After having another bash at electronic prescribing and TTOs again today, all I can say is that the junior doctors deserve every penny that they are asking for…
It is said that “Those who cannot remember the past are condemned to repeat it.”
I am grateful to
@AuschwitzMuseum
for keeping the flame of memory alive.
This year we are hoping to reach 1,5 million followers of
@AuschwitzMuseum
. Less than 140k is needed to reach this goal.
We kindly ask you to amplify our voice.
Every RT is important. You can all help us commemorate the victims, preserve memory & educate the world.
Hmmm… we already have a shortage of anaesthetists and I think about 40% of our trust’s consultant anaesthetists are over the age of 50… ticking time bomb here 💣
🚨 It's crazy that the NHS has told 350 doctors training in anaesthesia that the NHS has no job for them after 3 years training.
At the same time we have massive shortages of, you guessed it, anaesthetists. These self-defeating bottlenecks defy logic. Statement from
@RCoANews
Finally out in print & available to download. A fantastic effort by Hosam Matar along with Hugh Cameron and Peter James. Really proud of this.
@NottsHipKnee
One of our elective orthopaedic wards is turning into a medical ward today because covid admissions are ⬆️. This means that there will be fewer routine operations performed. How does removing all restrictions help to clear the elective surgery backlog Mr Merriman?
"In order to maximize the strength of the tibial tray/cement interface, cement should be applied to the component soon after mixing, contamination of the interface should be avoided, & the keel & the plateau should be cemented" finds study
#knee
#ortho
Thanks to our local
@DePuySynthes
team for supporting me through 1,000 Attune TKAs since starting as a consultant
@NottsHipKnee
in 2016. And also thank you for the cake which I’m sure
@NEO_Theatres
staff will enjoy!
Many thanks to my incredible theatre team today
@NEO_Theatres
who worked incredibly hard to get 6 joint replacements done through 1 theatre. You are all superstars and it is much appreciated
@LisaFlint18
@lilnat18
Great evening celebrating the careers of Peter James and Paul Szypryt and wonderful to see so many friends and colleagues again. Thanks to all the former Knee Fellows who made the trip back to Nottingham
@DrLindaDykes
Example from my SHO days - “no one has yet volunteered to cover tomorrow’s (long term rota gap) night shift. Sort it out amongst yourselves but if no one has come forward by 4pm I will just pick one of you to do it.”
The gaslighting cycle:
SAGE: Don't wait till hosp rise to act or it'll be too late
Govt/media:
-'too much uncertainty'/'mild'/'need more data'
-'SAGE modelling wrong'
-'closely following the data' (what data? PCRs/LFD capacity reached)
-'hosps mostly incidental'
-'too late now'!
Thanks to
@ArthroToday
for publishing our paper - DFRs are a good option in low periprosthetic TKA fractures which allow for early mobilisation and have good medium-term results.
@NottsHipKnee
@CastleOrtho
I increasingly believe that planned essential (NOT elective!) treatment will only be possible if physically removed from emergency hospitals. If that means regional collaboration in a SWLEOC-style elective centre then so be it.
We need true “hot” and “cold” sites everywhere.
Doctor: "We are being pushed to try to clear backlogs of people who have been waiting a year or more. Then they come in on the day of their long awaited surgery and get cancelled because there is no bed for them. It's awful."
How good is modern TKA? This large propensity-matched cohort study shows that within 1 year, TKA returns health-related quality of life to normal population levels for age, sex & BMI.
#Arthroplasty
#Knee
#BJJ
@EdinburghKnee
@lzyapp
The other barriers:
Orthopaedic wards full of medical (& covid) patients
Orthopaedic theatre staff manning critical care (understaffed & still trying to run at 120-150% normal capacity)
Anaesthetists are redeployed & there aren’t enough anyway
Staff sickness, burnout & leaving
We are all ready to go if we could just have our 2 wards back from “winter pressures”, our ward nurses back from looking after respiratory medical patients, our theatre staff back from critical care and trauma theatres, and our anaesthetists back too…
BREAKING: NHS to set out elective recovery plan by the "end of November" setting out how it will use additional spending and a workforce plan
@sajidjavid
says
This is great news.
Also we need to get rid of the “I replaced his left knee and he’s very happy but I need another referral to replace his right knee” malarkey. Complete waste of everyone’s time.
Today I had my covid jab at
@nottmhospitals
and also spent the day as part of the team prescribing vaccines - what a fantastic setup with an efficient process to assess, counsel, prescribe, vaccinate & then observe hundreds of people per day. Well done to all involved!
Back on the slopes for the first time in almost 4 years! Not bad for a first day back on skis but not in the same league as the Lego legend
@generalorthomd
Our paper from
@NottsHipKnee
is now out online! We found significantly reduced revision rates with 32mm & 36mm heads, but particularly reduced risk of revision for dislocation.
No higher risk of revision for loosening/wear with larger heads. We use 36mm heads whenever possible.
A very appropriate theatre hat for welcoming a new fellow & introducing them to the joys of metaphyseal sleeves and a balanced approach in revision knee surgery…
This is the way.
Increasingly I think that elective orthopaedics will only be able to recover if it is a completely separate estate. Either regional SWLEOC models or a separate building on an existing hospital campus.
SIX MILLION people on the waiting list for surgery
Let that sink in, it’s not far off 10% of the population
It’s not just:
🛏 Bed Base size of ‘postage stamp’
😴 It’s exhausted staff
👩🏻⚕️ Not enough staff
🌬 Not enough flow because of covid restrictions on areas
And more
When we can’t train our registrars because operating is cancelled we need to be more creative... thanks to Will and
@JNJMedDeviceUKI
for bringing in the VR training module!
