Top Three Healthcare Trends in Orthopaedics Affecting Musculoskeletal Care in the Elderly.

Several trends toward patient-centered multi-care models employing translational research strategies are currently emerging in orthopaedics. These align seamlessly with epigenetics discussions in pain, a clinical approach to pain management that prioritizes tailoring healthcare to individual needs, preferences, and circumstances. Recognizing the unique genetic and epigenetic factors influencing pain perception, healthcare providers can integrate personalized insights into their patient-centered approach, offering more targeted and effective pain management strategies tailored to each individual's experience. Custom 3D-printing technologies may also become increasingly relevant to more effectively and reliably treat painful degenerative structural abnormalities. They are expected to go hand-in-hand with the precision medicine redefinition of musculoskeletal care. More effective analysis of surgeons' clinical decision-making and patients' perception of high-value orthopaedic care is needed. Shared Decision Making (SDM) is critical to identifying the best solution for each patient and improving stakeholders' understanding of factors influencing the diverse prioritizing values of surgical or non-surgical treatments by payers, systems, and other providers. Identifying high-value orthopaedic surgeries via effective SDM in orthopedic surgery requires more than just presenting patients with information. The Rasch analysis of patient expectations can provide this nuanced approach that involves understanding patient values, addressing misconceptions, and aligning surgical recommendations with patient-specific goals. Optimizing orthopaedic treatment within the patient-centered framework can drive innovation in reimbursement policies that support the field more broadly. Research on separating high-value from low-value orthopaedic procedures may likely impact healthcare decision- makers' resource allocation.

Psychosocial Factors, Sleep, and Central Pain Processing for Making a Prognosis About Recovery of Pain, Function, and Quality of Life After Rotator Cuff Repair: An Exploratory Longitudinal Study.

OBJECTIVE: To explore modifiable psychosocial factors, sleep-related variables, indices of central pain processing and patients' characteristics as potential prognostic factors for pain, shoulder function, and quality of life (QoL) 1 year after rotator cuff repair. DESIGN: This observational longitudinal study included 142 patients who were undergoing rotator cuff repair. All measures took place pre-rotator cuff repair (T0), and 12 weeks (T1) and 12 months (T2) after rotator cuff repair. METHODS: Mixed-effects linear regression modeled relationships between the Western Ontario Rotator Cuff Index (WORC, model A), the Subjective Shoulder Value (SSV, model B), and EuroQol's EQ-5D-5L for QoL (model C), and potential prognostic factors over time. Factors included psychosocial variables, sleep-related indices, and proxies of central pain processing. Patients' age, sex, and body mass index complemented the analyses. RESULTS: At follow-up (T2), data from 124 participants were available for analysis. Five prognostic factors were identified for the 1-year outcome. Better expectations for symptom reduction (P<.0001, -1.4 mm) and an increase in Douleur Neuropathique 4 score (P = .0481, -0.9 mm) affected the evolution of WORC over time (model A). An increase in injury perception subscale consequence (P = .0035, 0.04%) influenced the SSV trajectory (model B). In addition, when sleep quality (P = .0011, -0.13%) and sleep efficiency (P = .0002, 0.005%) improved, the EQ-5D-5L slope was affected (model C). CONCLUSION: Addressing cognitions, pain mechanisms and sleep behavior prior to rotator cuff repair can identify people who are at risk of a poor outcome after surgery. J Orthop Sports Phys Ther 2024;54(8):530-540. Epub 4 July 2024. doi:10.2519/jospt.2024.12398.

Serum IL-6 as a Surrogate Biomarker of Post-operative Complications in Invasive Orthopaedic Surgeries: A Prospective Observational Study.

