Acute kidney injury is a recognised post-operative complication in primary joint replacement. Recently it has been demonstrated that antibiotic regimen can significantly impact on the proportion of patients who develop acute kidney impairment post-operatively. Within our unit an increased rate of acute kidney injury had been noted post-operatively over the last 5 years. This increase followed the introduction of a rapid recovery protocol for arthroplasty patients. Our aim was determine whether we could identify a causative factor or those who were at increased risk of post-operative renal impairment. Data were collected for 413 patients initially retrospectively but continued prospectively. Univariable and multivariable analysis was performed to determine any causative factors. The primary increase was 150% increase in baseline creatinine, but as some authors recognise an increase in 125% this was also analysed.Introduction
Methods
There is an increasing demand worldwide for total hip arthroplasty in patients over 80 years old. This study is the largest of its kind reporting long term outcomes and clinical survivorship of patients over 80 years old undergoing THR. 13171 patients 80 years or older who underwent THR between 2000 and 2019 were included. Demographic and operative data was collected including age, sex, laterality, date of surgery and operative technique. Presence and date of complications were collected. Data was also collected for the same time period on 80910 patients aged 51–79 years undergoing THR for comparison. 4103 (31.2%) male and 9068 female (68.8%) patients were included in the 80year old cohort. Median age was 83 (IQR 81–83, range 80–98). 32682 (40.4%) male and 48227 (59.6%) females were included in the 50–79year old cohort. Median age was 68 (IQR 62–73, range 50–79). The 80 cohort was more likely to sustain post operative complications in the 6 months following surgery including DVT (81/13171 vs 364/80910, P<0.05), myocardial infarction (177/13171 vs 341/80910, P<0.05),
Aim. Our aim was to evaluate cementless one-stage revision in chronic periprosthetic hip joint infection. Method and patients. The study was performed as a multicentre, proof-of-concept, observational study with prospective data collection. Inclusion of patients with a chronic periprosthetic hip joint infection (PJI) were followed by protocolled surgical treatment (cementless one-stage revision - the CORIHA protocol) at one of 8 participating departments of orthopaedic surgery between 2009 – 2014, and the patients enrolled in a 2-year follow-up program. A PJI were diagnosed based on adopted criteria from McPherson and Zimmerli. At the time of initiation of the study in 2009, the collaborating departments performed approximately one-fourth of all nationwide primary HJR and more than one-third of all revisions. In total 56 PJI patients with a median age of 72 years and a median pre-operative ASA score of 2 met the established eligibility criteria and accepted to participate; 31 (55%) were males. The cohort had a mean follow-up time of 4.0 years, with all patients followed for minimum 2 years. The primary outcome were relapse described as re-revision due to infection (regardless of considered as a relapse or new infection). This was evaluated by competing risk analysis (competing risks: aseptic revisions and death). Secondary, all-cause mortality was evaluated by survival analysis. The study was approved by the local Committees on Biomedical Research Ethics. Results. Five patients were revised due to relapse of infection. The cumulative incidence of re-revision due to infection was 8.9% (95% Confidence Interval 3.2–18.1). Seven patients had died in the follow-up period. None of these were believed to have been re-infected. The 1 and 5 year survival incidence was 96 (95% Confidence Interval 86–99) and 89 (95% Confidence Interval 75–95). Several complications were registered in the follow-up period: Three patients sustained periprosthetic fractures. Five patients had closed reduction due to dislocation - none have been open revised. Five patients sustained
