04 Dec 2019

JTO - December 2019

Volume 7 Issue 4

 

From the Executive Editor

‘Winter drawers on’, one of the oldest of schoolboy jokes, with its novelty lost in years of repetition. The same is true of winter bed pressure. Instead of an unpredicted crisis, it seems a necessary ritual on the road to spring; so we must be ready and prepare. One way to avoid the grip of the bed managers is to push the boundaries of daycase surgery to include a greater proportion of our work. Hip and knee replacement surgery with discharge on the same calendar day is shown to be possible in an NHS setting (page 33). This practice is not yet widespread and so there continues to be a loss of training opportunities when ‘winter pressures’ lead to cancellations or movement of patients. Moving the trainee to follow the training opportunity is shown to be achievable (page 26), but naturally requires forethought.

“No man is an island entire in itself”; this sentiment of John Donne applies to surgeons too. We may realise that we should communicate, discuss, refer and transfer but we also need the structure and funding to achieve it. Networks, be they hub & spoke or more web-like, already exist for some areas of practice, but will become more common. The article relating knee revision surgery (page 24) outlines the proposals in this area.

Continuing to demonstrate the changing and more broad-minded image of the Orthopaedic Surgeon we have now officially gone holistic and will recognise the ‘whole of the femur’ in new changes to Best Practice Tariff previously restricted to hip fracture. It is my earnest hope that this will be seen as a broadening of an index of performance and not an end in itself, and that we should treat patients on merit and not on tariff.

The specialty section on pelvic trauma also includes a broadening of our vision. Whilst naturally referring to the time-critical, lifesaving aspects of pelvic injury that both scare and enthral us, it also explores the less glamorous side. There is hidden morbidity in patients with frailty or the higher energy fractures. The pelvic fragility fracture so often consigned to being swept under the carpet of a different hospital service is now being studied to establish whether there are indications to be when we should be more interventional to improve quality of life. The higher energy injury also has a hidden burden of urological and sexual dysfunction.

A newcomer to our regular features is now to ask the Robert Jones Lecturer from the BOA Congress to provide a precis of their presentation. It had seemed that we did not make the most of the time and effort put not only into the presentation itself but the professional life underpinning it. A worthy first is provided by John Skinner (page 20).

Increasingly in this world, we not only have to do the right thing but prove we that have done it; this is even the case with the reading of the JTO. So I would ask that in addition to cherishing and studying your paper copy of JTO please do some of your reading on line via the App (see bottom page 1) or the BOA website; this helps our relationship with advertisers!

Bob Handley, Vice President Elect

 

 

Subspecialty Section

 

References

Robert Jones Lecture

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  2. Sampson B, Hart AJ. Clinical usefulness of blood metal measurements to assess the failure of metal-on-metal orthopaedic implants. Ann Clin Biochem. 2012;49(Pt 2):118-31. 
  3. Bills PJ, Racasan R, Underwood RJ, Cann P, Skinner J, Hart AJ, et al. Volumetric wear assessment of retrieved metal-on-metal hip prostheses and the impact of measurement uncertainty. Wear. 2012;274-275:212-9.
  4. Hart AJ, Muirhead-Allwood S, Porter M, Matthies A, Ilo K, Maggiore P, et al. Which Factors Determine the Wear Rate of Large-Diameter Metal-on-Metal Hip Replacements? Multivariate Analysis of Two Hundred and Seventy-six Components. J Bone Joint Surg Am. 2013;95(8):678-85.
  5. Hart AJ, Dandachli W, Schlueter-Brust K, Henckel J, Cobb J. Large ball metal on metal hips obscure cup angle measurement on plain radiographs. Hip Int. 2009;19(4):323-9.
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  9. Powell J, Papadaki A, Hand J, Hart A, McRobbie D. Numerical simulation of SAR induced around Co-Cr-Mo hip prostheses in situ exposed to RF fields associated with 1.5- and 3-T MRI body coils. Magn Res Med. 2012;68(3):960-8.
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BASK Revision Knee Working Group Update

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  4. Malik AT, Jain N, Scharschmidt TJ, Li M, Glassman AH, Khan SN. Does Surgeon Volume Affect Outcomes Following Primary Total Hip Arthroplasty? A Systematic Review. J Arthroplasty. 2018;33(10):3329-42.

