The stem design in total hip arthroplasty (THA) is constantly evolving. The impact of the collar on the risk of periprosthetic fracture remains controversial. This study aimed to determine whether adding a collar to the femoral stem impacts the early periprosthetic fracture risk within 90 days of surgery. This retrospective study included 1,623 patients who underwent primary total hip arthroplasty in a single orthopedic department between January 2010 and December 2020. The inclusion criteria were uncemented stem with or without a collar, in a primary intention, without previous hip surgery with a similar “corail like” design. The assessed data were demographic characteristics (age, gender, number of obese (BMI > 30)), single or dual mobility, the surgical approach, the early complication, particularly the periprosthetic femoral fractures. Of the 1,623 patients, 1,380 received a collared stem (85%), and 243 received a collarless stem (15%). A
Abstract. Background. There is a trend towards minimising length of stay (LOS) after total knee arthroplasty (TKA), as longer LOS is associated with poorer outcomes and higher costs. Patient factors known to influence LOS after TKA include age and ASA grade. Evidence regarding body mass index (BMI) in particular is conflicting. Some studies find that increased BMI predicts greater LOS, while others find no such relationship. Previous studies have generally not examined socioeconomic status, which may be a confounder. They have generally been conducted outside the UK, and prior to the Covid-19 pandemic. Methods. We conducted a retrospective cohort study of 1031 primary TKAs performed 01-04-2021 to 31-12-2021, after resumption of elective surgery in our centre. A
Introduction: Increasingly, clinical pathways and fast-track protocols are reducing hospital in-patient stay following elective joint replacement surgery. In order to improve efficiency in our unit, we undertook a prospective observational study to identify pre–and peri-operative factors associated with increased length of stay. Methods: From our prospective primary hip arthroplasty database we analysed data from 2678 consecutive patients over a 9-year period from 1998–2007. Patients were excluded who had bilateral hip replacement, died within 30 post-operative days, or had surgery for a diagnosis other than primary osteoarthritis. This left 2302 patients who were analysed using multiple logistic regression analysis. Results: Length of stay varied from 3 to 58 days, with a mean of 8.1 days, and median 7 days. After
INTRODUCTION. Although simulation studies have shown superior wear properties of metal-on-metal articulations, increased concern exists regarding the excess in-vivo wear of a small number of Metal-on-Metal-Hip-Resurfacing (MoMHRA) implants. Serum ion levels of Chromium (Cr) and Cobalt (Co) are surrogate markers of wear. Risk factors associated with increased wear include female gender, small components, dysplasia, cup orientation outside safe zone and femoral head downsize during surgery with an associated decrease in Head-Neck-Ratio (HNR). However, these factors are interlinked. This study aims to identify the factors that are most important for subsequent wear of MoMHRA, by performing a
Whilst clinical pathways have reduced the length of inpatient stay (LOS) and costs associated with total hip replacement (THR), it would be useful to be able to predict which factors affect the LOS following THR. In this way units could improve patient flow, and thus increase efficiency, by optimising case loads and staffing levels in all related departments. We hypothesised that there were pre-operative factors that will predict the length of inpatient stay following a unilateral primary THR. Prospective data from 2302 patients who underwent primary unilateral THR for osteoarthritis during a nine-year period from January 01 1998 were included. The relationship between each prospectively recorded factor and LOS was analyzed separately using t-tests or Pearson correlation. Multiple linear regression was used to analyze the effect of each significant factor adjusted for others. Length of stay varied from 3 to 58 days, with a mean of 8.1 and a median of 7.0. The pre-operative factors that were not significantly associated with the LOS were BMI, Scottish Index of Multiple Deprivation, disabling knee, back or contra-lateral hip pain. A number of pre-operative factors were found to be highly significant predictors of LOS when subjected to univariate analysis, but not significant after
