Aspirin may be a follow-on option to prevent blood clots, starting five days after hip or knee surgery
In a recent trial, switching to low-dose aspirin was just as effective at preventing blood clots after joint replacement surgery as continuing the anti-clotting drug rivaroxaban. Six per 1,000 people taking aspirin experienced a blood clot, compared with seven per 1,000 taking rivaroxaban. Three to five per 1,000 patients experienced major bleeding with either drug.
Rivaroxaban or similar drugs are usually prescribed for two or five weeks after knee or hip surgery, respectively, to reduce the r...
Hospital admission rates and costs increase in line with BMI
Each 2kg/m2 rise in body mass index (BMI) above the normal-weight threshold in women aged 55-79 leads to a 5% rise in annual hospital admissions and 7% rise in healthcare costs. In England, £662 million of the annual hospital admission costs in 2013 could be attributed to overweight or obesity in women of this age group.
This large study, partly funded by the NIHR, looked at over one million women participating in the NHS breast cancer screening programme. Five-year data on hospital admis...
A surgical procedure for shoulder pain is less effective than previously thought
An increasingly common surgical procedure for shoulder pain, subacromial decompression, was only slightly more effective than no treatment. In the first trial of this sort, improvements in pain and function following decompression or arthroscopy (a placebo surgery) did not reach a threshold of clinical importance compared with people allocated to no treatment at all.
This NIHR-funded study involved 313 people with shoulder pain that had not responded to physiotherapy and a steroid injection. Th...
Two common operations to fix a broken tibia have similar outcomes
In people who had broken the lower part of their tibia (shin bone), fixation using a metal rod nailed to the insideof the bone was compared with a locking plate screwed onto the surface of the bone. There was no difference in the quality of life, disability or pain at 12 months for people who had fractures of the lower tibia fixed using either technique.
NICE guidance recommends that surgery takes place within 24 hours of injury but does not mandate which type of surgery to perform. This NIHR U...
Local nerve blocks can improve outcomes for people with hip fracture
Local nerve blocks around the time of hip fracture surgery reduced pain on movement within 30 minutes of injection. People had less need for opioid pain-relief and were quicker to mobilise after surgery. Also, one case of pneumonia was prevented for every seven people given pain relief using a nerve block.
By injecting local anaesthetics close to the nerves to relieve pain after a hip fracture, it is hoped that the need for opioids can be reduced and people might recover more quickly. Nerve blo...
New casting technique is an option for older people with ankle fracture
A new casting technique called “close contact casting” is an alternative to surgery for older people with ankle fracture. Ankle function at six months was similar in people who had casting and those who had surgery but there are some disadvantages to both that patients and surgeons could consider.
This UK-based NIHR trial recruited 620 people aged over 60 years with an unstable ankle fracture that would usually be fixed with surgery.
People who had a cast were less likely to have i...
Ultrasound therapy doesn’t speed healing of leg fracture after surgery
Low intensity pulsed ultrasound (LIPUS), sometimes used to encourage bone fractures to heal after surgery, makes no difference to how soon people can get back to their normal activities or to the speed at which bones appear to heal on x-ray.
The biggest trial of the treatment to date recruited 501 adults with a fractured tibia (shin bone) and who’d had the break fixed surgically. They were asked to use LIPUS for a year at home, or until the bone had healed. Half were given dummy equipment...
Cement injections to treat spinal compression fractures from osteoporosis can reduce short term pain
Injecting cement into osteoporotic spinal fractures within six weeks reduces pain in the first few months and disability six months later. The trial was undertaken in people aged over 60 years and compared the one-off injection to a simulated dummy procedure.
The procedure, called vertebroplasty, aims to stabilise the collapsed vertebra and prevent further collapse.
This trial of 120 older people, average age of 80 years, found that vertebroplasty reduced disability and improved quality of lif...
One-stage, instead of two-stage, surgery may be almost as safe for infected knee replacements
A one-stage knee replacement procedure to treat an infected prosthetic knee may offer similar outcomes for most people as the more commonly used two-stage procedure. Re-infection was seen in 7.6% of people after one-stage revision surgery, compared to 8.8% after a two-stage procedure. Other outcomes, such as range of motion, were also similar.
This review of observational studies described different techniques and approaches and because of the way this information was gathered there are some un...
Nexgen found to be best value for total knee replacement
This economic analysis, using routinely collected National Joint Registry data from 2003 to 2012, found that Nexgen was the most cost-effective brand of prosthesis for total knee replacement. The cheapest brand was AGC Biomet, but Nexgen gave greater quality of life improvement, and the additional cost for the benefit - £2,300 per quality-adjusted life-year - was well within usual willingness to pay thresholds. Nexgen also had the lowest rates of revision surgery.
The study is the first t...