RSS 1.0Trauma and Orthopaedics
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Component mix-match for natomic total shoulder arthroplasty revision: a case reportAlthough mixing and matching components is a common, safe, and well-documented practice in hip revision surgery, our extensive search indicates that it has not been previously reported for shoulder arthroplasty. This case report presents the use of mixed implants in shoulder revision surgery to reduce morbidity and address flaws in the initial implant design. We describe a case of a patient with multiple epiphyseal dysplasia who was treated for osteoarthritis in his left shoulder with an anatomic shoulder replacement in 2014. In 2018, the patient presented with deteriorating function, increasing pain, and radiological signs of glenoid component wear and loosening. A decision was made to proceed with revision shoulder arthroplasty. Given the patient's young age and intact rotator cuff function, the revision was planned as an anatomic construct. The challenge was a well-fixed, fully hydroxyapatite-coated stem and a glenoid metal-backed component with a failing polyethylene locking mechanism. After extensive discussion with the patient, a combined decision was made to retain the well-fixed humeral stem and revise the glenoid side using impaction grafting with allograft, followed by cementing an all-polyethylene glenoid from a different company. The revision surgery was performed uneventfully, resulting in pain relief and improved function beyond the levels achieved in the initial operation. Notably, the original head and the revision glenoid had a curvature radius mismatch, in contrast to the original design's absolute congruence. Recent studies suggest that such a mismatch, within limits, can recreate normal shoulder kinematics and reduce glenoid loosening. Copyright ┬® 2024, Tsolis et al.
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Non-steroidal anti-inflammatory drugs and cyclooxygenase-2 inhibitors do not affect healing after rotator cuff repair: a systematic review and meta-analysisPurpose To determine whether non-steroidal anti-inflammatory drugs (NSAIDs) and cyclooxygenase-2 (COX-2) inhibitors affect healing rate, functional outcomes, and patient satisfaction after rotator cuff repair. Methods Medline, EMBASE, PsychINFO and the Cochrane Library were searched for randomized controlled trials (RCTs) investigating the use of NSAIDs and COX-2 inhibitors after arthroscopic rotator cuff repair. Primary outcomes included healing and retear rate, determined by radiological imaging. Secondary outcomes included shoulder-specific outcome measures and the visual analog scale (VAS). Risk of bias was graded using the Cochrane risk-of-bias v2.0 tool. The GRADE framework was used to assess certainty of findings. Results Seven RCTs with a total of 507 patients were included (298 randomized to NSAID/COX-2 vs 209 randomized to control). NSAIDs use did not yield a difference in retear rate (P = .77). NSAIDs were shown to significantly reduce pain in the perioperative period (P = .01); however, no significant difference was present at a minimum of 6 months (P = .11). COX-2 inhibitors did not significantly reduce pain (P = .15). Quantitative analysis of ASES and UCLA scores showed NSAIDs significantly improved functional outcomes versus control (P = .004). COX-2 inhibitors did not significantly improve functional outcomes (P = .15). Two trials were deemed “low” risk of bias, four trials were graded to have “some concerns”, and one trial was graded to have “high” risk of bias. Retear rate and functional PROMs were deemed to have “low” certainty. VAS pain scale was graded to have “moderate” certainty. Conclusions This systematic review and meta-analysis indicates that NSAIDs do not affect healing rate after arthroscopic rotator cuff repair, but they do significantly improve postoperative pain and functional outcomes. No significant difference was seen in pain or functional outcomes with the use of COX-2 inhibitors.
