There is growing interest in the peri-operative management of patients with indications for hip and knee arthroplasty in the setting of
Aims. Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories. Methods. This retrospective cohort study analyzed THA patients at a large academic centre (NYU Langone Orthopedic Hospital, New York, USA) from January 2018 to January 2023, who completed the Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity questionnaires, collected preoperatively at one-, three-, six-, 12-, and 24-month follow-up times. Growth mixture modelling (GMM) was used to model the trajectories. Optimal model fit was determined by Bayesian information criterion (BIC), Vuong-Lo-Mendell-Rubin likelihood ratio test (VLMR-LRT), posterior probabilities, and entropy values. Association between trajectory groups and patient characteristics were measured by multinomial logistic regression using the three-step approach. Results. Among the 1,249 patients, a piecewise GMM model revealed three distinct pain trajectory groups: 56 patients (4.5%) in group 1; 1,144 patients (91.6%) in group 2; and 49 patients (3.9%) in group 3. Patients in group 2 experienced swift recovery post-THA and minimal preoperative pain. In contrast, groups 1 and 3 initiated with pronounced preoperative pain; however, only group 3 exhibited persistent long-term pain. Multinomial regression indicated African Americans were exceedingly likely to follow trajectory groups 1 (odds ratio (OR) 2.73) and 3 (OR 3.18). Additionally, odds of membership to group 3 increased by 12% for each BMI unit rise, by 19% for each added postoperative day, and by over four if discharged to rehabilitation services (OR 4.07). Conclusion. This study identified three distinct pain trajectories following THA, highlighting the role of individual patient factors in postoperative recovery. This emphasizes the importance of preoperatively addressing
Aims. The aim of this study was to perform a systematic review and bias evaluation of the current literature to create an overview of risk factors for re-revision following revision total knee arthroplasty (rTKA). Methods. A systematic search of MEDLINE and Embase was completed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The studies were required to include a population of index rTKAs. Primary or secondary outcomes had to be re-revision. The association between preoperative factors and the effect on the risk for re-revision was also required to be reported by the studies. Results. The search yielded 4,847 studies, of which 15 were included. A majority of the studies were retrospective cohorts or registry studies. In total, 26 significant risk factors for re-revision were identified. Of these, the following risk factors were consistent across multiple studies: age at the time of index revision, male sex, index revision being partial revision, and index revision due to infection.
Aims. Periprosthetic hip fractures (PPFs) after total hip arthroplasty are difficult to treat. Therefore, it is important to identify
Infection following primary total knee arthroplasty (TKA) is fortunately a relatively uncommon complication with an incidence of approximately 1%. However, because the morbidity and cost of treatment of deep prosthetic TKA infections is so high, effective prevention strategies are key quality improvement initiatives. The cause of post-operative infections are multifactorial and complex but can generally be categorised into 1) host, 2) surgical, and 3) environmental factors. The purpose of this abstract to provide an outline of these factors and their influences on the infection risk following TKA. Patient factors and optimization of
Aims. This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. Methods. Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. Results. Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than
Introduction. Many patients with obesity experience knee pain. Excess body weight is a
Infection following primary total knee arthroplasty (TKA) is fortunately a relatively uncommon complication with an incidence of approximately 1%. However, because the morbidity and cost of treatment of deep prosthetic TKA infections is so high, effective prevention strategies are key quality improvement initiatives. The cause of post-operative infections are multifactorial and complex but can generally be categorised into 1) host, 2) surgical, and 3) environmental factors. The purpose of this abstract is to provide an outline of these factors and their influences on the infection risk following TKA. Patient factors and optimization of
Abstract. Introduction. Acute kidney injury (AKI) is a common post-operative complication which, in turn, significantly increases risk of other post-operative complications and mortality. This quality improvement project (QIP) aimed to evaluate and implement measures to decrease the incidence of AKI in post-operative Trauma and Orthopaedics (T&O) patients. Methods. Three data collection cycles were conducted using all T&O patients admitted to a single UK West Midlands NHS trust across three six-month periods between December 2018 and December 2020 (n=8215). Patients developing a post-operative AKI were identified using the Acute Kidney Injury Network criteria. Data was collected for these patients including demographic details and AKI risk factors such as ASA grade, hypovolaemia and use of nephrotoxic medications. Results. The percentage of post-operative AKI decreased from 2% (71 patients from 5899 operations) in the first cycles to 1.5% (19 from 1273 operations) by the final cycle. There was a high prevalence of
