The modern prevalence of primary tumours causing metastatic bone disease is ill-defined in the oncological literature. Therefore, the purpose of this study is to identify the prevalence of primary tumours in the setting of metastatic bone disease, as well as reported rates of pathological fracture, postoperative complications, 90-day mortality, and 360-day mortality for each primary tumour subtype. The Premier Healthcare Database was queried to identify all patients who were diagnosed with metastatic bone disease from January 2015 to December 2020. The prevalence of all primary tumour subtypes was tabulated. Rates of long bone pathological fracture, 90-day mortality, and 360-day mortality following surgical treatment of pathological fracture were assessed for each primary tumour subtype. Patient characteristics and postoperative outcomes were analyzed based upon whether patients had impending fractures treated prophylactically versus treated completed fractures.Aims
Methods
Objectives. The length of the tourniquet time during total knee arthroplasty (TKA) is related to the incidence of post-operative
Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in patients undergoing elective hip arthroplasty surgery. The balance of post-operative VTE prophylaxis and risk of post-operative haemorrhage remains at the forefront of surgeon's mind. The National Institute for Clinical Excellence (NICE) has altered their prophylaxis guidance in the setting of total hip arthroplasty (THA). The aim of this study was to present the VTE incidence in 8,890 patients who underwent total hip arthroplasty between January 1997 and March 2018 with Aspirin as the primary agent for pharmacological thromboprophylaxis. Analysis of prospective data collection from consecutive patients undergoing THA was performed with the incidence of
Abstract. Introduction. The Wells score is commonly used to assess the risk of proximal
Abstract. Aims. The association between body mass index (BMI) and venous thromboembolism (VTE) is well studied, but remains unclear in the literature. We aimed to determine whether morbid obesity (BMI≥40) was associated with increased risk of VTE following total knee arthroplasty (TKA) or unicompartmental knee arthroplasty (UKA), compared to those of BMI<40. Methods. Between January 2016 and December 2020, our institution performed 4506 TKAs and 449 UKAs. 450 (9.1%) patients had a BMI≥40. CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE) and ultrasound scan for suspected proximal
Abstract. BACKGROUND. The effectiveness of anti-embolic graduated compression stockings (GCSs) has recently been questioned. The aim of this study is to systematically review all the relevant randomised controlled trials published to date. PATIENTS AND METHODS. We systematically reviewed all the randomised controlled trials comparing anti-embolism stockings with no stockings. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL, Cochrane Musculoskeletal Injuries Group specialized register and the reference lists of articles as well as hand search results. Trials were independently assessed and data for the main outcome measures;
Introduction and Objective. The effectiveness of anti-embolic graduated compression stockings (GCSs) has recently been questioned. The aim of this study is to systematically review all the relevant randomised controlled trials published to date. Materials and Methods. We systematically reviewed all the randomised controlled trials comparing anti-embolism stockings with no stockings. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL, Cochrane Musculoskeletal Injuries Group specialized register and the reference lists of articles as well as hand search results. Trials were independently assessed and data for the main outcome measures;
Diabetes mellitus is a risk factor for complications after operative management of ankle fractures. Generally, diabetic sequelae such as neuropathy and nephropathy portend greater risk; however, the degree of risk resulting from these patient factors is poorly defined. We sought to evaluate the effects of the diabetic sequelae of neuropathy, chronic kidney disease (CKD), and peripheral vascular disease (PVD) on the risk of complications following operative management of ankle fractures. Using a national claims-based database we analyzed patients who had undergone operative management of an ankle fracture and who remained active in the database for at least two years thereafter. Patients were divided into two cohorts, those with a diagnosis of diabetes and those without. Each cohort was further stratified into five groups: neuropathy, CKD, PVD, multiple sequelae, and no sequelae. The multiple sequelae group included patients with more than one of the three sequelae of interest: CKD, PVD and neuropathy. Postoperative complications were queried for two years following surgery. The main complications of interested were:
Increased operative time has been previously identified as a risk factor for complications following total joint arthroplasty. The purpose of this study was to evaluate the influence of surgical time on 30-day complications following Total Knee Arthroplasty (TKA) and to determine if there were specific time intervals associated with worse outcomes. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was utilized to identify patients ≥18 years who underwent TKA between 2005 and 2016 using procedural codes. Patients with surgical durations >240 minutes were excluded. Patient demographics, operation length, and 30-day major and minor complication rates were captured. Multivariable logistic regression was used to determine if the rate of complications differed depending on length of operation, while adjusting for age, sex, American Society of Anaesthesiologists (ASA) class, functional status, smoking status, comorbidities, anesthesia type, and Body Mass Index (BMI). Multivariable linear regression was used to identify independent predictors of duration of surgery. A total of 213,921 TKA patients (average age 67 ± 10 years) were identified from the database. Within 30-days of the index procedure, 3,321 (1.55%) experienced a major complication, and 6,144 (2.86%) experienced a minor complication. Mean surgical duration was 92 minutes (range 20 – 240). Underweight, or overweight/obese BMI, male sex, hypertension, cancer, dependent functional status, epidural anaesthesia, and ASA class III and IV were determined to be independent predictors of prolonged operation length, while COPD, current smoking, spinal anesthesia, and older age predicted lower operation times. Operation lengths ≥ 90 minutes significantly increased the risk of both major and minor complications (P>0.01). Specifically, the rates of
