Elective Orthopaedic Surgery Research Articles (Page 1)

To assess the feasibility and acceptability of a multicomponent prehabilitation and perioperative care intervention for older persons with frailty scheduled for elective orthopaedic surgery prior to conducting an RCT. A mixed-methods feasibility study assessed reach, dose, data collection procedure, acceptability and adaptation. Data was collected through patient reported outcomes, electronic medical record, and interviews with patients and healthcare professionals. No pre-defined feasibility criteria were applied. Of those referred for surgery, 30% were screened for frailty, among those eligible, 78% consented to participate. Participants received six of the eight planned phone calls, adherence to nutrition advice and exercise was high, and medication review resulted in at least one drug change for 50% of participants. Qualitative analysis identified key themes including the importance of tailoring care to individual patient needs, strong support from healthcare professionals and family members, and effective interdisciplinary collaboration. The intervention appeared feasible and acceptable to both patients and healthcare professionals. Several adaptations were implemented immediately (refined recruitment procedures, reduced number of health coaching sessions, and modified data collection method), while others were proposed (earlier involvement of geriatrician, focusing on hip and knee surgery, 48-hour follow-up, and improved integration with municipal rehabilitation services and general practitioners). This study demonstrated the feasibility and acceptability of a prehabilitation and perioperative care intervention for older persons with frailty undergoing elective orthopaedic surgery. The proposed adaptations will inform the implementation strategy prior to conducting an RCT to evaluate effects on clinical outcomes and healthcare costs.

The rising volume of orthopaedic surgeries highlights the importance of optimal postoperative pain management, especially for trauma patients who frequently suffer inadequate analgesia and delayed recovery. This multicenter study aims to evaluate the prevalence of acute postoperative pain and identify contributing factors in traumatic and non-traumatic orthopaedic patients. This multicenter study analysed adult orthopaedic surgery patients from the China Acute Postoperative Pain Study between September 2019 and August 2023. Patients with preoperative acute physical injuries requiring surgical intervention were defined as trauma patients. Using multivariate regression, we compared pain outcomes between trauma/non-trauma groups and identified risk factors for moderate-to-severe postoperative pain. Among 10,892 orthopaedic patients (2833 trauma, 8059 non-trauma), trauma patients showed higher rates of moderate-to-severe pain (57.3% vs. 50.1%), experienced more anxiety and helplessness, and had a greater desire for additional pain management than non-trauma patients. Trauma was associated with the development of moderate-to-severe postoperative pain in both uni- and multivariate analyses (p < 0.001). Risk factors for postoperative pain differed: age over 65 years and preoperative chronic pain were significant in non-trauma patients, whereas intraoperative non-opioid analgesics and local anaesthetic infiltration were associated with a decreased incidence of moderate-to-severe postoperative pain in trauma patients. Over half of orthopaedic surgery patients experienced moderate to severe postoperative pain, with trauma patients reporting higher levels and greater impacts on their activities and emotional state, along with a greater need for additional pain relief. Distinct risk factors for trauma and non-trauma patients highlight the need for personalised perioperative analgesic strategies. This study advances perioperative pain management by identifying trauma as an independent risk factor for moderate-to-severe postoperative pain in orthopaedic patients, with distinct risk profiles for trauma and non-trauma subgroups. Trauma patients reported higher pain levels, greater distress and increased analgesic needs. These findings directly inform clinical practice, emphasising the need for personalised, risk-stratified pain management to improve recovery. The results provide an evidence-based framework for optimising analgesia in both trauma and elective orthopaedic surgery.

Investigating the opioid sparing effect of intravenous paracetamol combined with a multimodal analgesic protocol in dogs undergoing elective orthopaedic surgery