Introduction. Weight is a
Aims. Using the Australian and New Zealand Hip Fracture Registry (ANZHFR) data, this study aimed to identify patient, fracture, and management factors associated with survival, mobility and residential status at 120 days. This will allow future interventions to target
Clinically significant proximal junctional kyphosis (PJK) occurs in 20% of children treated with posterior distraction-based growth friendly surgery. In an effort to identify
Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a devastating complication. It is associated with high morbidity and mortality. It remains, unfortunately, one of the most common modes of failure in TKA. Much attention has been paid to the treatment of PJI once it occurs. Our attention, however, should focus on how to reduce the risk of PJI from developing in the first place. Infection prevention should focus on reducing
Hip fracture principally affects the frailest in society, many of whom are care dependent, and are disproportionately at risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England. We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1st February 2019 and 31st October 2020, in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England's SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models. Analysis of 102,900 hip fractures (42,630 occurring during the pandemic) revealed that amongst those with COVID-19 infection at presentation (n=1,120) there was a doubling of 90-day mortality; hazard ratio (HR) 2.05 (95%CI 1.86–2.26), while for infections arising between 8–30 days after presentation (n=1,644) the figure was even higher at 2.52 (2.32–2.73). Malnutrition [1.44 (1.19–1.75)] and non-operative treatment [2.89 (2.16–3.86)] were the only
The incidence of total shoulder arthroplasty (TSA) in increasing. Evidence in primary hip and knee arthroplasty suggest that preoperative opioid use is a risk factor for postoperative complication. This relationship in TSA is unknown. The purpose of this study was to investigate this relationship. The Truven Marketscan claims database was used to identify patients who underwent a TSA and were enrolled for 1-year pre- and post-operatively. Preoperative opioid use status was used to divide patients into cohorts based on the number of preoperative prescriptions received. An ‘opioid holiday’ group (patients with a preoperative, 6-month opioid naïve period after chronic use) was also included. Patient information and complication data was collected. Univariate and multivariate logistic regression were then performed. Fifty-six percent of identified patients received preoperative opioids. Multivariate analysis demonstrated that patients on continuous preoperative opioids (compared to opioid naïve) had higher odds of: infection (OR 2.34, 95%CI 1.62–3.36, p<0.001), wound complication (OR 1.97, 95%CI 1.18–3.27, p=0.009), any prosthetic complication (OR 2.62, 95%CI 2.2–3.13, p<0.001), and thromboembolic event (OR 1.42, 95%CI 1.11–1.83, p=0.006). The same group had higher healthcare utilization including extended length of stay, non-home discharge, readmission, and emergency department visits (p<0.001). This risk was reduced by a preoperative opioid holiday. Opioid use prior to TSA is common and is associated with increased complications and healthcare utilization. This increased risk is modifiable, as a preoperative opioid holiday significantly reduced postoperative risk. Therefore, preoperative opioid use represents a
The aim was to determine the influence of COVID-19 on 30-day mortality in hip fracture. Secondary aims were to examine: (1) predictors of COVID-19 on presentation and later in the admission; (2) rate of hospital-acquired COVID-19; (3) predictive value of negative swabs on admission. A nationwide multicentre retrospective cohort study of all patients with hip fracture in all 17 Scottish hospitals in March-April. Demographics, blood results, COVID-19 status, Nottingham Hip Fracture Score (NHFS), management, length of stay (LOS), and 30-day mortality were recorded. 78/833 (9.4%) patients had COVID-19 (65 swab-proven). 30-day survival with COVID-19 was lower than without (65.4% vs 91%; p<0.001). COVID-19 within 7 days of admission (likely community-acquired) was independently associated with male sex (OR 2.34, p=0.040, CI 1.04–5.25) and COVID-19 symptoms (OR 15.56, CI 6.61–36.60, p<0.001). COVID-19 within 7–30 days (probable hospital-acquired) was independently associated with male sex (OR 1.73, CI 1.05–2.87, p=0.032), NHFS □7 (OR 1.91, CI 1.09–3.34, p=0.024), pulmonary disease (OR 1.68, CI 1.00–2.81, p=0.049), ASA □3 (OR 2.37, CI 1.13–4.97, p=0.022) and LOS □9 days (OR 1.98, CI 1.18–3.31, p=0.009). 38/65 (58.5%) of COVID-19 cases were probably hospital-acquired. The false negative rate of swabs on admission was 0% in asymptomatic and 2.9% in symptomatic patients. COVID-19 was associated with a threefold-increased 30-day mortality. Nosocomial transmission may have accounted for half of all cases. Identification of risk factors for having COVID-19 on admission, or acquiring COVID-19 later, may guide patient pathways. LOS was the only