Aims. The risk factors for abnormal spinopelvic mobility (SPM), defined as an anterior rotation of the spinopelvic tilt (∆SPT) ≥ 20° in a flexed-seated position, have been described. The implication of pelvic incidence (PI) is unclear, and the concept of lumbar lordosis (LL) based on anatomical limits may be erroneous. The distribution of LL, including a unusual shape in patients with a high lordosis, a low pelvic incidence, and an anteverted pelvis seems more relevant. Methods. The clinical data of 311 consecutive patients who underwent total hip arthroplasty was retrospectively analyzed. We analyzed the different types of lumbar shapes that can present in patients to identify their potential associations with abnormal pelvic mobility, and we analyzed the potential risk factors associated with a ∆SPT ≥ 20° in the overall population. Results. ΔSPT ≥ 20° rates were 28.3%, 11.8%, and 14.3% for patients whose spine shape was low PI/low lordosis (group 1), low PI anteverted (group 2), and high PI/high lordosis (group 3), respectively (p = 0.034). There was no association between ΔSPT ≥ 20° and PI ≤ 41° (odds ratio (OR) 2.01 (95% confidence interval (CI)0.88 to 4.62), p = 0.136). In the
Aims. Patient dissatisfaction following primary total knee arthroplasty (TKA) with manual jig-based instruments has been reported to be as high as 30%. Robotic-assisted total knee arthroplasty (RA-TKA) has been increasingly used in an effort to improve patient outcomes, however there is a paucity of literature examining patient satisfaction after RA-TKA. This study aims to identify the incidence of patients who were not satisfied following RA-TKA and to determine factors associated with higher levels of dissatisfaction. Methods. This was a retrospective review of 674 patients who underwent primary TKA between October 2016 and September 2020 with a minimum two-year follow-up. A five-point Likert satisfaction score was used to place patients into two groups: Group A were those who were very dissatisfied, dissatisfied, or neutral (Likert score 1 to 3) and Group B were those who were satisfied or very satisfied (Likert score 4 to 5). Patient demographic data, as well as preoperative and postoperative patient-reported outcome measures, were compared between groups. Results. Overall, 45 patients (6.7%) were in Group A and 629 (93.3%) were in Group B. Group A (vs Group B) had a higher proportion of male sex (p = 0.008), preoperative chronic opioid use (p < 0.001), preoperative psychotropic medication use (p = 0.01), prior anterior cruciate ligament (ACL) reconstruction (p < 0.001), and preoperative symptomatic lumbar spine disease (p = 0.004). Group A was also younger (p = 0.023).
Aims. Hip fractures are some of the most common fractures encountered in orthopaedic practice. We aimed to identify whether perioperative hypotension is a predictor of 30-day mortality, and to stratify patient groups that would benefit from closer monitoring and early intervention. While there is literature on intraoperative blood pressure, there are limited studies examining pre- and postoperative blood pressure. Methods. We conducted a prospective observational cohort study over a one-year period from December 2021 to December 2022. Patient demographic details, biochemical results, and haemodynamic observations were taken from electronic medical records. Statistical analysis was conducted with the Cox proportional hazards model, and the effects of independent variables estimated with the Wald statistic. Kaplan-Meier survival curves were estimated with the log-rank test. Results. A total of 528 patients were identified as suitable for inclusion. On
Aims. The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates. Methods. A prospective cohort study of patients planned to undergo hip arthroplasty (n = 713) and knee arthroplasty (n = 737) at a UK university teaching hospital who had completed preoperative PROMs questionnaires, including the EuroQol five-dimension health-related quality of life score, and Oxford Hip Score (OHS) and Oxford Knee Score (OKS). Follow-up questionnaires were sent by post at one year, including satisfaction scoring. Attempts were made to contact patients who did not initially respond. Univariate, logistic regression, and receiver operator curve analysis was performed. Results. At one year, 667 hip patients (93.5%) and 685 knee patients (92.9%) had undergone surgery and were alive. No response was received from 151/667 hip patients (22.6%), 83 (55.0%) of whom were ultimately contacted); or from 108/685 knee patients (15.8%), 91 (84.3%) of whom were ultimately contacted. There was no difference in satisfaction after arthroplasty between initial non-responders and responders for hips (74/81 satisfied vs 476/516 satisfied; p = 0.847) or knees (81/93 satisfied vs 470/561 satisfied; p = 0.480). Initial non-response and persistent non-response was associated with younger age, higher BMIs, and worse preoperative PROMs for both hip and knee patients (p < 0.050). Being in employment was associated with persistent non-response for hip patients (p = 0.047).