@NottsHipKnee
@CastleOrtho
I have written to my MP,
@Mark_Spencer
. I know Liz Truss pledged to solve this issue, but based on previous correspondence I don't think
@DHSCgovuk
actually understand the issue. I hope they read these threads or even talk to Tony to get an idea of the problems.
1/ 🚨V IMPORTANT🚨
We need your help, today please, just 5 mins of your time to write to your MP.
With a new SOS for Health / Chancellor, PM who made promises to "fix" pension taxation, & increasingly calls from the opposition to fix this problem too. Please do this NOW & RT
Paging
@ExeterHipUnit
, and hoping he’s taken his antihypertensives this morning... 😉😬
Not entirely sure what problem this prosthesis is attempting to solve?
An Ultra-Short Femoral Neck-Preserving Hip Prosthesis - A 2-Year Follow-up Study with Radiostereometric Analysis and Dual X-Ray Absorptiometry in a Stepwise Introduction
Even better than dual consultant operating… 3 consultant operating!Great fun doing a tough complex revision today with my colleagues
@orthodoc_berber
& Hosam Matar.
The 3 Amigos of revision knee surgery!
The robot penguin can go round turning all the computers on and logging in at 6am - then there’s a small chance that they will be working by 8.30. Sorted!
The NHS 🤝 New tech.
This type of collaborative innovation can help to take the burden off NHS staff and improve access to care by removing causes of delays in discharging patients.
Visiting great UK-based business
@WeMakeAI
👇
@RoshanaMN
Revision TKR. Thinking about mode of failure & trying to address bone loss, fixation & stability. Lots of thinking and planning & although challenging, often rewarding too. Love it!
Large cementless hip stems have a higher revision rate due to periprosthetic fracture than small-medium stems. Using a collared stem reduces the rate of periprosthetic fracture.
Really pleased to see our paper from
@NottsHipKnee
published in
@BoneJointJ
this month!
“Outcomes of single- and two-stage revision total knee arthroplasty for chronic periprosthetic joint infection”
@LegoAnkhMorpork
@MMargolyes
“Granny turned a page. 'What about this one? Maids of Honour?'
'Weeelll, they starts out as Maids of Honour,' said Nanny, fidgeting with her feet, 'but they ends up Tarts.'”
- Maskerade
A medical student, Lee Kiefer, just won a gold medal in fencing!
What was the most impressive physical accomplishment you had in med school?
@CenterRotation
@_NancyMD
@kimtuckinAZ
@VaniSabesanMD
Mine was running 12 miles which seems very pathetic in comparison!!
Waiting >6 months for a hip/knee replacement is associated with a ⬇️quality of life and ⬆️frailty.
Increased frailty is associated with greater operative risk. Current NHS waiting times are much longer than 6 months.📈
@BoneJointJ
What a great bunch of (mostly)
#orthotwitter
I’ve been interacting with - I’ve learnt lots from you all & enjoyed the debate. Thanks very much everyone & look forward to more in 2022!
Really pleased to see our latest research from
@NottsHipKnee
on mortality in septic and aseptic revision total knee arthroplasty published in
@JArthroplasty
.
“Until or unless future randomized trials convincingly show a benefit either to
#PRP
or autologous blood injections, we recommend against their use in patients with lateral epicondylitis.”
#Orthotwitter
@TeemuVKarjalain
I note the company spokesperson comment for SpaceX Starship as having undergone “rapid, unscheduled disassembly”
It is my intention to henceforth use this phrase 2 explain the events within the knee, during multiligament injury.
#orthotwitter
#kneeinjury
Interesting study. Who still gets post-op X-rays in clinic and how often? And should we continue to do so??
(Post op day 1, 6m, 7y & every 3y thereafter here - but is there value in imaging asymptomatic hips & knees?)
"For patients without symptoms attributable to the TJA prosthesis, conducting virtual care visits without routine radiographs may be considered"
If you don't have a reason to X-ray, don't get an x-ray.
@uihealthcare
@uiowa
@AAHKS
@jointdocShields
19 November 1890 | Swiss Jewish woman, Marthe Bader (née Weil), was born in Basel. She lived in France during the war.
On 3 February 1944 she was deported from
#Drancy
to
#Auschwitz
and murdered in a gas chamber after arrival selection.
Use of a tibial stem during TKA for osteoarthritis in patients with increased BMI was not associated with lower revision rates, including for aseptic loosening. Using augmented tibial fixation with stemmed prosthesis in increased BMI may not be justified.
Our team
@NottsHipKnee
received a very nice email from
@AAOS1
this evening - so I guess I’m heading to San Diego this year! After last year’s cancellation I hope to meet some of you
#orthotwitter
lot there!
There’s 3 types of phone call:
1. “I need your advice” - self explanatory
2. “Just to let you know” - I’ve made a decision but for political reasons I need to run it by you
3. “I need you to come in. Now”
Completely agree with this - and they have done an amazing job over the last few years - Covid cancellations, winter pressures, all-year-round pressures, nursing strikes, medical strikes...
Thank you to all of our amazing admin teams.
Interesting paper - previous studies have failed to show any discernible benefit to a surgical helmet system. But I do like wearing one from a comfort point of view, and if they do significantly reduce the rate of PJI, then what's not to like?