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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...
NIHR Signal Partial knee replacements may save costs compared with total knee replacements
Partial knee replacements, when performed by experienced surgeons, can save costs and improve quality of life compared with total knee replacements. Partial replacements for selected patients improve quality of life and savebetween £600 and £2,000 over the patient’s lifetime, depending on age and gender. Knee replacements are commonly performed for people with ongoing pain and poor function. If the damage is limited to one side of the knee, it may be suitable to replace just t...
NIHR Signal Joint infection after hip replacement is linked to some risk factors that could be modified
Ten years of National Joint Registry data show that many factors may increase the risk of joint infection following hip replacement. Less than 1 in 1,000 people on average needed revision surgery for infection per year. Several modifiable patient factors increased risk, such as obesity and diabetes. Using ceramic components, and approaching surgery from the back rather than the side of the hip, may slightly reduce infection risk. This NIHR-funded study analysed registry data for 623,253 hip re...
NIHR Signal Negative pressure dressings are no better than standard dressings for open fractures
Negative pressure wound dressings are neither more nor less effective than standard wound dressings for severe open fractures of the lower leg. Any difference between groups was neither clinically important nor statistically significant. The outcomes included self-rated disability at one year, quality of life and deep surgical site infections at one month which occurred in around 7-8% in each group. Open fractures of the leg, where the broken bone is exposed by the original injury or has burst ...
NIHR Signal Keyhole surgery is more effective than physiotherapy for hip impingement
Keyhole surgery to reshape the joint surfaces in people with hip impingement improves hip-related quality of life more than physiotherapy. In hip impingement, there is a painful restriction of the smooth movement of the ball of the femur inside the cup (acetabulum) of the pelvis. It mainly affects younger, active people. Observational studies have supported the use of keyhole surgery (arthroscopy), but there was a lack of high-quality evidence. This NIHR-funded study is the first trial to compa...
NIHR Signal Fewer wound hernias occur if mesh is used to reinforce abdominal aortic aneurysm surgery
Mesh reinforcement may result in patients developing fewer hernias at the incision site after aortic aneurysm surgery. This type of hernia is a common complication of midline (vertical) incisions and can cause pain and restrict everyday activities. Although using mesh was linked with fewer incisional hernias, this systematic review could not determine with any certainty whether this led to fewer later operations on the hernia. Reoperation carries extra risk, especially in people who have had an...
NIHR Signal People with osteoarthritis can benefit from exercise but may harbour myths about safety
Programmes that show people with osteoarthritis how to exercise safely may slightly improve pain scores, self-belief and social function, but participants also report the myth that discomfort while exercising indicates on-going harm. The review combines evidence from 21 randomised controlled trials evaluating exercise in hip or knee osteoarthritis with 12 studies where people receiving the intervention were interviewed about the impact of exercise on their disease. Participants were men and wom...
NIHR Themed Review Moving Forward - Physiotherapy for musculoskeletal health and wellbeing
Muskuloskeletal problems are the leading cause of pain and disability in the UK. Characterised by pain and loss of function, these conditions can diminish quality of life, impact on family and social relationships, make everyday activities difficult and limit a person’s capacity to work. Physiotherapy is important for preventing and reducing the negative impacts of musculoskeletal conditions. Moving Forward provides an overview of research funded by the NIHR and others, focusing on physiothera...
NIHR Signal Opioid drugs are no better than standard painkillers for long-term back and joint pain
People with long-term back pain, or osteoarthritis of their hips or knees, do not get better pain relief from opioid drugs and are more likely to get side effects than those who take paracetamol or non-steroidal anti-inflammatory drugs (NSAIDs), like naproxen or ibuprofen. A US study assigned 240 patients to either opioid or non-opioid pain relief drugs and measured their pain over 12 months. Those who were assigned opioid drugs had less relief of their pain and also were more likely to have si...
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