Joint hypermobility syndrome (JHS) is the occurrence of musculoskeletal symptoms in the presence of joint laxity and hypermobility in otherwise healthy individuals. Patients presenting to us either in the OPD or admitted in the inpatient facility of our institution with generalized or localized joint or back pain were screened using the modified Beighton’s score. Patient history was elicited carefully along with relevant family history and a thorough clinical examination. As per the diagnostic criteria (Beighton, 1998) some major and minor criteria were evaluated. Among the 2328 symptomatic patients who were assessed for hypermobility 388 patients satisfied our inclusion criteria. The average duration of symptoms after which a patient presented to the OPD was 3.4 months. We conducted the study on the pattern of the presentation of the patients with JHS based on the chief complaints, out of 388 patients 120 (30.85%) did have other/secondary complaints involving the musculoskeletal system. Majority of the patients belonged to the 4th decade, amongst both the male as well as the female subgroups. Diagnosis can be made by a strong index of suspicionon the part of the physician in patients who appear to have vague symptoms without any obvious aggravating factors. Some of the patients were also found to have peculiar radiographic changes in weight-bearing joints. Along with a conservative management, most of the patients benefited immensely from proper explanation & counselling about the nature of their problem, as awareness among the patients was almost negligible regarding this syndrome.

Background

Blount’s disease has been thoroughly studied with multiple published reviews and reports, however the optimum method of correction and stabilization remains controversial. The purpose of this study is to evaluate the clinical and radiological outcomes of the acute single stage correction of late-onset tibial vara by percutaneous proximal tibial osteotomy with circular external fixation using two simple rings and weighing up the pros and cons to establish if this method would be the method of choice in similar cases.

Methods

This study was conducted between November 2016 and July 2020. We retrospectively reviewed the clinical notes and radiographs of a total number of 30 patients (32 tibiae). All cases were followed up to 2 years.

Results

The mean proximal tibial angle was 65.7° (±7.8) preoperatively and 89.8° (±1.7) postoperatively. The mean mechanical axis deviation improved from 56.2 (±8.3) preoperatively to 2.8 (±1.6) mm postoperatively. Complications included overcorrection (three cases) and pin tract infection (eight cases 25%). At final follow up, all patients had full knee range of motion and normal function. All cases progressed to union and there were no cases of recurrence of deformity.

Conclusion

This simple procedure provides secure fixation allowing early weight-bearing and early return to function. It is cost-effective and can be used in the context of health care systems with limited resources. with a relatively low complication rate. Our results suggest that acute correction and simple circular frame fixation is an excellent treatment choice for cases of late-onset tibia vara, especially in severe deformities.

COVID 19 virus and disease has shown to affect various systems in affected individual. This affliction has been patient specific and for reasons unknown the impact has been non-uniform. We report here the series of orthopedic manifestations of COVID 19 infection in patients who presented with the disease or in the immediate aftermath of disease (within 3 months).
A total of 6200 patients were seen in one-year period (22nd Marc 2020 to 21 March 2021) since the lock down began. Of these 90 patients who reported having Covid and came for an orthopaedic consult. Following were the clinical manifestations of the disease from the orthopedic standpoint:

1. Arthralgia and Myalgia: 62
2. Synovitis: 14
3. Acute Primary septic joint: 2
4. Spontaneous osteonecrosis: 2
5. Abscess: 4
6. Postoperative infection: 6

While no causal relationship between the symptoms and disease could be established, the association of certain rare condition like acute primary septic joints and spontaneous necrosis is a cause of worry and worthy of investigations. It is pertinent to note that not all patient had symptomatic COVID infection or received steroids. In light of these the cause is hypothetically attributed to phenomenon of ‘Consumption Immunocompromisation’ in which the COVID infection utilizes the available immune defense mechanism of the body leaving the patient vulnerable to infections. Similarly, a hypercoagulable state may be responsible for spontaneous osteonecrosis. This important observation from the current times needs to be investigated in depth to reach a meaningful conclusion.

