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Sacral insufficiency fractures can be managed conservatively, by surgical fixation or by sacroplasty. This systematic review compared the outcomes of different treatment modalities to ascertain the best. Studies included in this systematic review were those with sacral insufficiency fracture in elderly patients with some measure of outcomes reported. Fractures due to high-energy trauma or malignancy or in non-elderly patients were excluded. The review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE and Embase databases were searched from inception to January 6, 2022, yielding a total of 4299 papers of which 35 were eligible for inclusion. Pain reduction following sacroplasty (Visual Analogue Scale (VAS) difference 5.83, SD 1.14, n = 901) was superior compared with conservative management (VAS difference 3.7, SD 2.71, n = 65) (p <0.0001) and surgical fixation (with screws/rods +/- cement augmentation; VAS difference 4.1, SD 1.106, n = 154) (p< 0.001). There was no significant difference between pain relief following screw fixation and after conservative management (p = 0.1216). Hospital stay duration was shorter following sacroplasty (4.1 days )SD 3.9)) versus fixation (10.3 days (SD 5.59)) (p= 0.0001). Available evidence points to sacroplasty resulting in better pain relief and shorter hospital stay than other treatment options.

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Background: Total knee arthroplasty requires effective rehabilitation to achieve optimal results, but institutions often rely on unsupervised home exercises due to cost constraints. Wearable sensors have become increasingly popular as a potential method of monitoring patients remotely to ensure efficacy and compliance. This review assesses the current evidence for their use in remotely monitored rehabilitation following knee arthroplasty. Methods: A systematic review of the literature from 1st January 2000 to 17th February 2022 was undertaken. Devices were categorised as joint-specific or physical activity sensors. Studies were classified as those providing remotely supervised rehabilitation as an additional or as an alternative intervention. Results: Remotely supervised rehabilitation using wearable sensors demonstrated similar outcomes when provided as an alternative to standard care in most studies. One group found improved outcomes for knee-specific sensors compared with standard care. There were improved physical activity and healthcare resource use outcomes described in the literature where sensors were used in addition to standard care. Discussion: This review found evidence for the use of wearable sensors in remotely supervised rehabilitation following knee arthroplasty surgery. This included methodological heterogeneity, differing definitions of standard care, and variable follow-up periods. Robust randomised control trial data with a longer follow-up period are needed.

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Background: This article focuses on clinical implementation of smart knee implants for total knee replacement and the future development of smart implant technology. With the number of total knee replacements undertaken growing worldwide, smart implants incorporating embedded sensor technology offer opportunity to improve post-operative recovery, reducing implant failure rates, and increasing overall patient satisfaction. Methods: A literature review on smart implants, historical prototypes, current clinically available smart implants, and the future potential for conventional implant instrumentation with embedded sensors and electronics was undertaken. Results: The overview of current and future technology describes use cases for various diagnostic and therapeutic treatment solutions. Conclusion: Smart knee implants are at an early development stage, with the first generation of smart implants being available to patients and with more novel technologies under development.

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Fribrodysplasia ossificans progressiva (FOP) is a rare genetic disease characterized by progressive heterotopic ossification of connective tissues, episodic flare-ups and bilateral deformities of the great toe (hallux valgus). As faulty tissue repair processes progressively calcify tissue, patients suffer from swelling and limited mobility in that area. We present a case of a 66-year-old woman who had initially presented at age 54 without the hallux valgus deformity or classic-type flare-ups. As there is currently no cure for FOP, management is mainly symptom control. Physicians should still consider FOP if imaging indicates progressive heterotopic ossification in the absence of hallux valgus in an older patient.

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Total knee arthroplasty (TKA) is an effective treatment for patients with end-stage symptomatic knee osteoarthritis. As the aging population grows, the demand for the procedure is projected to increase. While highly successful, TKA has associated risks and complications. Complex regional pain syndrome is one uncommon but debilitating complication that can negatively impact patient satisfaction and quality of life. We present a case of complex regional pain syndrome in the operated leg that resulted in significant functional deficits. Key findings of this case include significant and disproportionate pain in the joint, altered cutaneous sensation around the joint, and decreased range of motion in flexion in the absence of any mechanical issues with the TKA. Because of the debilitating nature of this condition, patients must be fully informed of and realize the risks associated with undergoing a widely appreciated procedure such as TKA.

