The Provision of Primary and Revision Elbow Replacement Surgery in the NHS

Hay, Stuart; Kulkarni, Rohit; Watts, Adam C.; Stanley, David; Trail, I. A.; Rensburg, Lee Van; Little, Christopher; Samdanis, Vas; Jenkins, Paul J.; Eames, Michael; Phadnis, Joideep; Ali, Amjid; Rangan, Amar; Drew, Steve; Amirfeyz, Rouin; Conboy, Veronica; Clark, David; Brownson, Peter; Connor, Clare; Jones, Valerie A.; Tennent, Duncan; Falworth, Mark; Thomas, Michael; Rees, Jonathan

doi:10.1177/1758573218789849

Cited by 13 publications

(10 citation statements)

References 8 publications

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“…The familiarity of using a standard TEA implant may be one potential reason for a reduced revision rate with this implant, and although the UK National Joint Registry only reports an average of 467 cases performed annually over the last five years, it is likely that the BESS-GIRFT initiative will improve the experience of surgeons. 8,33 In addition, tumour cases which are deemed amenable to TEA rather than EPR or custom implants may require less soft tissue resection and present less challenging surgical procedures.…”

Section: Discussionmentioning

confidence: 99%

“…The studies were assessed for level of quality using the MINORS criteria. The mean MINORS score for all 11 studies was 9.8 (range [7][8][9][10][11] suggesting that these studies were of poor methodological quality.…”

Section: Study Qualitymentioning

confidence: 99%

“…A robust multidisciplinary approach has been developed by the British Elbow and Shoulder Society (BESS), and from here-on, these management principles will be as important to tumour practice as they are to elbow replacement in non-tumour patients. 8 It is important that an elbow arthroplasty specialist from a designated centre should be involved throughout the management process including surgery.…”

Section: Introductionmentioning

confidence: 99%

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Joint replacement surgery for elbow tumours: a systematic review of outcomes

et al. 2021

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Background Tumour resection followed by joint reconstruction is a surgical option in the appropriate patient. The evidence for such reconstructive surgery of the elbow joint is limited. The aim of this study is to review the literature to evaluate the outcomes of joint replacement surgery in tumours of the elbow. Methods A systematic review of PUBMED and EMBASE databases was conducted. Case series and comparative studies reporting results after total elbow arthroplasty, modular endo-prosthetic replacement and custom prosthesis were eligible for inclusion. Results Eleven eligible studies were identified (n = 134). At mean follow-up of 44 months, the overall revision rate was 14% and complication rate was 28%. The mean Mayo Elbow Performance Score was 75, with 56% of patients reporting good or excellent outcomes. The mean post-operative range of motion was 97°. Discussion Elbow prosthesis reconstruction after tumour resection can provide good functional outcomes at mid-term follow-up. The complication and revision rates are comparable to other indications for elbow replacement surgery. Further prospective studies are required to compare outcomes between different elbow arthroplasty options after tumour resection.

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Section: Discussionmentioning

confidence: 99%

Section: Study Qualitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Joint replacement surgery for elbow tumours: a systematic review of outcomes

et al. 2021

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“…Under these circumstances it can be ordered for a planned semi-elective case. However, the delivery of elbow replacement is currently in flux and it is likely that all elbow replacements, whether elective or traumatic, will be undertaken in specialist centres in the future [22].…”

Section: Theatre Equipment and Data Qualitymentioning

confidence: 99%

A 7-year Prospective Epidemiological Study of Acute Elbow Admissions to a Trauma Unit

Bolt¹,

Govilkar²,

Dover³

et al. 2020

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Introduction: This study represents an analysis of data collected prospectively over a seven-year period to our trauma unit, to identify the epidemiological background behind the admissions of patients with acute elbow problems and to highlight the impact of these admissions on our trauma service. Method: Nearly 16,000 patients were included in our database. The admissions were initially categorized into A) fractures/dislocations or B) soft tissue trauma. The fractures/dislocations were then further classified by radiographic anatomical location, with data also collected on length of stay and operative management. In total 509 admissions were included in this study; 193 were paediatric cases and 316 were adults. This included 428 admissions with fractures/dislocations and 81 cases of soft tissue trauma. Conclusion: In conclusion, this data allows us to identify relative frequency of acute elbow conditions, including the incidence of common fracture patterns. These figures help to facilitate resource planning, such as expertise amongst personnel or the acquisition of equipment, including radial head replacement, elbow arthroplasty, and periarticular locking plates.

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“…Further studies are required to ensure that mathematically rigorous learning curve techniques become commonplace when evaluating the learning curves of new orthopaedic procedures. Indeed, accurate and informative learning curve analysis is even more important in an era of centralisation of care, where difficult procedures are increasingly reserved for supra-specialist, high-volume surgeons[19].…”

Section: Learningmentioning

confidence: 99%

Evaluating learning and change in orthopaedics: What is the evidence-base?

Valsamis¹,

Sukeik²

2019

WJO

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Learning and change are key elements of clinical governance and are responsible for the progression of our specialty. Although orthopaedics has been slow to embrace quality improvement, recent years have seen global developments in surgical education, quality improvement, and patient outcome research. This review covers recent advances in the evaluation of learning and change and identifies the most important research questions that remain unanswered. Research into proxies of learning is improving but more work is required to identify the best proxy for a given procedure. Learning curves are becoming commonplace but are poorly integrated into postgraduate training curricula and there is little agreement over the most appropriate method to analyse learning curve data. With various organisations promoting centralisation of care, learning curve analysis is more important than ever before. The use of simulation in orthopaedics is developing but is yet to be formally mapped to resident training worldwide. Patient outcome research is rapidly changing, with an increased focus on quality of life measures. These are key to patients and their care. Cost-utility analysis is increasingly seen in orthopaedic manuscripts and this needs to continue to improve evidence-based care. Large-scale international, multi-centre randomised trials are gaining popularity and updated guidance on sample size estimation needs to become widespread. A global lack of surgeon equipoise will need to be addressed. Quality improvement projects frequently employ interrupted time-series analysis to evaluate change. This technique’s limitations must be acknowledged, and more work is required to improve the evaluation of change in a dynamic healthcare environment where multiple interventions frequently occur. Advances in the evaluation of learning and change are needed to drive improved international surgical education and increase the reliability, validity, and importance of the conclusions drawn from orthopaedic research.

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The Provision of Primary and Revision Elbow Replacement Surgery in the NHS

Cited by 13 publications

References 8 publications

Joint replacement surgery for elbow tumours: a systematic review of outcomes

Joint replacement surgery for elbow tumours: a systematic review of outcomes

A 7-year Prospective Epidemiological Study of Acute Elbow Admissions to a Trauma Unit

Evaluating learning and change in orthopaedics: What is the evidence-base?

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