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Aims Treatment of end-stage anteromedial osteoarthritis (AMOA) of the knee is commonly approached using one of two surgical strategies: medial unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA). In this study we aim to investigate if there is any difference in outcome for patients undergoing UKA or TKA, when treated by high-volume surgeons, in high-volume centres, using two different clinical guidelines. The two strategies are ‘UKA whenever possible’ vs TKA for all patients with AMOA. Methods A total of 501 consecutive AMOA patients (301 UKA) operated on between 2013 to 2016 in two high-volume centres were included. Centre One employed clinical guidelines for the treatment of AMOA allowing either UKA or TKA, but encouraged UKA wherever possible. Centre Two used clinical guidelines that treated all patients with a TKA, regardless of wear pattern. TKA patients were included if they had isolated AMOA on preoperative radiographs. Data were collected from both centres’ local databases. The primary outcome measure was change in Oxford Knee Score (OKS), and the proportion of patients achieving the patient-acceptable symptom state (PASS) at one-year follow-up. The data were 1:1 propensity score matched before regression models were used to investigate potential differences. Results The matched cohort included 400 patients (mean age 67 years (SD 9.55), 213 (53%) female, mean BMI 30.2 kg/m2, 337 (84%) American Society of Anesthesiologists grade ≤ 2). We found a mean adjusted difference in change score of 3.02 points (95% confidence interval (CI) 1.41 to 4.63; p < 0.001) and a significantly larger likeliness of achieving PASS (odds ratio 3.67 (95% CI 1.73 to 8.45); p = 0.001) both in favour of the UKA strategy. Conclusion UKA and TKA are both good strategies for treating end-stage AMOA. However, when compared as a strategy, UKA achieved larger improvements in OKS, and were more likely to reach the PASS value at one-year follow-up. Cite this article: Bone Jt Open 2022;3(5):441–447.

Survivors of critical illness frequently require increased healthcare resources after hospital discharge. We undertook a systematic review and meta-analysis to assess hospital re-admission rates following critical care admission and to explore potential re-admission risk factors. We searched the MEDLINE, Embase and CINAHL databases on 05 March 2020. Our search strategy incorporated controlled vocabulary and text words for hospital re-admission and critical illness, limited to English language. Two reviewers independently applied pre-defined eligibility criteria and assessed quality using the Newcastle Ottawa Score checklist and extracted data. Primary outcome was acute hospital re-admission in the year after critical care discharge. Of the 8851 studies screened, 87 met inclusion criteria and 41 were used within the meta-analysis. The analysis incorporated data from 3,897,597 individual patients and 741,664 re-admission episodes. Pooled estimates for hospital re-admission after critical illness were 16.9% (95%CI: 13.3–21.2%) at 30 days; 31.0% (95%CI: 24.3–38.6%) at 90 days; 29.6% (95%CI: 24.5–35.2%) at six months; and 53.3% (95%CI: 44.4–62.0%) at 12 months. Significant heterogeneity was observed across included studies. Three risk factor contributed to excess acute care rehospitalisation one year after discharge: the presence of comorbidities; events during initial hospitalisation (e.g. the presence of delirium and duration of mechanical ventilation); and subsequent infection during the post-hospital discharge period. Hospital re-admission is common in survivors of critical illness. Careful attention to the management of pre-existing comorbidities during transitions of care may help reduce healthcare utilisation after critical care discharge. Future research should determine if targeted interventions for at-risk critical care survivors can reduce the risk of subsequent rehospitalisation.

Enriching foods with long-chain (LC) n-3 polyunsaturated fatty acids (PUFAs) requires a delivery emulsion system, which is both thermodynamically and oxidatively stable. The antioxidant and stabilizing properties of three types of polysaccharide extracts from brown algae Saccharina latissima with mixed composition of polysaccharides (SA: 98% Sodium alginate, SF: 90% alginate and 9% fucoidan, SL: 14.5% fucoidan, 9.5% laminarin and co-extracted non-polysaccharides) were evaluated. SA, SF, SL and REF (added commercial sodium alginate) all showed in vitro ferrous ion chelating ability in the order: SA(99%)>SL(78%)>REF(31%)>SF(16%). The difference in antioxidant activity between SA, REF and SF appeared related to structural differences of alginate (M/G ratio). A storage trial was conducted using 70% (w/w) fish oil-in-water delivery emulsions added sodium caseinate (NaCas) (0.23 wt%) as emulsifier in combination with SA, SF, SL or commercial NaAlg (REF) in different concentrations (C1=0.1, C2=0.2 C3=0.3 and C4=0.4 wt%). A control with only NaCas were included (CON). The physical (e.g. creaming and droplet-size distribution) and oxidative (peroxide value and volatiles) stability of the emulsions, were evaluated (12 days, dark at 20˚C). Acceptable physical stability (creaming index, CI) was found for, REF (all concentrations), SF=0.2 wt% (C2), SL and SA=0.3 wt% (C3) and 0.4 wt% (C4). In general, the oxidative stability decreased by adding REF, SA and SF (except for REF at C1), as prooxidant activity was observed. However, SA showed antioxidant activity against formation of 2-ethylfuran. SL showed antioxidant activity in decreasing formation of volatile compounds in emulsions when added in concentrations above 0.2 wt%.