Author(s) Halim U.A.; Elbayouk A.; Javed S.; Ali A.M.; Cullen C.M.
Source Bone and Joint Journal; Nov 2020 (no. 11); p. 1446-1456
Language English
Publication Date Nov 2020
Aims Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. methods A systematic review was conducted by searching Medline, EMCARE, CINAHL, PsycINFO, and the Cochrane Library Database in April 2020, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to which we adhered. Original research papers pertaining to the prevalence and impact of GBSD, or mitigating strategies, within orthopaedics were included for review. Results Of 570 papers, 27 were eligible for inclusion. These were published between 1998 and 2020. A narrative review was performed in light of the significant heterogeneity displayed by the eligible studies. A total of 13 papers discussed the prevalence of GBSD, while 13 related to the impact of these behaviours, and six discussed mitigating strategies. GBSD was found to be common in the orthopaedic workplace, with all sources showing women to be the subjects. The impact of this includes poor workforce representation, lower salaries, and less career success, including in academia, for women in orthopaedics. Mitigating strategies in the literature are focused on providing female role models, mentors, and educational interventions. conclusion GBSD is common in orthopaedic surgery, with a substantial impact on sufferers. A small number of mitigating strategies have been tested but these are limited in their scope. As such, the orthopaedic community is obliged to participate in more thoughtful and proactive strategies that mitigate against GBSD, by improving female recruitment and retention within the specialty.Copyright © 2020 The British Editorial Society of Bone & Joint Surgery

Author(s) Rashed R.A.; Abdalaziz A.; Veivenn V.Y.; Tetali S.R.; Choudry Q.A. et al.
Source Injury; Nov 2020; vol. 51 (no. 11); p. 2676-2681
Language English
Publication Date Nov 2020
DOI 10.1016/j.injury.2020.07.045
ISSN 0020-1383
Database EMBASE
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Introduction: The incidence of heterotopic ossification after total hip replacement is variable in the literature. If symptomatic, it may cause pain and reduced range of motion. Dual mobility total hip replacements have been considered a valuable option for the treatment of femoral neck fractures in the active patients, achieving good range of motion with reduced risk of dislocation. The occurrence of HO may have detrimental effect on this type of articulation and may accelerate polyethylene wear and predispose to intra-prosthetic dislocation. We compared the incidence of HO in DMC versus conventional THR in femoral neck fracture patients across 3 large trauma institutes 

Author(s) Halim U.A.; Elbayouk A.; Javed S.; Ali A.M.; Cullen C.M.
Source The bone & joint journal; Sep 2020 ; p. 1-11

AIMS: Gender bias and sexual discrimination (GBSD) have been widely recognized across a range of fields and are now part of the wider social consciousness. Such conduct can occur in the medical workplace, with detrimental effects on recipients. The aim of this review was to identify the prevalence and impact of GBSD in orthopaedic surgery, and to investigate interventions countering such behaviours. 

Author(s) Cheung T.; Din A.; Zubairy A.
Source Journal of Orthopaedics; 2020; vol. 20 ; p. 286-292
Publication Date 2020
Background: Total ankle replacement (TAR) is a high-risk procedure with significant revision rates, post-op complications and implant failures. Long term follow-up data is less available for TAR compared to other joint replacement surgeries. To identify optimal follow-up parameters for patients with TAR, we conducted a study on the clinical outcomes and patient-reported outcome measurements (PROMs) in patients who had TAR performed in a non-designer's centre belonging to one of the hospitals of East Lancashire Hospitals NHS Trust (ELHT). Method(s): 60 TAR procedures were identified. Clinical outcomes being studied include post-op ankle range of movement (ROM), American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot scores, reoperation/revision rates, radiological parameters and general surgical outcomes. A Kaplan-Meier survival analysis was also conducted. PROMs data included the EQ-5D index and the Manchester-Oxford Foot Questionnaire (MOX-FQ). Result(s): Ankle range of movement and AOFAS scores improved from pre-op to post-op with statistical significance. The reoperation rate and revision rate were 3.3% and 8.3% respectively. 5-year survival of implant was 97.3% and 10-year survival was 84.2%. Overall PROMs data showed improvement from pre-op to post-op. Conclusion(s): The clinical outcomes of TARs were comparable with conventional literature. Improvements in clinical, radiological and patient-reported outcomes were observed from pre-op to post-op. Further follow-up studies are required to assess the long-term survival of implants.

Author(s) Lazic S.; Kellett C.; Afzal I.; Field R.E.; Mohan R. et al.
Source HIP International; May 2020; vol. 30 (no. 3); p. 303-308
Background: Polycarbonate urethane (PCU) is a bearing surface with a lower modulus of elasticity than polyethylene or ceramic and is thought to more closely replicate the tribology of native hyaline cartilage. The purpose of this study was to determine the clinical outcomes with the use of PCU in elective total hip arthroplasty (THA). 