Winter Pressures and effects on training

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  5. British Orthopaedic Trainees Association (2018). Position statement. Available from: http://www.bota.org.uk/bota-asit-position-statement-winter-pressures-affecting-surgeons-in-training/. Accessed November 2019.
  6. Royal College of Surgeons of England (2018). Press release. Available from: https://www.rcseng.ac.uk/news-and-events/media-centre/press-releases/more-patients-wait-longer-for-elective-surgery. Accessed 12th December 2018.
  7. Koç T, Bowditch M, Bucknall V. The Effects of 'Winter Pressures' on Trauma and Orthopaedic Training. Journal of Trauma & Orthopaedics. 2018;6(4):24-25.
  8. Norrish A, Bowditch M & Large D. The effect of winter pressures on operative experience in orthopaedics: does the length of training need to be extended? BOA Congress 2018, submitted for publication.
  9. The NHS Long Term Plan (2019). Available from: https://www.longtermplan.nhs.uk/wp-content/uploads/2019/01/nhs-long-term-plan-june-2019.pdf. Accessed 4th July 2019.
  10. https://www.theguardian.com/society/2019/jun/19/hospital-bed-cutbacks-have-gone-too-far-nhs-england-boss-simon-stevens-says. Accessed 5th July 2019.

Is day case hip and knee replacement surgery achievable in the NHS?

  1. Lazic S, Boughton O, Kellett CF, Kader DF, Villet L, Rivière C. Day-case surgery for total hip and knee replacement: How safe and effective is it? EFORT Open Rev. 2018;3(4):130-5.
  2. Kolisek FR, McGrath MS, Jessup NM, Monesmith EA, Mont MA. Comparison of outpatient versus inpatient total knee arthroplasty. Clin Orthop Relat Res. 2009;467(6):1438-42.
  3. Kelly MP, Calkins TE, Culvern C, Kogan M, Della Valle CJ. Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction? J Arthroplasty. 2018;33(11):3402-6.
  4. 2016 Orthopaedics Landscape. Sg2 Analysis 2016. Available at: https://orthoserviceline.com/wp-content/uploads/2016/11/Wellbe-Orthopedics-Forecast-Webinar-Final.pdf. Accessed November 2019.
  5. Meermans G, Konan S, Das R, Volpin A, Haddad FS. The direct anterior approach in total hip arthroplasty: a systematic review of the literature. Bone Joint J. 2017;99-B(6):732-40.
  6. Huang A, Ryu JJ, Dervin G. Cost savings of outpatient versus standard inpatient total knee arthroplasty. Can J Surg. 2017;60(1):57-62.
  7. Aynardi M, Post Z, Ong A, Orozco F, Sukin D C. Outpatient surgery as a means of cost reduction in total hip arthroplasty: a case-control study. HSS J. 2014;10(3):252-5.
  8. Malviya A, Martin K, Harper I, Muller SD, Emmerson KP, Partington PF, Reed MR. Enhanced recovery program for hip and knee replacement reduces death rate. Acta Orthop. 2011;82(5):577-81.
  9. Husted H, Lunn TH, Troelsen A, Gaarn-Larsen L, Kristensen BB, Kehlet H. Why still in hospital after fast-track hip and knee arthroplasty? Acta Orthop. 2011;82(6):679-84.
  10. Courtney PM, Boniello AJ, Berger RA. Complications Following Outpatient Total Joint Arthroplasty: An Analysis of a National Database. J Arthroplasty. 2017;32(5):1426-30.
  11. Shah RR, Cipparrone NE, Gordon AC, Raab DJ, Bresch JR, Shah NA. Is it safe? Outpatient total joint arthroplasty with discharge to home at a freestanding ambulatory surgical center. Arthroplast Today. 2018;4(4):484-7.

