Periprosthetic joint infections (PJIs) and osteomyelitis are clinical challenges that are difficult to eradicate. Well-characterized large animal models necessary for testing and validating new treatment strategies for these conditions are lacking. The purpose of this study was to develop a rabbit model of chronic PJI in the distal femur. Fresh suspensions of Aims
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Introduction. Hip resurfacing arthroplasty (HRA) is an alternative to traditional total hip arthroplasty (THA) in young active patients. While comparative implant survival rates are well documented, there is a paucity of studies reporting the patient mortality rates associated with these procedures. The purpose of this study was to evaluate the mortality rates in patients age 55 years and younger who underwent HRA versus THA and to assess whether the type of operation was independently associated with mortality. Patients and Methods. The database of a single high-volume surgeon was reviewed for all consecutive patients age 55 years and younger who underwent hip arthroplasty between 2002 and 2010. HRA became available in the United States in 2006. This yielded 504 patients who had undergone HRA from 2006 to 2010 and 124 patients who had undergone a THA. Patient characteristics were collected from the electronic medical record including age, gender, body mass index, Charleston comorbidity index, smoking status, and primary diagnosis. Mortality was determined through a combination of electronic chart reviews, patient phone calls, and online obituary searches. Univariate analysis was performed to identify a survival difference between the two cohorts. Multivariable Cox-Regression analyses were used to determine whether the type of operation was independently associated with mortality. Results. The mean follow up for consecutive patients was 7 years (up to 11 years) in the HRA group and 8 years (up to 16 years) in the THA group. A total of 467 HRA patients (92%) and 105 THA patients (85%) were followed for a minimum of 5-years. 92% of the THA procedures were performed prior to the availability of HRA. There were 8 mortalities (1.6%) in the HRA cohort and 11 (8.9%) in the THA cohort, a statistically significant difference (p<0.001) on univariate analysis.
Introduction. Knee arthroplasty is one of the most common inpatient surgeries procedures performed every year however complications do occur. Prior studies have examined the impact of insurance status on complications after TJA in small or focused cohorts. The purpose of our study was to utilize a large all-payer inpatient healthcare database to evaluate the effect of patient insurance status on complications following knee arthroplasty. Methods. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing knee arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical complications, surgical complications and mortality during the same hospitalization. A secondary analysis was performed using a matched cohort comparing patients with Medicare vs private insurance using the coarsened exact matching algorithm. Pearson's chi-squared test and multivariate regression were performed. Results. Overall, 1,352,505 (57.8% Medicare, 35.6% private insurance, 2.6% Medicaid or uninsured, 3.3% Other) patients fulfilled criteria for inclusion into the study. Most were primary total knee arthroplasties (96.1%) with 3.9% revision knee arthroplasties. Multivariate regression analysis showed that patients with private insurance had fewer complications (OR 0.82, p=<0.001) compared to Medicare patients. Similar trends were found for surgical complications and mortality. Patients with Medicare or no insurance had more surgical complications but equivalent rates of medical complications and mortality. The matched cohort showed Medicare and private insurance patients had overall