​Author(s): Joseph F.; Wolfendale H.; Hyatt R.; Holmes A.
Source: Osteoporosis International; Dec 2018; vol. 29
Publication Date: Dec 2018
Publication Type(s): Conference Abstract
Abstract:Background: Vertebral fractures (VF) are themost common osteoporotic fracture; however around 70% are undiagnosed. VF are powerful predictors for further fracture (relative risk 2.8 for hip; 5.4 for further VF) (1). Method(s): CT scans containing the spine of patients aged >50 years from December 2015-October 2016 were analysed for VF using the Optasia Aspire?service; a commercial case-finding service combining machine learning with radiologist over-read. Diagnosed fractures were graded (2) and only moderate or severe VF included. The data were also interrogated for clinical variables.A combination of case notes, clinical portal and FLS database were used. Result(s): 47/325 (14.5%) scans showed moderate-severe VF. 18/47 patients had died by commencement of this audit; in 5, data were insufficient. Data was collected from March-April 2018. 13 (54%) of patients were female; 7 (29%) were aged 50-69; 12 (50%) 70-89; 5 (21%) were 90-100. Patients had 1-12 comorbidities (average 6.4). 54%(13) had prior fracture(s); of these, 46% had VF. 6 (25%) were on bone sparing treatment; but only 2 (8%) known to FLS. 6 (25%) of reports used the terms: Bosteoporotic fracture/loss of vertebral height/wedge fracture; 18 (75%) made no mention of VF. 8 (33%) had prior spinal X rays, of which 6 (75%)were reported as VF. 3 (12%) were admitted with fragility fractures after the CT scan. Discussion(s): The majority of CT reports made no mention of VF. VF was more frequently reported on plain X-ray. Most patientswere over 70; with multiple comorbidities. The majority had prior fractures; many VF. Only a minority were on bone sparing treatment and few known to FLS. Significant numbers were admitted with fragility fracture after their CT. Conclusion(s): This sample confirms that VF is common; and important to detect. A significant number of patients were admitted shortly after the CT with a further fragility fracture, potentially preventable. Although we have FLS locally; it has recruited few patients with VF. This study will prompt it to expand its scope to cover vertebral fractures. The trust is also looking at implementing a VF assessment and treatment pathway.
Database: EMBASE

​Author(s): Staal J.; Peters A.; Kariki E.; Hyatt R.; Javaid K.; Russell E.; O'Neill T.; Poole K.; Chappell D.; Rajak R.
Source: Osteoporosis International; Dec 2018; vol. 29
Publication Date: Dec 2018
Publication Type(s): Conference Abstract
Abstract:Objectives: Vertebral Fragility Fractures (VFFs) are an early manifestation of osteoporosis. VFFs may triple the risk of future hip fracture1 yet VFF patients are often underrepresented in Fracture Liaison Services (FLSs). We assessed the rate of opportunistic VFFs in Computed Tomography (CT) scans of the Thorax, Abdomen and Pelvis and reviewed whether they had been previously reported.We also investigated whether the identified VFF patients had been referred to an FLS. Materials andMethods:We retrospectively audited pseudonymised CT scans of patients 50 years and older, containing the spine. The scans were performed over a 12-month period at 5 NHS hospitals in the UK (Cambridge, Croydon, East Lancashire, Oxford and Salford). We used the Optasia Medical ASPIRETM service, a commercial VFF case-finding service combining machine learning with radiologist over-read (EK). VFFs were classified using the Genant-SQ method2 and only moderate and severe VFFs were included. We compared our findings with the original radiology reports. Result(s): We collected meta-data from 47,889 scans (50.1% female) and used a sample of 1,638 scans for analysis. Of these, 237 patients (53.4% female) had VFFs (14.5% +/- 1.7%, 95% CI). VFF prevalence between sites was not significantly different. Four sites (Cambridge, Croydon, East Lancashire, Oxford) checked the original radiology reports and FLS referral. The median reporting rate was 67.7% (IQR 55.7%, 74.5%) and the median FLS referral was 13.3% (IQR 10.8%, 22.0%). Conclusion(s): On average, 1 in 7 patients had at least one moderate VFF with a median of only 13.3% being seen by the FLS. Whilst men are underrepresented in FLSs3, nearly as many men as women in this cohort were found to have VFFs. Opportunistic diagnosis of VFF can greatly increase the number of patients referred to FLSs, potentially protecting the patients' quality of life and decreasing the economic burden of osteoporosis4.
Database: EMBASE
 

​Author(s): Green, Carl M.; Zeiton, Moez; Foulkes, Katherine; Barrie, Jim
Source: Journal of Patient Safety; Dec 2018; vol. 14 (no. 4); p. 202-205
Publication Date: Dec 2018
Publication Type(s): Academic Journal
Abstract:Objectives: This study assesses fall prevention measures and subsequent incident reporting of falls resulting in an "inpatient fracture neck of femur (FNOF)" within a single NHS Trust, with the aim of identifying potential areas of improvement and changing practice within a Trust. Methods: Forty patients (mean age, 82.6 years) sustained an injury while being treated in hospital for an unrelated cause between January 2012 and June 2013. Case notes and incident reports were analyzed retrospectively. Results: Thirty-three (82.5%) of 40 patients had at least 1 fall screen on admission, with 27 patients (81.8%) identified as a fall risk. Fifteen patients (37.5%) had at least one fall before sustaining a FNOF. Fifteen falls occurred between midnight—0500 hours and only 4 falls were witnessed. Thirty-nine of 40 falls were reported, but none were rated as "severe" injuries. Twenty-eight (71.8%) of 39 patients had a root cause analysis performed for the injury, but only 10 root cause analyses (25.6%) produced an action plan. Fifty percent of patients died within 1 year of injury. Conclusion: Accurate fall risk assessments and adequate patient supervision are essential to minimize risks of falls, as the inpatient FNOF is linked to a higher mortality rate than patients injured in the community. A standardized method of analyzing such incidents and dissemination of the results of investigation are also required to reduce the risk of similar incidents from occurring within the hospital environment.
Database: CINAHL