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IntroductionKinesiophobia, the fear of physical movement and activity related to injury vulnerability, has been linked to sub-optimal outcomes following total knee replacement (TKR). This systematic review has two aims: to define the relationship between kinesiophobia and functional outcomes, pain and range of motion following TKR, and to evaluate published treatments for kinesiophobia following TKR. Materials and MethodsA primary search of electronic databases, grey literature, and trial registries was performed in March 2020. English-language studies recruiting adult primary TKR patients, using the Tampa Scale of Kinesiophobia (TSK) were included. Outcome measures were grouped into short (12 months). Study quality was assessed using the Newcastle Ottawa Scale for cohort or case control studies, and the Cochrane Collaboration Risk of Bias tool for randomised controlled trials. ResultsAll thirteen included papers (82 identified) showed adequately low risk of methodological bias. TSK1 (activity avoidance) correlated with WOMAC functional score at 12 months in three studies (r=0.20 p<0.05, R=0.317 p=0.001, and correlation coefficient 0.197 p=0.005). TSK score significantly correlated with mean active range of motion (ROM) at two weeks (65.98 (SD=14.51) vs 47.35 (SD=14.48) p=0.000), four weeks (88.20 (SD=15.11) vs 57.65 (SD=14.80) p=0.000), and six months (105.33 (SD=12.34) vs 85.53 (SD=14.77) p=0.000) post-operation. Three post-operative interventions improved TSK score vs control following TKR: a home-based functional exercise programme (TSK -14.30 (SD=0.80) vs -2.10 (SD=0.80) p<0.001)), an outpatient Cognitive behavioural therapy (CBT) programme (TSK 27.76 (SD=4.56) vs 36.54 (SD=3.58), and video-based psychological treatment (TSK 24 (SD=5) vs 29 (SD=5) p<0.01). ConclusionsKinesiophobia negatively affects functional outcomes up until one year post-operatively, while active ROM is reduced up to six months post procedure. Post-operative functional and psychological interventions can improve kinesiophobia following TKR.

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Background: Effective communication on surgical ward rounds should clarify for patients their management plan and answer questions adequately. Pressures on time conspire against this interchange of information. A patient-centred surgical communication check sheet was devised to enable rapid two-way transfer of information between surgeon and patient. Methods: A quality improvement project involved three cycles. Through the use of a patient survey, distributed following the daily ward round, areas for improvement in communication were highlighted in cycle one. The surgical communication check sheet was introduced in cycle two, and modified before cycle three following discussion with the orthopaedic department. The surgical communication check sheet was handed out to patients before the ward round, and its efficacy was measured by evaluating ward round communication using the survey as in cycle one. Results: Initial results showed a variable standard of communication, which improved following the introduction of the surgical communication check sheet in cycle two. In cycle three, 84.7% patients felt that the check sheet aided communication on the ward round. Measures of communication improved between cycles one and three: the percentage of patients with unanswered questions fell from 21.8% to 16.7%, the number of patients unsure why a test was done fell from 25.9% to 12.7%, and average understanding of the management plan rose from 64.7% to 83.3%. Conclusions: The introduction of the surgical communication check sheet improved ward round communication, and was welcomed by almost 85% of patients. Accounts from patients indicate two benefits of the check sheet: the surgeon is immediately aware of a patient with questions or concerns, allowing these to be adequately addressed, and patients can formulate questions before the ward round which bolsters their confidence to ask them.

BackgroundDespite contributing to significant morbidity in working age adults, there is no consensus on the optimal treatment for prepatellar bursitis. Much of the existing literature combines prepatellar and olecranon bursitis. This systematic review aims to determine the optimal management of prepatellar bursitis. Study design and methodsA primary search of electronic published and unpublished literature databases from inception to November 2019 was completed. Articles over 25 years old, case reports with less than four patients, paediatric studies, and non-English language papers were excluded. Our primary outcome was recurrence after one year. Comparisons included endoscopic vs open bursectomy, duration of antibiotics. Methodological quality was assessed using the Institute of Health Economics (IHE) and Revised Cochrane Risk of Bias (RoB-2) scoring systems. Meta-analyses were conducted where appropriate. ResultsIn total 10 studies were included (N=702). Endoscopic and open bursectomy showed no difference in recurrence after one year (OR=0.41, 95% CI 0.05-3.53, p=0.67), and surgical complications (OR=1.44, 95% CI 0.34-6.08, p=0.44). 80% endoscopically-treated patients were pain free after one year. Patients treated with antibiotics for less than eight days were not significantly more prone to recurrence (2/17 vs 10/114, OR 0.66, 95% CI 0.13-3.29, p = 0.64) compared to eight days plus at minimum one year post injury. ConclusionsOur study represents the largest cohort of patients evaluating management strategies for prepatellar bursitis, and includes data not previously published. Endoscopic bursectomy is non-inferior to open bursectomy, enabling a shorter hospital stay. It also offers a relatively low risk of post-operative pain. Endoscopic bursectomy is a viable option to treat both septic and aseptic prepatellar bursitis. Our small cohort suggests recurrence and hospital stay are not improved with antibiotic treatment exceeding seven days for septic prepatellar bursitis.