Background: Interleukin-6 (IL-6) is a cytokine released in response to tissue injury. Elevated serum IL-6 levels in trauma patients have been linked with increased risk of complications such as inapparent hypoxia (SpO2 < 94%), acute respiratory distress syndrome, fat embolism syndrome (FES), systemic inflammatory response syndrome, multiple organ dysfunction syndrome and sepsis. This study aims to determine the role of serum IL-6 as surrogate biomarker of post-operative complications after invasive orthopaedic surgeries. Methods: Thirty-seven adults between 18 and 65 years of age undergoing invasive orthopaedic surgeries were included in this hospital-based study. Serum IL-6 levels were estimated serially in the pre-operative period, after 24 h and 7 days post-operatively. Cases were monitored for post-operative complications. Results: Serum IL-6 levels showed maximum rise in the first 24 h post-operatively especially among older patients (> 60 years). Older patients undergoing bipolar hemiarthroplasty for neck of femur fracture showed highest median post-operative IL-6 level of 258 pg/ml. Serum IL-6 level > 130 pg/ml measured 24 h after surgery was predictive of post-operative complications (sensitivity of 75%). Among the cases with post-operative complications, inapparent hypoxia was the most common complication/event observed. Cases with sub-clinical FES had highest level of serum IL-6 in first 24 h following surgery with median IL-6 level of 300 pg/ml (range 155-444 pg/ml). Conclusion: Monitoring serum IL-6 level may help in both anticipation and early detection of post-operative complications in patients undergoing invasive orthopaedic surgeries; potentially enhancing patient safety.

Single Position Prone Lateral Lumbar Interbody Fusion: A Review of the Current Literature.

PURPOSE OF REVIEW: Spinal fusion, vital for treating various spinal disorders, has evolved since the introduction of the minimally invasive Lateral Lumbar Interbody Fusion (LLIF) by Pimenta in 2001. Traditionally performed in the lateral decubitus position, LLIF faces challenges such as intraoperative repositioning, neurological complications, and lack of access to lower lumbar levels. These challenges lead to long surgery times, increased rates of perioperative complications, and increased costs. The more recently popularized prone lateral approach mitigates these issues primarily by eliminating patient repositioning, thereby enhancing surgical efficiency, and reducing operative times. This review examines the progression of spinal fusion techniques, focusing on the advantages and recent findings of the prone lateral approach compared to the traditional LLIF. RECENT FINDINGS: The prone lateral approach has shown improved patient outcomes, including lower blood loss and shorter hospital stays, and has been validated by multiple studies for its safety and efficacy compared to the LLIF approach. Significant enhancements in postoperative metrics, such as the Oswestry Disability Index, Visual Analog Scale, and radiological improvements have been noted. Comparatively, the prone lateral approach offers superior segmental lordosis correction and potentially better subjective outcomes than the lateral decubitus position. Despite these advances, both techniques present similar risks of neurological complications. Overall, the prone lateral approach has emerged as a promising alternative in lumbar interbody fusion, combining efficiency, safety, and improved clinical outcomes.

A Survey of the Estimated Cost of Surgical Consumable Items Within Trauma and Orthopaedic Departments.

Introduction The impact of the current economic and environmental climate, both nationally and globally, is further straining the NHS. This has led to scrutiny of high-expenditure areas, including consumables. Clinician's knowledge surrounding health economics is sparse, and we conducted this survey to assess cost-awareness within the Trauma and Orthopaedic (T&O) departmental staff. Methods A questionnaire was digitally distributed to T&O staff in the East Kent Hospitals Trust. This included demographic data and to make estimations of the cost of 10 specialty-specific items. The data were analysed to determine the average, median, and interquartile range (IQR) of the estimated prices and compared to the actual costs. Results Approximately 7.1% of all item estimates were deemed 'correct'. No correlation was seen between years of staff experience and the accuracy of estimates. 'Kenalog 1 mL ampoule' (Kenalog, Bristol-Myers Squibb, NJ) had the highest accuracy of estimation across all responses (13%), whilst both 'kirschner wires' and '3.2 drill bit' had the lowest accuracy (4% each). The median estimated cost was closest to the actual cost for 'cement pack' (median estimate/actual cost = 0.9). The median estimated cost was furthest from the actual cost for 'tourniquet cuffs' (median estimate/actual cost = 0.16). 'Velcro wrist splint' was the item that was the most overestimated (median estimate/actual cost = 1.57), with only two of the 10 items being overestimated ('velcro wrist splint' and 'dynamic hip screw and plate'). The most underestimated item was 'tourniquet cuffs' (median estimate/actual cost = 0.16). Conclusions There is a paucity of knowledge surrounding the cost of specialist T&O consumables. The limitations included the sample size (98 respondents) and geographical area (East Kent Hospitals Trust). This study shows that there is a need for further research into this topic, with long-term outcomes, which may be beneficial both economically and environmentally.