Venous thromboembolic (VTE) events including
Introduction. We studied the safety and efficacy of multimodal thromboprophylaxis (MMP) in patients with a history of venous thromboembolism (VTE) undergoing total hip arthroplasty (THA). MMP includes discontinuation of procoagulant medications, VTE risk stratification, regional anesthesia, an intravenous bolus of unfractionated heparin before femoral work, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient's risk. Material and methods. From 2004 to 2018, 257 patients (mean age: 67 years; range: 26–95) with a history of VTE underwent 277 primary, elective THAs procedures (128 right, 100 left, 9 single-stage bilateral, 20 staged bilateral) by two orthopaedic surgeons at a single institution. The patients had a history
Introduction. Total knee arthroplasty (TKA) is one of the most successful surgeries to relieve pain and dysfunction caused by severe arthritis. However, it is a still big problem that there is a possibility of death in pulmonary embolism (PE) after TKA. We previously reported that there was more incidence of asymptomatic PE than estimated in general by detail examinations. But it was difficult to whom we decided to perform additional examinations except the patients with some doubtful symptoms. Therefore, we investigated detail of PE patients after primary TKA to find out anything key point in PE. Methods. Consecutive ninety-nine patients who underwent primary TKA from January 2015 to March 2018 were applied. There were 23 male and 76 females included, and the mean age was 73.7 years old. There were 96 cases of osteoarthritis, 2 cases of osteonecrosis and one of rheumatoid arthritis. A single knee surgery team performed all operations with cemented type prostheses and air tourniquet during operation. There were 35 cases of one-staged bilateral TKA and 64 of unilateral TKA. Detail examinations with contrast enhanced CT (CE-CT) and venous ultrasonography (US) were performed at the 3rd day after surgery. Next, we applied ultra sound cardiogram (UCG) to the patients diagnosed as PE by CE-CT, we checked right ventricular overload (RVO) to treat PE. These images were read by a single senior radiologist team. Results. CE-CT was performed in 87 patients (87.8%) and US was in all patients. The incidence of
Venous thromboembolism (VTE) is the second most common complication and pulmonary embolism (PE) is the fourth most common cause of death after a hip fracture. Despite thromboprophylaxis,
INTRODUCTION. The direct anterior approach (DAA) for total hip arthroplasty has become a popular technique. Proponents of the anterior approach cite advantages such as less muscle damage, lower dislocation risk, faster recovery, and more accurate implant placement for the approach. However, there is a steep, complex learning curve associated with the technique. The present study seeks to define the learning curve based on individual surgical and outcome variables for a high-volume surgeon. METHODS. 300 consecutive patients were retrospectively analyzed. Intraoperative outcomes measured include surgery time and estimated blood loss (EBL). Complications include intraoperative fracture, post-operative fracture, infection, dislocation, leg length discrepancy, loosening, and medical complications such as
Introduction. There is insufficient data on the trends of anticoagulation after total knee arthroplasty (TKA) in the USA, and the efficacy and safety of rivaroxaban, beyond randomized clinical trials and small cohort studies. Patients and Methods. Using the Truven Health MarketScan database, we retrospectively evaluated new anticoagulation prescriptions after elective TKA from 2010 to 2015. The frequency of
Venous thromboembolic events (VTE), including
Venous Thromboembolism (VTE) prophylaxis is an essential part of orthopaedic surgeries in preventing life-threatening thromboembolic events such as
Introduction:. Hallux surgery is the most commonly performed elective surgery in the foot and ankle. As with all surgery, there are many potential complications quoted in the literature. Venous thromboembolism (deep vein thrombosis and pulmonary embolism) incidence and prophylaxis, however, is not adequately addressed and remains controversial. Material and Method:. This prospective study includes one hundred patients who underwent hallux surgery. Risk factors implicated to increase the risk of developing venous thromboembolic disease as well as anaesthetic time, thigh tourniquet time and regional anaesthetic blocks were documented. Compressive ultrasonography was performed in all the patients postoperatively to assess for deep vein thrombosis. Results:. There was one incident of calf
Surgery for pelvic or acetabular fractures carries a high risk of deep-vein thrombosis (DVT). Reports indicate that fondaparinux is a more effective thromboprophylactic agent than low molecular weight heparin (LMWH) after major orthopaedic surgery. We prospectively evaluated a new protocol for DVT prophylaxis using fondaparinux. Patients and methods. One hundred and eight patients with pelvic or acetabular fractures were randomised to receive either fondaparinux or enoxaparin. Specific review points included the primary end-point of clinical
Introduction. Venous thromboembolism (VTE), including pulmonary embolism (PE) resulting from