Background. The evaluation and management of outcomes risk has become an essential element of a modern total joint replacement program. Our multidisciplinary team designed an evidence-based tool to address
Back pain is a complex problem affecting the majority of the population at some point in their life. This cross-sectional study evaluated patients presenting to a tertiary spine clinic with a primary complaint of back pain for modifiable lifestyle factors which may be associated with their back pain. Patients were also asked if any of these lifestyle factors had been addressed by primary care practitioners prior to referral to the spine surgeon’s office. The purpose of this cross-sectional study is to evaluate the modifiable lifestyle factors which may be associated with back pain in patients presenting to a tertiary spine clinic with a primary complaint of back pain and to compare these lifestyle factors with the general population. A secondary objective is to determine whether patients with back pain were given any instructions with regard to modifiable lifestyle factors by their primary care practitioner. Consecutive patients presenting to the orthopaedic spine surgery clinic at the Ottawa Hospital – Civic Campus are asked to complete a questionnaire upon presentation to the surgeon’s clinic and prior to their visit with the surgeon. Data being collected includes Body Mass Index, smoking history, physical activity history, perceived stress, and disability. Information is also being collected on sources of information about back pain including instructions given by primary care practitioners (physician, chiropractor, physiotherapist, massage therapist, acupuncturist, naturopath, and other). Data will be analyzed to determine the difference in
Great strides have been made in perioperative pain management after total knee arthroplasty (TKA) leading to reduced length of hospital stay, cost reduction, improved patient satisfaction, and more rapid recovery without affecting the rates of readmission after surgery. To assure a happy patient, early recognition of patients at risk for persistent postoperative pain prior to surgery is key. Patients on chronic pain medication should be evaluated by pain management specialists with the intention of reducing overall narcotic requirement prior to TKA. Patients with high anxiety levels, pain catastrophizing, and Kinesphobia are at increased risk for increased pain and poor outcomes and should be referred for cognitive behavioral therapy and coping strategies. Finally, patients with hypersensitivity syndromes localised in the soft tissue around the knee should undergo desensitization protocols prior to TKA. Patient education on the risk of increased postoperative pain is crucial to manage expectations and optimise
Malnutrition is an important consideration during the perioperative period and albumin is the most common laboratory surrogate for nutritional status. The purpose of this study is to identify if preoperative serum albumin measurements are predictive of infection following arthroscopic procedures. Patients undergoing knee, shoulder or hip arthroscopy between 2006–2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with an arthroscopic current procedural terminology code and a preoperative serum albumin measurement were included. Patients with a history of prior infection, including a non-clean wound class, pre-existing wound infection or systemic sepsis were excluded. Independent t-tests where used to compare albumin values in patients with and without the occurrence of a postoperative infection. Pre-operative albumin levels were subsequently evaluated as predictors of infection with logistic regression models. There were 31,906 patients who met the inclusion criteria. The average age was 55.7 years (standard deviation (SD) 14.62) and average BMI was 31.7 (SD 7.21). The most prevalent comorbidities were hypertension (49.2%), diabetes (18.4%) and smoking history (16.9%). The average preoperative albumin was 4.18 (SD 0.42). There were 45 cases of superficial infection (0.14%), 10 cases of wound dehiscence (0.03%), 17 cases of deep infection (0.05%), 27 cases of septic arthritis or other organ space infection (0.08%) and 95 cases of any infection (0.30%). The preoperative albumin levels for patients who developed septic arthritis (mean difference (MD) 0.20, 95% CI, 0.038, 0.35, P = 0.015) or any infection (MD 0.14, 95% CI 0.05, 0.22, P = 0.002) were significantly lower than the normal population. Additionally, disseminated cancer, Hispanic race, inpatient status and smoking history were significant independent risk factors for infection, while female sex and increasing albumin were protective towards developing any infection. Rates of all infections were found to increase exponentially with decreasing albumin. The relative risk of infection with an albumin of 2 was 3.46 (95% CI, 2.74–4.38) when compared to a normal albumin of 4. For each albumin increase of 0.69, the odds of developing any infection decreases by a factor of 0.52. This study suggests that preoperative serum albumin is an independent predictor of septic arthritis and all infection following elective arthroscopic procedures. Although the effect of albumin on infection is modest, malnutrition may represent a