Not all patients receive enhanced mobility and return to comfortable, independent living after Total Hip Arthroplasty (THA). It would be beneficial to both surgeons and patients to be able to predict short term outcomes for THA. The purpose of this study was to investigate factors affecting the short term outcome of primary THA and develop a multivariate regression model that can predict such outcomes. This was a prospective study of 101 patients, who underwent primary THA. All patients were followed for a minimum of 1 year. 12 independent variables, including age, gender, diagnosis, presence of preoperative comorbidities, BMI, preoperative WOMAC physical component (PC) score, type of anesthesia, type of fixation, surgical time, estimated blood loss, use of a postoperative drain, and length of stay were analyzed using correlation and multivariate regression analyses. Multivariate regression models were validated using an independent cohort. Correlation analyses showed three variables significantly influence short term THA outcome. These include preoperative WOMAC PC score (PC) (p<
0.01), gender (G) (p= 0.01) and the presence of preoperative comorbidities (CMB) (p= 0.02). By
Abstract. Introduction. We aimed to compare the outcomes of elderly patients with periarticular distal femur or supracondylar periprosthetic fractures treated with either open reduction internal fixation or distal femoral replacement. Methods. A retrospective review of patients over 65 years with AO Type B and C fractures of the distal femur or Su type I and II periprosthetic fractures treated with either a DFR or ORIF was undertaken. Outcomes including Length of Stay, PROMs (Oxford Knee Score and EQ 5D), infection, union, mortality, complication and reoperation rates were assessed. Data on confounding variables were also collected for
Introduction. Diaphyseal tibial fractures account for approximately 1.9% of adult fractures. Several studies demonstrate a high proportion of diaphyseal tibial fractures have ipsilateral occult posterior malleolus fractures, this ranges from 22–92.3%. Materials and Methods. A retrospective review of a prospectively collected database was performed at Liverpool University Hospitals NHS Foundation Trust between 1/1/2013 and 9/11/2020. The inclusion criteria were patients over 16, with a diaphyseal tibial fracture and who underwent a CT. The articular fracture extension was categorised into either posterior malleolar (PM) or other fracture. Results. 764 fractures were analysed, 300 had a CT. There were 127 intra-articular fractures. 83 (65.4%) cases were PM and 44 were other fractures. On univariate analysis for PM fractures, fibular spiral (p=.016) fractures, no fibular fracture(p=.003), lateral direction of the tibial fracture (p=.04), female gender (p=.002), AO 42B1 (p=.033) and an increasing angle of tibial fracture. On
The optimum indications for debridement, antibiotics and implant retention (DAIR) are unclear. Previous studies have demonstrated higher success rate of DAIR within one year of the primary arthroplasty. This study aimed to compare the success rate of DAIR vs revision in “early” and “late” infections to provide guidance for clinical decision making. The Prosthetic Joint Infection in Australia and New Zealand Observational (PIANO) cohort prospectively recorded PJIs between July 2014 and December 2017 in 27 hospitals. This study included PIANO patients with first time PJIs occurring after primary TKA. Treatment success was defined as the patient being alive, free from further revision and without clinical or microbiological evidence of reinfection at two years follow-up. “Early” and “late” infections were analyzed separately. Univariate analysis compared demographic and disease specific factors between the DAIR and Revision groups. Multivariate binary logistic regression identified whether treatment strategy and other risk factors were associated with treatment success in “early” and “late” infections. In 117 “early” (<1 year) infections, treatment success rate was 56% in the DAIR group and 54% in the revision group (p=0.878). No independent risk factors were associated with treatment outcome on
Aims. Hip fracture is a common injury in the elderly. Recent studies in orthopaedic access have demonstrated inequities affecting Māori. This study aimed to compare the demographic differences between Māori and NZ Europeans with hip fractures, identify any deficiencies in initial, surgical and post op care and in outcomes. Methods. All cases in New Zealand from 2018–2020 were included. Key outcomes included time to theatre from admission, change in walking status, residential status and survival at 120 days post fracture. Univariate analysis compared differences in demographics, surgical and management factors between ethnicities. Key outcome comparisons were conducted using
Objectives. Post-infective arthritis is an important sequalae of septic arthritis(SA). While total knee arthroplasty(TKA) is an effective treatment for said arthritis, previous SA brings challenges for treatment planning. Using prospectively collected data from a cohort of patients with knee SA, this study aims to determine the proportion of patients requiring eventual TKA, and risk factors of developing prosthetic joint Infection(PJI). Methods. All cases of 1st episode knee SA from 01/01/2000 to 31/12/2020 were identified in the Auckland region. Patient records and NZJR records of all cases were searched to identify subsequent TKA. PJI following arthroplasty was identified using ICM criteria. Univariate and
A hot swollen joint is a commonly encountered condition in clinical practice. With a broad range of differentials, septic arthritis (SA) is perhaps one of the most concerning. Treated by culture-specific antibiotics and arthroscopic lavage, some patients require multiple washouts. We aimed to determine:. (1) What are the risk factors for development of SA?. (2) What are the risk factors for repeat washout in SA patients?. (3) What are the important clinical differences between a periprosthetic joint infection (PJI) and SA cohort?. All patients presenting to the emergency department, orthopaedic, and rheumatology clinics between January 2020 to January 2021 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma on the ipsilateral joint, with data missing from their medical records in any of the variables required for analysis, <24 months follow-up were excluded. Variables of interest in the three-month period preceding the diagnosis of SA were compared between SA and non-SA patients. Factors with a p-value of p<0.100 in univariate analysis were included in a stepwise multivariate logistic regression model. Similar analyses were performed to compare SA patients with multiple washouts with those needing one washout. Demographical and clinical data for PJI patients were collected to delineate important differences with SA cohort. 211 patients were included (SA:28;PJI:24;pseudogout:32;gout:26;others:101).