Litigation, regulation and the cost of indemnity

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  3. Law Reform (Personal Injuries) Act 1948. Available at: https://www.legislation.gov.uk/ukpga/Geo6/11-12/41/contents. Accessed November 2019.
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  10. Ministry of Justice: Press Release (27 February 2017). New discount rate for personal injury claims announced. Available at: https://www.gov.uk/government/news/new-discount-rate-for-personal-injury-claims-announced. Accessed November 2019.
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Cognitive Simulation: A novel method to improve operative skills

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Pelvic Ring Injuries – An overview

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  4. CRASH-2 collaborators, Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, et al. The importance of early treatment with tranexamic acid in bleeding trauma patients: an exploratory analysis of the CRASH-2 randomised controlled trial. Lancet. 2011;377(9771):1096-101. Morrison JJ, Dubose JJ, Rasmussen TE, Midwinter MJ. Military application of tranexamic acid in trauma emergency resuscitation (MATTERs) study. Arch Surg. 2012;147(2):113-9.
  5. Suzuki T, Smith WR, Moore EE. Pelvic packing or angiography: competitive or complementary? Injury. 2009;40(4):343-53.
  6. Burlew CC, Moore EE, Stahel PF, Geddes AE, Wagenaar AE, Pieracci FM. Preperitoneal pelvic packing reduces mortality in patients with life-threatening hemorrhage due to unstable pelvic fractures. J Trauma Acute Care Surg. 2017;82(2):233-42.
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  10. Fang R, Rodriguez CJ. Venous thromboembolism among military combat casualties. Curr Trauma Rep. 2016;2:48.
  11. Steer R, Balendra G, Matthews J, Wullschleger M, Reidy J. The use of anterior subcutaneous internal fixation (INFIX) for treatment of pelvic ring injuries in major trauma patients, complications and outcomes. SICOT J. 2019;5:22.
  12. Smith A, Malek IA, Lewis J, Mohanty K. Vascular occlusion following application of subcutaneous anterior pelvic fixation (INFIX) technique. J Orthop Surg (Hong Kong). 2017;25(1):2309499016684994.
  13. Booth, Alison, et al. (2019), 'Effectiveness of surgical fixation for lateral compression type one (LC-1) fragility fractures of the pelvis: a systematic review. BMJ Open. 2019;9(5):e024737.
  14. Borg T, Hernefalk B, Carlsson M, Larsson S. Development of a pelvic discomfort index to evaluate outcome following fixation for pelvic ring injury. J Orthop Surg (Hong Kong). 2015;23(2):146-9.

