Woodend Hospital

The use of reverse shoulder arthroplasty (RSA) for proximal humeral fractures (PHFx) has expanded in recent decades. However, data on functional outcomes post-RSA for PHFx remain limited. This single-centre observational cohort study aimed to evaluate functional outcomes in patients undergoing RSA for PHFx using a single fracture specific design of RSA.Forty-six patients who underwent RSA using a Mathys Fracture Inverse prosthesis for acute complex three and four-part PHFx and fracture dislocations from 2014 to 2023 were prospectively reviewed. Procedures were performed by four fellowship trained shoulder surgeons. Patients were assessed independently at a minimum of one-year post-op. Outcome measures included time to functional recovery, range of motion (ROM) and patient reported outcome measures using the Oxford Shoulder Score (OSS).Five males and forty-one females were included, averaging 71.4 years of age (range: 59–85 years). The mean follow-up duration was 50.6 months (range: 16–118 months). All patients regained independent self-care, and all previous drivers returned to driving. Objective ROM showed mean values for flexion, abduction, and external rotation of 134□, 121□, and 29□, respectively. The mean OSS was 43.6/48. Patient satisfaction averaged 4.7/5, with 93% of patients reporting being satisfied or very satisfied. Three patients (6.5%) experienced complications comprising one case of radial nerve neuropraxia, and 2 (4.4%) re-operations; 1 washout for infection and 1 two-stage revision.In this study, RSA for acute PHFx or fracture-dislocation using a fracture specific prosthesis was associated with high rates of return to independence, high satisfaction scores and favorable patient reported outcome measures.

The rising prevalence of osteoarthritis, associated with an ageing population, is expected to deliver increasing demand for arthroplasty services in the future. Understanding the scale of potential change is essential to ensure adequate provision of services and prevent prolonged waiting times that can cause patient harm. We set out to provide projections of future primary knee and hip arthroplasty out to 2038 utilising historical trend data (2008-2018) from the Scottish Arthroplasty Project. All analyses were performed using the Holt's exponential smoothing projection method with the forecast package in R statistics. Results were adjusted for projected future population estimates provided by National Records of Scotland. Independent age group predictions were also performed. The predicted rise of primary hip arthroplasty for all ages is from 120/100k/year in 2018 to 152/100k/year in 2038, a 28% increase. The predicted rise of primary knee arthroplasty for all ages is from 164/100k/year in 2018 to 220/100k/year in 2038, a 34% increase. Based on a static 3-day length of stay average this would see 4280 and 7392 additional patient bed days required for primary hip and knee arthroplasty patients respectively per annum. The associated additional cost is anticipated to be approximately £26 million. Anticipated future demand for arthroplasty will require significant additional resource and funding to prevent deterioration in quality of care and an increase in patient wait times, additional to that already required to clear the COVID-19 backlog. Understanding presented projections of changes to arthroplasty demand is key to future service delivery.

Ankle arthrodesis (AA) has traditionally been the surgical standard for patients with an end-stage ankle osteoarthritis, with total ankle arthroplasty (TAA) recently becoming an alternative. The aim of this study was to update evidence in terms of functional outcomes, complications, and quality of life between AA and TAA by analyzing comparative studies. PubMed, MEDLINE, Scopus, and Cochrane Central databases were used to search keywords. A total of 21 studies entered our qualitative and quantitative analysis. Demographics, functional outcomes, and complications were extracted. Random and fixed-effect models were used for the meta-analysis of standardized mean differences (SMDs) and odds ratios (ORs). A total of 18,448 patients were identified, with a mean age of 57.3 ± 11.3years. TAA showed significantly greater post-operative range of motion (SMD - 0.883, 95% CI - 1.175 to - 0.590; I2 < 0.001) and Ankle Osteoarthritis Scale scores (SMD - 1.648, 95% CI - 3.177 to - 0.118; I2 = 97.67), but no differences in other patient-reported outcome scores were found. Patients undergoing TAA showed higher post-operative SF-36 (SMD - 0.960, 95% CI - 1.584 to - 0.336; I2 = 68.77). The total complication rate was similar between the two procedures (OR 0.936, 95% CI 0.826 to 1.060; I2 = 87.44), including the incidence of re-operations (OR 1.720, 95% CI 0.892 to 3.316; I2 = 77.65). While TAA and AA showed no differences in most post-operative functional outcomes, our review demonstrates that patients undergoing TAA show better health-related quality of life than AA. We found no evidence to suggest that TAA carries a higher risk of complications and re-operations compared to AA.

