Background Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA). There are many contributing factors. The relationship between preoperative osteoarthritis (OA) severity and outcome post TKA remains unclear. This review explores the relationship between preoperative OA severity with patient reported pain, function and satisfaction post TKA. Methods A pre‐registered systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Major databases were searched until September 2017. We included studies assessing adults undergoing TKA for OA. Minimum follow‐up was 6 months. Methodological quality assessment was conducted using the Newcastle‐Ottawa Scale. Results Twenty cohort studies with 7478 patients were included. There were 16 good, one fair and three poor quality studies. Knee OA was most commonly reported according to the Kellgren and Lawrence tool. Ten studies showed statistically significant pain outcomes for those with worse preoperative OA. This was supported by meta‐analysis of the Knee Society Score pain change scores to final follow‐up for those with Kellgren and Lawrence grade 4 OA. Six studies showed statistically significant results for various aspect of functional recovery, although meta‐analysis of Knee Society Score function change scores identified no difference. Meta‐analysis of final follow‐up pain and function scores alone yielded no significant difference. Patients with more severe preoperative OA were more likely to be satisfied. There were no studies demonstrating that less severe OA resulted in better pain, function or satisfaction. Conclusion Review of available research indicates that TKA for OA improves pain, function and satisfaction. Those with more severe preoperative radiological knee OA benefit most.

The response rate to the questionnaire was 100 per cent. Eleven Australian medical schools reported offering a teaching-skills programme, of which five were described as compulsory formal programmes. Eight schools did not offer such a programme, citing time restraints and other subjects taking higher priority. Formal peer-to-peer teaching opportunities were described by 17 schools, with 13 offering this electively. Two schools reported that they did not offer such opportunities because of time restraints, the belief that the quality of expert teaching is superior and because of a lack of staffing. The demand for the teaching and supervision of medical students and junior doctors is increasing CONCLUSIONS: Despite the increasing number of medical students and subsequently junior doctors in Australia, a minority of Australian medical schools report including a formal, compulsory teaching-skills programme. These results may imply a lost opportunity to use the positive effects of teaching-skills programmes, and are in line with studies from other countries.

Background Orthopaedic surgery is largely successful; however, a proportion of patients are dissatisfied and report pain and poor function. Psychological factors have been shown to influence orthopaedic surgical outcomes. This systematic review and meta‐analysis investigates the types and effectiveness of preoperative psychological interventions in elective orthopaedic surgery. Methods A registered systematic review (PROSPERO CRD42017073833) was performed on literature (1960–January 2018) using eight databases. Prospective controlled clinical trials involving adult and adolescent elective orthopaedic surgery were included. Interventions examined included relaxation, cognitive behavioural therapy, hypnosis, emotional counselling and mixed psychotherapies; general procedural education was excluded. Outcomes extracted included pain, anxiety, quality of life and disability. Results A total of 19 studies met the inclusion criteria (n = 1893 patients). Meta‐analyses were performed for pain, anxiety and quality of life. Analysis did not find enough evidence to confirm reduction in post‐operative pain (seven studies, 666 patients; g = −0.15 (95% CI −0.42, 0.13), P = 0.305). Pooled data from six studies on acute post‐operative anxiety (589 patients) showed a moderate statistically significant benefit (g = −0.26 (−0.49, −0.03), P = 0.024). There was an improved quality of life (mental component) at longer term follow‐up (g = 0.25 (0.02, 0.49), P = 0.034). Conclusions These studies provide evidence that psychological interventions have a positive effect on anxiety in the acute post‐operative period, and on mental components of quality of life at longer term follow‐up.

Incidental durotomy is a relatively common complication of spine surgery and if the durotomy is not addressed at the time of an operation a pseudomeningocele may develop. A pragmatic approach for GP is to individualise management based upon symptoms. Although GP are rare, prevention is likely the best approach. We outlined a structured approach to the management of an incidental dural leak that formed the largest reported pseudomeningocele reported to date.

ObjectivesThe aim of this review was to assess the current evidence regarding the efficacy of teaching skills programs for junior medical officers.  We aimed to compare and contrast these results with findings from previous literature reviews, the last of which were published in 2009. MethodsIn order to capture studies since the last published literature reviews, five databases and grey literature were searched for publications from January 2008 to January 2015. A search for literature reviews without using the timeframe limitation was also performed. ResultsThe search from January 2008 to January 2015 resulted in the inclusion of 12 studies. Five systematic reviews of the topic were found which included 39 individual studies that were also analysed. Nearly all studies reported positive effects. Twenty nine studies reported change in attitudes, 28 reported modification in knowledge, 28 reported change in behaviour, 6 reported change in the organisation and two reported change in program participant’s students. There were substantial threats of bias present. ConclusionsThe literature reviewed demonstrated many positive effects of teaching skills programs, which supports their utilization. However, high level outcomes need to be evaluated over longer periods of time to establish their true impact. An organisation specific approach to these programs needs to occur using sound course design principles, and they need to be reported in evaluation trials that are designed with robust methodology.