introduction :Osteomyelitis is infection of bone and is challenging to treat when involving long bones. Osteomyelitis of humerus is uncommon and the guidelines are drawn from literature on treatment of tibial osteomyelitis .case report : 20 year old lady presented with pain and swelling over posterior aspect of left arm since 1 year patient denied any history of trauma or other illness on examination tenderness and swelling was present over posterior aspect of left arm.xray was showing sequestrum in the lower third of humerus, diagnosis of osteomyelitis was confirmed on mri . ESR CRP and wbc count was raised surgery : patient operated in lateral position with posterior approach for humerus , after reaching muscle layer pus was seen . local tissue debridement was done then cortical defect in the posterolateral part of humerus was seen. whole of the sequestered bone was removed, bony curettage done till the punctate bleeding was observed from all the sides of the cavity.care was taken not to damage the radial nerve . thorough wash was given and wound sutured .arm was supported with above elbow slab later shoulder immobilizer was given, intraoperative samples were sent for microscopic analysis and antibiotics were started empirically. later staph aureus was isolated and piperacillin tazobactam was given for 6 weeks . 2 year follow up shows partial defect filling with bony growth and patient is doing all activities conclusion : for a case of osteomyelitis of long bones debridement and saucerization with antibiotics postop gives good clinical outcome.

Introduction: Posterior transpedicular decompression has become a standard surgery to achieve anterior spinal cord decompression. However, one of its main disadvantages is the inadequate visualization of the anterior surface of the dura. As most pathologies cause anterior spinal cord compression, frequently the surgeon has to rely on palpation to judge the adequacy of spinal cord decompression. We describe a technique that utilizes an arthroscope to visualize the anterior surface of the dura during transpedicular decompression. Methods: 20 consecutive patients were operated for neurological deficit using an arthroscope-assisted unilateral transpedicular approach. The pathologies treated with tuberculosis (12), fractures (6), metastasis (2). We retrospectively reviewed the preoperative, intraoperative and postoperative records. 70-degree arthroscope was used in 11 patients and 30 degree was used in nine. Results: Both 30° and 70° arthroscopes provide good visualization of the anterior surface of the dura without manipulating spinal cord. Adherent epidural cuff in patients with tuberculosis could be peeled off the dura under direct visualization. A complete decompression on the far lateral side could be visually confirmed in spite of using only a unilateral transpedicular approach. The visualization was poor in two patients operated for metastasis due to repeated pooling of blood in the anterior cavity. All patients with tuberculosis achieved complete neurological recovery. No patient had neurological deterioration. No iatrogenic dural tears were noted. Conclusion: Arthroscope-assisted transpedicular decompressions can Improve the surgeon's operative field and magnification thereby ensuring complete decompression without Injuring the dura or spinal cord.

Picture Archiving and Communication Systems(PACS) is the most commonly used software to measure perioperative radiological parameters mostly due to a lack of reliable and cheaper alternatives. Bone Ninja(BNA) is an upcoming alternative cheaper software application but its accuracy and reliability have not been peer-reviewed. The purpose of this study is to assess the accuracy of preoperative limb deformity and postoperative alignment measurements on the BNA compared to PACS and to determine the intra- and inter-observer variability among different orthopedic practitioners.
Methods
After ethical committee approval, Three orthopedists( two fellows and consultant) measured preoperative limb deformity (tibiofemoral angle(TFA), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA)} and postoperative alignment parameters { tibiofemoral angle(TFA), tibial alignment angle(TAA), femoral alignment angle(FAA)} for 50 consecutive patients undergoing Total Knee replacement using both BNA and PACS using long length radiographs. The difference between the measurements obtained with the BNA and PACS was measured. We determined the consistency of the interobserver and intra-observer using the intra-class correlation coefficient (ICC) for both systems. No participant had any financial or developmental involvement in the BNA.
Results
There were no statistical differences in Preoperative(TFA, MPTA, LDFA with p = 0.78, 0.92, and 0.97 respectively) or postoperative (TFA,TAA,FAA with p= 0.82, 0.76, 0.92 respectively) measurements between BNA and PACS . Also, the intra-observer and interobserver ICC was similar between both the groups.
Conclusions
Bone Ninja is an accurate, reliable, and cheaper educational tool for measuring preoperative deformity and postoperative alignment parameters when compared to PACS

Haemophilic arthritis is one of the most debilitating diseases in children, causing impairment in joint function that lasts for life. The etiology of this disease is multifactorial. It affects predominantly the knee, hip, ankle and elbow. This disease can be screened for, evaluated and followed up in affected individuals using magnetic resonance ( MR ) imaging / ultrasound / radiographs. MR scans are not easily accessible for the un-insured in developing countries. Amongst radiography and ultrasound, the latter is used more in recent times. In a cohort of 100 patients in our center, we evaluated and validated ultrasound as a tool for detection and follow up using the Hemophilia Early Arthropathy Detection - Ultra Sound scoring system against the more established Arnold - Hilgartner radiographic staging - by matching according to the criteria in both the stagings. This validation can lead to ultrasound being used even more, which is logistically easy and involves no radiation.