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 modifiable risk factors to improve the overall care of patients with hip fractures. Methods. All NZ patients from 2018 – 2020 were included. Baseline demographics, management factors, and outcomes were recorded. Key outcomes were change in walking status, residential status and survival at 120 days. Univariate analysis was performed to compare differences in demographics, surgical and management factors for the key variables.
Aims. This study aimed to evaluate the effectiveness of the induced membrane technique for treating infected bone defects, and to explore the factors that might affect patient outcomes. Methods. A comprehensive search was performed in PubMed, Embase, and the Cochrane Central Register of Controlled Trials databases between 1 January 2000 and 31 October 2021. Studies with a minimum sample size of five patients with infected bone defects treated with the induced membrane technique were included. Factors associated with nonunion, infection recurrence, and additional procedures were identified using logistic regression analysis on individual patient data. Results. After the screening, 44 studies were included with 1,079 patients and 1,083 segments of infected bone defects treated with the induced membrane technique. The mean defect size was 6.8 cm (0.5 to 30). After the index second stage procedure, 85% (797/942) of segments achieved union, and 92% (999/1,083) of segments achieved final healing. The
Aims. To evaluate mid-to long-term patient-reported outcome measures (PROMs) of endoprosthetic reconstruction after resection of malignant tumours arising around the knee, and to investigate the risk factors for unfavourable PROMs. Methods. The medical records of 75 patients who underwent surgery between 2000 and 2020 were retrospectively reviewed, and 44 patients who were alive and available for follow-up (at a mean of 9.7 years postoperatively) were included in the study. Leg length discrepancy was measured on whole-leg radiographs, and functional assessment was performed with PROMs (Toronto Extremity Salvage Score (TESS) and Comprehensive Outcome Measure for Musculoskeletal Oncology Lower Extremity (COMMON-LE)) with two different aspects. The thresholds for unfavourable PROMs were determined using anchor questions regarding satisfaction, and the risk factors for unfavourable PROMs were investigated. Results. The thresholds for favourable TESS and COMMON were 64.8 and 70.4 points, respectively.
Aims. The proximal tibia (PT) is the anatomical site most frequently affected by primary bone tumours after the distal femur. Reconstruction of the PT remains challenging because of the poor soft-tissue cover and the need to reconstruct the extensor mechanism. Reconstructive techniques include implantation of massive endoprosthesis (megaprosthesis), osteoarticular allografts (OAs), or allograft-prosthesis composites (APCs). Methods. This was a retrospective analysis of clinical data relating to patients who underwent proximal tibial arthroplasty in our regional bone tumour centre from 2010 to 2018. Results. A total of 76 patients fulfilled the inclusion criteria and were included in the study. Mean age at surgery was 43.2 years (12 to 86 (SD 21)). The mean follow-up period was 60.1 months (5.4 to 353). In total 21 failures were identified, giving an overall failure rate of 27.6%. Prosthesis survival at five years was 75.5%, and at ten years was 59%. At last follow-up, mean knee flexion was 89.8° (SD 36°) with a mean extensor lag of 18.1° (SD 24°). In univariate analysis, factors associated with better survival of the prosthesis were a malignant or metastatic cancer diagnosis (versus benign), with a five- and ten-year survival of 78.9% and 65.7% versus 37.5% (p = 0.045), while in-hospital length of stay longer than nine days was also associated with better prognosis with five- and ten-year survival rates at 84% and 84% versus 60% and 16% (p < 0.001). In