Introduction. This study was designed to evaluate the effect of discharge timing on 30-day major and minor complications in patients undergoing total knee arthroplasty (TKA) while adjusting for other variables. Methods. Patients 18 years and older undergoing TKA between the years of 2005 and 2016 were identified from the American College of Surgeons National Surgical Quality Improvement Program (NSQIP). Patients whose length of stay (LOS) was >4 days were excluded. Patient demographics, anesthesia type, length of operation and hospital stay, as well as 30-day major and minor complications were collected from the database. Chi square tests were utilized to compare the unadjusted rates of complications between patients whose LOS was 0, 1, 2, and 3–4 days. Multivariable regression was utilized to evaluate the effect of LOS on complication rates, while adjusting for age, American Society of Anesthesiologist (ASA) class, type of anaesthesia, functional status, comorbidities, sex, steroid/immunosuppressant use, body mass index (BMI), diabetes, length of operation and smoking status. Results. A total of 198,191 TKA patients were identified (average age 66 ± 10 years). Average LOS was 2.5 ± 0.81 days. Of these patients, 1,667 (0.84%) were discharged the day of surgery, while 16,186 (8.17%) were discharged one-day post-surgery, 63,540 (32.06%) were discharged on day two, and 115,471 (58.25%) were discharged between 3 and 4 days post-surgery. Unadjusted rates of complications were significantly higher for patients who were discharged on the day of surgery (2.64%), or those whose LOS was 3–4 days (2.78%) compared to those whose LOS was 1 (1.40%) or 2 days (1.67%). After adjusting for all relevant covariables, discharge on the day of surgery increased the risk of major complications by 1.8 (95% Confidence interval [95%CI] 1.2–2.8), and minor complications by 1.6 (95%CI 1.2 – 2.2) compared to patients whose LOS was 2 days. A LOS of 1 day did not affect the risk of major complications compared to a LOS of 2 days, while a LOS of 3–4 days increased the risk of major complications by 1.4 (95%CI 1.3 – 1.6), and minor complications by 1.6 (95%CI 1.4 – 1.7). Regarding specific complications, same-day discharge remained an independent predictor of myocardial infarction (MI), cardiac arrest, pulmonary embolism (PE), unplanned reintubation, >48 hours on ventilator, pneumonia and renal insufficiency, while a LOS of 3–4 days remained an independent predictor of MI, cardiac arrest, sepsis,
Hip fractures are among the most common orthopaedic injuries and represent a growing burden on healthcare as our population ages. Despite improvements in preoperative optimisation, surgical technique and postoperative care, complication rates remain high. Time to surgery is one of the few variables that may be influenced by the medical team. The aim of the present study was to evaluate the impact of time to surgery on mortality and major complications following surgical fixation of hip fractures. Utilising the American College of Surgeons' National Quality Improvement Program (NSQIP) database, we analysed all hip fractures (femoral neck, inter-trochanteric, and sub-trochanteric) treated from 2011 to 2013 inclusively. We divided patients into three groups based on time to surgery: less than one day (<24h), one to two days (24–48h), and two to five days (48–120h). Baseline characteristics were compared between groups and a multivariate analysis performed to compare 30-day mortality and major complications (return to surgery, deep wound infection, pneumonia, pulmonary embolus,
It is the prime responsibility of the treating surgeon to identify and treat the vascular injury along with the skeletal trauma. Limbs with combined Orthopaedic and Vascular injuries are traditionally admitted as an Orthopaedic emergency. In a 17 year period we treated 67 cases of vascular injuries (including 16 pseudo aneurysms) associated with fractures and dislocations or soft tissue injuries of the limbs. Three cases have been followed up for over 20 years. All patients were operated by Orthopaedic residents on duty with limited resources, without the help of vascular surgeons. We relied on clinical diagnosis and immediate exploration of the blood vessels rather than time consuming procedure of arteriography. Skeletal stabilisation was achieved by internal or external fixation. Vascular reconstruction involved end to end repair or vein grafting. Fasciotomy was performed in selected cases where the injury-revascularisation time was more than 6 hours. Post-operative care involved limb placement at body level, Sympathetic blockade for 48 hours, vasodilators, Lomodex, Mannitol, Aspirin and antibiotic therapy. Urine was monitored for smoky color indicating myoglobinuria. Though only 17 were repaired within six hours, limb viability with good function was obtained in 51 cases. Complications included 7 deaths, 6 amputations, 2