Introduction: Long bone osteomyelitis has been described as a complex disease with high complications. The purpose of this study was to assess the rate and risk factors for postoperative complications in chronic long bone osteomyelitis patients. Methods: The National Surgical Quality Improvement Program was queried to identify all patients who underwent surgery in 2008-2016 for chronic osteomyelitis of the long bones. Postoperative outcomes were investigated (≥75th percentile length of stay (LOS)). Binary logistic regression controlling for the modified Charlson Comorbidity Index identified risk factors for adverse outcomes. Results: 318 patients were identified. 64 (20.1%) patients had postoperative complications. Major complications were deep surgical site infection (16 patients, 25%) and sepsis (13 patients, 20.3%). Binary logistic regression revealed diabetes (OR=2.7 [1.1-6.6], p=0.027), open wound (OR=2.0 [1.2-3.6], p=0.015), and hypoalbuminemia (OR=1.9 [1.1-3.6], p=0.032), to be significant risk factors for complications. Hypoalbuminemia was found to be a significant factor for reoperation (OR=4.0 [1.2-13.5], p=0.027), readmission (OR=2.6 [1.1-6.3], p=0.032) and extended LOS (OR=3.1 [1.8-5.5], p<0.001). Patients with open wound(s) (6.6 days vs 10.1 days; p=0.004) had significantly longer LOS. Conclusion: History of diabetes, open wound, and hypoalbuminemia were identified as risk factors for postoperative complications, with hypoalbuminemia also being a significant risk factor for extended length of stay, reoperation, and readmission.

Introduction and objectives: Evidence underpinning the management of musculoskeletal (MSK) injuries across low and middle-income countries (LMICs) across Sub-Saharan Africa (SSA) is poor and is currently almost exclusively based on evidence from high-income countries. This study used a consensus-based approach to determine research priorities in SSA in order to set the agenda for studies into clinical effectiveness in musculoskeletal trauma care throughout SSA. Methods: A modified Delphi process was used. This involved an initial survey of AO Alliance and Orthopaedic research Collaborative in Africa (ORCA) members. This was followed by a two-round Delphi process with an expert panel. The survey was conducted across MSK/orthopaedic surgeons and health care practitioners in SSA. Results: A total of 256 questions were submitted in the initial phase from 132 respondents across 29 countries. An expert panel reviewed these questions and a total of 37 questions were then submitted and distributed across 2 Delphi rounds. Questions were scored by 311 respondents on a five-point Likert scale. Finally, questions were ranked by mean priority score to produce the top ten research questions in ‘clinical effectiveness in trauma care’ and ‘general trauma public health care’. Uncertainties involving general trauma public health care were ranked higher than those involving clinical effectiveness in trauma care. Conclusion: This consensus-based approach to setting research goals in SSA will help set the agenda for studies into clinical effectiveness in MSK trauma care throughout SSA. This can then be presented to funders ultimately leading to the development of large-scale regional research.

Post-injection paralysis (PIP) is an iatrogenic paralysis of a limb that occurs after an intramuscular injection causes nerve injury, with resultant foot deformity and disability. This study investigates the epidemiology and treatment of PIP in Uganda. Methods: Health records of pediatric patients surgically treated for PIP at the CoRSU Rehabilitation Hospital from 2013 to 2018 were retrospectively reviewed. Pre-operative demographics, perioperative management, and outcome were coded and analyzed with descriptive statistics, chi-square for categorical and linear models for continuous variables. Results: 403 pediatric patients underwent 492 total surgical procedures. 83% of reported injection indications were for febrile illness. 25% of reported injections explicitly stated quinine as the agent. Those who lived further from the facility had longer times between the inciting injection and initial hospital presentation (p=0.0216) and were more likely to be lost to follow-up (p=0.0042). Although 26 different procedure combinations were performed, achilles tendon lengthening, triple arthrodesis, tibialis posterior and anterior tendon transfers composed 83% of all conducted surgeries. Amongst 5 different foot deformities, equinus and varus were most likely to undergo soft tissue and bony procedures, respectively (p=0.0223). 18.6% of patients received two or more surgeries. 67% of patients achieved a plantigrade outcome; 13.61% had not by the end of the study period; 19.3% had unreported outcomes. Conclusion: PIP is a serious iatrogenic disability. Prevention strategies are imperative, as over 400 children required 492 total surgical procedures within just six years at one hospital in Uganda.

