Colchester Hospital

BackgroundOne of the most common causes of total hip Arthroplasty (THA) failures is instability and dislocation of the implant. Dual Mobility (DM) Liners were developed to help mitigate this risk.Aim of the studyThis study aims to study the functional at subjective results of Dual mobility THA performed for various purposes at a tertiary centre hospital in Mumbai, with a minimum post-operative period of five years.MethodologyThe study was conducted as a retrospective study in a tertiary health care hospital in a metropolitan city over a period of one year. Patients were examined clinically, and questions were asked to calculate the Harris hip score and Oxford hip score. Fresh plain radiographs were taken and evaluated. The mid-term post-operative results were analysed. We recruited 60 participants with a mean age of 65.77 years with SD 10.13, and the age range was between 35-88; and 53.3% of them (n = 28) were female.ResultsThe range of post-operative period at the time of participant recruitment was 5-8 years, with a mean of 6.15 ± 0.77. Out of the total 60 patients, we observed complications in only four patients, which included persistent thigh pain in the post-op period (n=2), heterotrophic calcification in the post-op period (n=1), and revision THR at six years post-operatively (n=1). We also observed that only one participant developed aseptic loosening of the hip postoperatively.The clinical outcomes and observed the mean Harris’ hip score to be 87.38 ± 4.41 in our population, and the mean Oxford hip score in our population was 37.35 ± 4.60. The observed mean score for Moore’s criteria for osteointegration was 3.10 ± 0.47. Most of the participants reported their post-operative condition to be excellent (60%), while 22% reported it to be good and 10% reported it to be fair.ImplicationsA statistically significant association between the clinical outcomes and the subjective outcomes, indicating that participants who had better Harris’ Hip scores and Oxford hip scores were more likely to subjectively feel their post-operative condition to be better. A statistically significant association between the radiological outcomes and the subjective outcomes, indicating that participants who had better Moore’s criteria for osteointegration were more likely to subjectively feel their post-operative condition to be better. No statistically significant association between age and the Harris hip score and Oxford hip scores, indicating that the clinical outcomes were similar across all age groups. However, we observed a statistically significant difference between age and Moore’s criteria for osteointegration, indicating that the radiological outcomes were worse with advancing age.

Electric bicycles (e-bikes) and electric scooters (e-scooters) have been rapidly adopted in urban environments in the United Kingdom and various Western countries. This has introduced a new mechanism of injury in these environments. Whilst the initial research studies focused on head injuries, upper limb injuries and overall epidemiology, the specific patterns regarding lower limb orthopaedic injuries, especially ankle fractures, are not well defined.This systematic review aims to characterise ankle fracture patterns due to e-bike and e-scooter use and assess whether the incidence and severity have worsened since adopting these devices. We performed a systematic literature review in PubMed for articles published between 2015 and 2025. This timeframe was selected as micromobility adoption was uncommon prior to 2015. Our initial search yielded 83 studies; after screening and eligibility assessment, 11 studies were included for final analysis. From the studies, we were able to identify that there was a distinct injury pattern associated with e-scooters, i.e., isolated ankle rotational fractures from low-energy falls. Data from UK Government sources initially indicated that e-scooter users primarily experienced low-energy injuries, while e-bike users, although reported less frequently, seemed to suffer more high-energy fracture patterns due to higher speeds. However, recent data suggest that the frequency and severity of injuries from e-scooter accidents are increasing, with more cases exhibiting high-energy mechanisms. UK-specific data, though limited, align with global trends, indicating a significant and growing burden on Emergency Departments and Orthopaedic services, with a notable proportion of injuries requiring operative intervention. In comparative studies, e-bike crashes were less frequently linked to ankle fractures. All data indicate a sharp rise in overall micromobility injuries over recent years.Ankle fractures from electric micro-mobility devices represent a significant and evolving public health issue. While consistent with international findings, the current evidence from the UK is insufficient. There is a pressing need for prospective, multicentre studies and national registry data to define these injury patterns better and inform targeted public safety measures and orthopaedic preparedness.

Purpose: To highlight the burden of surgical site complications (SSCs) across inpatients who have recently undergone orthopedic surgery by undertaking surgical site infection (SSI) prevalence days. Patients and Methods: Sites from the United Kingdom and Ireland enrolled in a single day's data collection (either March or September 2022) to capture inpatient prevalence of SSIs and other SSCs. Data were collected from patients recovering from primary and revision hip or knee surgery and neck of femur (NOF) fracture surgery. Results: Data were collected on 851 inpatients across the two days, with NOF fracture surgery representing 50% of overall procedures, followed by primary hip (25.4%) and primary knee (12.8%) procedures, with 11.9% of patients in the hospital following revision procedures. The majority of patients documented across both days had at least one risk factor (76% overall). The overall prevalence of SSCs was 8% (n = 68). Revision surgical procedures had significantly higher complication rates than primary surgical procedures in both hips and knees (p < 0.01). The highest observed odds ratios (ORs) for SSCs were in patients who listed immunosuppression (OR = 2.47), previous SSI (OR = 4.59), and smoking (OR = 2.34) among their risk factors. Higher overall lengths of stay were observed in patients with complications. Conclusion: These prevalence days were a successful initiative to help hospital sites understand their own burden, benchmark against national averages, and contribute to a better national understanding of the burden of SSC, both to healthcare systems and, most importantly, patients.

