Initial assessment of framework for delivery of elective orthopaedic surgery in the United Kingdom following the COVID-19 pandemic.

PURPOSE: In light of the COVID-19 pandemic, a framework for safe provision of elective orthopaedic surgery must be developed in order to restore and maintain activity. The aim of this study was to explore patient attitudes to surgery and theatre efficiency as a result of the COVID-19 pandemic and assess a potential framework for the delivery of such services. METHODS: Prospectively collected data on theatre timings and procedures completed per session used to assess theatre efficiency comparing June 2019 to June 2020. Information on patient compliance with 14-day household isolation and attitudes to surgery were collected prospectively over a seven-week period using a questionnaire. Follow-up data were collected via telephone consultation a minimum of two weeks after discharge. RESULTS: Significant reduction in the number of points per session (p = 0.02) with a mean of 3.19 in 2019 and 2.42 in 2020. Only 18 of 31 patients were compliant with pre-operative isolation with individual failures accounting for four of 13 and failures by household members accounting for nine. Impact of COVID-19 and precautions on patient anxiety was mixed. No patients required symptomatic COVID-19 swab post-operatively. CONCLUSION: With the restrictions of COVID-19, there are significant problems with theatre efficiency, in effect losing an operation a list. Furthermore, compliance with pre-operative isolation was poor but to the best of our knowledge no patients became unwell from COVID-19 post-operatively. Additional strategies will be required to reinstate an effective elective orthopaedic service, especially as the nation heads into another wave.

Posterolateral corner injuries of the knee: a serious injury commonly missed.

We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

The precision and accuracy of templating the size of unicondylar knee arthroplasty.

In trauma and joint arthroplasty, preoperative templating is an important step that can help in the selection of implant size, position and alignment. Although the precision (reproducibility) of templating in unicondylar knee arthroplasty has been assessed previously, the accuracy has never been studied. Our aim is to assess the precision and accuracy of using the templating system for one commonly used unicondylar knee arthroplasty, ALPHANORM design (Alphanorm Medizintechnik, Germany). Eight observers used the templating system to estimate the size of the unicondylar knee prosthesis ALPHANORM in 29 randomly selected patients with osteoarthritis. The observers, who all were orthopaedic surgeons with two different levels of experience, worked independently and repeated their measurements 2 weeks later. All the patients subsequently underwent unicondylar knee replacements, and the actual size of the femur and tibia was assessed intra-operatively without any knowledge of the template sizes. Our results revealed a high level of intra-observer reproducibility. However, the inter-observer reproducibility and the accuracy all were poor.

Gluteal compartment syndrome after total knee arthroplasty with epidural postoperative analgesia.

We describe two patients who developed gluteal compartment syndrome after total knee arthroplasty (TKA) carried out under epidural analgesic infusion and light sedation. To our knowledge, this occurrence has not been described previously after TKA.