Shivering is a common spinal anesthetic side effect that occurs in 40–60% of people who have had subarachnoid block. Shivering is typified by spontaneous, involuntary, rhythmic fasciculation or skeletal muscular activation that resembles tremors. Hypothalamic thermoreceptors attempt to increase heat synthesis by shivering when they sense this drop in core body temperature due to peripheral heat redistribution. Objectives: To compare anti-shivering effects of intravenous versus intrathecal tramadol in patients receiving subarachnoid block for lower limb orthopedic operations. Methods: This Quasi-experimental study included 130 patients scheduled for elective orthopedic surgery under spinal anesthesia in the Operation Theater, Allied Hospital, Faisalabad. Patients were randomly divided into two groups: Group A (intrathecal tramadol with bupivacaine) and Group B (intravenous tramadol with intrathecal bupivacaine). The frequency of post-anesthesia shivering was recorded in both groups. Results: The mean ± SD of sensory and motor block duration in Group A was 331.72 ± 33.09 and 231.14 ± 11.22 minutes, respectively, while in Group B it was 228.12 ± 12.15 and 157.42 ± 10.02 minutes, respectively (p&lt;0.001). Post-anesthesia shivering occurred in 9 (13.84%) patients in Group A and 23 (35.38%) patients in Group B (p&lt;0.05). Conclusions: Post-anesthesia shivering was significantly higher in patients receiving intravenous tramadol (Group B) compared to those receiving intrathecal tramadol (Group A).

BackgroundThe COVID-19 pandemic has affected elective surgeries, including Total Hip Arthroplasty (THA). This study compared THA outcomes before and after the COVID-19 outbreak in a center without a specific COVID-19 protocol for elective surgeries.MethodsThis cross-sectional study included a total of 304 THA surgeries. The study period was divided into pre-COVID-19 outbreak (April 21, 2017 to April 21, 2019) and post-COVID-19 outbreak (April 21, 2020 to April 21, 2022) groups. Demographic characteristics, etiology of operations, anesthesia time, pre-operation length of stay (LOS), post-operation LOS, comorbidities, mortality, complications, and transfusion needs were compared between the two periods.ResultsPatients during the COVID-19 pandemic were significantly younger (mean = 49.2 ± 16.3 vs. 53.7 ± 17.1 years) (P-value = 0.02). The most common indication for THA in both periods was trauma, but there was a significant difference in the distribution of etiologies between the two periods (P-value = 0.01). Pre-operative LOS was significantly longer during the COVID-19 pandemic (mean = 2.75 ± 1.69 days) compared to the pre-pandemic period (mean = 2.28 ± 1.5 days) (P-value = 0.01). However, there was no significant difference in post-operative LOS or total LOS. There were no significant differences in comorbidities between the two periods. In-hospital mortality was low in both periods, with no significant difference. Complications and transfusion needs did not show any significant differences.ConclusionsCOVID-19 pandemic led to younger THA patients, changes in etiologies, longer pre-operative LOS, but no difference in mortality, complications, anesthesia time or transfusion needs. Further research is needed to better understand the impact of the pandemic on elective orthopedic surgeries.

Prolonged fasting before surgery remains common despite guidelines recommending liquid fasting for 2 h and solid fasting for 6 h preoperatively. Consuming carbohydrate-rich drinks until 2 h before surgery improves patient well-being and reduces postoperative complications and insulin resistance. Given the persistence of implementation barriers, including logistical challenges and insufficient patient education, this study aimed to implement drinking up to 2 h before elective orthopedic surgery. The Grol and Wensing implementation approached was followed in a before-after study conducted at a Dutch academic orthopedic ward (April 2023 to May 2024), after approval by the Scientific Ethical Committee. Current practices and barriers were assessed, and tailored strategies were developed using implementation theory and taxonomies to develop implementation strategies for the identified factors, followed by integration and evaluation. Implementation included dissemination, patient-oriented, organizational, educational, and risk prevention strategies. A total of 39 patients participated in the initial analysis and 48 patients participated in the evaluation. Preoperative fasting from liquids significantly reduced from 8:20 h (IQR: 4:42-12:19 h) to 4:38 h (IQR: 2:58-6:12) by informing patients about the importance of drinking up to 2 h before surgery and to 2:45 h (IQR: 2:21-3:26) by facilitating drinking lemonade after admission when surgery would start in ≥2 h. Patients' comfort improved regarding thirst, whereas no effect was found for other symptoms. Adverse events, including postponement of surgeries and pulmonary aspirations, during surgery did not occur while accepting >1 h of fasting at the start of surgery. Scalable implementation strategies for patient education on fasting and coordinated provision of lemonade reduced fasting duration among elective orthopedic patients.