Blast injuries to the pelvis: essential lessons learned

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  2. Edwards DS, McMenemy L, Stapley SA, Patel HD, Clasper JC. 40 years of terrorist bombings - A meta-analysis of the casualty and injury profile. Injury. 2016;47(3):646-52. 
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  7. Webster CE, Clasper J, Stinner DJ, Eliahoo J, Masouros SD. Characterization of Lower Extremity Blast Injury. Mil Med. 2018;183(9-10):e448-53.
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  12. Bull AM, Clasper JC, Mahoney PF. (2016). Comprar Blast Injury Science And Engineering. A Guide For Clinicians And Researchers. Anthony M.J. Bull. 9783319218663, Springer.
  13. Rankin IA, Nguyen TT, Carpanen D, Clasper JC, Masouros SD. Restricting Lower Limb Flail is Key to Preventing Fatal Pelvic Blast Injury. Ann Biomed Eng. 2019;47(11):2232-40.
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  15. Gennarelli TA, Wodzin E. AIS 2005: a contemporary injury scale. Injury. 2006;37(12):1083-91. 
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  18. Manzano Nunez R, Naranjo MP, Foianini E, Ferrada P, Rincon E, García-Perdomo HA, et al. A meta-analysis of resuscitative endovascular balloon occlusion of the aorta (REBOA) or open aortic cross-clamping by resuscitative thoracotomy in non-compressible torso hemorrhage patients. World J Emerg Surg. 2017;12:30. 
  19. Lendrum R, Perkins Z, Chana M, Marsden M, Davenport R, Grier G, et al. Pre-hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) for exsanguinating pelvic haemorrhage. Resuscitation. 2019;135:6-13. 
  20. Bonner TJ, Eardley WGP, Newell N, Masouros S, Matthews JJ, Gibb I, et al. Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring. J Bone Joint Surg Br. 2011;93-B(11):1524-8. 
  21. Dubose J, Inaba K, Barmparas G, et al. Bilateral internal iliac artery ligation as a damage control approach in massive retroperitoneal bleeding after pelvic fracture. J Trauma 2010;69(6):1507-14.
  22. Gordon WT, O'Brien FP, Strauss JE, Andersen RC, Potter BK. Outcomes associated with the internal fixation of long-bone fractures proximal to traumatic amputations. J Bone Joint Surg Am. 2010;92(13):2312-8. 
  23. Penn-Barwell JG, Bennett PM, Kay A, Sargeant ID, Severe Lower Extremity Combat Trauma (SeLECT) Study Group. Acute bilateral leg amputation following combat injury in UK servicemen. Injury. 2014;45(7):1105-10. 
  24. Glasgow SC, Heafner TA, Watson JD, Aden JK, Perry WB. Initial management and outcome of modern battlefield anal trauma. Dis Colon Rectum. 2014;8:1012-8. 
  25. Fleming M, Waterman S, Dunne J, D’Alleyrand JC, Andersen RC. Dismounted complex blast injuries: patterns of injuries and resource utilization associated with the multiple extremity amputee. J Surg Orthop Adv. 2012;21(1):32-7. 
  26. Williams M, Jezior J. Management of combat-related urological trauma in the modern era. Nat Rev Urol. 2013;10(9):504-12. 
  27. Bumbasirevia M, Lesic A, Mitkovic M, Bumbasirević V. Treatment of blast injuries of the extremity. J Am Acad Orthop Surg. 2006;14(10 Spec No.):S77-81.
  28. Valerio IL, Sabino J, Mundinger GS, Kumar A. From battleside to stateside: the reconstructive journey of our wounded warriors. Ann Plast Surg. 2014;72(Suppl 1):S38-45. 
  29. Brown KV, Murray CK, Clasper JC. Infectious complications of combat-related mangled extremity injuries in the British military. J Trauma. 2010;69(Suppl 1):S109-15.
  30. Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma. 2011;71(2 Suppl 2):S210-34.
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The hidden side of pelvic fractures: Urological and sexual dysfunction following injury

  1. Ayers DC, Franklin PD, Ring DC. The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics: AOA Critical Issues. J Bone Joint Surg Am. 2013;95(21):e165.
  2. British Orthopaedic Association. The Management of Patients With Pelvic Fractures. Available from: https://www.boa.ac.uk/uploads/assets/e0ff512b-6364-42ef-af23617e1894d8bd/04fe5a18-47a2-46d7-9aa6cc158825014d/the%20management%20of%20patients%20with%20pelvic%20fractures.pdf. Accessed November 2019.
  3. Odutola AA, Sabri O, Halliday R, Chesser TJ, Ward AJ. High rates of sexual and urinary dysfunction after surgically treated displaced pelvic ring injuries. Clin Orthop Relat Res. 2012;470(8):2173–84.
  4. Harvey-Kelly KF, Kanakaris NK, Eardley I, Giannoudis PV. Sexual function impairment after high energy pelvic fractures: evidence today. J Urol. 2011;185(6):2027-34.
  5. Chung PH, Gehring C, Firoozabadi R, Voelzke BB. Reconstructive Urology Risk Stratification for Erectile Dysfunction After Pelvic Fracture Urethral Injuries. Urology. 2018;115:174–8.
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