Suzanne Edwards

The 2026 Demographics of Spinal Disc Arthroplasty Supplementary Report is based on the analysis of 14,733 spinal disc procedures recorded by the Registry with a procedure date up to and including 31 December 2025. This supplementary report provides summary data and demographic information on spinal disc replacement surgery. Data are broken down into the five classes of spinal disc replacement: spinal segment, spinal ball trough, insert and endplate, cervical intervertebral disc and lumbar intervertebral disc. Revision rates are not provided for spinal disc replacement. The Spinal Disc Arthroplasty Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2026. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report . The Registry data quality processes, including data collection, validation and outcome assessment, are provided in detail in the Data Quality chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report: https://registry.aoa.org.au/annual-reports-2026.

This summary is an explanation of the major findings of the Australian Orthopaedic Association National Joint Replacement Registry 2026 Annual Report for Hip, Knee and Shoulder Arthroplasty (replacement). This is the major clinical report produced by the Registry each year. The full version of the 2026 Annual Report on Hip, Knee and Shoulder Arthroplasty is available in the ‘Publications’ section of the Registry website https://registry.aoa.org.au/annual-reports-2026. The Lay Summary is provided to ensure that a clear, concise, and easily understood explanation of the published findings is available to all those who may be interested. The Lay Summary also provides guidance for those who may wish to further review the full extent of the data published by the Registry in the Annual Report. The Australian Orthopaedic Association (AOA) believes this is especially important because of the high level of community interest in the Registry and the need to ensure that reports are accessible to all. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2026. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report: https://registry.aoa.org.au/annual-reports-2026.

This Ankle Arthroplasty Supplementary Report is based on the analysis of 7,103 ankle procedures with a procedure date from 2006 up to and including 31 December 2025. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2026. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report: https://registry.aoa.org.au/annual-reports-2026

The Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) is proud to announce the release of the 2026 Hip, Knee and Shoulder Arthroplasty Annual Report, which provides a comprehensive analysis of joint replacement procedures in Australia. This marks the Registry's 27th Annual Report and continues our commitment to enhancing orthopaedic care through data-driven insights. In addition to the main report, the AOANJRR is proud to present 14 supplementary reports that complement the 2026 Annual Report. These reports cover a wide range of arthroplasty topics, including demographics, revision rates, and prosthetic performance All reports are available for download on our website via the 'Publications' tab on the menu ribbon on the AOANJRR website: https://registry.aoa.org.au/annual-reports-2026

Objectives: To describe clinician perspectives, priorities, and concerns regarding the development of a shared care model for long-term management of stable vulvar lichen sclerosus (VLS). Methods: A cross-sectional online survey was conducted of clinicians involved in managing VLS. Stable VLS was defined as controlled disease on maintenance topical corticosteroids, ≤5 self-managed flares per year, patient acceptance of chronic therapy, no history of neoplasia, and no vulvar biopsy within the preceding 12 months. Survey items assessed current models of long-term care, perceived need for expanded community-based follow-up, barriers to shared care, and views on the appropriateness and requirements for successful implementation. Quantitative data were analyzed descriptively, and free-text responses underwent thematic analysis. Ethics approval was obtained. Results: A total of 120 clinicians from 12 countries completed the survey, with 44.2% based in Australia. Respondents were predominantly gynecologists (51.3%) and dermatologists (27.7%), with most (68.1%) having more than 10 years’ experience managing VLS. Overall, 85.1% supported a shared care model, with 68.4% rating it very appropriate, and 16.7% somewhat appropriate . Major barriers related to primary care included time and resource pressures, limited VLS knowledge, and inconsistent genital examination. Barriers identified in the specialist setting included patient preference for specialist-led care, concerns about the ability of other providers to titrate topical steroids, difficulty re-accessing specialist-led care, and communication or documentation gaps. Conclusion: Vulvar specialists internationally support shared care for stable VLS, yet formal models remain rare. The barriers are largely structural and modifiable, underscoring the need for operationalized shared care frameworks.