Background: The Covid-19 pandemic has had an unprecedented effect on global healthcare practices. The constant influx of patients with Covid-19 forced Orthopedic surgeons to modify their daily clinical and surgical activities. As a developing nation with an overburdened healthcare system the effect was felt more acutely in India; which prompted us to assess the same through this study. Method: A structured online survey was conducted with over 400 responses from orthopedic surgeons across India. 371 responses were statistically analysed to determine the impact of pandemic on Orthopedic practice. Results: The mean age of participants was 27 ± 9 years (min 25 years, max. 67 years). Almost all respondents saw a drop in the Outpatient visits with a substantial number (37%) resorting to telemedicine facilities to provide consultations. Nearly 87% of surgeons were willing to operate on COVID positive patients and 2/3 respondents had received COVID Specific training and a similar number felt that their institutions were well equipped to manage COVID patients. Most surgeons (78%) also reduced the number of elective surgeries by nearly 90% and there was a significant association (p<0.001) between age of surgeon and reduction in surgeries, with greater reduction in elderly surgeons. Conclusions: The pandemic has led to massive restructuring in orthopaedic practices with drop in outpatient visits and surgeries. Telemedicine has emerged as a potent tool to continue Orthopaedic practices. Despite limited resources most Orthopedic surgeons in India are optimistic about their institutional capabilities and with training are committed to providing optimum patient care.

Introduction: Infected orthopaedic metalwork is challenging to treat. Negative pressure wound therapy (NPWT) with irrigation is an emerging therapy for infected wounds as an adjunct to antibiotic therapy. The senior author had devised a modified technique to augment its efficacy, utilising high-flow rate irrigation and skin closure over the standard NPWT dressing. This novel technique was originally evaluated in a different centre and produced 100% success in hardware retention. The present study is a second evaluation of the same technique. Methods: A retrospective review was performed on 24 patients with infected orthopaedic metalwork, including 3 upper limb and 21 lower limb cases, for outcomes relating to hardware retention and clearance of infection. Patients underwent a modified NPWT technique as an adjunct to antibiotic therapy and surgical debridement. Detailed medical and microbiology information were obtained from the patient records. Results: 23 of 24 (96%) patients had successful hardware salvage with healed wounds and clearance of infection. 27 infective organisms were identified in this cohort and the antibiotic regimens for each patient are provided. The average follow-up was 663 days. No adverse effects were observed. Conclusion: This series supports the modified NPWT technique as a safe, reliable and effective adjunct therapy to resolve metalwork infection. The same results have been reproduced as the previous cohort in a different centre.

The worldwide incidence of road traffic accidents and subsequent open fractures has a devastating impact on the young working aged population, especially at a district hospital level in low and middle income countries (LMICs). The importance of improving the management of open fractures has been highlighted by the Lancet Commission for Global Surgery and supporting clinical officers in rural areas through training is a key strategy. The British Orthopaedic Association Standards for Trauma (BOAST) guidelines on open fractures have been adapted by a national expert group and then adopted as the Malawi Orthopaedic Association guidelines. An infographic has been produced to convey these guidelines in an accessible manner using evidence-based principles in design for education. These include the use of clear headings and subheadings, appropriate images and minimal colour, the latter also being useful for reproducibility in a low resource setting. It was further reviewed and edited by Malawian stakeholders before distribution. Infographics are used widely to deliver messages in a way that is easy to understand and have a great role to play in healthcare. The aim is that this infographic, displayed in district hospitals in Malawi, will provide a visual reminder of the steps involved in providing optimal care for open fractures and improve overall patient outcomes. It also offers a basis for audit and quality improvement studies.