To investigate changes in gastrointestinal biomarkers over time in dogs undergoing elective orthopedic surgery and in dogs with acute nonspecific diarrhea (AD). Prospective cohort study of 20 dogs undergoing surgical repair of cranial cruciate ligament disease (CCL cohort) and 8 dogs with AD. Serum concentrations of cobalamin, folate, methylmalonic acid, and C-reactive protein and fecal calprotectin concentrations were measured before and 12 to 18 hours, 4 weeks, and 8 weeks after surgery in the CCL group. These biomarkers were also measured in AD dogs at initial evaluation and 4 and 8 weeks postrecovery. Serum cobalamin (437 ± 186 ng/L) and folate concentrations (10.5 ± 4.8 ng/mL) at 12 to 18 hours were lower than corresponding cobalamin (630 ± 235 ng/L; P < .001) and folate concentrations (14.61 ± 6.3 ng/mL; P = .001) before surgery in CCL dogs. However, serum cobalamin (637 ± 195 ng/L) and folate concentrations (13.8 ± 5.7 ng/mL) at 4 weeks were higher than at 12 to 18 hours (P < .001 and P = .01, respectively) and similar to baseline. All 3 AD dogs with serum cobalamin concentrations below the reference interval at baseline had serum cobalamin concentrations within the reference interval at 4 weeks. Major orthopedic surgery and acute nonspecific enteropathy transiently lowered serum cobalamin and folate concentrations in dogs. Serum folate and cobalamin should be interpreted cautiously in the immediate postoperative setting or during acute gastrointestinal illness. Abnormalities should be reevaluated at a later date before pursuing other diagnostics or instituting supplementation.

Abstract Background Musculoskeletal diseases requiring surgical procedures in working-age adults impose a significant financial burden on many societies. We evaluated seven most common elective orthopedic surgeries among the Finnish working-age employed population with an aim to quantify losses in productivity-adjusted life years (PALY) and assess the societal economic impact of PALY loss due to sickness absence. Methods Data from electronic health records from the Wellbeing Services County of Southwest Finland, Finland, in 2020-2022 compiled with information from national administrative registries were used to identify working-age, employed patients from seven disease groups (N = 770). PALY losses were estimated in the year before hospitalization, during the hospitalization, and in the year after hospitalization. The economic value of PALY losses was calculated in total and on a per-patient basis based on a reported national average value of one sickness absence day (€344). Results In all seven patient groups together, on average, 17.4 PALY (27.5% of total PALY loss) were annually lost (corresponding to €2,192,683) in the year before hospitalization, 1.0 (1.6%) PALY annually lost (€194,773) during the hospitalization, and 44.8 (70.9%) PALY annually lost (€5,619,243) in the year after hospitalization. The highest pre-operative per-patient PALY loss in monetary terms was among patients with lumbar spine fusion (€16,693) while the highest post-operative per-patient PALY loss in monetary terms occurred among patients with knee osteoarthritis and knee replacement (€28,673). Conclusions The PALY loss in monetary terms per-patient was higher in the post-operative period compared to the pre-operative period. The seven patient groups examined produced considerable PALY losses and related total economic value to the Wellbeing Services County of Southwest Finland. The results of the study call for actions to support a more rapid return to work. Key messages • Although most of the PALY losses over the periods occurred in post-procedural recovery, approximately one-quarter of the total PALY losses had already accumulated before the surgical procedures. • The public health impact of PALY losses is considerable in the studied region and the results call for studies on waiting lists for treatment and actions to support more rapid return to work.

Objective: To determine the correlation between baseline perfusion index and post-spinal hypotension. Study Design: Prospective longitudinal study Place and Duration of Study: Combined Military Hospital, Rawalpindi from April to July, 2021. Methodology: Male and female ASA I and II adult patients undergoing elective orthopaedic surgery under spinal anaesthesia were included in the study. Non-randomized, consecutive sampling was used. Brachial Non Invasive Blood Pressure (NIBP) was measured before administration of spinal anaesthesia and immediately post-spinal plus 2 additional readings at 3 minute intervals. Lowest post-spinal NIBP reading for a subject was considered in determining occurrence of hypotension. Hypotension was defined as either a drop of systolic B.P. to 100 mmHg or lower, or a drop to 80% baseline or lower. Results: Of the 371 subjects, 189(50.9%) were male. Mean age was 47.19±18.93 years. 203(54.7%) subjects were ASA I. Most frequently performed procedure was Knee Arthroscopy (n=54 [14.6%]). Mean Perfusion Index at baseline was 3.52±2.05 (from 0.3 to 7.7). At baseline, mean systolic B.P. was 135.53±17.12 mmHg, mean diastolic B.P. was 76.10 ±12.27 mmHg, and mean MAP was 95.92±10.09 mmHg. Post-spinal mean values were 112.37±17.24 mmHg for systolic, 68.19±11.65 mmHg for diastolic, and 82.60±10.85 mmHg for MAP, respectively. Overall, 201(54.2%) of the subjects exhibited post-spinal hypotension. Correlation between PI and Post-spinal Hypotension revealed a statistically significant association (p =0.043). Conclusion: A higher PI score at baseline could have predictive value for development of post-spinal hypotension in orthopaedic procedures. Further studies are needed to determine utility of PI as a predictor of ..