Background: Deep neck space infections (DNSIs) present ongoing challenges to all clinicians, from physicians to surgeons. While several risk factors for adverse outcomes have been well established, to our knowledge, this is the first study to link Indigenous status directly to DNSI outcomes. We performed a retrospective cohort analysis of 351 adult patients with DNSIs who were admitted to the intensive care unit (ICU) at a South Australian quaternary centre between 2018 and 2024. We assessed outcomes such as hospital length of stay (LOS), 30‐day readmission rates, and returns to the theater. We had a particular emphasis on Indigenous status and socioeconomic status. Methods: Multivariable linear regressions were performed to analyse the primary outcome of Hospital LOS identifying several associations with adverse DNSI outcomes. Indigenous status was self‐identified by patients to be Aboriginal and/or Torres Strait Islander. Socioeconomic disparities were characterized using the Socioeconomic index for areas (SEIFA) deciles. Results: Aboriginal and Torres Strait Islander patients had markedly longer hospital stays (adjusted mean ratio, 1.41; 95% CI, 1.10–1.81; p = 0.0073) and a more than five‐fold increase in readmission rates (OR, 5.59; 95% CI, 1.55–20.19; p = 0.0086) compared to nonindigenous patients. Each 10‐year increase in age was associated with a 6% rise in the mean LOS ( p = 0.0038), and each single unit increase in glucose level correlated with a 3% increase in LOS ( p = 0.0077). Conclusion: These findings underscore the importance of incorporating demographic variables such as Indigenous status, alongside clinical parameters, in DNSI risk stratification and management. The literature addressing the influence of Indigenous status in surgical outcomes, particularly in DNSIs, remains limited. We advocate for further prospective observational studies and the development of care models co‐designed with Indigenous patients and healthcare professionals as key stakeholders, with the goal of narrowing persistent disparities across Australian healthcare.

Introduction: Skin cancer is the most prevalent cancer in Australia. Known challenges affecting rural populations include delayed diagnosis, limited access to healthcare and increased burden of disease. We investigated the outcomes of skin cancer excisions, focusing on excision completeness, between rural and metropolitan patients. Methods: We conducted a retrospective cohort study of melanoma and keratinocyte skin cancer excisions from August 2003 to November 2023, from a prospectively entered database. We identified 26,064 skin lesions excised in theatre. The primary outcome was the rate of incomplete excisions, defined by an involved histopathologic margin. Secondary objectives included assessing demographic and clinical factors influencing the rate of complete excisions. Results: The study included 14,996 specimens from 5522 patients. Keratinocyte-based cancers made up 96.3 per cent of specimens and in 13.0 per cent of excisions, patients lived in a rural postcode. Rural patients were 34 per cent more likely to have an incomplete excision of keratinocyte skin cancers compared with metropolitan patients (OR = 1.34, p < 0.0001). Key factors associated with incomplete excisions included renal transplant recipients, younger age, head and neck location, and female sex. Notably, renal transplant recipients had a markedly lower risk of incomplete excision (OR = 27.6, p < 0.05). We found excisions in the head and neck region were significantly more prone to incompleteness, likely due to anatomical challenges and cosmetic concerns. The overall incomplete excision rate at our centre was 8.1 per cent. Conclusion: These findings demonstrate the increased risks faced by rural populations, highlighting the need for tailored surgical approaches and vigilant follow-up. Clinicians should be aware of these clinical and demographic factors and consider adjusting excision margins to reduce rates of incomplete excision.

Stroke is a major pathology, but current diagnostic methods are prone to misclassification with other neurological conditions, e.g., epilepsy or migraine, which delays proper treatment and carries a poorer prognosis. Development of accurate biomarkers to diagnose stroke events could decrease misidentification occurrence and promote appropriate, timely management. Lipid peroxidation products are generated under oxidative stress conditions and have previously been shown to increase in stroke patients. As the reference standard for lipid peroxidation, oxylipins could be biomarkers for acute ischemic cerebrovascular syndrome (AICS) events. Moreover, the ability to triage at-risk patients could expedite the necessary procedures required to conclusively diagnose AICS incidents. A label-free, in vivo oxidative status (IVOS) technology measuring carbonylation was also tested to determine efficacy as a point-of-care assessment tool. Potential AICS patients were independently clinically classified as transient ischaemic attack (TIA) or minor ischaemic stroke (grouped as AICS), or mimics per our published FAST-IT Protocol, including radiological assessment. Plasma oxylipins were quantified using liquid chromatography tandem mass spectrometry while carbonylation was determined with IVOS technology. Oxylipin and IVOS metrics from diagnostic groups were compared using respective, univariate linear regressions. Concentrations of 4(RS)-4-F4t-NeuroP fragment (oxylipin) and Mean Fluorescence (ARBU) detected by mass spectrometry or IVOS technology, respectively, were higher in AICS patients compared with mimics. This is the first study to investigate an early point-of-care assessment device combined with a panel of oxylipins to identify markers of oxidative stress associated with transient or minor ischemic stroke incidents to improve diagnostic differentiation of AICS patients from mimics.

The following reported tables and figures represent analyses of Shoulder Replacement data from AOANJRR. The comparisons do not find a significant difference between the illustrated cohorts. These additional accounts of Shoulder Replacement revision rates are complimentary records to the AOANJRR Annual Report and Shoulder Replacement in Australia supplementary report. This Report is one of 14 supplementary reports to complete the AOANJRR Annual Report for 2025. Information on the background, purpose, aims, benefits and governance of the Registry can be found in the Introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report. The Registry data quality processes, including data collection, validation and outcomes assessment, are provided in detail in the Data Quality section of the introductory chapter of the 2025 Hip, Knee and Shoulder Arthroplasty Annual Report: https://aoanjrr.sahmri.com/annual-reports-2025.