Pre-Operative Digital Templating Aids Restoration of Leg-Length Discrepancy and Femoral Offset in Patients Undergoing Total Hip Arthroplasty for Primary Osteoarthritis.

Background Pre-operative planning and templating is a crucial pre-requisite for total hip arthroplasty (THA). Recently, the use of digital radiography has allowed templating to be digitalised instead of traditional methods involving the use of radiograph transparencies. The primary aim of this study was to compare the accuracy in correction of leg length discrepancy (LLD) and restoring femoral offset in patients undergoing THA for primary osteoarthritis with pre-operative digital templating (PDT) versus conventionalplanning without digital templating. Methods This retrospective cohort study compared two groups of patients who underwent THA for primary osteoarthritis. During the period of the year 2020, 56 patients underwent THA with pre-operative digital templating and 50 patients without digital templating. Two independent blinded observers recorded all radiological data. Results The digital templated and non-digital templated cohorts were matched for variables including age (mean = 71.8 years vs 70.9 years), pre-operative LLD (-4.9mm vs -5.2mm) and pre-operative offset (41.2mm vs 43.7mm). PDT resulted in correction of LLD to <5mm compared to the contralateral hip in 76.8% of cases, 5-10mm in 21.4% and >10mm in one case (1.8%). The non-digital templated cohort had a LLD of <5mm in 50% of cases, 5-10mm in 28% and >10mm in 22%. Chi-square testing demonstrated these results to be statistically significant (p = 0.002). The mean pre-operative offset in the digital templated group was 40mm and 46mm post-operatively. The non-digital templated cohort had a mean pre-operative offset of 42mm and 36mm post-operatively. Independent t-testing revealed statistical significance of these results (p = 0.05). Conclusion PDT leads to an increased likelihood of restoring LLD to <5mm and a significantly increased likelihood of preventing lengthening >10mm. PDT also significantly increases the chance of restoring femoral offset to match the pre-operative native hip. Decreased offset is seen predominantly in the non-digitally templated patients.

A graphical assessment of emergency surgical list efficiency to determine operating theatre capacity needs.

BACKGROUND: Unlike elective lists, full utilisation of an emergency list is undesirable, as it could prevent patient access. Conversely, a perpetually empty emergency theatre is resource wasteful. Separately, measuring delayed access to emergency surgery from time of booking the urgent case is relevant, and could reflect either deficiencies in patient preparation or be because of an occupied (over-utilised) emergency theatre. METHODS: We developed a graphical method recognising these two separate but linked elements of performance: (i) delayed access to surgery and (ii) operating theatre utilisation. In a plot of one against the other, data fell into one of four quadrants, with delays associated with high utilisation signifying the need for more emergency capacity. However, delays associated with low utilisation reflect process deficiencies in the emergency patient pathway. We applied this analysis to 73 consecutive lists (>300 cases) from two UK hospitals. RESULTS: Although both hospitals experienced similar rates of delayed surgery (21.8% vs 21.0%; P=0.872), in one hospital 83% of these were associated with low emergency theatre utilisation (suggesting predominant process deficiencies), whereas in the other 73% were associated with high utilisation (suggesting capacity deficiency; P<0.0001). Increasing emergency capacity in the latter resulted in shorter delays (just 6.7% cases excessively delayed; P<0.0001 for effect of intervention). CONCLUSIONS: This simple graphical analysis indicates whether more emergency capacity is necessary. We discuss potential applications in managing emergency surgery theatres.

What it takes to become an orthopaedic surgeon: A comparison of orthopaedic surgical training programmes in 10 countries focusing on structure and fellowship requirements.

BACKGROUND: The quality of surgical training has been highlighted as one of the most important patient safety issues in the future. Training surgeons and supporting them to do their best should be considered integral in providing optimum and safe care for the individual patient and the best possible return on investment in training medical professionals. In 2011, an international consensus statement defined fundamental principles for surgical training. PURPOSE: This study examines orthopaedic surgical training to explore the similarities and differences in the requirements for trainees to obtain board certification in ten countries. METHODS: Countries of the Commonwealth Health Care Comparison: Canada, the United Kingdom, the United States of America, Australia, New Zealand, Germany, France, the Netherlands, Norway and Switzerland were chosen to be compared. The relevant information was extracted from official information from authorities and administrative bodies. RESULTS: The study revealed significant differences in duration, organisation and assessment of training. So-called "competency-based" training is not featured in every country, and the manner of its implementation is variable. In particular, the numbers in surgical cases required to be accredited varies by country ranging from 1260 (UK) to 340 (Norway). CONCLUSION: Despite the recommendation in 2011 for some degree of uniformity across surgical training in industrialised countries, evidence suggests wide variation in the training programmes which is likely to be a concern in both quality of training as well as present and future patient safety.