Introduction: We aim to develop an accurate prediction tool for antibiotic sensitivity and prognostication for septic arthritis patients to facilitate effective empirical antimicrobial therapy in concert with surgical management. Methods: Culture-positive joint fluid aspirations from Queen Mary Hospital patients between 2003 and 2020 were reviewed. Repeated and culture-negative joints aspirations were excluded. Microorganism and antibiotic sensitivity, anatomical location, joint nature (native, prosthetic, fracture implant-related, or post arthroscopic procedure), and laterality were recorded. Patient demographic, physiological, and serological parameters were recorded. Machine learning methods (including artificial neural network, random forest classifier, decision tree classifier, K-neighbours classifier, support vector machine, and logistic regression (LR) were used to construct algorithms to predict antibiotic sensitivity, intensive care admission, and 1-year mortality. Results: 447 subjects were included analysis - 357 subjects were used as the training set for model development, with the remaining 90 as the test set for validation. Random forest classifier model predicted ceftriaxone susceptibility with 85% accuracy and AUC of 0.87, while artificial neural network model predicted cloxacillin susceptibility with 78% accuracy and AUC of 0.82. Random forest classifier model was superior in predicting ICU admission with 84% accuracy and AUC of 0.82, while artificial neural network was the optimal model for prediction of 1-year mortality with 88% accuracy and AUC of 0.89. Conclusion: Our machine learning models enable a personalised medicine approach in tailoring antibiotic treatment for patients with septic arthritis and prognostication.

Leptospirosis is a common zoonosis in tropical countries caused by the pathogenic spirochaete Leptospira. Humans become infected through contact with colonized animals’ urine or contaminated water. While manifestation range from vague, self-limiting symptoms to jaundice, renal failure and pulmonary haemorrhage; peripheral gangrene from septic emboli is extremely rare with only three cases reported in the literature. A previously healthy 16-year-old-boy presented with a-week history of arthralgia, vomiting and numbness of lower extremities. Patient denied recent travelling, jungle-trekking or watersports. On presentation, he was lethargic, with pale lower limbs and weak distal pulses. Serology for leptospirosis returned positive. He subsequently developed swelling of the right upper limb and foul smelling gangrenous desquamation of bilateral lower limbs. CT Angiogram revealed right brachial artery and distal aorta thromboses, extending into both common iliac arteries. Bilateral-high-above-knee amputations were performed, with the right upper limb managed conservatively with anticoagulants. With no amelioration in his clinical course, patient succumbed to fulminant sepsis on post-operative day-18. Leptospirosis is a systemic disease characterized by vasculitis which may affect a multitude of systems. Mortality in severe leptospirosis is high, even with optimal treatment. Early initiation of appropriate antimicrobial regime may halt progression of disease. Diagnosis is often achieved with suggestive history, in conjunction with serological tests. A high index of suspicion is necessary for diagnosis and timely surgical intervention in critical patients. Preventative practice and health education in endemic regions may reduce transmission, create awareness and encourage patients to seek medical attention promptly as delayed presentation portents ominous outcome.

Introduction: Long bone osteomyelitis is often associated with high morbidity and complications. This study was to assess the prevalence of long bone osteomyelitis and compare the postoperative outcomes between chronic and acute patients. Methods: The NSQIP database was queried for chronic (CO) and acute osteomyelitis (AO) long bone patients in 2008-2016. Postoperative outcomes were investigated and compared. Logistic regression analysis predicted relative odds of postoperative complications. Results: 318 and 158 patients were identified in the chronic and acute groups respectively. Prevalence of osteomyelitis in the humerus (CO:28 [8.8%] vs AO:12 [7.6%]; p=0.654), ulna/radius (CO:16 [5.0%] vs AO:9 [5.7%]; p=0.759), femur (CO:95 [29.9%] vs AO:60 [38%]; p=0.076), tibia/fibula (CO:179 [56.3%] vs AO:77 [48.7%]; p=0.119) were similar among the two groups. Logistic regression analysis determined AO patients to have increased odds of complications (OR=2.1 [1.3-3.2], p=0.001) and extended length of stay (EOLS) (OR=2.0 [1.3-3.0], p=0.001). Hypoalbuminemia was found to be a factor for EOLS in both groups, and any complications in CO (all p<0.04). When compared, logistic regression analysis determined AO patients were more likely to have had hypoalbuminemia preoperatively (OR=1.6 [1.0-2.4], p=0.032). Conclusion: Acute long bone osteomyelitis patients were more likely to have complications and EOLS postoperatively. Hypoalbuminemia was more likely to be found in acute patients.

