The Role of a Seven-Day Physiotherapy Service in Reducing Length of Stay and Improving Cost-Effectiveness in Arthroplasty Surgery.

Background Length of hospital stay post hip and knee arthroplasty is influenced by several factors, including gender, home circumstances and underlying diagnosis. Due to increasing demand for hip and knee arthroplasty, elective units, operating within already stressed healthcare systems, must identify methods of increasing efficiency and capacity. We sought to establish whether the lack of a seven-day inpatient physiotherapy service resulted in an increased hospital length of stay post primary hip and knee arthroplasty. Methods One hundred consecutive joint replacements (50 total hip replacements and 50 total knee replacements (TKRs)), performed in our institution from January to February 2020, were assessed. The length of stay for the cohort was analysed, and delays to discharge were identified. T-test was used to analyse the difference in length of stay based on the day of the week the surgery was performed. Results The mean length of stay for all primary hip and knee arthroplasties was 3.42 (standard deviation (SD): 1.62) days. Hip and knee arthroplasties performed on a Thursday or Friday had a significantly higher average length of stay than those performed on Monday, Tuesday or Wednesday (3.89 versus 3.02, p=0.006). We calculated that operating a six-day versus seven-day physiotherapy service in our unit cost 318 bed days per year equating to €986,535. Conclusion Length of stay post total hip and knee arthroplasty in our unit is significantly affected by the day of the week that surgery is performed. Elective orthopaedic units should consider all means of maximising efficiency and lowering costs given the future challenges in service provision.

A Systematic Review of Total Knee Arthroplasty in Neurologic Conditions: Survivorship, Complications, and Surgical Considerations.

BACKGROUND: Patients with neurologic disorders present a unique set of challenges for knee surgeons because of contractures, muscle weakness, spasticity, and ligament instability. The primary purpose of this review was to report the outcomes of total knee arthroplasty (TKA) in these patients, including survivorship, complications, and surgical considerations. METHODS: We performed a systematic review of articles using PubMed, Cochrane Central, EMBASE, and Google Scholar. All studies reporting outcomes of TKA in patients with Parkinson disease, multiple sclerosis, poliomyelitis, Charcot joint, spina bifida, stroke, and cerebral palsy were included. RESULTS: In total 38 studies were included: 22 studies (461 patients) reported patient-reported outcome measures and 24 studies (510 patients) reported survivorship. All 38 studies reported complication rates. TKA resulted in an improvement in functional outcome in all series. Complication rate was higher in patients with neurologic conditions. Of studies reporting survivorship, mean follow-up ranged from 1 to 12 years with survivorship from 66% to 100%. All levels of implant constraint were reported without consensus. Limited rehabilitative data exist. CONCLUSION: TKA in patients with neurologic disorders improves symptoms and function but carries significant risk. This review helps surgeons preoperatively counsel their patients in an informed manner. Careful planning, perioperative care, and appropriate implant selection may mitigate risk of complication.

Online Curves: A Quality Analysis of Scoliosis Videos on YouTube.

STUDY DESIGN: A cross-sectional study. OBJECTIVE: The aim of this study was to evaluate the quality of online scoliosis information available on the video sharing site YouTube. SUMMARY OF BACKGROUND DATA: The Internet is an increasingly utilized resource for accessing information about a variety of heath conditions. YouTube is a video sharing platform used to both seek and distribute information. METHODS: A search for "scoliosis" was carried out using YouTube's search engine and data were collected on the first 50 videos returned. A JAMA score to determine currency, authorship, source and disclosure, and scoliosis-specific score that measures the amount of information on the diagnosis and treatment options (as devised by Mathur et al in 2005; scored 0-32) was recorded for each video to measure quality objectively. In addition, the number of views, number of comments, and feedback positivity was documented for each. Data analysis was conducted using R 3.1.4/R Studio 0.98 with control for the age of each video in analysis models. RESULTS: The average number of views per video was 71,152 with an average length of 7 minutes 32  seconds. Thirty-six percent of the videos fell under the authorship category of personal experience. The average JAMA score was 1.32/4 and average scoliosis specific score was 5.38/32. There was a positive correlation between JAMA score and number of views (P = 0.003). However, in contrast, there was a negative correlation between scoliosis-specific score and number of views (P = 0.01). CONCLUSIONS: Online health information has historically been poor and our study shows that in an environment like YouTube that lacks a peer review process, the quality of scoliosis information is low. Further work is needed to determine whether accessing information on YouTube can play a role in patient care other than simple education pertaining to the disease and its management. LEVEL OF EVIDENCE: 3.