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Total joint arthroplasties are increasing worldwide in both frequency and prevalence. When successful, they offer great improvements in quality of life. However, fractures around implants are often difficult to manage and require prolonged inpatient stays in tertiary hospitals. Management may differ between surgeons, but most patients will be managed surgically if mobility or joint stability is threatened. Those affected are often at higher risk from surgery, are frailer and at higher risk of mortality and a lifelong reduction in mobility. The incidence of these fractures is increasing, and patients should appreciate the risk and implications of this recognised complication of joint arthroplasty.

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BACKGROUND: Accurate limb volume measurement is key in the assessment of outcomes in lymphedema microsurgery. There are two commonly used methods as follows: manual circumferential measurement (tape) or Perometer measurement. There are no data on the intra- and interclass correlation of either method, making it difficult to establish a gold standard of limb volume measurement. We aim to assess the intra- and interclass correlation of each method to establish the most appropriate method for clinical practice and future research studies, aiming to compare the accuracy and reliability of tape measurement as assessed against Perometer measurement. METHODS AND RESULTS: Student volunteers and experts (lymphedema practitioners) were each asked to perform repeat tape and Perometer measurements on the upper or lower limb of one healthy volunteer. Perometer measurements were globally more accurate than tape (average SE [Perometer]: 23.23 vs. 77.21 [tape]). For intraobserver reliability, experts outperformed students in all domains tested, with little difference in intraobserver reliability using tape or Perometer (average Cronbach's alpha 0.9597 [expert)] vs. 0.6033 [student]). CONCLUSIONS: We recommend that, for increased interobserver reliability, the Perometer provides a more reliable standard of limb volume measurement.

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BACKGROUND: Uterovaginal prolapse in very elderly women is a growing problem due to increased life expectancy. Surgeons and anaesthetists may be wary of performing quality of life surgery on this higher risk group. Where surgery is undertaken, it is commonly performed vaginally; there is a perception that this is better tolerated than abdominal surgery. Little data is published about laparoscopic prolapse surgery tolerability in this population, and laparoscopic surgery is perceived within the urogynaecological community as complex and lengthy and hence inherently unsuitable for the very elderly. In Oxford, UK, laparoscopic abdominal surgical techniques are routinely employed for urogynaecological reconstructive surgery. The authors offer abdominal laparoscopic prolapse surgery to patients suitable for general anaesthesia with apical vaginal prolapse, irrespective of age. We here report outcomes in this elderly patient cohort and hypothesise these to be acceptable. This is a retrospective case note review of all patients aged 79 years old and above undergoing laparoscopic prolapse surgery (hysteropexy or sacrocolpopexy) in two centres in Oxford, UK, over a 5-year period (n = 55). Data were collected on length of surgery, length of stay, intraoperative complications, early and late post-operative complications and surgical outcome. RESULTS: Mean age was 82.6 years (range 79-96). There were no deaths. Minor post-operative complications such as UTI and constipation were frequent, but there were no serious (Clavien-Dindo grade III or above) complications; 80% achieved objective good anatomical outcome. CONCLUSIONS: Laparoscopic prolapse surgery appears well tolerated in the elderly with low operative morbidity and mortality.

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INTRODUCTION: Recurrent cellulitis is a frequent and challenging complication of lymphoedema. British Lymphology Society cellulitis guidelines state that decongestive lymphatic therapy reduces the frequency of cellulitis attacks, but do not mention the effect of surgical interventions. This systematic review aims to assess whether surgical interventions for lymphoedema reduce the frequency of attacks of cellulitis. MATERIALS AND METHODS: Embase, Medline, and the Cochrane database were searched for relevant articles from database inception to January 2016. Four hundred and thirty-six abstracts were retrieved. Studies were included which contained quantitative data on cellulitis incidence before and after a surgical intervention. Two independent reviewers applied selection criteria, selecting 27 papers for full text review. Two were unavailable in the UK from any source. RESULTS: A variety of surgical techniques were utilized in the 25 papers included: lymphaticovenous anastomosis, superficial-to-deep lymphaticolymphatic anastomosis, lymph node transfer, Charles procedure, muscle flap transfer, Homan's procedure, and subcutaneous tissue excision below skin flaps. Five studies combined techniques. One study compared the intervention to a control group (physical therapy). Cellulitis incidence was decreased following surgical intervention in 24/25 studies included. Eight had quantifiable reductions in cellulitis over a set follow-up period; in the other 16 preoperative incidence was not precisely defined. CONCLUSION: Surgery appears effective at reducing cellulitis incidence in lymphoedema. However, high quality evidence from randomized controlled trials is lacking. Future research should concentrate on comparison with control groups, for example compression alone versus compression with surgical intervention, in patients with lymphoedema and greater than two attacks of cellulitis per year.

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