Background Patient-reported outcome measures (PROMs) are commonly used by healthcare providers as means of assessing health-related quality of life and function at any given time. The complexity of PROMs can differ and when combined with varying degrees of adult literacy, error can be introduced if patients fail to understand questions. With an average adult literacy level of 11-year-old students in the United Kingdom, it is unclear to what degree PROMs can be read and understood by most patients (readability); to our knowledge, this has not been evaluated. Questions/purposes We wished to determine the readability of commonly used PROMs in orthopaedic surgery, as assessed by a validated tool that measures the complexity of the language in these surveys. MethodsWe performed a MEDLINE search to identify the most-commonly reported PROMs in orthopaedic research. One hundred twenty-one PROMs were identified and reviewed by 19 attending orthopaedic surgeons at our institution. Fifty-nine were selected as the most commonly used in our department. Of these, 52 (78%) were disease specific and included: 12 (20%) knee, 10 (17%) shoulder, seven (12%) spine, six (10%) hip, five (8%) foot and ankle, four (7%) elbow, three (5%) pelvis, three (5%) hand and wrist, and two (3%) lower limb. The remaining seven (12%) PROMs were general health questionnaires. The Flesch Reading Ease Score is a validated readability tool measuring average sentence length and syllables per word. It is expressed on a scale from 0 to 100 with higher scores indicating easier reading. We extracted the text from each PROM and inserted it in the same online Flesch Reading Ease Score calculator to generate a score. Results The mean readability score was 55 (range, 0-93), corresponding to text best understood by 16-to 18-year-old

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Extreme wear through the metal-backed acetabular cup following total hip arthroplasty is rare, as symptoms such as pain and disability will usually manifest earlier. We present the second reported case of extreme wear in a 78-year-old male patient, who presented 20 years following an uncemented total hip replacement with a 3-year history of hip pain, clicking on ambulation and worsening mobility. Radiographs demonstrated that the femoral head had migrated superolaterally through the polyethylene liner and the acetabular cup, and was articulating with the superior wall of the acetabulum causing bony destruction. Metallic fragments were also evident. A review of the current literature on metallosis suggests that should there be any clinical suspicion, blood metal ion levels are monitored and an MARS-MRI scan performed if indicated. If metallosis is detected, then revision surgery can be attempted at an earlier date, where the procedure is not as technically difficult.

IntroductionThe gold standard for diagnosis of primary oesophageal dysmotility (POD) is high-resolution manometry (HRM). Barium swallow (BS) studies remain integral to many diagnostic algorithms for dysphagia. Our aim was to assess the sensitivity and specificity of BS in the diagnosis of POD including achalasia as defined using HRM.MethodPatients that had a BS and HRM within a year of each other over a period of 10 years were identified. Those with a history of upper gastrointestinal surgery were excluded. The HRM diagnosis was algorithmically deduced from the raw dataset using the appropriate Chicago classification1. All HRM diagnoses and barium term extractions were manually verified by the authors. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) and accuracy for BS were calculated for each of the positive BS terms identified. Subset analysis for achalasia specifically and all spasticity excluding achalaisa were performed.ResultsConclusionThis study suggests that BO patients with LGD have a high risk of developing HGD or Cancer. Furthermore, BO patients with ID have a low risk of progression. It is of paramount importance that patients diagnosed with LGD are intensively monitored through endoscopic surveillance or treated. ID patients should also be followed up but less frequently. This study highlighted that abnormal p53 expression detected through immunohistochemistry is a stronger predictor of malignant progression than LGD.Disclosure of InterestNone DeclaredAbstract PWE-113 Table 1Sensitivity and specificity for diagnosing all spasticity (i.e including DES, nutcracker, jackhammer, rapid contraction, hypertensive) EXCLUDING achalasia Barium swallow termSensitivitySpecificityNPVPPVAccuracyNo of positive BSNo of negative BSTPFPTNFN Tertiary6068.268.198.93.1941983911962Dysmotility091.289.798.10252670252625Spasm099.397.698.202290022855