Quality of life of survivors following road traffic orthopaedic injuries in Rwanda.

Background: Road traffic injuries (RTI) pose a global public health threat, especially in low- and middle-income nations. These injuries typically cause orthopaedic problems that may negatively impair a person's physical and mental health and quality of life. Our study examined the quality of life of road traffic orthopaedic injuries (RTOI) survivors. Methods: A cross-sectional study at five Rwandan referral hospitals, included 369 adult RTOI victims. Two years post-injury, participants completed the European Quality of life 5 Dimension 5 (EQ-5D-5L) and Visual Analogue Scale (VAS) Questionnaire between June 2 and August 31, 2022, with informed consent. Three EQ-5D-5L-VAS scores were used: low (0-40%), fair (41-60%), and excellent (61-100%). We used logistic regression analysis with a significance threshold of p < 0.05 to determine odds ratios (OR) and 95% CI. Results: The RTOI victims had a mean age of 37.5 ± 11.26 years with sex ratio M:F:3:1. Usual activities (66.8%) and mobility (54.8%) were the most affected EQ-5D-5L dimensions. Residence, hospital stay, rehabilitation, and return to work affected mobility, usual activities, pain/discomfort, and anxiety/depression. The EQ-5D-5L/VAS score showed 34.95% poor QoL (0-40%) and 35.50% good QoL. Factors affecting QoL include level of education (OR = 1.66, p < <0.01), type of intervention (OR = 1.22, p = 0.003), rehabilitation (OR = 2.41, p < 0.01) and level of disability (OR = 196.41, p < 0.01). Mobility, self-care, usual activities, pain, comfort, anxiety, and depression vary moderately on Shannon's index. Conclusion: The study highlights the significant impact of road traffic orthopaedic injuries (RTOI) on survivors' quality of life in Rwanda, revealing challenges in mobility and daily activities. Factors influencing quality of life include education level, medical intervention type, rehabilitation, and disability degree. The findings emphasize the need for tailored rehabilitation strategies and policy interventions to improve long-term outcomes for RTOI survivors.

Acute Compression of the Anterior Interosseous Nerve After a Proximal Both-Bone Forearm Fracture: A Case Report.

Anterior interosseous nerve (AIN) syndrome is a rare condition characterized by isolated weakness in the flexor pollicis longus (FPL) muscle, sometimes accompanied by weakness in the index flexor digitorum profundus (FDP) muscle. In this clinical case report, an 18-year-old male presented with a right proximal both-bone forearm fracture that was sustained while playing soccer, with subsequent development of AIN palsy, without sensory deficits or progressive pain. Preoperative imaging was performed, showing a proximal third radius and mid-shaft ulna fracture. Given the progressive presentation of an acute AIN palsy, the patient was indicated for urgent operative intervention. During exploration and decompression of the AIN within the pronator tunnel, the nerve was found to be in continuity but was compressed by a large hematoma and the distal radial shaft. The patient recovered full median nerve function by his six-week postoperative examination and by his final follow-up recovered full range of motion with painless return to full activities. In proximal or mid-shaft both-bone forearm fractures, a careful neurovascular exam is essential, as uncommon conditions like anterior interosseous syndrome (AIS) can present without obvious sensory deficits or pain. Potential etiology for traumatic AIN compression includes significant fracture displacement, soft tissue injury, active extravasation on advanced imaging, and/or clinical concern for compressive hematoma. Patients presenting with FPL and/or index FDP weakness in the absence of sensory deficits or pain on passive stretch may benefit from dedicated surgical exploration and decompression of the AIN to prevent irreversible nerve damage.

