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NIHR Signal Functional braces are effective alternatives to plaster casts for ruptured Achilles tendons
Early weight-bearing in a below-knee rigid boot, a functional brace, following ruptured Achilles tendon can achieve similar results to traditional plaster casting. This NIHR-funded trial included 540 people, and after nine months there appeared to be no difference between the two treatments in terms of how well patients recovered from their injury. The functional brace was preferred by patients. Functional bracing is an alternative to traditional plaster casting that allows earlier weight-beari...
NIHR Signal Plasma and blood cell injections have not shown a benefit for Achilles tendon injury
Injecting a ruptured Achilles tendon with a small sample of a person’s own plasma, without the red blood cells, has no functional or other benefit. Plasma rich in platelets and white blood cells for the acute injury was compared with placebo. The NIHR-funded trial involved 230 adults with acute Achilles tendon rupture (the tendon which connects the calf muscles to the heel). All were attending UK hospitals within 12 days of injury. The trial found no difference in function at 24 weeks aft...
NIHR Signal Using wires to fix wrist fracture has good long-term outcome
Fixing a displaced broken wrist with wires is as effective as fixation with locking plates in the long term. Wrist function and pain continueto improve in the five years following either operation, with no evidence of a difference between the two treatments. In 2014, a trial comparing the use of Kirschner wires and locking plates for displaced fractures of the distal radius reported that patients treated with either operation did equally well after 12 months. This follow-up study allays fears t...
NIHR Signal Outcomes similar for full or partial hip replacement after hip fracture
For older people with hip fracture, the choice between full or partial hip replacement does not greatly influence outcomes. In this trial, approximately 8% of patients having each operation required further surgery within a 24-month period. Mortality rates were also similar at around 13%. Thismultinational trial included 1,495 adults aged over 50 with a hip fracture, who were previously able to walk unassisted. It found that both hemiarthroplasty (partial replacement) and total hip replacement ...
NIHR Signal Partial knee replacement ‘could be first choice’ for suitable patients with osteoarthritis
Partial knee replacement surgery improves pain and function similarly tototal knee replacement in people with osteoarthritis that affects only a single compartment of the knee. Partial knee replacement surgery is also cheaper. In this NIHR-funded trial of 528 people with osteoarthritis affecting only one compartment of the knee, those who had partial knee replacement saw at least as much improvement as those who had a total joint replacement. Their care also cost about £900 less over five...
NIHR Signal More than 50% of hip replacements appear to last 25 years
Data from national registries and large case series showthat in those countries, around 85% of total hip replacements last for 15 years, with 58% lasting for 25 years. This means that those hip replacements have lasted last longer than was first thought. It is good news for an ageing population, as it should mean that the chances of needing a second hip operation are reducing. However, it is not clear how directly relevant the results of this study are to the UK. The NIHR-funded study didn&rsqu...
NIHR Signal More than 80% of total knee replacements can last for 25 years
Large data sets from national registries and case series show that about 82% of total knee replacements and 70% of partial (unicompartmental) knee replacements last for 25 years. This NIHR-funded review of that data is the first to demonstrate longer-term effectiveness of these procedures. This means that the operation, which aims to relieve pain for osteoarthritis, may not need to be delayed to reduce the chance of a patient needing further surgery at a later date. It is an encouraging finding...
NIHR Signal A traditional implant is as effective as more expensive newer types for people over 65 having a hip replacement
A commonly used, cheaper implant used in total hip replacement surgery is as effective as more expensive options for over-65s, a new study has found. A range of prosthetic implants is used for hip replacement, including newer and more expensive options, with different surface materials and some that do not require cement. They may wear at different rates, and all can require further surgery if they become loose. This risk is greater for younger and more active patients. This large NIHR-funded ...
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...
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