Treatment of a large chronic prepatellar bursitis can be difficult to manage surgically because of a high rate of local complications and a significant chance of recurrence. We present a 2-stage technique using negative pressure dressings which produced a good outcome with no recurrence at one year after surgery.

Optimal surgical treatment of lateral epicondylitis remains uncertain. Recently, radiofrequency microtenotomy (RFMT) has been proposed as a suitable treatment. We compared RFMT with standard open release (OR) in this prospective randomized controlled trial. In total, 41 patients with symptoms for at least 6 months were randomized into two groups: 23 patients had RFMT and 18 had OR. Two patients from RFMT withdrew. Each patient underwent Numerical Rating Scale (NRS) pain score, grip strength and Disabilities of the Arm, Shoulder and Hand (DASH) scores pre-operatively and at 6 weeks. Pain and DASH scores were repeated at 6 months and 12 months. NRS pain scores improved by 4.8 points for RFMT and by 3.9 points for OR. There was a significant improvement in both groups from pre-operative scores, although there was no statistically significant difference between the groups at 1 year. Grip strength improved by 31% in the RFMT group compared to 38% in OR. There was no significant difference between the initial and 6 weeks scores or between treatments. At 1 year, DASH was 39.8 points for RFMT and 24.4 points for OR. There was a significant improvement in both groups from pre-operative scores, although there was no statistically significant difference between the groups at 1 year. Both groups showed significant improvements and similar benefit to the patient. The results of the present study do not show any benefit of RFMT over the standard OR. As a result of the extra expense of RFMT, we therefore recommend that OR is offered as the standard surgical management.

Osteoarthritis of the finger proximal interphalangeal joints (PIPJ's) is common and severely limits hand function. Intra-articular steroid injections are frequently used, but there is little research assessing this treatment option. This was a prospective audit of patients undergoing intra-articular steroid injections into the PIPJ under image intensifier guidance. The aims were to assess the duration of pain relief, hand function and range of movement following this procedure. Fifty injected joints were followed up at six weeks, three and six months. There were significant improvements in both pain scores and the range of movement for up to three months. Analgesia requirements decreased and hand function improved up to three months. By six months, patients were approaching their preinjection scores. X-ray guided injections are a simple procedure which can be effectively performed in the out- patient setting, resulting in satisfied patients with improved hand function and pain scores.

BackgroundFalls are common events in older people, which cause considerable morbidity and mortality. Non-pharmacological interventions are an important approach to prevent falls. There are a large number of systematic reviews of non-pharmacological interventions, whose evidence needs to be synthesized in order to facilitate evidence-based clinical decision making.ObjectivesTo systematically examine reviews and meta-analyses that evaluated non-pharmacological interventions to prevent falls in older adults in the community, care facilities and hospitals.MethodsWe searched the electronic databases Pubmed, the Cochrane Database of Systematic Reviews, EMBASE, CINAHL, PsycINFO, PEDRO and TRIP from January 2009 to March 2015, for systematic reviews that included at least one comparative study, evaluating any non-pharmacological intervention, to prevent falls amongst older adults. The quality of the reviews was assessed using AMSTAR and ProFaNE taxonomy was used to organize the interventions.ResultsFifty-nine systematic reviews were identified which consisted of single, multiple and multifactorial non-pharmacological interventions to prevent falls in older people. The most frequent ProFaNE defined interventions were exercises either alone or combined with other interventions, followed by environment/assistive technology interventions comprising environmental modifications, assistive and protective aids, staff education and vision assessment/correction. Knowledge was the third principle class of interventions as patient education. Exercise and multifactorial interventions were the most effective treatments to reduce falls in older adults, although not all types of exercise were equally effective in all subjects and in all settings. Effective exercise programs combined balance and strength training. Reviews with a higher AMSTAR score were more likely to contain more primary studies, to be updated and to perform meta-analysis.ConclusionsThe aim of this overview of reviews of non-pharmacological interventions to prevent falls in older people in different settings, is to support clinicians and other healthcare workers with clinical decision-making by providing a comprehensive perspective of findings.