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To determine the risk of total knee replacement (TKR) for primary osteoarthritis (OA) associated with overweight/obesity in the Australian population.This population-based study analyzed 191,723 cases of TKR collected by the Australian Orthopaedic Association National Joint Registry and population data from the Australian Bureau of Statistics. The time-trend change in incidence of TKR relating to BMI was assessed between 2015 and 2018. The influence of obesity on the incidence of TKR in different age and gender groups was determined. The population attributable fraction (PAF) was then calculated to estimate the effect of obesity reduction on TKR incidence.The greatest increase in incidence of TKR was seen in patients from obese class III. The incidence rate ratio for having a TKR for obesity class III was 28.683 at those aged 18-54 years but was 2.029 at those aged75 years. Females in obesity class III were 1.7 times more likely to undergo TKR compared to similarly classified males. The PAFs of TKR associated with overweight or obesity was 35%, estimating 14,287 cases of TKR attributable to obesity in 2018. The proportion of TKRs could be reduced by 20% if overweight and obese population move down one category.Obesity has resulted in a significant increase in the incidence of TKR in the youngest population in Australia. The impact of obesity is greatest in the young and the female population. Effective strategies to reduce the national obese population could potentially reduce 35% of the TKR, with over 10,000 cases being avoided.

Previous published research has shown promising results with flexion splinting post total knee arthroplasty. Before instituting this practice, we conducted a randomised controlled trial to confirm any benefits over splinting in extension. Five patients were recruited into the trial. 5 were excluded. The flexion group consisted of 49 patients who had their knee placed in 70 degrees of flexion over an inactive CPM machine for 24 h post operation. The extension group consisted of 46 patients who were splinted in full extension for the first 24 h post operation. We assessed post-operative day 1 drain volume, haemoglobin and haematocrit, blood transfusions, duration of inpatient stay, range of motion and complications within 6 weeks of surgery. There was no significant difference between the two groups among any of the outcomes measured. As such, we have been unable to demonstrate any benefit with splintage in flexion post total knee arthroplasty and have not adopted it as part of our post-operative management.

The importance for observing the intention-to-treat approach in clinical studies is explained. Cite this article: Bone Joint J 2013;95-B:1443–4.

The Journal of Bone & Joint Surgery (British Volume) had a long and justified reputation for delivering the latest musculoskeletal research in a well-written and easily digestible format. Readers want and deserve clear and concise reporting of research findings and, in particular, how these will

The Bone & Joint Journal provides the latest evidence to guide the clinical practice of orthopaedic surgeons. The benefits of one intervention compared with another are presented using outcome measures; some may be specific to a limb or joint and some are more general health-related quality of life measures. Readers will be familiar with many of these outcome measures and will be able to judge the relative benefits of different interventions when measured using the same outcome tool; for example, different treatments for pain in the knee measured using a particular knee score. But, how should readers compare outcomes between different clinical areas using different outcome measures? This article explores the use of standardised effect sizes. Cite this article: Bone Joint J 2014;96-B:853–4.

There has been a debate amongst orthopaedic surgeons about which plain radiographs are required in common knee conditions and this is a 5-year review assessing the influence of recent publications on the use of radiographs. A postal survey of all members of the British Orthopaedic Association was performed. The response rate was 60% (990/1,650). There was a broad agreement on the use of anteroposterior and lateral radiographs. The use of the posteroanterior (PA) weight-bearing radiograph has increased from 82 to 86%. The use of skyline view for suspected arthritis and after knee replacement has increased from 23 to 41%. There is still disparity amongst orthopaedic surgeons regarding the knee flexion angle for skyline and weight-bearing views. After review of the literature we recommend that a single skyline view in 30 degrees flexion is adequate and should be a standard investigation in knee disorders. We also stress the importance of weight-bearing PA radiograph in 30 degrees knee flexion for adequate assessment in all patients with suspected arthritis.

The quality and public perception of research has never been under greater scrutiny, whether by formal mechanisms such as the Research Excellence Framework[1][1] or via the media. The scale and intent of a recent high-profile case of research fraud,[2][2] amongst a host of others too numerous to

Richard Carey Smith is an orthopaedic oncology surgeon with fellowship training in the UK, USA, Australia and Canada, and has worked in Zambia, Zimbabwe and Papa New Guinea. David Wood is head of the University Department of Orthopaedics in Perth, Western Australia. He did his masters in Africa, and first experienced Papa New Guinea on his medical elective, starting a lifelong commitment to medical aid work there.

Purpose to report a challenging case of reconstructing a massive chest wall defect. To demonstrate the usefulness of the pedicled latissimus dorsi flap to reconstruct massive sternal wounds. Methodology Case Report – A 35 year old man presented 2 weeks after a chest wall resection for a primary amyloidoma and reconstruction using a combination of a titanium mesh and Gore-tex soft tissue patch with primary skin closure. He was clinically septic, with the primary focus being the chest wound. The infected Gore-tex and titanium mesh were removed, and the cavity debrided, resulting in a chest wall defect measuring 30 cm (subcutaneous width) × 20 cm (height) and a bony defect measuring 15 cm (width) × 18 cm (height). An initial attempt of reconstructing this with a free latissimus dorsi flap was abandoned prior to raising of the flap because of difficulty in finding a recipient vessel. The defect was finally reconstructed using a pedicled latissimus dorsi flap. Result We describe a single stage technique for reconstructing a massive sternal defect. The use of a pedicled latissimus dorsi flap provided a reliable reconstruction in what can be a traditionally difficult reconstructive site. Conclusion A pedicled latissimus dorsi flap is useful even in the reconstruction of large chest wall defects.

A 51 year old man presented in 1975 at the age of 19 with a right hallux mass and underwent wide local excision, pathology revealing a chondroid syringoma. This was complicated by local recurrence within 12 months requiring 1st ray excision and a transposition flap. He was symptom free for 12 years and represented with pain on weight bearing. There was a 1 year delay in management as he refused amputation, and underwent “natural treatment by diet”. Subsequent above knee amputation was performed with radiographic evidence of chest metastasis. He represented in 2004 with an abdominal mass and had a nephrectomy for metastasis, and in 2006 with proximal femoral metastasis requiring allograft reconstruction of the hip. 33 years from initial diagnosis with a documented 13 year history of thoracic metasteses we review the literature on chondroid syringoma.

Dear Sir, We enjoyed reading the excellent, concise summary of limb salvage surgery, and the early emphasis and references to patient-directed outcomes, as well as surgical markers of success by Grimer and Jeys.1 The consequences of large muscle-group resection or the loss of the motor nerves on functional outcome are well documented and will remain a problem for patients and surgeons alike. Soft-tissue rotation and free-flap augmentation remain core techniques in orthopaedic oncology. …