Secondary Linburg-Comstock syndrome post-trapeziectomy surgery.

Linburg-Comstock syndrome is an acquired symptomatic restrictive thumb index finger flexor tenosynovitis involving a hypertrophic tenosynovium between flexor pollicis longus and flexor digitorum profundus. Patients may report synkinetic movement of the thumb and index finger, pain and swelling. We present the case of a woman in her 80s who presented with painless Linburg-Comstock syndrome after a trapeziectomy 4 months earlier for trapeziometacarpal arthritis. A literature review of PubMed-indexed case reports found that Linburg-Comstock syndrome has never been described in a post-trapeziectomy patient. This unusual presentation that arose as a side effect of hand surgery remains unreported in the literature. We present this unique complication as the first such case in the world. This case report is a valuable addition to the existing knowledge on the complications of trapeziectomy surgery.

Emergency department encounters and opioid prescribing following orthopaedic trauma among Black and White patients with substance use disorders.

INTRODUCTION: Patients living with substance use disorder (SUD) have complex pain management needs, which may be mismanaged during hospital admission. Ineffectively managed pain following orthopaedic trauma, influenced by clinician biases related to race or SUD diagnosis, may subject patients to worse pain outcomes and subsequent emergency department (ED) encounters. This study examined ED encounters and opioid prescribing for pain-related complaints following orthopaedic trauma, among patients with SUD who identify as Black or African American relative to White patients. METHODS: This retrospective analysis included 1089 patients with a SUD diagnosis discharged from a Level I trauma center, following hospitalization for orthopaedic injuries, between 2016 and 2021. Multivariable regressions assessed the associations among race, opioid prescribing, and ED encounters within 90 days for pain-related care. RESULTS: Among the 1089 patients included in the sample, the proportion of individuals with an ED encounter within 90 days for pain-related care was 12.4 % and 4.5 % for Black and White patients, respectively (odds ratio [OR] = 3.0, p < .001). When adjusting for injury severity and demographics, the difference in ED encounters between Black and White patients remained significant (OR = 2.8, p = .002). Opioid prescription doses did not statistically differ by race. CONCLUSIONS: The difference in ED encounters between Black and White patients with SUDs following orthopaedic trauma may indicate a need to optimize pain management prior to initial discharge and improve post-injury care.

Multidisciplinary management of orthopaedic trauma - are we adhering to the guidelines?

INTRODUCTION: A multidisciplinary team (MDT) approach to polytrauma patients minimises morbidity and mortality. This project assesses the extent to which British Orthopaedic Association Standards for Trauma guidelines for the management of the frail Orthopaedic patient are currently being met. METHODS: A retrospective analysis was performed of all Trauma and Orthopaedic patients in multiple medical institutions over a 2-week capture period from 1 March 2022 until 14 March 2022 inclusive. Data collected included age, sex, injury, length of stay and dates of speciality input. RESULTS: A total of 1,050 patients were included from 27 hospitals. The median age was 80 years, with 560 (53.3%) of all fractures being neck of femur fractures. Of the 1,050 patients, 870 (82.9%) were managed operatively. The median number of different speciality involvements was 3; 645 (61.4%) had an orthogeriatric (OG) review. In major trauma centres (MTC), 93.3% had OG input, compared with 66.3% in non-MTC. The speciality with the greatest input was Radiology, with Plastics having the lowest input. CONCLUSION: A standardised MDT approach is needed to optimise care and recovery in orthopaedic trauma patients. The difference in results regarding speciality involvement is substantial and needs to be addressed to minimise disparities in care received by this vulnerable cohort of patients.

Control of Haemorrhage in Orthopaedic Trauma.

