Is it safe to perform elective orthopaedic surgery with high community rates of COVID-19? An observational cohort study.

INTRODUCTION: During the first wave of the COVID-19 pandemic, University Hospitals Birmingham NHS Foundation trust was able to recommence elective orthopaedic surgery using private hospitals procured by the NHS as COVID-19 free 'green' sites. We report on the safety of elective orthopaedic surgery with high rates of community transmission. METHODS: We conducted an observational cohort study on consecutive NHS patients attending three private hospitals between 4 May 2020 and 16 June 2020. Patients attended preoperative assessment, including coronavirus disease (COVID-19) symptom screening, were instructed to self-isolate for 14 days and had a negative COVID-19 swab within 72 hours of surgery. Patient age, American Society of Anesthesiologists (ASA) grade, body mass index, surgery performed, type of anaesthetic and length of stay were collected. Our primary outcome was a positive COVID-19 swab, secondary outcomes were COVID-19 symptoms, readmission, surgical complications and mortality. RESULTS: Between 4 May 2020 and 16 June 2020, 191 patients were admitted to three private hospitals for elective surgery; 121 (67%) patients underwent general or regional anaesthetic, 179 patients were ASA grades 1 or 2 (94%) and 12 (6%) were ASA 3. In total, 187 (98%) patients were successfully contacted at 30 days postoperative and no COVID-19 symptoms, positive COVID-19 swabs or mortality or were recorded. One patient was readmitted following a pulmonary embolism and two patients were treated as outpatients for a deep vein thrombosis and a superficial infection. CONCLUSION: With 'green pathways' elective orthopaedic surgery can safely be performed while rates of COVID-19 in the community are high.

Arthroscopic arthrolysis for the treatment of stiffness after total knee replacement gives moderate improvements in range of motion and functional knee scores.

Twenty-two total knee replacements (TKR's) were treated for stiffness with arthroscopy and arthrolysis. The median follow-up was 38 months. No patients were lost to follow up. Extensive scarring was found and debrided in all of the knees. The mean Oxford Knee Score improved from 42.6 (+/-7.5) to 36.3 (+/-8.5) (P < 0.05) with TKR and from 36.3 (+/-8.5) to 29.3 (+/-9.0) (P < 0.05) with arthroscopic arthrolysis. The mean arc of motion improved from 8-69 degrees post-TKR to 3-105 degrees on table, but declined slightly to 4-93 degrees (P < 0.05) at most recent review. Arthroscopic arthrolysis compares well with other methods of treatment for stiffness with regard to improvements in range of motion and functional knee scores.

Assessment of the antero-posterior and rotational stability of the anterior cruciate ligament analogue in a guided motion bi-cruciate stabilized total knee arthroplasty.

Abnormal knee kinematics and sagittal instability after most knee replacements are due in part to deficient anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) function. The guided motion bi-cruciate stabilized knee replacement aspires to stabilize the knee posteriorly and anteriorly by means of a cam-post mechanism. This investigation studies the ACL-stabilizing function of that mechanism in early flexion, and 25 knees that had undergone replacement with this implant were studied. Antero-posterior laxity at 15 degrees flexion was adequately restored for 76% (16/21) of the knees (side-to-side difference <3 mm on KT assessment), and 72% (18/25) knees exhibited a positive pivot shift test. The findings of this study suggest excellent early clinical outcomes for this implant, but the goal of replicating ACL function has only been partially achieved.

Total knee replacement and patellofemoral pain.

