UHCW publication: Safety and feasibility evaluation of tourniquets for total knee replacement (SAFE-TKR): study protocol

Safety and feasibility evaluation of tourniquets for total knee replacement (SAFE-TKR): study protocol
Wall, Peter Dh; Ahmed, Imran; Metcalfe, Andrew; Price, Andrew J; Seers, Kate; et al. BMJ Open Vol. 8, Iss. 4,  (April 10, 2018): e022067.

This study is designed to determine whether a full randomised controlled trial (RCT) examining the clinical effectiveness and safety of total knee replacement surgery with or without a tourniquet is warranted and feasible.


Get full text at http://bmjopen.bmj.com/content/8/4/e022067

Blue Book on the Management of Distal Radial Fractures

British Society for Surgery of the Hand publishes its Blue Book on the Management of Distal Radial Fractures


UHCW Consultant Orthopaedic Surgeon Helen Hedley and Electronic Systems & Resources Librarian Helga Perry contributed to this publication.


Obtain the full document at: http://www.bssh.ac.uk/_userfiles/pages/files/professionals/Radius/Blue%20Book%20DRF%20Final%20Document.pdf

UHCW publication: Prevalence of cam hip shape morphology: a systematic review.

Prevalence of cam hip shape morphology: a systematic review.
Osteoarthritis Cartilage. 2016 Jun;24(6):949-61
Dickenson E, Wall PD, Robinson B, Fernandez M, Parsons H, Buchbinder R, Griffin DR


ABSTRACT
OBJECTIVE: Cam hip shape morphology is a recognised cause of femoroacetabular impingement (FAI) and is associated with hip osteoarthritis. Our aim was to systematically review the available epidemiological evidence assessing the prevalence of cam hip shape morphology in the general population and any studied subgroups including subjects with and without hip pain. DESIGN: All studies that reported the prevalence of cam morphology, measured by alpha angles, in subjects aged 18 and over, irrespective of study population or presence of hip symptoms were considered for inclusion. We searched AMED, MEDLINE, EMBASE, CINAHL and CENTRAL in October 2015. Two authors independently identified eligible studies and assessed risk of bias. We planned to pool data of studies considered clinically homogenous. RESULTS: Thirty studies met inclusion criteria. None of the included studies were truly population-based: three included non-representative subgroups of the general population, 19 included differing clinical populations, while eight included professional athletes. All studies were judged to be at high risk of bias. Due to substantial clinical heterogeneity meta analysis was not possible. Across all studies, the prevalence estimates of cam morphology ranged from 5 to 75% of participants affected. We were unable to demonstrate a higher prevalence in selected subgroups such as athletes or those with hip pain. CONCLUSIONS: There is currently insufficient high quality data to determine the true prevalence of cam morphology in the general population or selected subgroups. Well-designed population-based epidemiological studies that use homogenous case definitions are required to determine the prevalence of cam morphology and its relationship to hip pain.


Read full text at: https://www.oarsijournal.com/article/S1063-4584(16)00005-4/fulltext

Rigerimod plus Standard of Care for Systemic Lupus Erythematosus

Systemic lupus erythematosus (SLE) is a long-term condition causing inflammation to the joints, skin and other organs. Symptoms presented are usually very general, including fever, joint pain and skin rash but can progress to the most severe, e.g. kidney failure. SLE typically has patterns of flare-ups where the condition gets worse for a period of time. The disease is likely to be caused by a combination of genetic and lifestyle factors and most commonly affects middle-aged women and those of African-Caribbean ethnicity.


http://www.io.nihr.ac.uk/report/rigerimod-plus-standard-of-care-for-systemic-lupus-erythematosus/




From the NIHR Innovation Centre

New NICE Technology appraisal guidance TA508: Autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee

Autologous chondrocyte implantation using chondrosphere for treating symptomatic articular cartilage defects of the knee.

Evidence-based recommendations on autologous chondrocyte implantation using chondrosphere (Spherox) for treating symptomatic articular cartilage defects of the knee in adults.Guidance development process.

Published March 2018
Next review March 2021


Full guidance available at https://www.nice.org.uk/guidance/ta508

New NICE Interventional procedures guidance IPG607: Mosaicplasty for symptomatic articular cartilage defects of the knee

Mosaicplasty for symptomatic articular cartilage defects of the knee


Evidence-based recommendations on mosaicplasty in people with symptomatic articular cartilage defects of the knee. This involves taking healthy cartilage from the edge of the joint and inserting it into drilled tunnels in the damaged site.