This paper aims to outline current practices and examine promising new advancements in the modern management of haemorrhage in orthopaedic trauma. Many prehospital and perioperative haemorrhage control strategies and techniques have been available to clinicians for multiple decades, yet our understanding and utilisation of these practices continues to be refined and optimised. There is a particular focus in this article on issues related to resuscitation and coagulation in trauma. We examine the complex mechanisms that lead to coagulopathy in trauma patients as well as the transformative effect tranexamic acid has had in limiting blood loss. We also explore some emerging technologies such as endovascular interventions and clot-stabilising dressings and devices that are likely to have a significant impact going forward.

Extended Release of Bupivacaine from Temperature-Responsive PNDJ Hydrogels Improves Postoperative Weight-Bearing in Rabbits Following Knee Surgery.

Effective treatment of postoperative pain lasting for multiple days without opioids is an important clinical need. We previously reported analgesia lasting up to 96 h in a porcine soft tissue model of postoperative pain using SBG004, an extended-release formulation of bupivacaine based on the temperature-responsive polymer poly(N-isopropylacrylamide-co-dimethylbutyrolactone acrylamide-co-Jeffamine M-1000 acrylamide) [PNDJ]. Orthopaedic surgical sites such as the knee can involve complex sensory innervation which presents a distinct challenge to local anesthetic delivery. The purpose of this work was to evaluate the pharmacokinetics and efficacy of SBG004 in an orthopaedic surgical model in comparison to currently available local anesthetics. Pharmacokinetics following periarticular (PA) or intraarticular (IA) injection of SBG004 were compared against liposomal bupivacaine (Lip-Bupi) PA in New Zealand White rabbits (all doses 14.5 mg/kg). Analgesic efficacy of SBG004 (IA, PA, or IA + PA), three active comparators, and saline was evaluated following knee surgery in New Zealand White rabbits. Analgesia was assessed via weight-bearing on the operated limb during spontaneous large steps in video recordings. Systemic bupivacaine exposure lasted at least 7 days for SBG004 PA, 4 days for SBG004 IA, and 2 days for Lip-Bupi PA. In the analgesia study, weight-bearing in all active groups except SBG004 IA was more frequent versus saline through 8 h postoperatively (p < 0.05). Only SBG004 IA + PA resulted in a higher proportion of weight-bearing rabbits at 24 h versus saline (6/7 versus 2/10, p = 0.015). Analysis of pooled data from 24-72 h showed significantly greater frequency of weight-bearing in rabbits receiving SBG004 IA + PA (71%) versus saline (37%), ropivacaine cocktail (41%), and Lip-Bupi PA (36%). The results indicate that the release profile from SBG004 PA or IA coincides reasonably with the time course of postoperative pain, and SBG004 may produce longer duration of analgesia than local anesthetics currently used in knee surgery, including during the period of 24-72 h recognized as a target for extended-release local anesthetics.

Unnecessary care in orthopaedic surgery.

Unnecessary care, where the potential for harm exceeds the potential for benefit, is widespread in medical care. Orthopaedic surgery is no exception. This has significant implications for patient safety and health care expenditure. This narrative review explores unnecessary care in orthopaedic surgery. There is wide geographic variation in orthopaedic surgical practice that cannot be explained by differences in local patient populations. Furthermore, many orthopaedic interventions lack adequate low-bias evidence to support their use. Quantifying the size of the problem is difficult, but the economic burden and morbidity associated with unnecessary care is likely to be significant. An evidence gap, evidence-practice gap, cognitive biases, and health system factors all contribute to unnecessary care in orthopaedic surgery. Unnecessary care is harming patients and incurring high costs. Solutions include increasing awareness of the problem, aligning financial incentives to high value care and away from low value care, and demanding low bias evidence where none exists.

A Perspective of Growth of Unicompartmental Knee Replacement in India - Registry Data and Global Trends.