Aim: An epidemiological analysis of spontaneous community acquired septic arthritis cases in an elderly population at a university teaching hospital. Method: We studied confirmed cases of spontaneous septic arthritis in the over 65 population. Patients with prosthetic joint infections were excluded from the study. We analysed data relating to initial presenting complaint and clinical examination, haematological and microbio-logical tests along with ultimate patient outcome. Results: There were 7 confirmed cases of spontaneous septic arthritis in over 65 population in the last 6 months (2 hips, 5 knees). The mean age was 72.14 (range 65–82) with a mean length of stay of 49 days. Those with septic arthritis of the knee presented with swelling, pain and immobility. Hip cases presented with pain and immobility. All patients were systemically well at time of presentation, with no other foci of infection detected after septic screening. All patients had aspirate and arthroscopic/arthrotomy confirmed infection. Staphylococcus Aureus was isolated from 6 joint aspirations and Pseaudomonas Auruginosa from one patient. Complications of treatment included
Antibiotic prophylaxis for joint replacement surgery is widely recommended and has been shown to reduce infection rates. Cephalosporins have commonly been used but are associated with development of Clostridium difficile associated diarrhoea (CDAD). The purpose of this study was to assess whether a change of protocol aimed at reducing CDAD, including a change of antibiotic prophylaxis would reduce rates of CDAD and other postoperative complications. We studied all 7989 patients in our trust that underwent hip or knee replacement from May 2002 to March 2009. These patients fell into two cohorts, firstly those who were prescribed cefuroxime as prophylaxis and secondly those prescribed gentamicin which was introduced following national concern regarding CDAD. Following the change of prophylaxis from cefuroxime 750mg three doses to gentamicin 4.5 mg/kg single dose the rate of CDAD reduced significantly (0.17% to 0%, p<0.03), however the rate of
Background: Total joint arthroplasty (TJA) is a successful procedure. With the demographic tendency towards an elderly society and a relatively high prevalence of arthritis, the number of joint replacement in the US will increase dramatically in the upcoming years. The orthopaedic surgeons need to be aware of the various types of complications in the early hospital setting associated with elective TJA. Methods: This prospective study reviewed the systemic and local early complications occurring after 13133 TJA which included 7,438 hip arthroplasties (6,010 primary and 1,428 revisions) and 5,695 knee replacements (4,944 primary and 751 revisions). A standardized and detailed form intended to capture all medical and orthopedic complications was devised, plus a full-time research fellow was dedicated to this study. The hospital course of every patient was followed on a daily basis closely. The circumstances leading to the complications and the details of the therapeutic intervention for each complication were recorded. Results: In general the incidences of complications were higher following TKA compared to THA. There was 26(0.19%) deaths in the cohort that occurred within 10 days after surgery. 329 major (life threatening) complications occurred in the cohort that included myocardial infarction (36), hypotensive crisis (11), pulmonary embolus (145), tachyarrhythmia (93), pulmonary edema (10),
Background: Patients undergoing total knee arthroplasty (TKA) frequently require allogenic blood transfusion. The incidence of blood transfusion varies between 1.4 and 24.5% in the published literature. Purpose of the study: In order to determine the incidence of allogenic blood transfusion in patients undergoing primary TKA at our centre, we performed retrospective analysis of prospectively collected data for all patients who underwent TKA between 1 April 2006 and 31 March 2008. Material and Methods: 1488 eligible patients were categorized into two groups: those who underwent TKA in year 2006 (group I, n= 647) and in year 2007 (group II, n = 841), respectively. Patients with haematological diseases, coagulation disorders or with a known malignancy or infection were excluded. Data were collected for haemoglobin levels (pre-operative, postoperative and predischarge), duration of operation, ASA grade, number of transfusions, use of tranexamic acid and suction drains with relevant clinical data including postoperative medical and surgical complications. Allogenic blood transfusions were administered according to hospital policy. The transfusion threshold was haemoglobin of 8g/dl or less or a symptomatic patient. Results: The two groups were similar with respect to age, gender, ASA, BMI, duration of operation, pre and post-op haemoglobin and tranexamic acid usage. A significantly greater proportion of patients in group I required allogenic blood transfusion when compared to group II. (4.2% vs. 1.2%, group I vs. group II, p <
