic minimal surfaces (TPMS), exemplified by the Schwarz geometry, provide an optimal platform for bone scaffolds due to their high surface-to-volume ratio, continuous porosity, and bone-analogous mechanical response. Here, titanium TPMS scaffolds were additively manufactured via laser powder bed fusion (L-PBF) with precise control over geometric parameters. A data-driven surrogate model, informed by experimental and numerical analyses, was developed to map the relationship between design variables and mechanical performance. The model enabled the design of scaffolds with tailored stiffness matching that of native bone, while revealing the dominant roles of wall thickness and cell size. Porosity varied from 47 % to 68 %, governed inversely by wall thickness, while elastic modulus scaled from 6 to 24 GPa, driven primarily by wall thickness and secondarily by cell size. Yield and ultimate strengths exhibited strong positive correlations with wall thickness, spanning 240–655 MPa and 320–784 MPa, respectively. This study provides a predictive framework for engineering 3D printed titanium scaffolds with targeted mechanical properties, offering a basis for next-generation load-bearing orthopaedic implants.
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Efficacy of Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis.The study was conducted to evaluate the safety and effectiveness of platelet-rich plasma (PRP) injections for knee osteoarthritis. A systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were performed in PubMed, Scopus, Web of Science, and the Cochrane Database for studies published between January 2015 and June 2025. Only randomized controlled trials (RCTs) published in the English language were included, while reviews, case reports, and non-randomized studies were excluded. Six high-quality RCTs were identified, including a total of 1,162 patients with mild-to-moderate knee osteoarthritis. PRP injections were compared with hyaluronic acid, corticosteroid injections, or placebo. Pain and function were assessed using standardized tools such as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the International Knee Documentation Committee (IKDC) score, the Knee Injury and Osteoarthritis Outcome Score, and the Visual Analog Scale. Significant improvements with PRP were observed at 6 and 12 months. The WOMAC pain score was reduced by an average of -8.5 points, and the IKDC score increased by +6.2 points. Both results were statistically significant. Moderate variability was found between studies, but sensitivity analyses confirmed stability of the results. Subgroup analysis did not show consistent differences between leukocyte-rich PRP and leukocyte-poor PRP. Reported side effects were minor and self-limiting. Overall, PRP demonstrated significant improvements at 6 and 12 months. Pooled analysis indicated moderate pain reduction (standardized mean difference (SMD) = -0.32, 95% confidence interval (CI) = -0.48 to -0.15; I² = 46%) and functional improvement (SMD = -0.28, 95% CI = -0.44 to -0.12; I² = 52%) compared with control groups. However, long-term structural improvement was not demonstrated. Larger trials are still needed to confirm benefits, optimize preparation methods, and assess cost-effectiveness.
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The Effect of Leucine-Enriched β-Lactoglobulin Versus an Isonitrogenous Whey Protein Isolate on Skeletal Muscle Protein Anabolism in Young Healthy Males.BACKGROUND: β-lactoglobulin (BLG) is a protein found within whey protein (WP) that is rich in essential amino acids, most notably, leucine (LEU). LEU is considered the most potent EAA in the postprandial stimulation of muscle protein synthesis (MPS), such that suboptimal protein/essential amino acid (EAA) doses containing higher LEU content elicit muscle anabolism comparable to larger protein doses. Our objective was to test the effects of naturally LEU-rich BLG (~10 g protein) versus isonitrogenous whey protein isolate (WPI, ~10 g) on MPS. METHODS: Ten healthy young men (26 ± 2 y; 179 ± 2 cm; 81 ± 3 kg) received BLG (1.57 g LEU) or WPI (1.02 g LEU) in a randomised double-blind cross-over fashion. A primed constant intravenous infusion of [1,2 13C2] LEU was used to determine MPS (isotope ratio mass spectrometry) at baseline and in response to feeding (FED) and feeding-plus-exercise (FED-EX; 6 × 8 unilateral leg extensions; 75% 1-RM). Plasma insulin and EAA's were quantified. RESULTS: Plasma EAA, branched-chain amino acid (BCAA), and LEU concentrations increased rapidly following both protein supplements but exhibited a significantly greater EAA/BCAA/leucinemia following BLG (p < 0.05 for all). MPS increased significantly in both FED (~52%) and FED-EX (~58%) states, with no significant differences between supplements. CONCLUSIONS: Both BLG and WPI effectively stimulated MPS doses in young healthy males, with BLG offering an advantage in EAA/BCAA/LEU bioavailability. It follows that future research should explore the potential of BLG in populations exhibiting anabolic resistance and exercise anabolism deficiency, such as older adults as well as frail and clinical populations, to assess its utility in preserving muscle mass under conditions of suboptimal protein intake.
