11:30-12:00
Chaired by Mr Abtin Alvand
Oxford has a strong commitment to academia, often based at the Botnar. At any given time, about one fifth of our trainees are out of training for dedicated research time, often for a higher degree. This session will showcase some of the work going on in region.
Over half of patients report significant acute post-operative pain following knee replacement. The aim of this study was to evaluate the clinical and cost effectiveness of peri-articular liposomal bupivacaine for post-operative recovery and pain.
This multi-centre, patient-blinded, randomised controlled trial involved 533 participants at 11 institutions. Adults undergoing primary unilateral knee replacement were randomised to liposomal bupivacaine (266mg) admixed with bupivacaine hydrochloride (100mg) or bupivacaine hydrochloride (100mg) alone (control). The co-primary outcomes were Quality of Recovery 40 (QoR-40) score at 72hours and pain visual analogue score (VAS) area under the curve (AUC) 6 to 72hours. Secondary outcomes included: QoR-40 and mean pain VAS at days 0 (evening of surgery), 1, 2 and 3, cumulative opioid consumption over 72hours, functional outcomes and quality of life at 6weeks, 6months and 1year, and cost-effectiveness over one year. Adverse Events and Serious Adverse Events up to 12months post-randomisation were also assessed.
There was no difference in either primary outcome (adjusted mean difference for QoR-40: 0.54 (97.5% CI -2.05 to 3.13, p=0.643); pain VAS AUC -21.5 (97.5% CI -46.8 to 3.8; p=0.057)). Only one statistical difference, with the liposomal bupivacaine arm having lower pain scores the evening of surgery (day 0; adjusted difference -0.54, 97.5% CI -1.07 to -0.02; p=0.021) was detected in secondary outcomes with liposomal bupivacaine found not to be cost-effective.
This study found no difference in post-operative recovery associated with the use of peri-articular liposomal bupivacaine and does not support its use for knee replacement.
Trial Registration: ISRCTN 54191675, registered on 14 November 2017.
The purpose of this multicentre study was to determine the epidemiology and weight-bearing practice of operatively managed fragility fractures of the lower limb in the setting of the UK and Ireland National Health Service (NHS).
A multicentre audit of all adult patients aged 60 and over receiving surgery for a fragility fracture of the lower limb between 1st January 2019 – 30th June 2019 and 1st February 2021 – 14th March 2021 was conducted. No outcome data were collected. In line with British Orthopaedic Association (BOA) guidance, the primary audit criteria were “all surgery in the frail patient should be performed to allow full weight-bearing for activities required for daily living and within 36 hours of admission”.
Data from 19768 patients with a median age of 83 were included in the analysis. Data from 16416 hip fracture patients and 3352 non-hip fracture patients were analysed. In the non-hip fracture population, the most common fractures were of the foot and ankle (44.9%), distal femur (16.8%), femoral shaft (15.2%) and proximal tibia (6.1%). 15543 (95.7%) hip fracture and 1071 (32.3%) non-hip fracture patients were allowed to weight-bear immediately post-operatively.
The non-hip fracture population were younger, more mobile, more likely to have normal cognition and experienced more post-operative weight-bearing restrictions. Patients sustaining fractures of the shaft and distal femur had a longer median length of stay compared to demographically similar patients that received surgery for a hip fracture.
RCTs have shown that aromatase inhibitors (AIs) increase survivorship and reduce recurrence in women with post menopausal breast cancer compared to tamoxifen (TMX). Unfortunately arthralgia is a commonly reported side effect in using these drugs, with a biological plausibility that oestrogen blockade increases incidence of musculoskeletal conditions. This international observational study aimed to identify if there was an increased risk of osteoarthritis (OA), tendinopathy and carpal tunnel syndrome (CTS) in women taking AIs in comparison to those taking tamoxifen (TMX).
A federated network cohort study was designed in UK primary care data and replicated in 15 datasets in 8 countries. All female new users of either drug, aged over 55 and with a diagnosis of breast cancer in the previous year were included (01/01/2006-31/04/2021). Outcomes of hip, knee, shoulder, hand and thumb OA (BTOA); shoulder, elbow, hand and wrist, knee and foot and ankle tendinopathy, and CTS were studied. Analysis was undertaken using large scale propensity score adjustment in a cox proportional hazards model, with results blindly appraised prior to inclusion.
Over 1 million women were included. A twofold relative risk of CTD and wrist tendinopathy was seen in new AI users, with a 40% increased relative risk of a medical BTOA diagnosis within the first year. No association was found between the relative risk of OA, nor tendinopathy at any other sites.
This study identified an increased risk of CTS, BTOA and hand and wrist tendinopathy in new users of AIs compared to TMX.