Objective: Surgical antimicrobial prophylaxis (SAP) is vital for preventing surgical site infections (SSIs). This study evaluated adherence to local SAP guidelines and assessed SSI-related risk factors in elective orthopaedic surgeries. Methods: A prospective observational study was conducted at a tertiary care hospital between August and October 2023. Patients were categorised into two groups: those receiving guideline-adherent SAP (SAP group) and those with inadequate SAP (ISAP group), defined by incorrect dosing or prolonged duration. Various patient- and procedure-related SSI risk factors were compared between groups. Results: Among 82 patients, 81 received SAP, but only a small proportion received it correctly. Most deviations were due to extended duration and incorrect dosing, resulting in 90.20% non-adherence. Despite this, no significant differences in known SSI risk factors were observed between the two groups, and no SSIs were reported during the study period. Conclusions: Non-adherence to SAP guidelines was widespread, mainly due to extended prophylaxis. Importantly, non-adherence was not associated with increased SSI risk, nor was it linked to higher baseline patient risk factors, suggesting that decisions were influenced more by clinical routine than by patient-specific risk. These findings emphasize the need to strengthen staff education and adherence to guidelines, thereby supporting antimicrobial stewardship in resource-limited settings.

ObjectivesTo investigate the effect of general anesthesia with spontaneous breathing laryngeal mask airway (LMA) intubation combined with a peripheral nerve block (PNB) in orthopedic surgery through a retrospective study.MethodsData from 160 adult patients (American Society of Anesthesiologists grade 1–3) who underwent elective orthopedic surgery under general anesthesia with LMA intubation combined with PNB were retrospectively analyzed. All patients received ultrasound-guided PNB before general anesthesia. Among them, 78 patients were assigned to the spontaneous breathing group and 82 patients to the pressure-controlled ventilation group. The parameters compared included baseline characteristics, perioperative anesthetic drug dosages, anesthesia recovery time, adverse events during recovery, numerical rating scale score at 2 h postoperatively, postoperative pulmonary complications, hospitalization costs, and length of stay.ResultsBoth groups successfully completed the surgeries. Compared to the pressure-controlled ventilation group, the spontaneous breathing group exhibited significantly lower doses of fentanyl and rocuronium bromide (p < 0.001), shorter length of stay (p = 0.047), reduced incidence of postoperative hypertension in the post-anesthesia care unit (p < 0.001), and lower anesthesia costs (p < 0.001) and total hospitalization costs (p = 0.001). No statistically significant differences were observed between the two groups in baseline characteristics, anesthesia recovery time, incidence of postoperative hypoxemia or hypotension in the post-anesthesia care unit, numerical rating score at 2 h postoperatively, incidence of postoperative pulmonary complications, or surgical costs.ConclusionGeneral anesthesia with spontaneous breathing LMA intubation combined with PNB is safe and feasible for elective orthopedic surgeries in adults. This approach is beneficial in shortening the length of stay and reducing hospitalization costs.