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Investigating the potential association between tattoos and lymphoma: an exploratory systematic review and meta-analysis.BACKGROUND: The tattooed population has risen significantly over the last few decades, leading to increased scrutiny into potential side effects. The recent publication of scientific articles linking tattooing to lymphoma has led to a systematic review being conducted to investigate if an association exists. METHODS: Following the PICO framework, we formed a systematic review comparing tattooed to non-tattooed adults belonging to any region of the world and investigated the likelihood of lymphomagenesis. The protocol was pre-registered on PROSPERO (ID: CRD42024586505). Relevant studies were searched for in PubMed, Web of Science, Embase, Google Scholar, and CENTRAL on 10/09/2024 and updated on 16/07/25. The inclusion criteria consisted of primary studies, including observational studies and case reports which investigated the association between tattoos and non-Hodgkin lymphoma. Exclusion criteria were publications involving subjects under 18 and non-English papers. Data extraction was performed using published numbers from individual papers after requesting raw data. Study quality was assessed using ROBINS-E, and evidence certainty using GRADE. Outcomes assessed were any odds/risk/incidence ratios that associated tattooing with non-Hodgkin lymphoma. FINDINGS: A total of four observational studies, totalling 17,941 participants (2485 cases and 15,456 controls) and three case reports were identified. None of the included studies demonstrated a statistically proven link between lymphomagenesis and tattooing. ROBINS-E showed relatively low bias for our three included studies; however, the certainty of our evidence is low due to the lack of high-quality studies with similar methodologies. The meta-analysis conducted for non-Hodgkin's lymphoma, with subtypes follicular lymphoma and diffuse large B-cell lymphoma, produced odds ratios of 1.01 (95% CI 0.82-1.24), 1.01 (95% CI 0.77-1.33) and 0.89 (95% CI 0.54-1.46), respectively. INTERPRETATION: No significant association was found between tattooing and lymphoma. Due to limitations in the data quality and lack of standardised measurable outcomes, further high-quality research is needed. FUNDING: There was no funding for this study.
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Consensus on long-term follow-up and surveillance of elective primary shoulder arthroplasty using a real-time Delphi technique.BACKGROUND: Long-term follow-up of elective primary shoulder arthroplasty remains contentious. A real-time Delphi technique allows a single survey to obtain a consensus from experts on the optimum surveillance protocol. METHODS: A real-time Delphi consensus study was delivered using Surveylet. Delphi statements surveyed whether a type of shoulder arthroplasty requires follow-up in the initial 10 postoperative years and beyond 10 postoperative years. Further statements related to surveillance episode format were included. British Elbow and Shoulder Society members were invited to participate. Participants rated agreement with statements using a 5-point Likert scale. Study results were used to produce expert-opinion recommendations that were presented to a patient group. RESULTS: The study received 37 responses of which 31 were complete. 78% of respondents were orthopaedic surgeons and 19% were physiotherapists. Mean survey visits per participant was 3.8 (total 140). The patient group included 13 patients. Consensus agreement was reached on surveillance requirement for numerous shoulder arthroplasty types and aspects of surveillance format, including requirement for radiological assessment and completion of a patient-reported outcome measure. All patients expressed agreement with the resulting expert-opinion recommendations. DISCUSSION: A real-time Delphi among expert clinicians identified areas of consensus in long-term surveillance of elective primary shoulder arthroplasty.
