Introduction COVID-19 has necessitated significant changes to healthcare delivery but little is known regarding patient opinions of risks compared with benefits. This study investigates patient perceptions concerning attendance for planned orthopaedic surgery during the COVID-19 pandemic. Materials and methods A total of 250 adult patients from the elective orthopaedic waiting list at Cardiff and Vale University Health Board were telephoned during lockdown. They were risk stratified for COVID-19 based on British Orthopaedic Association guidance and a discussion was held to determine patient willingness to proceed with surgery. The primary outcome measure was patients’ willingness to proceed. Results Of the total number telephoned, 196 patients were included in the study, with a mean age of 57.4 years; 129 patients were willing to attend for surgery, leaving over one-third wishing to cancel or defer. The most frequent reason given for not wishing to attend was fear of contracting COVID-19. There was a statistically significant difference in the willingness to proceed observed with increasing clinical risk (χ2(3) = 50.073, p = .000) with almost double the expected count of unwilling to proceed in the high and very high risk groups, equalled by half the expected count in the low risk group. Discussion This study illustrates the variable and personal decisions that patients are making about orthopaedic care because of COVID-19. It highlights the need for change to departmental processes regarding recommencement of planned surgical lists. It also reconfirms the importance of regular communication and shared decision making between a well-informed patient and a holistic orthopaedic team.

We sought to identify the impact of whole-body computed tomography (WBCT) on working and suspected diagnoses in Emergency Department (ED) trauma patients and to determine the rate of WBCT scans with no detectable traumatic injuries. We performed a retrospective database analysis of all trauma patients who underwent WBCT in 2009, comparing pretest suspicion of specific injury to WBCT findings, looking for the rates of unexpected findings and the absence of traumatic injury in WBCT studies. Our results showed that of the 179 patients who underwent WBCT, no traumatic injury reported in 17 patients while 162 patients demonstrated pathology (47 confirming previously suspected or diagnosed injury and 115 with previously unexpected injury). Overall, WBCT results differed from clinical findings in 130 (72.6%) patients, a statistically significant difference (P<0.0001). In conclusion, WBCT identifies previously unexpected injuries in almost 66% of ED trauma patients, supporting its continued use in the initial assessment of trauma patients.

This study aimed to examine the effect of high tibial osteotomy (HTO) on the ankle and subtalar joints via analysis of static radiographic alignment. We hypothesised that surgical alteration of the alignment of the proximal tibia would result in compensatory distal changes.35 patients recruited as part of the wider Biomechanics and Bioengineering Centre Versus Arthritis HTO study between 2011 and 2018 had pre- and postoperative full-length weightbearing radiographs taken of their lower limbs. In addition to standard alignment measures of the limb and knee (mechanical tibiofemoral angle, Mikulicz point, medial proximal tibial angle), additional measures were taken of the ankle/subtalar joints (lateral distal tibial angle, ground-talus angle, joint line convergence angle of the ankle) as well as a novel measure of stance width. Results were compared using a paired T-test and Pearson's correlation coefficient.Following HTO, there was a significant (5.4°) change in subtalar alignment. Ground-talus angle appeared related both to the level of malalignment preoperatively and the magnitude of the alignment change caused by the HTO surgery; suggesting subtalar positioning as a key adaptive mechanism. In addition to compensatory changes within the subtalar joints, the patients on average had a 31% wider stance following HTO. These two mechanisms do not appear to be correlated but the morphology of the tibial plafond may influence which compensatory mechanisms are employed by different subgroups of HTO patients.These findings are of vital importance in clinical practice both to anticipate potential changes to the ankle and subtalar joints following HTO but it could also open up wider indications for HTO in the treatment of ankle malalignment and osteoarthritis.

Tibial articular surface deforms by the bone defects and articular wear with progression of medial knee osteoarthritis (knee OA). It will affect the kinematics of knee joint and lower extremity under various loading conditions, however the detail of this mechanism has not been clarified enough. The purpose of this study was to investigate the effect of tibial articular surface deformity on the kinematics of lower extremity during level in some severities of medial knee OA. Methods: Subjects were 57 knees in 50 adults (18 males and 32 females, age: 56.6±19.2y.o.). Medial knee OA severity was graded by the Kellgren and Lowrence classification (grade-0: 8 knees,-I: 8 knees,-II: 15 knees,-III: 18 knees and-IV: 8 knees). The deformity of tibial articular surface was analyzed by their computed tomography-based three-dimensional (3D) bone model, and the tilt of articular surface was evaluated as the angle of articular surface relative to the long axis of tibia on the frontal plane. Level walking of the subject was measured by a motion capture system at a sampling rate of 250Hz (VICON, Vicon Motion Systems, Ltd, UK), and then the kinematics of femur and tibia relative to the ground during level walking was estimated by combining the motion capture data and the femorotibial bone models. Knee-joint kinematics was evaluated as tibial motion relative to femur. Additionally, stride length and walking velocity were assessed as walking performance. The differences in the parameter among knee OA severities were analyzed statistically by the Kruskal-Wallis test (alpha ¼ 5%). Results: Following several tendencies indicated with progression of knee OA: (1) The tibial articular surface tilted medially relative to the long axis of tibia (p<0.05); (2) The stride length and walking velocity decreased significantly (p<0.01); (3) The peak of knee flexion angle decreased (p<0.01), and the peak of knee varus angle increased (p<0.01); (4) The tibial and femoral long axes during stance phase tilted to the lateral and medial sides relative to the vertical axis of the ground, respectively (p<0.01); (5) The tilt of tibial articular surface relative to the ground demonstrated no significant difference among knee OA severities. Conclusions: The knee-joint line during the stance phase kept the constant tilt relative to ground with progression of knee OA. The deformity of tibial articular surface affected to the kinematics of tibia relative to the ground during the stance phase. The results of this study indicated that the femoral motion relative to tibia during the stance phase was mainly regulated by the deformity of tibial articular surface. Consequently, there was the possibility that the deformity of tibial articular surface became stronger than healthy condition by the imbalance of contact force and the increased shear force on the tibial articular surface under the loading condition. These findings may be helpful to improve the implant placement of total knee arthroplasty and to develop the orthosis for preventing the medial knee OA progress...