Introduction: The purpose of this study is to analyze the trend of unicompartmental knee replacement (UKR) in India, based on the data obtained from the Indian joint registry, in comparison with the global trends. Materials and Methods: This study is a retrospective analysis of data from an Indian joint registry for cases performed between 2016 and 2021. A total of 1086 UKRs were identified and the following information was analyzed: demographic data, diagnosis leading to primary UKR, yearwise surgeon inclination toward UKR, implant preference, regions where UKR was preferred, and the effect of robotics in UKR. UKR registry data were compared with the registry data from the UK (NJR), Sweden (SKAR), Australia (AOJR), and the USA (AJRR). Results: One thousand eighty-six UKRs were included in the study: The vast majority of them (97%) were implanted due to primary osteoarthritis followed by deformity (2%), as in accordance with other registries. Since 2016, though very minimal, there has been a gradual increase in the numbers and the percentage of cases contributed by UKR, of all knee replacements with the maximum of 2.85% reported in 2019. The same has been observed in the global trends as well. Oxford knees (60%) are the most preferred implants followed by journey uni knee (20%) in India. The cities where more unicompartmental knee are performed are in the order of Mumbai (32.78%), Faridabad (9.39%), Pune (7.92%), and Hyderabad (6.35%). Surgeon preference for robotic assisted UKR is increasing, accounting for 34% of UKR in 2020, which is in coherence with AOJR. Conclusion: The percentage of knee replacements contributed by UKR is increasing globally and the same trend can be observed in India. Oxford phase III prosthesis are the most preferred UKR prosthesis. UKRs are mostly performed in selected pockets of India, with Mumbai almost contributing to one-third of all the cases. The use of robotics in UKR is increasing and is expected to give better results in the future.

Evaluation of the Early Administration of Tranexamic Acid in Geriatric Hip Fractures in the Emergency Department: A Retrospective Study.

Introduction Tranexamic acid (TXA) administration perioperatively has demonstrated efficacy in reducing postoperative drops in hemoglobin levels and the need for transfusions among patients with peritrochanteric hip fractures. This study aims to perform a retrospective analysis to assess the impact on hemoglobin levels by comparing patients with fragility hip fractures who received TXA in the ED, in addition to the standard perioperative TXA dose, with those who did not receive TXA in the ED. Methods This study retrospectively reviewed 64 patient records from May 2020 to May 2021 at a Level II trauma center that were classified into two groups: patients who received one gram (g) of TXA in the ED, within five hours of injury (new protocol), or patients who received no TXA in the ED (old protocol). The primary outcomes of the study were hemoglobin and adverse events. An independent t-test was performed on continuous variables. A chi-square test was used to analyze noncontinuous variables. Statistical Product and Service Solutions (SPSS, version 25; IBM SPSS Statistics for Windows, Armonk, NY) was used for analysis. Statistical significance was set at a p value < 0.05. Results We measured the difference between hemoglobin on the day of surgery or day zero and on arrival in the ED, which was not statistically significant between the two protocols (p value = 0.322). The difference between hemoglobin levels on postoperative day one and on arrival in the ED was also not statistically significant (p = 0.339). Adverse events were lower in the new protocol but not statistically significant between the two protocols (p = 0.178). Conclusion Our study showed improved outcomes in postoperative hemoglobin with early administration of TXA in the ED. This is demonstrated by continuous higher postoperative hemoglobin in the new protocol group without an increase in adverse events. While the data did not achieve statistical significance, we believe there is clinical benefit in the early administration of TXA in the ED, a finding that continues to be explored and supported in the literature.

Unlocking the Potential of Underutilized Technology: A New Paradigm for Resident Doctor Efficiency.

