Clinical frailty is independently associated with joint-specific function and health-related quality of life in patients awaiting a total hip or knee arthroplasty.

The aims were to assess whether preoperative joint-specific function (JSF) and health-related quality of life (HRQoL) were associated with level of clinical frailty in patients waiting for a primary total hip arthroplasty (THA) or knee arthroplasty (KA). Patients waiting for a THA (n = 100) or KA (n = 100) for more than six months were prospectively recruited from the study centre. Overall,162 patients responded to the questionnaire (81 THA; 81 KA). Patient demographics, Oxford score, EuroQol five-dimension (EQ-5D) score, EuroQol visual analogue score (EQ-VAS), Rockwood Clinical Frailty Score (CFS), and time spent on the waiting list were collected. There was a significant correlation between CFS and the Oxford score (THA r = -0.838; p < 0.001, KA r = -0.867; p < 0.001), EQ-5D index (THA r = -0.663, p =< 0.001; KA r = -0.681; p =< 0.001), and EQ-VAS (THA r = -0.414; p < 0.001, KA r = -0.386; p < 0.001). Confounding variables (demographics and waiting time) where adjusted for using multiple regression analysis. For each 8.5 (THA, 95% CI 7.1 to 10.0; p < 0.001) and 9.9 (KA, 95% CI 8.4 to 11.4; p < 0.001) point change in the Oxford score, there was an associated change in level of the CFS. For each 0.16 (THA, 95% CI 0.10 to 0.22; p < 0.001) and 0.20 (KA, 95% CI 0.12 to 0.27; p < 0.001) utility change in EQ-5D, there was an associated change in level of the CFS. EQ-VAS (THA, B = -11.5; p < 0.001, KA B = -7.9; p = 0.005) was also associated with CFS. JSF and HRQoL in patients awaiting THA or KA for more than six months, were independently associated with level of clinical frailty. With further prospective studies, clinical frailty may prove to be a useful metric to assist in the prioritization of arthroplasty waiting lists.

Significant deterioration in quality of life and increased frailty in patients waiting more than six months for total hip or knee arthroplasty : a cross-sectional multicentre study.

AIMS: The primary aim of this study was to assess whether patients waiting six months or more for a total hip (THA) or knee (KA) arthroplasty had a deterioration in their health-related quality of life (HRQoL). Secondary aims were to assess changes in frailty and the number of patients living in a state considered to be worse than death (WTD), and factors associated with changes in HRQoL and frailty. METHODS: This cross-sectional study included 326 patients, 150 males (46.0%) and 176 females (54.0%), with a mean age of 68.6 years (SD 9.8) who were randomly selected from waiting lists at four centres and had been waiting for six months or more (median 13 months, interquartile range 10 to 21) for a primary THA (n = 161) or KA (n = 165). The EuroQol five-dimension questionnaire (EQ-5D) and visual analogue scores (EQ-VAS), Rockwood Clinical Frailty Scale (CFS), and 36-Item Short Form Survey subjective change in HRQoL were assessed at the time and recalled for six months earlier. A state that was WTD was defined as an EQ-5D of less than zero. RESULTS: There were significant deteriorations in the EQ-5D (mean 0.175, 95% confidence interval (CI) 0.145 to 0.204; p < 0.001), EQ-VAS (mean 8.6, 95% CI 7.0 to 10.4; < 0.001), and CFS (from 3 "managing well" to 4 "vulnerable"; p < 0.001), and a significant increase in the number of those in a state that was WTD (n = 48; p < 0.001) during the previous six months for the whole cohort. A total of 110 patients (33.7%) stated that their health was much worse and 107 (32.8%) felt it was somewhat worse compared with six months previously. A significantly greater EQ-5D (-0.14, 95% CI 0.08 to 0.28; p = 0.038) and a state that was not WTD (-0.14, 95% CI 0.01 to 0.26; p = 0.031) were associated with a deterioration in the EQ-5D. THA (0.21, 95% CI 0.07 to 0.34; p = 0.002) or a lower (better) CFS (0.14, 95% CI 0.07 to 0.20; p < 0.001) were independently significantly associated with a deterioration in the CFS. CONCLUSION: Patients waiting more than six months for THA or KA had a significant deterioration in their HRQoL and increased frailty, with two-thirds of patients feeling that their health had worsened.Cite this article: Bone Joint J 2022;104-B(11):1215-1224.

Epidemiology of American Football Injuries at Universities in the United Kingdom.

BACKGROUND: College-level American football injury data are routinely collected; however, data relating to American football injuries at universities in the United Kingdom have never been reported. PURPOSE: To describe the epidemiology of UK university American football injuries. STUDY DESIGN: Descriptive epidemiology study. METHODS: An online survey tool was used to collect the injury data of 410 players from 56 UK university teams who participated in the 2014-2015 British Universities and College Sports American football season. Survey data were collected from January to February 2016 and were analyzed to determine the incidence and patterns of injury. RESULTS: Overall, 710 injuries and 204 concussions were self-reported among the 410 participants, of which 334 (81.5%) were injured and 131 (32.0%) experienced concussion symptoms. The rate of injury per 100 athlete-seasons was greater in defensive players (195.3) than offensive players (155.1). The most common injuries were knee and ankle ligament injuries. Most injuries were classified as severe (time loss of >4 weeks). CONCLUSION: UK university American football injuries differ markedly from those reported for US colleges. UK university players appear to have less playing experience, greater concussion risks, more severe injuries, and a greater proportion of injuries in defensive players versus offensive players.

The impact of a preoperative information leaflet on expectation management, satisfaction and patient outcomes in patients undergoing knee arthroscopy.

BACKGROUND: This study examined the effects of a patient information leaflet on outcomes related to patient satisfaction following knee arthroscopy. METHODS: Cohort study of patients listed for knee arthroscopy under the care of a single surgeon over a nine-month period (May 2017-January 2018) following the introduction of an information leaflet as an adjunct to the consent process. Outcome data was collected postoperatively through telephone follow-up. Outcome measures included feelings of involvement with decision-making, expectations being met, satisfaction, postoperative pain numerical rating scales and the Forgotten Joint Score-12. RESULTS: Fifty-five patients were consented by the operating surgeon, of which 28 (50.9%) received a leaflet and 27 (49.1%) did not. Patients who received the information leaflet felt more involved in and informed about the decision to have an operation than patients who did not (p = 0.016), however there were no differences in any other outcomes between patients who did and did not receive a leaflet (p > 0.05). CONCLUSIONS: The use of an information leaflet as an adjunct to the preoperative consultation is an effective way of helping patients feel more involved in the surgical decision-making process, however this does not influence overall outcome or satisfaction metrics.