Aims: To determine patterns and outcomes of pelvic injury resulting from motorcycle and car accidents. Methods: Review of the records of 233 patients (151 male, 82 female, median age 31(6–91) years) admitted to a teaching hospital (1996–2001) with pelvic injuries resulting from a road trafþc accident. Results: Ninety-One (39.1%) car occupants (53 drivers, 23 front and 15 rear seat passengers) and 57 (24.5%) motorcyclists (52 riders, 5 pillion) sustained pelvic injuries. Both groups had similar median ages (27.0 years (15–81) and 33.7 years (12–72)) and mean Injury Severity Scores (23.0(4–75) and 20.4(4–57)) respectively. Motorcyclists more commonly sustained pelvic fractures associated with major blood loss (18% vs 9%) and fractures more commonly involved the sacro-iliac joint (40% vs 24%). Head*, facial* and thoracic* injuries predominated in car occupants and extremity injuries in motorcyclists. Two (2%) car occupants and 2(4%) motorcyclists died. Operative procedures were required in 49(86.0%) motorcyclists and 67(73.6%) car occupants. Thirty (52.6%) car occupants and 28(30.8%) motorcyclists required pelvic surgery. The median hospital stay was 19(1– 93) and 20(1–93) days respectively. Conclusions: Patterns of pelvic and associated injuries differ markedly between car occupants and motorcyclists reßecting differing injury mechanisms. Although pelvic injuries sustained in car and motorcycle accidents have a relatively
Introduction: Joint replacement has a
Objective: Descriptive retrospective analysis of hip peri-prosthetic fractures treated surgically from 2000 to 2005 analysing risk factors and Results:. Material and Methods: 31 patients with a mean age of 77 years (56–94) were operated of a periprosthetic fracture which happened 73 months (0–300) after the index arthroplasty. Fractures were classified following the Vancouver system: 1 patient presented a type Al(3%), 4 a B1(13%), 23 suffered a B2(74%), 1 a B3(3%) and 2 patients presented a type C(6%). The risk factors described in the literature were evaluated, as well as the different types of treatment with their clinical and radiological results. Risk factors:. Personal: 21(68%) patients were women. Previous condition of arthroplasty: 22(71%) non cemented, 23(74%) total prosthesis, 3(10%) revision surgery; 13(54%) presented osteointegration, 2(8%) stable fibrous fixation and 9 (38%) were unstable; in (7%) there was subsidence. Surgical technique: 11(52%) patients had insufficient size of the implant and 15 stems were in varus (54%). Bone status: 5 femur (20%) presented stress risers and 29(97%) diffuse osteopenia. Polyethylene wear: 10(50%) of THA. Osteolysis was observed in 21 patients (70%): 19(90%) in zone 1, 4(19%) in zone 2, 3(14%) in zone 3, 2(10%) in zone 4, 2(10%) in zone 5, 4(19%) in zone 6 and 15(71%) in zone 7. 5(24%) patients presented osteolysis in one zone, 9(43%) in two zones, 4(19%) in three zones, 2(10%) in four zones and 1(5%) in six zones. Type of treatment: 19(61%) patients were treated with open reduction and internal fixation (ORIF) without revision of the prosthesis, 11(35%) with revision surgery plus ORIF and 1(3%) with a resection arthroplasty. Bone graft was used in only 1(3%) patient. Type of osteosynthesis: 16(52%) only cables, 1(3%) cables and plates, 2(6%) plates and screws, 11(35%) plates and cables and screws, 1(3%) intramedullary nail. Clinical results:. There were 0(0%) infections and 0(0%) exitus but 7(23%) patients suffered postoperative medical complications. The mean time for allow weight-bearing was 3 months (2–6). For the 25 patients that achieved the complete follow up, maximum recovery was recorded after 9 months (3–13); 24(89%) patients recovered their previous status and 15(60%) had no pain. 15 patients maintained the instrumental level before the fracture and 10(66%) recovered it. Radiological results:. The mean time for fracture union was 6 months (3–18). At the end of follow-up 1(4%) patient presented non-union. 0(0%) patients presented mal-union, 2(8%) a refracture, and 6(24%) evolved to implant loosening. Conclusions:. Patients with periprosthetic fractures present a high number of previous local risk factors. Surgical treatment achieves a very
Hip fracture patients have high morbidity and mortality. Patient-reported outcome measures (PROMs) assess the quality of care of patients with hip fracture, including those with chronic cognitive impairment (CCI). Our aim was to compare PROMs from hip fracture patients with and without CCI, using the Norwegian Hip Fracture Register (NHFR). PROM questionnaires at four months (n = 34,675) and 12 months (n = 24,510) after a hip fracture reported from 2005 to 2018 were analyzed. Pre-injury score was reported in the four-month questionnaire. The questionnaires included the EuroQol five-dimension three-level (EQ-5D-3L) questionnaire, and information about who completed the questionnaire.Aims
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