Introduction: The osteoporotic vertebra has poor implant purchase power. The study aim was to evaluate the effectiveness of sublaminar mersilene tape (SMT) to augment pedicle screw fixation in osteoporotic burst fracture. Methods: 20 osteoporotic burst fracture patients included in this prospective study. All patients managed by posterior instrumentation, decompression and interbody fusion. Pedicle screws were augmented with supplementary SMT. Minimum follow-up was 24 months. Demographic data, clinical parameters [Visual Analog Score (VAS), Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment scale], radiological parameters (local kyphosis) and surgical variables were recorded and analysed. Neurological status, complications, and implant failures were noted. Results: Significant improvement was noted in VAS, ODI and kyphosis. VAS improved from 7.90±0.60 preoperative to 1.90±0.54 at final follow-up. ODI improved from 77.10±6.96 to 16.30±3.70 at final follow-up. Local kyphosis angle improved from preoperative 21.14±2.60 to 10.40±1.40 postoperative. At the final follow‐up loss of kyphosis was less than 5%. Complete neurological recovery noted in all patients except one remains same (ASIA Grade-D). No Implant related complication noted. One patient had proximal junctional failure managed with the extension of fixation. No iatrogenic dural or nerve injury. Conclusions: SMT augmented pedicle screws provide dual cortical support in osteoporotic vertebral fracture and enhanced implant stability, avoid long constructs and improve clinical and functional outcomes. SMT is a safe and simple alternative to cement augmented pedicle screw in osteoporotic vertebral fracture. A mersilene-tape is radiolucent material and does not effect on postoperative MRI.

Background: Low bone mineral density (BMD) is known to negatively impact postsurgical outcomes. Hence, this study was conducted to determine the prevalence of osteoporosis and/or osteopenia in patients undergoing elective arthroplasty and spinal procedures in India.
Methods: This prospective, multicenter, cross-sectional study included males (≥60 years) females (≥55 years) undergoing arthroplasty or spinal procedures. BMD at femoral neck and lumbar spine was measured by dual-energy X-ray absorptiometry (DEXA). Fracture Risk Assessment Tool (FRAX®) was used to evaluate fracture risk. Serum homocysteine levels were monitored.
Results: Mean age of included patients; 66.83±7.9 years; Women (76.4%; 97/127). Majority (76.4%; 97/127) had low BMD (osteoporosis: 39.4% [50/127]; osteopenia: 37% [47/127]), including those undergoing TKR/THR (Total: 75.6%; 59/78; osteoporosis: 38.5% [30/78]; osteopenia: 37.2% [29/78]) and spinal procedures (total: 93.10% [27/29]; osteoporosis: 65.5% [19/29]; osteopenia: 27.6% [8/29]). Radial BMD showed low BMD (79.01% [64/81]; osteoporosis: 45.68% [37/81]; osteopenia: 33.33% [27/81]). Mean T-score at radius (osteoporosis: –3.50±1.34; osteopenia: –1.79±1.76) was lower than femoral neck (osteoporosis: –2.64±0.89; osteopenia: –1.56±0.5) and spine (osteoporosis: –2.85±1.2; osteopenia: –1±1.01). Nearly 30% (38/127) were at a high risk (>3%) hip fracture in next 10 years; 3.1% (4/127) high risk (>20%) of MOF. In patients with osteoporosis, mean 10–year probability of hip fracture and MOF was 4.15±3.43 and 9.21±5.25 respectively. Serum homocysteine values did not show any correlation with BMD, T-Scores, or BMI.
Conclusions: High prevalence of low BMD in patients undergoing arthroplasty and spinal procedures in India, necessitates pre-operative bone health evaluation and adequate pharmacological management to improve clinical outcomes.

