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National projections of future joint replacement use can help us understand the changing burden of severe osteoarthritis. This study aimed to compare actual utilisation rates for primary total hip replacement (THR) and total knee replacement (TKR) to previously forecast estimates for Australia. Data from the Australian Orthopaedic Association National Joint Replacement Registry and Australian Bureau of Statistics were used to calculate 'actual' THR and TKR utilisation rates for the years 2014-2019, by sex and age group. 'Forecast' utilisation rates for 2014-2019 were derived from an earlier study that modelled two alternate scenarios for THR and TKR in Australia: Scenario 1 assumed a constant rate of surgery; Scenario 2 assumed continued growth in surgery rates. Actual utilisation rates were compared descriptively to forecast rates for females and males (overall and by age group). Rate ratios were calculated to indicate the association between actual and forecast THR and TKR rates, with a rate ratio of 1.00 reflecting perfect alignment. Over the study period, 191,996 THRs (53% in females) and 312,203 TKRs (55% in females) were performed. For both sexes, actual rates lay clearly between the Scenario 1 and 2 forecast estimates. In 2019, actual THR utilisation rates were 179 per 100,000 females (Scenario 1: 156; Scenario 2: 200) and 158 per 100,000 males (Scenario 1: 139; Scenario 2: 191). Actual TKR utilisation rates in 2019 were 289 per 100,000 females (Scenario 1: 275; Scenario 2: 387) and 249 per 100,000 males (Scenario 1: 216; Scenario 2: 312). Age-specific rate ratios were close to 1.00 for all age groups, indicating good alignment between forecast and actual joint replacement rates. These validation analyses showed that linear plus exponential growth forecasting scenarios provided an efficient approximation of actual joint replacement utilisation. This indicates our modelling techniques can be used to judiciously predict future surgery demand, including for age

BACKGROUND: Advances in digital technology and the use of multimedia platforms to deliver information provide clinicians with a unique opportunity to develop innovative ways to consistently provide high-quality, accessible, and evidence-based information to support patient participation. Introducing new technologies into everyday acute care clinical practice can be difficult. OBJECTIVE: The aim of this paper was to provide a description of an implementation strategy and the subsequent evaluation undertaken to examine the contextual factors important to the successful adoption of new technology by nurses in the context of acute postoperative care. METHODS: Implementation of the intervention and process evaluation was undertaken in 3 phases: phase 1, preimplementation stakeholder engagement and identification of barriers and enablers to implementation; phase 2, supported implementation of the intervention; and phase 3, evaluation of uptake, usability, and acceptability of the intervention in clinical practice. RESULTS: The outcomes of the implementation of the multimedia intervention in the context of acute postoperative care were positive. Of the 104 patients in the intervention group, 103 (99%) received the intervention. All 103 patients completed the 8-item intervention questionnaire and 93.3% (97/103) were interviewed on day 3 to evaluate usability, uptake, and acceptability. Of these 97 patients, almost all (n=94, 91%) found the program easy to use and most (n=64, 62%) could view the MyStay Total Knee Replacement program as often as they wanted. The findings also suggest that the time to implement the program was minimal (5-10 minutes). Collaboration with nurses and patients before and during implementation to identify potential barriers to successful implementation of the intervention was essential to develop timely strategies to overcome these barriers. To ensure end-user engagement, careful consideration was given to nurses' views on who was responsible for fa

AIM: The Anatomique Benoist Girard (ABG) II femoral implant was a commonly used stem for primary total hip replacement (THR) at our institution (Launceston, Tasmania Australia). We identified peri-prosthetic fracture as the main cause of late failure. METHODS: The late periprosthetic fracture rate for ABG II implants was reviewed with national statistics, using Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) data. National revision rates for periprosthetic fracture were used to compare ABG II with all other cementless femoral stems. RESULT: ABG II stems accounted for 1% (2719 implants) of all femoral stem implants in Australia during the 12-year review period, compared to 23% (587 implants) in Launceston Hospitals. Although the Launceston cumulative percent revision rate for the ABG II stem was lower than the National rate at all time points, the reasons for revision were similar. The most common reason for revision of ABG II was fracture (56.8%), followed by loosening (15.3%). This differs from the reasons for revision in other cementless prostheses (loosening 23.9%, fracture 20.8%, dislocation 18.7%). Cumulative percent revision rates from late periprosthetic fracture, were higher for the ABG II stem than other cementless femoral prostheses. CONCLUSION: This review of the AOANJRR has confirmed a local and national higher revision rate of the ABG II stem due to late periprosthetic fracture compared with other cementless stems. Stem design must be considered to reduce the risk of late periprosthetic fracture.

AIMS: The aim of this study was to estimate the 90-day periprosthetic joint infection (PJI) rates following total knee arthroplasty (TKA) and total hip arthroplasty (THA) for osteoarthritis (OA). METHODS: This was a data linkage study using the New South Wales (NSW) Admitted Patient Data Collection (APDC) and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), which collect data from all public and private hospitals in NSW, Australia. Patients who underwent a TKA or THA for OA between 1 January 2002 and 31 December 2017 were included. The main outcome measures were 90-day incidence rates of hospital readmission for: revision arthroplasty for PJI as recorded in the AOANJRR; conservative definition of PJI, defined by T84.5, the PJI diagnosis code in the APDC; and extended definition of PJI, defined by the presence of either T84.5, or combinations of diagnosis and procedure code groups derived from recursive binary partitioning in the APDC. RESULTS: The mean 90-day revision rate for infection was 0.1% (0.1% to 0.2%) for TKA and 0.3% (0.1% to 0.5%) for THA. The mean 90-day PJI rates defined by T84.5 were 1.3% (1.1% to 1.7%) for TKA and 1.1% (0.8% to 1.3%) for THA. The mean 90-day PJI rates using the extended definition were 1.9% (1.5% to 2.2%) and 1.5% (1.3% to 1.7%) following TKA and THA, respectively. CONCLUSION: When reporting the revision arthroplasty for infection, the AOANJRR substantially underestimates the rate of PJI at 90 days. Using combinations of infection codes and PJI-related surgical procedure codes in linked hospital administrative databases could be an alternative way to monitor PJI rates.Cite this article: Bone Joint J 2022;104-B(9):1060-1066.

Our understanding of the interaction of the large-scale heliosphere with the local interstellar medium (LISM) has undergone a profound change since the very earliest analyses of the problem. In part, the revisions have been a consequence of ever-improving and widening observational results, especially those that identified the entrance of interstellar material and gas into the heliosphere. Accompanying these observations was the identification of the basic underlying physics of how neutral interstellar gas and interstellar charged particles of different energies, up to and including interstellar dust grains, interacted with the temporal flows and electromagnetic fields of the heliosphere. The incorporation of these various basic effects into global models of the interaction, whether focused on neutral interstellar gas and pickup ions, energetic particles such as anomalous and galactic cosmic rays, or magnetic fields and large-scale flows, has profoundly changed our view of how the heliosphere and LISM interact. This article presents a brief history of the conceptual and observation evolution of our understanding of the interaction of the heliosphere with the local interstellar medium, up until approximately 1996.