Objectives: This study aimed to determine the incidence of postoperative deep vein thrombosis (DVT) and pulmonary embolism (PE) following orthopedic surgeries and to identify independent clinical, laboratory, and procedural factors associated with thromboembolic risk. Materials and Methods: A retrospective cohort analysis was conducted on 300 patients who underwent elective or emergency orthopedic surgeries (hip/knee arthroplasty, fracture fixation, and spinal procedures) between January 2020 and December 2024 at two tertiary centers. Demographic, clinical, and biochemical data were collected. Patients were stratified into two groups: those who developed DVT/PE and those who did not. Univariate analyses were performed to identify significant factors, and a multivariate logistic regression model with stepwise variable selection was applied in accordance with the events-per-variable (EPV) criterion. Receiver operating characteristic (ROC) curve analyses were conducted to evaluate the discriminative performance of significant predictors. Results: Among 300 patients who underwent orthopedic surgery, postoperative deep vein thrombosis (DVT) and/or pulmonary embolism (PE) occurred in 50 cases (16.7%). Patients who developed thromboembolic events were older (72.5 ± 8.7 vs. 65.2 ± 10.1 years, p < 0.001), had higher body mass index (32.1 ± 5.3 vs. 28.3 ± 4.5 kg/m2, p < 0.001), and showed a greater prevalence of diabetes mellitus (40% vs. 20%, p < 0.01) and chronic kidney disease (24% vs. 10%, p < 0.001) compared to those without DVT/PE. Laboratory analyses revealed significantly elevated neutrophil count, D-dimer, C-reactive protein (CRP), glucose, and troponin levels in the DVT/PE group. In the stepwise multivariate logistic regression model, age (OR = 1.44, p = 0.003), diabetes mellitus (OR = 2.88, p = 0.046), chronic kidney disease (OR = 2.33, p = 0.014), D-dimer (OR = 2.15, p = 0.019), and immobilization duration (OR = 2.21, p = 0.028) emerged as independent predictors of thromboembolic events. ROC analysis revealed that D-dimer > 0.9 mg/L had the highest discriminative performance (AUC = 0.89, sensitivity 88%, specificity 84%, p = 0.003), followed by troponin > 0.5 U/L (AUC = 0.86, p = 0.005), immobilization > 3 days (AUC = 0.82, p = 0.012), and age > 65 years (AUC = 0.74, p = 0.021). Conclusions: DVT and PE remain significant postoperative complications with a multifactorial etiology in orthopedic surgeries. Advanced age, comorbidities (such as diabetes mellitus and chronic kidney disease), and elevated inflammatory and metabolic markers (including neutrophil count, glucose, CRP, and D-dimer), together with procedural factors like prolonged immobilization, were identified as independent risk factors. Early recognition of these high-risk features and implementation of individualized prophylaxis strategies may improve postoperative outcomes and reduce thromboembolic risk.

Pelvic and acetabular fractures, often resulting from high-impact trauma, pose significant challenges due to extensive blood loss and complex surgical procedures. Tranexamic acid (TXA), widely used in elective orthopedic surgeries, offers a potential strategy for managing blood loss. However, its efficacy and safety in pelvic-acetabular trauma surgeries have shown inconsistent results in prior studies. To systematically evaluate the safety and efficacy of intravenous TXA in reducing perioperative blood loss, transfusion requirements, and complications in pelvic and acetabular trauma surgeries. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following PRISMA guidelines. Literature searches of PubMed, Embase, and Cochrane databases identified relevant studies. Data on blood loss, transfusion rates, thromboembolic events, surgical time, and complications were extracted and analyzed using RevMan 5.4 software. A random-effects model was applied to account for heterogeneity. After screening, a total of 6 RCTs with 511 patients were included in this meta-analysis. TXA did not significantly reduce estimated blood loss (mean difference: 117.54ml; 95% CI -286.48-51.40; p = 0.17) or transfusion rates (risk ratio: 0.88; 95% CI 0.48-1.60; p = 0.67). No significant differences were observed in the number of transfused blood units, surgical duration, or complication rates, including thromboembolic events (risk ratio: 1.36; 95% CI 0.57-3.22; p = 0.48). TXA demonstrated a favorable safety profile with no increased risk of systemic or local complications. While TXA appears safe in pelvi-acetabular trauma surgery, current evidence from six RCTs does not support a significant reduction in blood loss or transfusion needs. Further high-quality RCTs with standardized protocols are needed to refine TXA's role in this context.