Introduction: Opioid use has increased in recent decades and may be a source of concern for patients undergoing arthroplasty. This study evaluates postoperative opioid prescribing practices and patient usage following primary knee and hip arthroplasty performed at a single center. Methods: All patients presenting for their 6-week postoperative visit following total hip arthroplasty (THA), total knee arthroplasty (TKA), or unicompartmental knee arthroplasty (UKA) were asked to fill out an anonymous questionnaire. The following information was collected: preoperative narcotic use, postoperative use of acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs), opioids (type, amount prescribed), opioids remaining and appropriate disposal. Results: A total of 101 questionnaires were analyzed. Sixty percent of patients underwent TKA, 30% THA and 10% UKA. Oxycodone was prescribed in 75% of cases. Preoperative opioid exposure (p=0.0006) and the quantity of opioids prescribed (p<0.0001) independently correlated with postoperative opioid consumption. Neither the procedure type (p=0.56) nor NSAID consumption (p=0.44) had an impact on opioid consumption. At 6 weeks, 64% of patients had surplus opioids and nearly half (46%) could not recall the appropriate disposal method. Discussion: The present study describes current opioid prescription patterns and patient opioid consumption following primary hip and knee arthroplasty at a single Canadian center. Both preoperative opioid exposure and quantity of opioids prescribed correlated significantly and independently with postoperative opioid consumption. The following areas for improvement in perioperative opioid management were identified: 1) patient education (preoperative opioid reduction, stepwise analgesic ladder, opioid disposal); 2) standardization of postoperative prescriptions; 3) periodic re-evaluation of patients’ pain management needs.

Introduction: Vertebral compression fractures treated non-operatively can diminish function and quality of life, and lead to chronic health effects. The effectiveness of vertebroplasty for symptomatic severe vertebral compression fractures are well-documented, but there is a number of complication of cementing. A study purpose was to evaluate the efficacy of percutaneous vertebroplasty with short-segment percutaneous pedicle screw fixation (PPF) with polymethylmethacrylate (PMMA) augmentation in treating symptomatic vertebra plana, in patients with osteoporosis. Methods: A retrospective study. 18 osteoporotic thoracolumbar compression fracture patients were treated by novel percutaneous vertebroplasty and short-segment PPF with PMMA augmentation. Preoperative and postoperative clinical and radiological parameters (kyphotic angle, compression ratio, the visual analog scale for back pain, and the Oswestry Disability Index (ODI) were analyzed.
Results: A significant improvement was noted in VAS (pre-operative, 7.90 ±0.60; final follow-up 2.90 ± 0.54) and ODI (preoperative, 77.10 ± 6.96; final follow-up 21.30 ± 6.70), (𝑃 < 0.05). Neurological improvement was noted in all patients. Vertebral height and kyphotic angle of the compressed vertebral bodies were significantly corrected, preoperative 22.14 ± 2.60 to postoperative 10.40 ± 1.40 with a 10% (2.5 ± 0.90) loss of correction at final follow-up. There was a proximal junctional failure in one patient managed with revision surgery. No cement leakage was found. No implant-related complication was seen. No iatrogenic dural or nerve injury. Conclusions: Our results suggested that good vertebroplasty with PMMA augmentation PPF may be an effective minimally invasive treatment for osteoporotic vertebral compression fractures.

Objective: To compare functional outcomes among post-operative geriatric fragility hip fracture patients who receive formal and informal rehabilitation. Method: This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were interviewed and asked to answer two questionnaires through Telemedicine – the Modified Harris Hip Score (MHSS) and the EuroQol-5D—5L (EQ-5D—5L). These scores were tallied and used to compare the functional outcomes between the two rehabilitation pathways. Results: Among the 50 patients included, twenty-three (46%) underwent formal rehabilitation, while 27 (54%) underwent informal rehabilitation. The average corrected MHSS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent formal rehabilitation, and an outcome of 75.9 among patients who underwent informal rehabilitation. Results to the EQ-5D—5L survey showed that majority of patients who underwent formal rehabilitation reported having ‘no problems’ with self-care, and anxiety or depression; while more patients reported ‘any problems’ with mobility. On the other hand, a more patients from the informal rehabilitation group presented with ‘any problems’ in their usual activities. Neither group of patients reported extreme pain or discomfort. Conclusion: In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive formal rehabilitation from those who undergo informal rehabilitation.