The ethylene oxide sterilised Opera acetabular component demonstrates high rates of loosening and revision compared to the gamma irradiated Ogee cup: a cohort study demonstrating potential shortcomings of revision-based registry data.

AIMS: To evaluate the long-term clinical outcomes of 2 cemented ultra-high molecular weight polyethylene (UHMWPE) acetabular components, with the main difference between the 2 components being their method of sterilisation. PATIENTS AND METHODS: Data was collected prospectively on 352 consecutive total hip replacements, performed between March 2000 and July 2004, at a single centre. A posterior approach was used with a cemented C-Stem femoral component (DePuy, Warsaw, IN, USA) in all cases and either the Ogee (DePuy, Warsaw, IN, USA) or the Opera (Smith & Nephew, Memphis, TN, USA) acetabular implant. Patients were reviewed clinically and radiologically with a median 12-year follow-up (6-16 years). RESULTS: The risk of experiencing loosening was 90% lower for the Gamma irradiated implant (GII) group compared to the ethylene oxide sterilised implant (EOSI) group, which was statistically significant (p = 0.003), (HR 0.10; 95% CI, 0.02-0.45). The incidence of cup revision was also lower in the GII group (p = 0.029), but after adjustment for age, gender and BMI was not statistically significant (p = 0.104). 15-year survivorship with failure/loosening as an endpoint was 70.1% for the EOS implant and 92.9% for the GII (OR 4.99; CI 95%, 1.75-14.2) and with revision as an endpoint was 81.4% for the EOSI and 92.9% for the GII (OR 2.60; CI 95%, 0.87-7.75). CONCLUSIONS: We report increased rates of loosening, revision and failure for the EOSI compared to the GII at long-term follow-up. This may have been attributable to the different sterilisation methods used.

The changing pattern of acute spinal referrals during primary and secondary waves of the COVID-19 pandemic.

INTRODUCTION: The COVID-19 pandemic has had a devastating effect on health systems globally. This led to changes in patient access to healthcare particularly spinal services. This study investigates the impact of the pandemic on the volume of patients being referred to and accessing spinal services during both the first and second waves. METHODS: All emergency spinal referrals and related hospital attendances to the emergency department in a busy district general hospital were analysed. The data were evaluated at three time points each covering a 3-month period. Data collected included patient demographics, duration and nature of symptoms, reason for referral, clinical and MRI findings, length of stay in hospital, any interventions performed and the follow-up plan. RESULTS: There were a total of 316 emergency referrals across the three time periods. The number of referrals fell by 15% between the pre-COVID-19 period and the first wave. Comparing the first and second waves, the number of referrals was increased by 58%. Comparing the second wave to the pre-COVID-19 period, referrals were 34% greater in the second wave (p < 0.005). CONCLUSION: We highlight an increase in referrals to our spinal service during the secondary wave, having fallen during the first wave. We hypothesise that the increase in referrals, despite similar restrictions to the first wave, is a result of changing patterns of behaviour due to the fear of contracting COVID during the first wave and difficulty in accessing primary care services in the second wave.

Autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with microfracture for arthroscopic treatment of femoroacetabular impingement and chondral lesions of the hip: bridging the osteoarthritis gap and facilitating enhanced recovery.

In an attempt to bridge the osteoarthritis (OA) gap, this study compared biological reconstruction with traditional microfracture (MF) techniques in patients with femoroacetabular impingement and focal cartilage defects. Cohorts of two groups were investigated; age, gender and Tonnis grade matched comparison for outcomes between MF and newer biological reconstruction techniques hip arthroscopy surgery using autologous matrix-induced chondrogenesis and bone marrow aspirate combination. Outcomes investigated were pre-op and post-op mean iHOT-12 scores up to 18 months after surgery with a Kaplan-Meier survivorship analysis. Of 111 patients, 46 patients underwent MF and 65 biological reconstruction hip arthroscopy including cam/pincer osteoplasty and labral repair surgery. Age range was 20-69, mean age 45 years for both groups, Tonnis grading was as follows: Grade 0: 26% versus 30%, Grade 1: 52% versus 47% and Grade 2: 22% versus 23% in MF and biological reconstruction groups, respectively. The mean post-operative iHOT-12 score differences between MF and biological reconstruction were significant at 1-year minimum follow-up (P = 0.01, SD 2.8). Biological reconstruction allowed for an enhanced recovery protocol. The MF group had a 67.4% survivorship for conversion to hip replacement at 18 months (32.6% failure rate for any reason) and biological reconstruction had 100% survivorship at 18 months post-operatively with no failures for any reason. This study provides further support to the evidence base for biological reconstructive techniques as superior to MF in combination with joint preservation arthroscopic surgery, even in the face of focal cartilage defects and offers both surgeons and patients a potential bridging of the OA gap.

Does a daily consultant ward round affect the outcomes of orthopaedic patients?

INTRODUCTION: In the UK, more than 60 000 patients present with a fractured neck of femur each year. These patients represent a huge financial cost. This study looks at the 30-day readmissions and total length of hospital stay of patients presenting with a fractured neck of femur, as well as length of stay in non-hip fracture trauma patients, following the change to a daily consultant-led ward round. METHODS: A total of 200 records of patients with fractured neck of femur were reviewed with data collected retrospectively and prospectively following the introduction of the daily consultant-led ward round. Readmissions were classed as patients who spent a period of time admitted to hospital. Those who only attended an emergency unit were not included. Reasons for readmission and length of readmission were reviewed as were the initial and total length of stay. The authors also evaluated the length of stay in trauma patients (non-hip fracture emergency admissions) for a period of 6 months before and 4 months after the new working model was introduced. RESULTS: With the new working pattern, there was a reduction in the length of stay in those readmitted (13 vs 8 days), and the total length of stay of readmitted patients was also considerably lower (23 vs 13 days). In non-hip fracture trauma patients, there was a reduction in length of stay (8 vs 6 days). CONCLUSIONS: This study demonstrates that by adopting a daily orthopaedic consultant-led ward round, it is possible to reduce the length of stay for patients with a fractured neck of femur, both on initial and subsequent hospital admissions, as well reducing the length of stay for non-hip fracture trauma patients.