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Operative Versus Nonoperative Outcomes: A Cohort Study on Distal Biceps Tendon Rupture.Background Distal biceps tendon ruptures typically occur in middle-aged men following eccentric loading activities. While surgical repair is common, comparative data on operative versus nonoperative outcomes remain limited. We conducted a retrospective study to compare the outcomes of operative versus nonoperative management in Queen's Hospital Burton. Methods We reviewed the records of 72 patients (52 operative, 20 nonoperative) treated during the period of 2016-2023 for complete distal biceps tendon ruptures. All diagnoses were confirmed clinically and radiologically. Operative management was via a single anterior incision or a modified two-incision technique using cortical button fixation. Complications, range of motion, and return to activity were abstracted from clinical records documented at the time of care. Validated outcome measures, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Mayo Elbow Performance Score (MEPS), were not collected as part of routine care. Results Operative management was associated with a higher rate of complications, including nerve injuries and wound issues, though most patients ultimately regained a full range of motion and function. Nonoperative management resulted in minimal complications, with patients reporting return to their previous activity levels and only minor subjective strength deficits. Overall, operative repair offered greater strength recovery, particularly in supination, but at the cost of increased morbidity, whereas nonoperative management provided excellent functional outcomes with lower risk. Conclusion Nonoperative management appeared to be a reasonable option for selected patients in this cohort. Operative repair is effective but associated with a higher complication rate. Treatment should be individualised, balancing patient activity level, expectations, and risk profile.
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Improving surgical outcomes through non-technical skills: the case for better training and national evaluationEffective communication and teamwork are as crucial as technical proficiency for achieving positive surgical outcomes. Non-technical skills (NTS)-including communication, leadership, decision-making, and situational awareness— enhance surgical performance by fostering awareness and capability among both trainees and experienced surgeons. Despite growing recognition of its importance, NTS training is not uniformly implemented in surgical education, leaving a significant gap. This study examines opportunities to expand NTS training within surgical practice. A survey at a local hospital assessed the availability of NTS training and perceived needs among 38 surgical trainees and professionals. The majority acknowledged the value of NTS in improving clinical performance but reported limited focus on human factors in daily practice. Complementing the survey, a literature review was conducted across Medline, EMBASE, and PsycINFO databases, identifying 414 relevant articles, 114 of which focused on clinical or educational contexts. Of these, 61 studies emphasized psychomotor skill assessment via direct observation, patient outcomes, and peer feedback, underscoring the critical role of effective evaluation methods. Findings indicate that while NTS training is appreciated, its effectiveness depends heavily on feedback quality and team dynamics, particularly in addressing challenging behaviors. The study highlights the need for enhanced training design and robust feedback mechanisms. Although current evidence linking NTS training to improved patient outcomes is largely anecdotal, there is strong professional support for broader implementation. The authors advocate for a systematic, nationwide evaluation to determine the true impact of NTS training on surgical performance and outcomes
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ColoRobotica: Structured training in robotic colorectal surgeryThe adoption of robotic surgery has increased rapidly. The robotic surgery market is projected to reach $14 billion globally by 2026, with an increasing number of robotic platforms entering the market. Structured training remains an important issue in robotic colorectal surgery. ColoRobotica at the European School of Coloproctology, the European Society of Coloproctology, was established in 2018 to benchmark robotic colorectal training in Europe. A multidisciplinary team was formed, and a framework was established. Building the infrastructure of the programme took 2 years. A training pathway was designed to provide a structured training programme with quality assurance interventions embedded in the programme. The programme was launched in 2022. Preliminary results showed clinical outcomes of trainees are comparable to those of expert robotic surgeons. The model could serve as a template for both other scientific societies and different specialties to provide structured robotic surgical training.