BACKGROUND: The decision to resurface the patella or not during total knee replacement (TKR) is a controversial issue. During primary TKR some surgeons routinely resurface the patella, others operate a selective policy and a third group never resurfaces the patella. AIM: This study attempts to investigate the relationship of patellofemoral knee pain and TKR. MATERIALS AND METHODS: This was a prospective, non-randomised, multi-centre outcome study of 638 primary Insall Burstein II total TKRs, and their effect upon patellofemoral pain. Of those enrolled 378 knees had pre-operative patellofemoral pain; 236 of these underwent patella resurfacing and 142 did not. There were no statistically significant differences in the post-operative incidence of patellofemoral pain between the groups treated with resurfacing of the patella and those in which the patella was left intact. In those knees that developed patellofemoral pain after TKR there was no significant difference as to whether the knee had had resurfacing done or not. CONCLUSION: Given that the cost of patella resurfacing is not insubstantial and that there are well-known complications resulting from it, we conclude that the role of patellar resurfacing for patellofemoral pain in knee arthritis remains unclear.

Diabetic pregnancy. The effect of genetic susceptibility for diabetes on fetal weight.

Since macrosomic infants of diabetic mothers tend to remain obese throughout their lives, and obesity and heredity are factors predisposing to Type II diabetes, it can be hypothesized that infants who are going to develop diabetes later in life are more likely to be macrosomic at birth than those who are not going to develop diabetes as adults. This hypothesis was tested, using the c57/KsJdb+/+m mouse animal model of gestational diabetes. This animal is frankly diabetic in the homozygous diabetic form. In the heterozygous form, it develops gestational diabetes, and in the homozygous normal form, it is normal. The pups of heterozygous males and females that were bred were weighed, classified by sex, and identified. At 4 weeks of age, the genetic makeup of the pups was determined. From 37 litters, 140 pups were born and raised to weaning age. Multiple regression analysis of the data revealed that the homozygous diabetic pups weighed most at birth; the heterozygous gestationally diabetic pups weighed less, and the homozygous normal pups weighed the least. All comparisons of these groups were statistically significant. Sex and interlitter variation also were found to be significant factors determining birthweight. Controlling for sex and interlitter variation did not change the significance of the effect of the genetic tendency for diabetes on birthweight. This study indicates that in Type II diabetes, neonatal macrosomia in part may be determined by the genetic or congenital susceptibility to develop diabetes in the future.

Affective empathy and cognitive role-taking in delinquent and nondelinquent youth.

Ten male and 10 female delinquents were compared with 10 male and 10 female nondelinquents on a structured self-reported affective empathy task, an unstructured affective empathy task, and a cognitive role-taking measure. Differences between groups were found only on the unstructured empathy task, with delinquents performing more poorly than nondelinquents. Sex differences were noted in the delinquent sample on the structured empathy task, with males demonstrating less empathic responding than females. The role of empathic skills in the etiology of delinquent behavior is addressed. In addition, the need to further differentiate the cognitive and affective components of the empathic construct is emphasized.

An animal model of gestational diabetes.

Glucose tolerance tests (GTTs), hemoglobin A, levels, and pup weights were studied in both normal (C57BL/KsJ-+m/ + m) and heterozygous (C57BL/KsJ-db+/ + m) mice. There was no difference in GTT or hemoglobin A, levels between heterozygotes and normal animals in the nonpregnant state. However, the pregnant heterozygous mouse had significantly elevated GTTs (p less than 0.001) and hemoglobin A, levels (p less than 0.002) when compared to the normal pregnant mouse. The mean weight of pups from heterozygous parents was significantly greater than that of pups from normal parents (p less than 0.0005). Because the heterozygous mouse (C57BL/KsJ-db+/ + m) exhibits these characteristics of gestational diabetes, it may be possible to use it as an animal model of gestational diabetes.

Sex, sex-role identity, and cognitive style.

Two studies were conducted to test competing theoretical predictions concerning the relationships among sex, sex-role identity, and field independence: (1) Witkin and Vaught's positions that maleness and masculinity (regardless of biological sex) are associated with field independence and (2) the present author's contention sex reversed sex-role identity, irrespective of sex, would be predictive of field independence. Data collected from 110 high school males and 78 college females and males supported the latter prediction but only for males. No main effects due to sex were found.