Longer term follow up of outcomes following implantation of a modular rotating hinge knee prosthesis: 53 implants at mean 7.6 year follow up.

BACKGROUND: Rotating hinge knee replacements are becoming more common but have historically had high complication and failure rates. This study is one of the largest to assess the implant survival and patient outcomes of a third-generation rotating hinge knee replacement at a single tertiary orthopaedic centre. METHODS: Data for consecutive operations at our tertiary unit between 2006 to 2020 were assessed with review of electronic patient and radiology records. The Oxford Knee Score was used to assess outcomes and the Kaplan Meier method used to estimate survivorship. RESULTS: 53 rotating hinge knees were implanted in 46 patients (13 male, 33 female) at a mean age of 67.8 years. 21 were primary and 32 were revision procedures. Indications for use of this implant included instability, loosening, fracture and infection. Survivorship was 77.8% at the mean follow up of 7.6 years. A total of 29 complications were noted with ongoing pain, stiffness, infection and patellofemoral symptoms being the most common. 8% of unresurfaced patellas required a subsequent secondary resurfacing. The Oxford Knee Score demonstrated a significant improvement from 14.6 preoperatively to 27.5 at one year postoperatively, which was maintained in the longer term. CONCLUSION: The third-generation rotating hinge knee implant in use at our unit has improved outcomes for patients. The survivorship of the implant is comparable to the published literature, although there is a paucity of data. The complication rates remain relatively high and patients should be counselled appropriately. We advise resurfacing the patella to avoid the need for secondary procedures.

Tibial Intramedullary Nailing by Suprapatellar Approach: Is It Quicker and Safer?

Background With the increasingly accepted method of suprapatellar tibial nailing for tibial shaft fractures, we aimed to compare intraoperative and postoperative outcomes of infrapatellar (IP) vs suprapatellar (SP) tibial nails. Methods This is a retrospective cohort analysis of 34 SP tibial nails over three years vs 24 IP tibial nails over a similar time frame. We compared total radiation dose (TRD), patient positioning time (PPT), fracture healing and follow up time. Knee pain in the SP group was evaluated utilising the Hospital for Special Surgery (HSS) Knee Injury and Osteoarthritis Outcome Score (KOOS). Results Fifty-eight patients with a mean age of 43 years were included. Mean intraoperative radiation dose for SP nails was 61.78 cGy (range: 11.60-156.01 cGy) vs 121.09 cGy (range: 58.01-18.03 cGy) for IP nails (p < 0.05). Mean PPT for SP nails was 10 minutes vs 18 minutes for IP nails (p < 0.05). All fractures united in the SP group vs one non-union in the IP group. Mean follow up was 5.5 months vs 11 months in the IP and SP groups, respectively. Mean KOOS was 7 (range: 0-22) at six months for the SP group. Conclusion The semi-extended position (SP group) leads to reduced TRD because of ease of imaging. Patients showed improved outcomes with shorter follow up and fracture union in all patients (SP group). The KOOS revealed that SP nail patients had minimal pain and good knee function. This study establishes a management and patient-reported outcome measures (PROMs) baseline for ongoing evaluation of SP nails.

The Exeter Knee Infection Multi Disciplinary Team approach to managing prosthetic knee infections: A qualitative analysis.

BACKGROUND: A Knee Infection Multi-Disciplinary Team meeting was established in Exeter. This study was designed to qualitatively evaluate the impact of the MDT on those involved. MATERIALS AND METHODS: Semi-structured interviews of all members of the MDT at Exeter were undertaken and analysed using Nvivo software. Data was coded to identify common patterns and trends. RESULTS: The common themes identified were improved communication and standardisation of care. The main challenges identified were the timing of the meetings and funding. CONCLUSION: This study has used established qualitative techniques to evaluate the impact of the Exeter Knee Infection MDT.

Mental health in medical students: time to act.

BACKGROUND: Mental health problems are prevalent amongst medical students. However, many students delay seeking medical help or support from the medical school for a variety of reasons, including a fear of facing fitness to practice proceedings. Tackling this problem of awareness and delayed presentation will need a strong and dedicated focus at all stages, with prevention being of great importance. METHODS: A conference dedicated to mental health and well-being was organised for students of all years. The first part of the conference centred on well-being dilemmas and the second part focused on discussing important issues in small group sessions. RESULTS: Students were divided into eight groups and each group suggested improvements to the course that they felt would improve mental health and well-being. The main suggestions raised were: reassurance that the disclosure of mental health problems would not automatically result in fitness to practice proceedings; separate academic and pastoral roles of tutors; open up the topic of mental health and well-being more frequently during the programme; improve knowledge about the availability of support services; and have mentors who are at an earlier stage in postgraduate training (e.g. junior doctors). DISCUSSION: It is necessary to tackle the prevalent myths about this topic. Many students are unaware of the support services available. This conference has therefore sought to increase awareness of the topic. An approach is also now needed to identify those who need extra help. The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference, for example. Many students are unaware of the support services available The authors strongly advocate opening up this topic throughout the course in the context of a dedicated conference ….

Consensus views on the optimum training curriculum for advanced minimally invasive surgery: A delphi study.

INTRODUCTION: There has been a wide uptake in the use of Minimal Invasive Surgery (MIS) globally across different surgical specialties. Whilst evidence exists for a structured training curriculum for basic laparoscopic surgery, there is little agreement on a complete framework for an advanced MIS training curriculum, defining the essential elements of the curriculum including the optimal assessment methods. The aim of this study is to obtain a consensus on the essential elements of a training curriculum for advanced MIS. MATERIALS AND METHODS: A Delphi study was carried out involving 57 international experts in advanced MIS across different surgical specialties. A three round survey was conducted to reach consensus on the essential domains of a curriculum. This included defining the learners, trainers and training centres; curriculum content and competency based assessment. RESULTS: Unanimous agreement was reached for the completion of basic laparoscopic training before entry into advanced training. A trainer should have reached competency in advanced MIS and attended a 'Train the trainer' course. The curriculum should be delivered as modular training, including a multi-modal approach with a structured clinical proctorship programme. Formative assessment was considered as an integral part of learning and should be performed using objective work based assessment tools such as global assessment scale (GAS) forms. Accreditation in advanced MIS can be achieved by objective assessment of technical performance of unedited videos in addition to key clinical performance outcomes. CONCLUSION: A consensus on the framework of an advanced MIS training curriculum has been achieved defining the essential elements of entry criteria, selection of trainers and training units and curriculum content. Multimodal learning, clinical proctorship programme and competency based assessment are integral parts of the curriculum.