Peter Choong

Background Opioids are commonly used both before and after total joint arthroplasty (TJA). Objective The objective of this study was to estimate the long-term effects of pre- and perioperative opioid use in patients undergoing TJA. Methods We used linked population datasets to identify all (n =18,666) patients who had a publicly funded TJA in New Zealand between 2011 and 2013. We used propensity score matching to match individuals who used opioids either before surgery, during hospital stay, or immediately post-discharge with individuals who did not based on a comprehensive set of covariates. Regression analysis was used to estimate the effect of opioid use on health and socio-economic outcomes over 5 years. Results Opioid use in the 3 months prior to surgery was associated with significant increases in healthcare utilization and costs (number of hospitalizations 6%, days spent in hospital 14.4%, opioid scripts dispensed 181%, and total healthcare costs 11%). Also increased were the rate of receiving social benefits (2 percentage points) and the rates of opioid overdose (0.5 percentage points) and mortality (3 percentage points). Opioid use during hospital stay or post-discharge was associated with increased long-term opioid use, but there was little evidence of other adverse effects. Conclusions Opioid use before TJA is associated with significant negative health and economic consequences and should be limited. This has implications for opioid prescribing in primary care. There is little evidence that peri- or post-operative opioid use is associated with significant long-term detriments.

Purpose To determine if a consumer co‐designed infographic increased knowledge of physical activity and self‐efficacy for exercise after total knee joint replacement surgery. Methods Forty‐four adults with primary knee joint replacement surgery were recruited from a public and a private hospital in Melbourne, Australia. Participants were randomly allocated to an experimental or control group. The experimental group received a consumer co‐designed infographic. All participants received usual care. Primary outcome measures were knowledge of physical activity and self‐efficacy for exercise. Outcomes were administered at baseline, week 1 and week 6. Semi‐structured interviews with experimental group participants explored the acceptability, implementation and efficacy of the infographic. Results There were no between‐group differences for knowledge of physical activity at week 1 (MD −0.02 units, 95% CI −0.9 to 0.9) or week 6 (MD 0.01 units, 95% CI −0.9 to 0.9). Self‐efficacy for exercise increased at week 1 (MD 14.2 units, 95% CI 2.9–25.4) but was not sustained. Qualitative data showed that the infographic was embraced by some participants but not by others. Conclusions A consumer co‐designed infographic did not improve knowledge of physical activity but may have had a short‐term positive effect on self‐efficacy for exercise after knee joint replacement. Trial registration ACTRN12621000910808.

New developments in additive manufacturing and regenerative medicine have the potential to radically disrupt the traditional pipelines of therapy development and medical device manufacture. These technologies present a challenge for regulators because traditional regulatory frameworks are designed for mass manufactured therapies, rather than bespoke solutions. 3D bioprinting technologies present another dimension of complexity through the inclusion of living cells in the fabrication process. Herein we overview the challenge of regulating 3D bioprinting in comparison to existing cell therapy products as well as custom-made 3D printed medical devices. We consider a range of specific challenges pertaining to 3D bioprinting in regenerative medicine, including classification, risk, standardization and quality control, as well as technical issues related to the manufacturing process and the incorporated materials and cells.