A comparison of risk profile for orthopaedic operations when utilizing individually wrapped screws (IWS) when compared with sterile screw caddies (screw racks).

INTRODUCTION: There has been a global trend towards individually packaged screws for orthopaedic operations. Traditional practice makes use of screw caddies that require re-sterilization. Individually wrapped screws (IWS) are purported to decrease infection rates and avoid the deleterious effects of repeated screw sterilizations, despite marginal evidence. This review aimed to evaluate the safety, effectiveness and economics of screw caddies with IWS. MATERIAL AND METHODS: The literature was surveyed in a systematic fashion between 1998 and 2017 and all relevant health technology assessments, systematic reviews, meta-analyses, randomized controlled trials, cohort studies, case-controlled studies and case series were sought. Any benefits or otherwise of IWS over screw caddies were then evaluated in the areas of safety, effectiveness and economics. RESULTS: Two level III-3 papers suggested the use of caddies at least as safe as individual screws. Four level III-2 papers demonstrated that screws from caddies were as effective as individual alternatives, while a level III-3 paper reported that individual screws were significantly more expensive than screw caddies. Cost increases to our regional health service from ankle open reduction and internal fixations alone of at least $50,112 (AUD) per annum were calculated. CONCLUSIONS: From the results obtained, the authors recommend the continued use of screw caddies for orthopaedic procedures.

Current variability in the assessment of component position for the unhappy knee replacement.

INTRODUCTION: Total knee arthroplasty (TKA) has a success rate of 80-90%, but despite this encouraging figure a painful TKA can be a source of dismay for patients and surgeons. Computed tomography (CT) scan has been developed as a tool to collect data in the analysis of TKA component placement. Protocols used to collect such data exist in orthopaedic and radiology practice with little standardization and significant variation. The aim of this review article was to evaluate such variability by sampling a series of protocols from a range of different radiology practices within NSW, Australia in a case-based manner and to then compare them against any literature standards. METHODS: The literature was surveyed for existing CT scan protocols used in TKA assessment. These were then compared with a series of metropolitan and rural radiology firms across the public and private sectors in NSW, Australia. RESULTS: Considerable variability exists between current protocols across NSW, Australia, which differ with proposed literature standards. CONCLUSION: Variabilities encountered when comparing the different scanning protocols in use for the assessment of TKA constitute a large potential source of error in the analysis of TKA component positioning. The reliance surgeons place on such analyses suggests the need for an established scanning protocol with an incorporated grading system and standardized values to allow reproducible data to help assess and predict TKA function.

Femoral side-only revision options for the Birmingham resurfacing arthroplasty.

BACKGROUND: The Birmingham Hip Resurfacing (BHR) system (Smith and Nephew) was developed as an alternative to conventional total joint replacement for younger, more active patients. Among other complications exists the risk for femoral component failure. The only marketed revision option for such a complication involves exchange of all components for a total replacement arthroplasty. This presents as a considerable and potentially unnecessary operative burden where revision of only the femoral prosthesis would suffice. We have analysed revision options for BHR in the context of periprosthetic femoral fractures with a stable acetabular component. METHODS: Technical details of dual mobility hip systems available in Australia were collated and analysed to assess for potential 'off label' use with an existing BHR acetabular component. These data were then compared with the custom-made Smith and Nephew dual mobility implant with respect to clearance and sizing. RESULTS: Two dual mobility articulation modalities from two companies were identified as appropriate for potential usage with four products analysed in detail. These two demonstrated acceptable sizing and clearance measurements. CONCLUSION: Comparison between readily available dual mobility prostheses with custom-made implants showed off label dual mobility prosthetic use to be a viable alternative for femoral-only revisions with in situ BHR. Single component revision has several advantages which include: a less complex surgical procedure, shorter operative time, decreased blood loss and the expectation of resultant lower morbidity. Furthermore, this less complex revision surgery should give comparable results to that of primary total hip arthroplasty.

Can Alberta's primary care networks provide any lessons for Medicare Locals?

Australia's Medicare Locals are in a formative period, and any comparison so far has focused on the United Kingdom.