This guidance replaces NICE interventional procedures guidance on mosaicplasty for knee cartilage defects (IPG162).
Published March 2018
Next review: this guidance will be reviewed if there is new evidence or safety concerns.


Full guidance available at: https://www.nice.org.uk/guidance/ipg607

UHCW publication: pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1):56–63
Abstract

Aims: Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

Patients and Methods: A single-centre assessor-blinded, comprehensive cohort study, incorporating a pilot randomized controlled trial (RCT) was performed on patients with a symptomatic compartment of the knee in which a (sub)total meniscectomy had previously been performed. They were randomized to be treated either with a meniscal allograft transplantation or personalized physiotherapy, and stratified for malalignment of the limb. They entered the preference groups if they were not willing to be randomized. The Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score and Lysholm score and complications were collected at baseline and at four, eight and 12 months following the interventions.

Results: A total of 36 patients entered the study; 21 were randomized and 15 chose their treatments. Their mean age was 28 years (range 17 to 46). The outcomes were similar in the randomized and preference groups, allowing pooling of data. At 12 months, the KOOS4 composite score (mean difference 12, p = 0.03) and KOOS subscales of pain (mean difference 15, p = 0.02) and activities of daily living (mean difference 18, p = 0.005) were significantly superior in the meniscal transplantation group. Other PROMs also favoured this group without reaching statistical significance. There were five complications in the meniscal transplantation and one in the physiotherapy groups.

Conclusion: This is the first study to compare meniscal allograft transplantation to non-operative treatment. The results provide the best quality evidence to date of the symptomatic benefits of meniscal allograft transplantation in the short term, but a multicentre RCT is required to investigate this question further. Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00010&D=ovft&PDF=y (UHCW Athens login required)

UHCW publication: Meniscal transplantation is beneficial at one year

Infographic: Meniscal transplantation is beneficial at one year.
Smith, N. A.; Parsons, N.; Wright, D.; Hutchinson, C.; Metcalfe, A.; Thompson, P.; Costa, M. L.; Spalding, T.
The Bone & Joint Journal 2018 January 100B(1): 64–65


Menisci protect the knee joint from wear by distributing load, providing stability, and improving congruency. Partial and complete meniscectomies are widely performed for patients with meniscal tears that are not repairable, but meniscal loss increases contact pressures and predisposes patients to degenerative change. Meniscal allograft transplantation (MAT) aims to improve symptoms, increase function, and reduce the development of osteoarthritis in patients with a symptomatic, meniscal deficient knee. However, outcomes following MAT have never been definitively tested. We performed a comprehensive cohort study with a pilot randomized controlled trial (RCT) designed to assess the benefits of MAT over a programme of personalised physiotherapy. In this small study, we demonstrate that patients undergoing meniscal allograft transplantation using a ‘soft-tissue’ technique show better patient-reported outcome measures at one year. A long-term multicentre RCT is now required to confirm these promising early findings and to evaluate whether MAT can slow the progression to osteoarthritis and improve function in the long term.


Full text PDF available at http://ovidsp.ovid.com/athens/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=01714648-201801000-00011&D=ovft&PDF=y (UHCW Athens login required)

NIHR Signal A surgical procedure for shoulder pain is less effective than previously thought

An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all.


This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. The main intervention, decompression, involved removing any bony outgrowths that could have been causing the tendons around the shoulder to be “pinched”. This was compared with an arthroscopy used for investigation only; this did not include removing any bone or tissue. Those in the third “no treatment” arm did not receive any physiotherapy or advice.


From the NIHR Dissemination Centre

RCOT announces revised guidelines for occupational therapy and total hip replacement

The Royal College of Occupational Therapists (RCOT) is delighted to announce the publication of the second edition of the practice guidelines for working with people undergoing total hip replacement. Endorsed by the British Hip Society, the new guidelines recognise in particular the changes in length of recommended stay for patients as well as the fact that this surgery is increasingly being performed on younger patients.
https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/hip

NIHR Signal Two common operations to fix a broken tibia have similar outcomes

In people who had broken the lower part of their tibia (shin bone), fixation using a metal rod nailed to the inside the bone was compared with a locking plate screwed onto the surface of the bone. There was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique.






NICE guidance recommends that surgery takes place within 24 hours of injury but does not mandate which type of surgery to perform. This NIHR UK-based trial was funded to find which treatment was better for lower tibial fractures.




From the NIHR Dissemination Centre

Cranio-Cervical Trauma Eidemiology, Classification, Diagnosis and Management

J Spine Neurosurg 2017, 6:5. DOI: 10.4172/2325-9701.1000284

Objective: To provide an overview of current knowledge of the management of Cranio-Cervical (Occipito-cervical) injuries.

