The effect of high dose antibiotic impregnated cement on rate of surgical site infection after hip hemiarthroplasty for fractured neck of femur : a protocol for a double-blind quasi randomised controlled trial

Background: Mortality following hip hemiarthroplasty is in the range of 10-40% in the first year, with much attributed to post-operative complications. One such complication is surgical site infection (SSI), which at the start of this trial affected 4.68% of patients in the UK having this operation. Compared to SSI rates of elective hip surgery, at less than 1%, this figure is elevated. The aim of this quasi randomised controlled trial (RCT) is to determine if high dose antibiotic impregnated cement can reduce the SSI in patients at 12-months after hemiarthroplasty for intracapsular fractured neck of femur. Methods: 848 patients with an intracapsular fractured neck of femur requiring a hip hemiarthroplasty are been recruited into this two-centre double-blind quasi RCT. Participants were recruited before surgery and quasi randomised to standard care or intervention group. Participants, statistician and outcome assessors were blind to treatment allocation throughout the study. The intervention consisted of high dose antibiotic impregnated cement consisting of 1 gram Clindamycin and 1 gram of Gentamicin. The primary outcome is Health Protection Agency (HPA) defined deep surgical site infection at 12 months. Secondary outcomes include HPA defined superficial surgical site infection at 30 days, 30 and 90-day mortality, length of hospital stay, critical care stay, and complications. Discussion: Large randomised controlled trials assessing the effectiveness of a surgical intervention are uncommon, particularly in the speciality of orthopaedics. The results from this trial will inform evidence-based recommendations for antibiotic impregnated cement in the management of patients with a fractured neck of femur undergoing a hip hemiarthroplasty. If high dose antibiotic impregnated cement is found to be an effective intervention, implementation into clinical practice could improve long-term outcomes for patients undergoing hip hemiarthroplasty

Clinical and Radiographic Outcomes of the Infinity Total Ankle Arthroplasty System

Category: Ankle Arthritis Introduction/Purpose: We report our early results of the Infinity Total Ankle Arthroplasty (TAA) system, a third generation, constrained implant, recently introduced to the UK market. Methods: All ankles were uncemented and standard instrumentation was used. Patients were reviewed at 3, 6 and 12 months for radiological and clinical assessment including Ankle Osteoarthritis Score (AOS), Visual Analogue Scale (VAS) and subjective component of AOFAS Ankle/Hindfoot score. Results: Mean age was 66 (range 42-88), 14 females and 21 males. The mean follow-up 12 months (range, 4-18 months), and no patients were lost to follow-up. The diagnosis was post-traumatic in 15 cases, primary osteoarthritis in 15 and inflammatory arthritis in 5 cases. Preoperative coronal alignment deformity was 20 degrees in 3%. Mean AOS score improved from from 64 to 24, AOFAS score improved from 19/70 to 49/70 and VAS from 7.0 to 2.0. Tibial component subsidence was noted in 1 case (3%), and asymptomatic periprosthetic lucent lines in 6 cases (17%). No ankles were revised. Complications included intraoperative medial malleolar fracture (8.5%), delayed wound healing (14%), tibial osteotomy non-union (3%), and regional pain syndrome (3%). The mean radiographic coronal plane alignment of the tibial component was 1.9 degrees varus (range, 5.3 varus to 1.7 valgus) and its mean sagittal plane alignment 2.8 (range -1.7 to 8.5) degrees dorsiflexion. Conclusion: Our early experience has demonstrated good patient outcomes, low complication rate and reproducible alignment with the Infinity implant

The Preoperative ‘6 Pack’ for Patients With Ankle Arthritis

Category: Ankle Arthritis Introduction/Purpose: There is paucity of literature relating to information needs of patients in Orthopaedic Surgery, despite the fact that Orthopaedic Surgeons in the UK welcome the use of patient decision aids for joint replacement surgery. This multi- centre study aimed to study the information needs of patients for surgical treatment of ankle arthritis from 6 different hospitals across the North East region of England. Methods: Ethical permissions were obtained for this multi-centre qualitative research study. The study recruited 18 patients from 6 hospitals across the North East of England. They were invited to take part in patient focus group meetings. 3 focus groups were conducted with 4-8 patients/ group. These groups were facilitated by independent researchers using a semi-structured discussion approach. Patients were asked for their views on information needs for surgical treatment of ankle arthritis. The focus group meetings were digitally recorded and transcribed verbatim. Data was analysed using the nVIVO software with framework analysis. Results: The analysis highlighted 4 main themes: A) Factors influencing surgical decision making B) Information needs of patients C) Information provision and D) Patient expectations. Theme B is discussed in detail for this abstract. Primary information needs requested by over 70% of patients were: 1. Desire to meet with patients who had undergone similar surgical procedure 2. Information on post-operative rehabilitation 3. Information on return to work and driving 4. Experience of consultant team 5. Written information regarding procedures (advantages, disadvantages, survivorship and outcomes) and 6. Personalized decision support based on individual patient’s lifestyle and preferences. These components form the Preoperative/information ‘6 pack’. Conclusion: When developing information materials and decision tools for patients, providing them with the Ankle Arthritis ‘6 pack’ will enable them to make a more informed choice of the surgical options offered by the consultant