0.001; respectively). In group I, the usage of suction drain was significantly greater when compared to group II (48% vs. 20%, group I vs. group II, p = 0.27 respectively). The medical complications in group I, included superficial wound infections (two patients), myocardial ischemia (one patient) and reversible
Introduction: The emergence of Independent Sector Treatment Centres (ISTCs) in the UK for the provision of elective orthopaedic services began in 2002–3. Within our trust the bulk of elective orthopaedic surgery is performed in an ISTC however there is a small but significant cohort of patients who are deemed not suitable for treatment at the ISTC. Patients with a BMI (body mass index) ≥40 or an ASA (American society of anaesthesiologists) grade of 3 or more are automatically rejected. With increasing levels of obesity and an aging population the size of the reject cohort is going to rise. These patients are then returned to the NHS to be placed on a new (complex elective) waiting list for their surgery. The aim of this study was to assess the early outcomes and complications following primary knee arthroplasty on our high risk patients. Methods: A retrospective review of a consecutive series of 214 primary knee arthroplasties in patients rejected from the ISTC was performed. Data (demographics, ASA grade, BMI, length of stay, complications, range of knee movement and requirement for HDU/ICU) were collected from preoperative assessments, inpatient notes, anaesthetic charts, discharge summaries and follow up clinic letters. All patients were followed up for a minimum of 6 months. Results: 155 (72%) patients were female. 140 (65%) had ASA of 3 or more. 88 (41%) had a BMI of 40 or more. Median length of stay was 8 days (6 to 11 IQR) and did not vary with increasing BMI but increased to 10 days in the ASA 3 and 12 days in the ASA 4 group. There were a total 90 complications in 71 patients. The most common complications were 22 superficial wound infections (10.3%), 11 Pneumonias (5.1%), and 9 symptomatic DVTs (4.2%). There were 16 severe complications (2 Deep infections, 4 PEs, 2 CVAs, 4
To map literature on prognostic factors related to outcomes of revision total knee arthroplasty (rTKA), to identify extensively studied factors and to guide future research into what domains need further exploration. We performed a systematic literature search in MEDLINE, Embase, and Web of Science. The search string included multiple synonyms of the following keywords: "revision TKA", "outcome" and "prognostic factor". We searched for studies assessing the association between at least one prognostic factor and at least one outcome measure after rTKA surgery. Data on sample size, study design, prognostic factors, outcomes, and the direction of the association was extracted and included in an evidence map.Aims
Methods
This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures. Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed. Propensity score matching was conducted between COVID-19-positive and -negative patients. Multivariable regression was then performed to identify both patient and provider risk factors independently associated with the occurrence of 30-day postoperative adverse events.Aims
Methods
With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected.Aims
Methods
A fracture of the hip is the most common serious orthopaedic
injury, and surgical site infection (SSI) is one of the most significant
complications, resulting in increased mortality, prolonged hospital
stay and often the need for further surgery. Our aim was to determine
whether high dose dual antibiotic impregnated bone cement decreases the
rate of infection. A quasi-randomised study of 848 patients with an intracapsular
fracture of the hip was conducted in one large teaching hospital
on two sites. All were treated with a hemiarthroplasty. A total
of 448 patients received low dose single-antibiotic impregnated
cement (control group) and 400 patients received high dose dual-antibiotic impregnated
cement (intervention group). The primary outcome measure was deep
SSI at one year after surgery.Aims
Patients and Methods