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The economic and resource burden of e-scooter-related orthopaedic injuries: A district general hospital's experiencePurpose: Electric scooters (e-scooters) are an increasingly popular method of transportation worldwide. However, there are concerns regarding their safety, specifically with regards to orthopaedic injuries. We aimed to investigate the overall burden and financial impact on orthopaedic services as a result of e-scooter-related orthopaedic injuries. Methods: We retrospectively identified all e-scooter-related injuries requiring orthopaedic admission or surgical intervention in a large District General Hospital in England over a 16-month period between September 2020 and December 2021. Injuries sustained, surgical management, inpatient stay and resources used were calculated. Results: Seventy-nine patients presented with orthopaedic injuries as a result of e-scooter transportation with a mean age of 30.1 years (SD 11.6), of which 62 were males and 17 were females. A total of 86 individual orthopaedic injuries were sustained, with fractures being the most common type of injury. Of these, 23 patients required 28 individual surgical procedures. The combined theatre and recovery time of these procedures was 5500 min, while isolated operating time was 2088 min. The total cost of theatre running time for these patients was estimated at £77,000. A total of 17 patients required hospital admission under Trauma and Orthopaedics, which accounted for total combined stay of 99 days with a mean length of stay of 5.8 days. Conclusion: While there are potential environmental benefits to e-scooters, we demonstrate the risks of injury associated with their use and the associated increased burden to the healthcare system through additional emergency attendances, frequent outpatient clinic appointments, surgical procedures, and hospital inpatient admissions.
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Improvements in networking processes for hip or knee revision arthroplasty: a silver lining of the COVID-19 pandemicBackground: Improvements in outcomes following hip and knee revision arthroplasties have been demonstrated following the introduction of specialised orthopaedic services in the form of 'hub and spoke' networking models. In light of the COVID-19 pandemic, these networks have undergone some inevitable adaptations. We investigated the impact of recent adaptations on the performance of our regional revision arthroplasty network. Methods: A retrospective review of all referrals that were discussed at our regional revision arthroplasty meeting, over 2 separate phases, was undertaken. Phase 1 included data between March 2018 and April 2019, representing an interval prior to COVID-19 pandemic. Phase-2 included data between September 2020 and March 2021 (during COVID-19 pandemic). Data were collected from East Midland South Orthopaedic Network (EMSSON) database and included data relating to indication and time to revision surgery, surgeon's proposal plan, network proposal plan, and executed definitive plan. We compared and analysed network performance between 2 phases. Results: In phase 1, 99 cases were discussed in EMSSON meetings, equating to 35.7% of the region's revision arthroplasty volume, according to the National Joint Registry (NJR) records. Plan alterations were recommended in 48/99 cases (48.5%), of which 41/48 (85.4%) were adhered to. Phase 2 included 98 discussed cases, equating to 81.6% of the region's revision arthroplasty volume. Plan alterations were recommended in 20/98 cases (20.4%), all of which were adhered to (100%). Adherence to recommended adaptations showed significant improvement (p < 0.03). Conclusions: Based upon our observations, a greater volume and proportion of revision arthroplasty cases are now being discussed. Adherence to MDT recommendations has significantly improved following the described adaptations. The number of recommended adaptations to management plans have decreased, indicating an educational value of the network.Overall, these findings demonstrate a trend towards NHS England's target of 100% of revision arthroplasty cases undergoing MDT discussion.
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A systematic review and network meta-analysis of outcomes after total wrist arthroplasty in inflammatory and non-inflammatory arthritisThis systematic review analysed the available evidence on the clinical outcomes of total wrist arthroplasty (TWA) in patients with inflammatory and non-inflammatory arthritis. After screening, 12 studies met the inclusion criteria. They involved 359 patients with 378 TWA implants. The results showed that TWA significantly improved Disabilities of the Arm, Shoulder and Hand (DASH)/Quick-DASH scores and pain visual analogue scale scores in both arthritis groups compared with preoperative values. However, there was no statistically significant difference in the outcome scores between the two groups. Three studies reported Patient-Rated Wrist Evaluation (PRWE) scores, and TWA significantly improved PRWE scores in non-inflammatory arthritis but not in inflammatory arthritis, with no significant difference in postoperative outcome scores between the two groups. Although the included studies have limitations, the review suggests that TWA may be a successful treatment for wrist pain in individuals with either inflammatory or non-inflammatory arthritis. However, further high-quality trials are needed to confirm these findings.