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NIHR Signal Partial knee replacements have some short-term advantages compared to total knee replacements
Replacing one side of the knee, unicompartmental knee replacement, may result in shorter hospital stays, fewer short-term complications, faster recovery and better knee function than total knee replacements. However, about 8% need revision by five years - about two to three times the rate with total knee replacements. People with pain and immobility from osteoarthritis that cannot be controlled by other treatments may be referred for knee surgery. If the damage is only to one side of the knee, ...
NIHR Signal Switching to oral antibiotics early for bone and joint infections gave similar results to continuing intravenous therapy
For adults with bone or joint infection, many of whom had metal implants, beginning six weeks of oral antibiotics within seven days of intravenous treatment, was no worse than a regimen delivered wholly intravenously (IV). After one year, around 14% of both groups still had an infection, showing the difficulty of treatment, irrespective of the route of administration. Although current practice suggests antibiotics should be given IV for bone and joint infections, for at least six weeks, this la...
NIHR Signal Keyhole surgery may be better than physiotherapy for hip impingement
Adults with painful restriction of movement of their hip had greater improvements in their symptoms after arthroscopy (keyhole surgery) than those who had physiotherapy. This NIHR-funded study included 222 people with hip pain and limited movement due to femoro-acetabular (hip) impingement but without a diagnosis of osteoarthritis. Their average age was 36 years. Half of the people who had surgery had significant benefit compared with a third of those having physiotherapy. NICE has recommended...
NIHR Signal Torn Achilles tendons have similar outcomes if treated with or without surgery
Outcomes for ruptured Achilles tendons appear similar irrespective of the choice of intervention. This systematic review and meta-analysis found that while the risk of re-rupture with corrective surgery was small at 2.3%, with conservative management (immobilisation in a cast), the rate was only 3.9%. The complication rate at 4.9% was three times higher in those who had surgery. Nearly all of the included studies were observational in this review, and no information was provided on the severit...
NIHR Signal Long-term exercise programmes reduce falls and injuries in older adults
Older people who participate in year-long exercise programmes fall less and are less likely to be injured if they do fall. Exercise does not increase or decrease their risk of hospitalisation. The people aged 60 or over (average age 73 years) who were included in this review took part in supervised training programmes. Typically, about half of people at this age can fall at least once a year. These programmes combined aerobic, strength and balance training, exercising at a moderate intensity fo...
NIHR Signal Medication to reduce stomach acid may increase risk of hip fractures
People who take proton pump inhibitors for digestive disorders such as stomach ulcers and acid reflux may be up to 24% more likely to experience hip fractures. Nevertheless, the benefits of treatment in an individual may outweigh this effect unless the risk of osteoporosis or fracture is high. A conversation between the prescriber and the individual patient on relative risks should help in a treatment decision. The link may be important for people taking these drugs, especially if they have ot...
NIHR Signal Transcutaneous electrical stimulation (TENS) may help lower limb spasticity after stroke
Transcutaneous electrical stimulation (TENS) delivered alongside standard physical therapies could reduce spasticity in the lower limbs following a stroke. Spasticity is a muscle control disorder characterised by tight muscles. It is common after stroke and accounts for significant disability. TENS is often used to treat pain and can affect nervous stimulation of the muscles. The main evidence in this systematic review came from five trials which suggested that TENS combined with other physica...
NIHR Signal A new tool helps predict recovery from ankle sprain
The SPRAINED model may improve prediction of people who are at risk of delayed recovery from ankle sprain. This model was developed in the UK using clinical information from 584 adults with ankle injuries. The model was validated using observational data from 682 people with ankle sprains across 10 different UK emergency departments. Delayed recovery from ankle injury was more likely to be detected when using the SPRAINED model than by clinicians using judgment alone. Re-assessing pain levels ...
NIHR Signal Complications following hip or knee surgery are more likely for people with long-term illness, but benefits are still worthwhile
People with long-term illness are just as likely to benefit from knee or hip surgery as those without. However, they are more likely to have complications following surgery and to be readmitted within three months. This study reviewed data from 70 studies to determine the chance of short-term harms and long-term benefits linked to 11 different co-existing health conditions (such as diabetes and cancer) following hip and knee replacement. Short-term outcomes included surgical complications, infe...
NIHR Signal Robot-assisted arm training after stroke helps people regain some strength and independence
People who have electromechanical or robot-assisted arm rehabilitation after stroke have better arm function and strength as well as finding it easier to complete activities of daily living. Although moderate, the improvements suggest it may be worth considering these interventions as an adjunct to usual therapy. Many people have impaired arm function after a stroke and rehabilitation is often required. Robot-assisted arm training uses devices to support therapeutic movements. Feedback, given b...
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