Exploring patient acceptability of a short-stay care pathway in hospital post arthroplasty: A theory-informed qualitative study.

INTRODUCTION: Arthroplasty is an effective, yet costly, surgical procedure for end-stage osteoarthritis. Shorter stays in hospital are being piloted in Australia. In some countries, short stay is established practice, associated with improving perioperative care and enhanced recovery after surgery practices. Exploring the acceptability to patients of a short stay care pathway in hospital postarthroplasty is important for informing health policy, adoption and potential scalability of this model of care. METHODS: Consecutive patients at one site, at least 3 months post total joint arthroplasty, were invited to participate in theory-informed semi-structured qualitative interviews. The Theoretical Framework of Acceptability (TFA) informed development of the interview guide. Interview data were analysed using the Framework Method. RESULTS: Eighteen patients were invited. Fifteen consented to be contacted and were interviewed. Short-stay post arthroplasty was highly acceptable to patients who had the supports necessary to recover safely at home. Key findings were as follows: flexibility of short-stay care pathway was essential and valued; prior beliefs and expectations informed acceptability; and the absence of out-of-pocket expenses had an incentivizing effect, but was not the primary reason for patients choosing this care pathway. Further themes analysed within the TFA constructs highlighted nuances of acceptability relating to this model of care. CONCLUSIONS: A short stay in hospital post arthroplasty appeared to be acceptable to patients who had experienced this care pathway. Our thematic findings identified aspects of the short-stay care pathway that enhanced acceptability and some aspects that limited acceptability. These findings can inform refinement of the short-stay care pathway. PATIENT OR PUBLIC CONTRIBUTION: Patients/people with lived experience were not involved in the study design or conduct of this preliminary work; as this short-stay model of care was recently introduced, only a small group of patients was eligible to participate in this study. This study is the first step towards understanding the experiences of patients about a short-stay model of care post arthroplasty. The findings will help inform future patient and public involvement in expanding the programme.

Proximal Hamstring Repair - Surgical Pearls for the Novice.

Introduction: Proximal hamstring injuries are rarely encountered sport injuries which cause great functional impairment in the activities of performance. Since these injuries are rarely encountered in orthopedic training, many young surgeons find it challenging to explore and successfully perform the required repairs. The technical demands of tendon retraction, scar tissue formation along with a great possibility of nerve injury during surgical dissection make these procedures a nightmare for young surgeons. Results: Between January 2020 and December 2021, 11 patients underwent a proximal hamstring repair at our practice. All cases were of acute hamstring tears and diagnosed on magnetic resonance imaging (MRI) evaluation post-injury. No repeat MRI was performed but the patients outcomes were judged based on clinical outcomes such as return to sport or the presence of residual pain. All patients reached their pre-injury level of activity within 6 months of surgical repair. Conclusion: This technical note describes pearls of surgical repair of these injuries that help in better execution of such injuries with minimal soft tissue damage and complications.

The Immediate Post-Operative Radiograph is an Unreliable Measure of Coronal Plane Alignment in Total Knee Replacement.

BACKGROUND: Restoration of a neutral mechanical axis is a primary goal of total knee replacement (TKR). A mechanical axis within 3° of neutral has been correlated with improved implant longevity, function, and patient satisfaction. We hypothesize that the immediate post-operative radiograph is an unreliable method of measuring alignment following TKR surgery. METHODS: Seventy-five consecutive patients had supine X-rays performed on day two post-operatively followed by standing long-leg radiographs (LLRs) 6 weeks post-operatively. Correlation was sought between the mechanical axis measured on the LLR and surrogate markers of alignment on the post-operative X-ray including component alignment and an estimation of anatomical alignment using the available length of femoral and tibial shafts. Inter- and intra-observer reliabilities were assessed. RESULTS: The mean mechanical axis on the LLR was 180.5 (SD 3.0, range 175.1-187.1). Mean offset between anatomical axis and mechanical axis was 6.4°. The mean anatomical axis measured on the short-leg X-ray was 174.9 (SD 2.4, range 169.5-181.3). Mechanical axis on the LLR was compared to the anatomical axis measured on the short-leg radiograph (SLR) + 6° with an interclass correlation coefficient of 0.588 (p < 0.001). The level of disagreement between the short- and long-leg X-rays was assessed using the Bland-Altman method and demonstrated clinically important discrepancies of 5 or more degrees in 9% of cases. Inter- and intra-observer agreements were high on all measures (p < 0.001). CONCLUSION: The long-leg weight bearing X-ray is an essential tool to accurately assess coronal plane alignment post TKR. While the immediate post-operative X-ray taken supine provides useful information to the surgeon on any immediate complications, our results indicate that it cannot be relied upon to determine correct restoration of the mechanical axis.