Background The precision of clinical documentation in trauma and orthopaedic surgery is pivotal, given its profound implications on patient care and medicolegal risks. This study assessed the impact of an autotext template intervention on the adherence of clinical documentation to the neurovascular assessment standards set by the National Institute for Health and Care Excellence (NICE) and the British Orthopaedic Association Standards for Trauma (BOAST). Methods Conducted at a single hospital, this observational study comprised two phases: a retrospective analysis of clinical documentation for 56 fracture patients (n=56) followed by the implementation of an autotext template and subsequent analysis of a new cohort of 57 patients (n=57). The intervention aimed to enhance documentation quality in line with NICE and BOAST guidelines. Results Initial findings revealed a prevalent use of the nonspecific term "NVI" (neurovascularly intact), with only 8.5% (n=5) of pre-intervention documents adhering to detailed motor function assessments and a mere 6.8% (n=4) recording limb colour. Post-intervention analysis showed a significant improvement, with 91.23% (n=52) of documents listing nerves (P < 0.001) and 96.49% (n=55) adhering to motor function documentation using the Medical Research Council (MRC) grading scale (P < 0.001). Despite these advancements, the study acknowledges potential limitations such as the Hawthorne effect and the ongoing challenge of staff rotations. Conclusion The autotext template intervention markedly enhanced the adherence to neurovascular assessment documentation standards, as evidenced by the substantial increases in detailed parameter reporting and supported by statistically significant P-values. This advancement highlights the necessity of equipping clinicians with practical tools to uphold high documentation standards amidst challenging clinical conditions. Future investigations should focus on the long-term sustainability of these improvements across varying medical staff cohorts.

Research Output inOrthopaedics and Sports Medicine from Nigeria and Africa - A Bibliometric Analysis.

Background: Nigeria has a relatively large scientific community that produces an adequate research output among African countries. Not many studies have analysed the research output in orthopaedics and sports medicine from Nigeria and Africa. Hence, we aimed to analyze the research output in orthopaedics and sports medicine from Nigeria and Africa. Methodology: We used the SCOPUS data from the Scimago Journal & Country Rank website. It allows us to draw various journal metrics for research. Results: Between 1996 and 2022, Nigerian research publications in orthopaedics and sports medicine had grown from 4 in 1996 to 39 in 2022 (a 10-fold growth) but overall is 62nd in the world representing 0.07% of publications in the period. In the same period, Africa published 8297 papers in orthopaedics and sports medicine representing only 1.24% of the global publications in this field. Conclusion: There is low research output in Orthopaedics and Sports Medicine from Nigeria and, the whole African continent. However, there has been a growth in the publications from Africa.

Weibull analysis of ceramics and related materials: A review.

It has been realized throughout the years that an ideal combination of high toughness, hardness and strength is required in many engineering applications that need load-bearing capabilities. Ceramics and related materials have significant constraints for structural and particular non-structural applications due to their low toughness and limited strength while having substantially superior hardness than typical metallic materials. For example, hydroxyapatite (HAp) has gained attention for applications in orthopaedic implants, dental materials, drug delivery, etc. Researchers have continued to strive to produce HAp materials with reliable properties within the acceptable Weibull modulus (m) for load bearing. The Weibull analysis (WA) is a statistical analysis adopted widely in reliability applications to detect failure periods. Researchers have confirmed it to be an effective technique to get results on the reliability of materials at a moderately low rate with assured reliability of the material or component. This review summarizes the WA and the steps in the Weibull method for its reliability analysis to predict the failure rate of ceramics like HAp and other related materials. Also, the applications of WA for these materials were reviewed. From the review, it was discovered that Weibull distribution is proven to confer to the feeblest-link concept. For brittle materials, it was revealed that the Weibull Modulus ranges from 2 to 40, and environment, production processes, and comparative factors are well-thought-out contributing factors for reliability. In addition, the confidence interval can be up to 95 %. The frequently used technique for reliability valuation is to syndicate the Weibull statistics. Also, a very narrow distribution is desirable to offer the expected likelihood. Furthermore, when paired with trials, Monte Carlo simulations prove to be a very helpful tool for forecasting the dependability of different estimate techniques and their optimization. Finally, if the equivalent m is anticipated to be high, it signifies that the material has a high degree of homogeneity of properties and high reliability. WA can find application in predicting the dependability and lifetime of materials, making it widely utilized in engineering and other disciplines. It is especially useful for analysing data in which the likelihood of failure per unit of time varies over time.