Conclusion: Cranio-cervical injuries constitute a significant proportion of high velocity trauma and can be missed. There is a need for high index of suspicion in such patients. Recent trends seem to favour surgical management of these injuries even in the elderly. Aim should be early surgical fixation wherever possible even in elderly patients, if there is no significant co-morbidity or contraindication for surgery.

UHCW Research: Amar Saxena

Infographic: Meniscal transplantation is beneficial at one year

Bone Joint J. 2018 Jan;100-B(1):64-65. doi: 10.1302/0301-620X.100B1.BJJ-2017-1478.
UHCW Research: Smith NA, Wright, D, Spalding, T, Hutchinson, C and Thompson, P

A pilot randomized trial of meniscal allograft transplantation versus personalized physiotherapy for patients with a symptomatic meniscal deficient knee compartment

Bone Joint J. 2018 Jan;100-B(1):56-63. doi: 10.1302/0301-620X.100B1.BJJ-2017-0918.R1.

Meniscal allograft transplantation is undertaken to improve pain and function in patients with a symptomatic meniscal deficient knee compartment. While case series have shown improvements in patient reported outcome measures (PROMs), its efficacy has not been rigorously evaluated. This study aimed to compare PROMs in patients having meniscal transplantation with those having personalized physiotherapy at 12 months.

UHCW Research: Smith NA, Wright, D, Spalding, T and Thompson, P

Rotational glenohumeral adaptations are associated with shoulder pathology in professional male handball players

Knee Surgery, Sports Traumatology, Arthroscopy, Jan2018; 26(1): 67-75

Glenohumeral range of motion adaptations may affect throwing athletes and contribute to shoulder injury. The purpose of this study was to evaluate shoulder rotation deficits among elite professional handball players and its correlation to the presence of shoulder pain and morphological changes

UHCW Research: Lior Laver

Children best placed to explain facts of surgery to patients, say experts

Medical Devices & Surgical Technology Week; Atlanta [Atlanta]31 Dec 2017: 90.
Research shows that patients who are given clear information about their test, operation or care are less anxious and more satisfied with their care.

Patient information leaflets are a popular way to support verbal discussion with a health professional, particularly where consent is needed. However, the average reading age in the UK is 9 years, and some studies indicate that the average readability (a measure of how easy a piece of text is to read) needed for patient information leaflets is beyond 9 years.

So Dr Catrin Wigley at University Hospitals Coventry and Warwickshire NHS Trust and colleagues assessed the average readability of six NHS patient information leaflets for hip replacement surgery (total hip arthroplasty) and found an average readability score of 17 - well above a reading age of 9 years.

They then recruited 57 school children aged 8-10 at a local primary school to help revise the content.

A prospective, observational cohort study of patients presenting to an emergency department with acute shoulder trauma: the Manchester emergency shoulder (MESH) project

BMC Emergency Medicine 201717:40 https://doi.org/10.1186/s12873-017-0149-y

Fracture and dislocation of the shoulder are usually identifiable through the use of plain radiographs in an emergency department. However, other significant soft tissue injuries can be missed at initial presentation. This study used contrast enhanced magnetic resonance arthrography (MRA) to determine the pattern of underlying soft tissue injuries in patients with traumatic shoulder injury, loss of active range of motion, and normal plain radiography.

UHCW Research: Charles E. Hutchinson

The Assessment and Management of Simple Elbow Dislocations

The Open Orthopaedic Journal,  Volume 11, 2017

The majority of simple elbow dislocations can be successfully managed non-operatively with good reliable outcomes. Careful follow up is essential, however, to identify patients that may occasionally develop persistent instability or stiffness and require intervention.

UHCW Research: Andrew J. Grazette and Alex Aquillina

Current Concepts in Elbow Trauma

Editorial in The Open Orthopaedics Journal vol 11, 2017

Elbow injuries are relatively common and have a significant socioeconomic impact, accounting for 10% of all injuries to the upper limb with almost one third of these being dislocations and approximately 10% being fractures.  Furthermore, the elbow is the second most commonly dislocated joint in adults and the most commonly dislocated joint in the paediatric population with 40% of these injuries being associated with sport.  Injuries patterns can range from simple low-energy dislocations up to high-energy complex fractures and fracture-dislocations.

UHCW Research: Chetan S. Modi

Distal Biceps and Triceps Injuries

The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M4) 1364-1372

Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.

James C. Beazley, Thomas M. Lawrence, Steven J. Drew and Chetan S. Modi