The treatment for an acute Periprosthetic Joint Infection (PJI) is historically described using the acronym DAIR (Debridement, Antibiotics, Implant Retention). However, this acronym, by intention, does not imply that the modular parts of an implant system are always exchanged. There are many circumstances where modular exchange is not possible. It is well known that DAIR procedures with modular exchange show improved results. To reduce heterogeneity in the published literature, we introduce the supplementary acronym DECRA (Debridement, Modular Exchange, Component Retention, Antibiotics) for the treatment of acute PJI. The DECRA acronym will identify studies where modular exchange is always performed and will be separate from DAIR, where modular exchange is not performed or is unclarified. This will reduce heterogeneity and provide fidelity in research analysis. Moving forward, we advocate that the orthopaedic community, reviewers, and journal editors mindfully reflect this distinction in publications.

<h3>Background</h3> Maintenance of SR (sinus rhythm) after ECV (electrical cardioversion) for AF remains challenging. Studies have shown that patients with impaired left ventricular (LV) function have poorer chances of SR maintenance post ECV. Better understanding of the role certain HF therapies play in patients with impaired LV function undergoing ECV is vital to enable better allocation of resources and provision of a more integrated community cardiology service, from which these patients can gain from. <h3>Methods</h3> A single centre retrospective study was conducted at a district hospital to assess outcomes of patients with persistent AF/A.Flutter undergoing elective ECV, with varying degrees of LV dysfunction. LV dysfunction was categorised based on the EF (Ejection fraction %) from the most recent pre-procedural TTE (trans-thoracic echocardiogram) and clinical records. Patients aged ≥18years, with persistent AF/A.flutter, with recent pre-procedural TTE, who underwent an ECV (January 2019-January 2024) and were followed up 6–8 weeks post ECV (with an ECG to assess whether SR was maintained) were included. <h3>Results</h3> Of 176 patients who underwent an ECV during the study period, 50 had EF&lt;40% and 38 had an EF ≥40%-&lt;50%.The proportion who were under HF nurse follow up was 58% and 18.4% respectively. The association between regular community HF nurse follow-up and maintenance of SR post ECV was not significant in each heart failure cohort {EF&lt;40% :Fisher’s exact test p=0.139,χ² p=0.79} {EF ≥40% &lt;50% : Fisher’s exact test p= 0.203, χ² p= 0.099}. However this association was significant in the cohort of patients with prior diagnosis of ‘CCF’ on clinical records {n= 24,Binary logistic regression p=0.009, Fishers exact test p=0.011,χ² p= 0.005}. Additionally, in patients with EF&lt;40% and EF&lt;50%, there was a significant association between them being on HF prognostic medications and chances of SR maintenance post ECV { χ²p&lt;0.001 and 0.038}. Regarding specific HF prognostic medications, MRA (mineralocorticoid receptor antagonist) use was significantly associated with increased chances of SR maintenance in both cohorts {Binary logistic regression p=0.005 and 0.026}, whereas use of Beta blockers, ACE-I (Angiotensin-converting enzyme inhibitors), Sodium-glucose co-transporter-2 (SGLT2) inhibitors, Sacubitril/valsartan in either cohort of patients was not. <h3>Conclusion</h3> Despite a relatively modest sample size, our findings suggest patients with appropriately managed HF have improved chances of SR maintenance than patients with poorly managed HF. Further similar studies with a larger cohort are recommended to reaffirm our findings. Our results can be applied in the community to ensure these patients are provided more regular community HF nurse follow up, allowing optimisation of their HF prognostic medication and augment their HF status. This has the potential to reduce the burden of repeat ECV procedures, and tertiary care referrals for AF ablation.

Case Series A 53-year-old patient presented with severe chemical injury.During the post-operative period developed severe corneal scarring and melt requiring limbal transplant (SLET) and subsequent Femtosecond PKP.

89 Background: Darolutamide has authorisation for treatment of metastatic hormone sensitive prostate cancer (MHSPC) in combination with docetaxel chemotherapy and androgen deprivation therapy (triplet therapy) based on ARASENS trial results. The RECOMMEND study is a prospective real-world evaluation (RWE) of clinical outcomes in patients with MHSPC treated with this regimen in the UK. Methods: 318 patients were enrolled from 21 UK centres over 20 months from November 2022. Data cut-off was 14 August 2024. Disease characteristics were evaluated. Descriptive statistics have been used for patient demographics and PSA changes with treatment were analysed. Results: Patients on the study had a median age of 67 (range 38-84) years. Majority of the patients were de novo metastatic (91.2%). 68.2% have a Gleason score ≥8. 76 patients (23.9%) had next generation imaging (NGI) at diagnosis. Performance score was 0 (62.7%) or 1 (37.3%). The distribution of metastases (%) were: bone (84.9), nodal (60.4), lung (12.6) and liver (2.5). The median PSA level was 134 (range 1 to 5628) ng/mL at diagnosis. At the end of docetaxel chemotherapy median PSA was 0.35 ng/mL. PSA response see in the 226 patients who had completed 6 cycles of docetaxel chemotherapy at the data cut-off, PSA 50 was seen in 87.6% (198/226) and PSA 90 in 53.2%. PSA responses in those who only completed 4/5 cycles of docetaxel (n=14) did not significantly differ compared to those who completed all 6 cycles (PSA 50 p=0.445 and PSA 90 p-0.664). At 6 months from darolutamide initiation, quality of life (QoL) data is currently available for 173 patients, of these 88.4% reported either stable or improved QoL and 11.6% had a decline in QoL at the end of chemotherapy. Conclusions: The tolerability and efficacy profile of treatment with ADT+Darolutamide+Docetaxel in MHSPC in the RECOmMEnD study is similar to that reported in the ARASENS trial. The QoL data available for 173 patients to date reports either stable or improved QoL at 6 months for 88.4% cases. This provides important prospective RWE data, enabling patients and clinical teams to make informed choices in this setting.