Outcomes in the elderly patient following enhanced recovery pathways for elective lower-limb arthroplasty surgery.

INTRODUCTION: Enhanced recovery pathways (ERPs) have been shown to reduce both morbidity and mortality, as well as length of stay, in very elderly patients undergoing joint replacement surgery. However, their impact on patient-reported outcome measures (PROMs) in this vulnerable cohort of patients has not previously been investigated. METHODS: Oxford Hip and Knee Scores were collected pre- and postoperatively for patients undergoing joint replacement surgery at Wrexham Maelor Hospital, along with data on patient demographics. RESULTS: Of the 646 who had total hip replacements, 32 (4.95%) were aged 85 years or over, and of the 875 who had total knee replacements, 39 (4.46%) were aged 85 years or over. Similarly to younger patients, those over the age of 85 years saw a benefit in the outcome at 6 months and 24 months following elective hip and knee arthroplasty on an ERP. This was reflected by a significant increase in the outcome scores at 6 months postoperatively in both age groups undergoing either a total hip replacement or total knee replacement. CONCLUSIONS: We found no detrimental effect of ERPs on PROMs data in older patients. In fact, these patients saw a similar benefit in outcome following elective hip and knee arthroplasty as the younger cohort.

An observation of massive lumbar disc prolapse.

BACKGROUND: The aim of this study was to investigate whether massive lumbar disc herniations (LDH) can be managed safely with non-operative treatment. Whilst most LDH are treated successfully with analgesia and physiotherapy, there is little literature regarding the treatment of massive LDH. Their impressive size raises the suspicion that they may cause cauda equina syndrome and are therefore often treated surgically. METHODS: Patients were referred to our tertiary unit by either their general practitioner or the musculoskeletal service. To be included in the study, patients had to have a diagnosis of massive LDH on their initial magnetic resonance imaging (MRI) and opt for non-operative treatment. Seventeen patients with a diagnosis of massive LDH with an average follow-up of 209 days (0 to 1,005 days) were reviewed. RESULTS: One patient was listed for surgery due to persisting radicular pain only. However, they were deemed unfit for surgery and this was therefore cancelled. One patient developed impending cauda equina syndrome and underwent urgent discectomy with no complications. All remaining patients were managed safely non-operatively with no complications. CONCLUSIONS: We conclude that the massive LDH can be safely managed non-operatively, providing patients are examined for cauda equina syndrome and are fully educated on the need to represent urgently should red-flag symptoms develop.