BackgroundTotal knee and hip arthroplasty (TKA and THA) are among the most performed elective procedures. Rising demand and the resource-intensive nature of these procedures have contributed to longer wait times despite significant health care investment. Current scheduling methods often rely on average surgical durations, overlooking patient-specific variability.ObjectiveTo determine the potential for improving elective surgery scheduling for TKA and THA, respectively, by using a 2-stage approach that incorporates machine learning (ML) prediction of the duration of surgery (DOS) with scheduling optimization.MethodsIn total, 2 ML models (one each for TKA and THA) were trained to predict DOS using patient factors based on 302,490 and 196,942 patients, respectively, from a large international database. In total, 3 optimization formulations based on varying surgeon flexibility were compared: Any (surgeons could operate in any operating room at any time), Split (limitation of 2 surgeons per operating room per day), and multiple subset sum problem (MSSP; limit of 1 surgeon per operating room per day). Two years of daily scheduling simulations were performed for each optimization problem using ML prediction or mean DOS over a range of schedule parameters. Constraints and resources were based on a high-volume arthroplasty hospital in Canada.ResultsThe TKA and THA prediction models achieved test accuracy (with a 30 min buffer) of 78.1% (mean squared error 0.898) and 75.4% (mean squared error 0.916), respectively. Any scheduling formulation performed significantly worse than the Split and MSSP formulations with respect to overtime and underutilization (P<.001). The latter 2 problems performed similarly (P>.05) over most schedule parameters. The ML prediction schedules outperformed those generated using a mean DOS for most scheduling parameters, with overtime reduced on average by 300-500 minutes per week (12‐20 min per operating room per day; P<.001). However, there was more operating room underutilization with the ML prediction schedules, with it ranging from 70‐192 minutes more underutilization (P<.001). Using a 15-minute schedule granularity with a waitlist pool of a minimum of 1 month generated the ML schedule that outperformed the mean schedule 97.1% of times.ConclusionsAssuming a full waiting list, optimizing an individual surgeon’s elective operating room time using an ML-assisted predict-then-optimize scheduling system improves overall operating room efficiency, significantly decreasing overtime. This has significant potential implications for health care systems struggling with pressures of rising costs and growing operative waitlists.

An audit of last-minute cancellations of elective orthopaedic surgery at Chorley and South Ribble District Hospital

The sport of golf is recognized as a lifelong activity enjoyed by individuals of all ages, and part of its popularity with the aging population is due to its low impact nature. It has been shown to provide many mental and physical health benefits. With increasing participation, surgeons will encounter patients looking to return to sport after elective orthopaedic surgery. The aim of this review is to evaluate the effects of elective orthopaedic surgery on a patient's ability to return to golf. Total hip arthroplasty, hip arthroscopy, total knee arthroplasty total ankle arthroplasty, and total shoulder arthroplasty all have a return-to-play rate above 85% with slightly lower return-to-play rates for reverse shoulder arthroplasty, rotator cuff repair, and lumbar spinefusion. This review will elucidate how elective orthopaedic surgery on the primary joints affects individual return to play, the timeline of recovery, and how best to advise future patients on the recovery process.

AimsKnee joint distraction (KJD) has been proposed as a joint-preserving alternative to arthroplasty. The objective of this study was to evaluate the clinical and cost-effectiveness of KJD compared to arthroplasty for knee osteoarthritis.MethodsThis phase III multicentre, pragmatic, randomized controlled non-inferiority trial recruited adults aged ≤ 65 years with symptomatic osteoarthritis refractory to non-surgical treatment and suitable for knee arthroplasty. Patients were randomized to static, linear, KJD of 5 mm, produced with an external fixator construct for six-week duration, or total knee arthroplasty. The primary outcome measure was the Knee injury and Osteoarthritis Outcomes Score (KOOS) pain subscale 12 months post-surgery. The trial was terminated early due to failure to recruit following cessation of elective orthopaedic surgery during the COVID-19 pandemic.ResultsA total of 24 participants were randomized with baseline characteristics balanced between groups. Improved median KOOS pain scores at 12 months postoperatively were observed in both treatment groups. The median KOOS pain score in the KJD group improved from 38.9 (IQR 30.6 to 41.7) at baseline to 55.6 (IQR 41.7 to 94.4) at 12 months, while corresponding scores in the arthroplasty group improved from 30.6 (IQR 11.1 to 36.1) to 75.0 (IQR 66.7 to 88.9). Similar improvements following KJD were seen across other KOOS subdomains and pain VAS, range of motion, or timed up-and-go test. The small sample size does not provide sufficient information to make meaningful comparisons between treatment groups. Pin site infection was seen in two patients, and a fracture through a pin site after frame removal following trauma in one patient.ConclusionKJD appears to be associated with improved pain and function compared to baseline. The clinical and cost-effectiveness of KJD compared to arthroplasty remains uncertain.Cite this article: Bone Jt Open 2025;6(8):886–893.

Surgical cancellations have been a long-standing issue in the United States health care system, with orthopaedic surgery having some of the highest cancellation rates among all specialties. This study aims to assess the reasons for surgical cancellations by exploring patient, surgeon, and institutional factors. A retrospective chart review of elective orthopaedic surgery procedures performed at an academic outpatient hospital between January 2019 and August 2024 was conducted. Total joint and hand procedures had the highest relative cancellation rates. Among the subspecialties, trauma and joints were the most common. The predominant reasons for cancellation were patient-related, surgeon-related, clerical issues, medical/anaesthesia-related matters, and COVID-19, respectively. The most common patient-related factors included clearance, lack of transportation, and patient noncompliance with day of surgery instructions (eating, drinking, and medications). This study highlights opportunities for interventions to reduce same-day cancellations through patient engagement, preoperative planning, resource coordination, and administrative efficiency.

Surgical outcomes are worse in people with diabetes, in part, because of the effects of hyperglycaemia, obesity and other comorbidities. Two important uncertainties in the management of people with diabetes undergoing major surgery exist: (1) how to improve diabetes management prior to an elective procedure and (2) whether that improved management leads to better post-operative outcomes. The Optimising Cardiac Surgery ouTcOmes in People with diabeteS project aimed to assess whether a pre-operative outpatient intervention delivered by a multidisciplinary specialist diabetes team could improve diabetes management and cardiac surgical outcomes for people with diabetes. Although the intervention could be applied to any surgical discipline, cardiothoracic surgery was chosen because 30-40% of those undergoing elective cardiac revascularisation have diabetes. The project had three phases: (1) designing the intervention, (2) a pilot study of the intervention and (3) a multicentre randomised controlled study in United Kingdom cardiothoracic centres to assess whether the intervention could improve surgical outcomes. The first two phases were completed, but the COVID-19 pandemic and its subsequent effects on cardiothoracic services and research capacity in the United Kingdom meant that the randomised controlled study could not be undertaken. Two rapid literature reviews were undertaken to understand what factors influence surgical outcomes in people with diabetes and what interventions have previously been tested. The Optimising Cardiac Surgery ouTcOmes in People with diabeteS intervention was based on an existing nurse-led outpatient intervention, delivered in the 3 months before elective orthopaedic surgery. This intervention reduced pre-operative glycated haemoglobin and reduced length of stay. We undertook a survey of United Kingdom cardiothoracic surgeons, which found limited and inconsistent pre-operative management of people with diabetes awaiting cardiothoracic surgery. A prototype intervention was developed following discussions with relevant stakeholders. The pilot feasibility study recruited 17 people with diabetes and was undertaken by the diabetes and cardiothoracic surgery departments at University Hospital Southampton NHS Foundation Trust. Biomedical data were collected at baseline and prior to surgery. We assessed how the intervention was used. In-depth qualitative interviews with participants and healthcare professionals explored perceptions and experiences of the intervention and how it might be improved. Thirteen people completed the study and underwent cardiothoracic surgery. All components of the Optimising Cardiac Surgery ouTcOmes in People with diabeteS intervention were used, but not all parts were used for all participants. Minor changes were made to the intervention following feedback from the participants and healthcare professionals. Median (interquartile range) glycated haemoglobin fell 10mmol/mol (3-13) prior to surgery. The median duration of admission for surgery was 7 (interquartile range 6-9) days. We could not proceed to the multicentre randomised controlled study because of the impact of COVID-19 on the delivery of cardiothoracic surgical services and research capacity. There remains an urgent need to improve the surgical outcomes for people with diabetes. This project demonstrated that it is possible to develop a clinical pathway to improve diabetes management prior to admission. We could not test the effectiveness of the intervention in a multicentre randomised controlled trial because of the COVID-19 pandemic. The intervention is available for future research or clinical implementation. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programmme as award number 16/25/12.

Environmental impact of single-use items and their contamination levels in elective orthopaedic surgery.