The June 2024 Knee Roundup³⁶⁰ looks at: The estimated lifetime risk of revision after primary knee arthroplasty influenced by age, sex, and indication; Should high-risk patients seek out care from high-volume surgeons?; Stability and fracture rates in medial unicondylar knee arthroplasties; Rethinking antibiotic prophylaxis for dental procedures post-arthroplasty; Evaluating DAIR: a viable alternative for acute periprosthetic joint infection; The characteristics and predictors of mortality in periprosthetic fractures around the knee; Patient health-related quality of life deteriorates significantly while waiting six to 12 months for total hip or knee arthroplasty; The importance of looking for diversity in knee implants.

Aims

To assess the feasibility of a randomized controlled trial (RCT) that compares three treatments for acetabular fractures in older patients: surgical fixation, surgical fixation and hip arthroplasty (fix-and-replace), and non-surgical treatment.

This edition of Cochrane Corner looks at some of the work published by the Cochrane Collaboration, covering pharmacological interventions for the prevention of bleeding in people undergoing definitive fixation or joint replacement for hip, pelvic, and long bone fractures; interventions for reducing red blood cell transfusion in adults undergoing hip fracture surgery: an overview of systematic reviews; and pharmacological treatments for low back pain in adults: an overview of Cochrane Reviews

Aims

The purpose of this study was to compare outcomes of combined total joint arthroplasty (TJA) (total hip arthroplasty (THA) and total knee arthroplasty (TKA) performed during the same admission) versus bilateral THA, bilateral TKA, single THA, and single TKA. Combined TJAs performed on the same day were compared with those staged within the same admission episode.

Aims

Between 2002 and 2011, 81 patients with a traumatic total brachial plexus injury underwent reconstruction by double free muscle transfer (DFMT, 47 cases), single muscle transfer (SMT, 16 cases) or nerve transfers (NT, 18 cases).

Degenerative problems of the hip in patients with childhood and adult onset neuromuscular disorders can be challenging to treat. Many orthopaedic surgeons are reluctant to recommend total hip replacement (THR) for patients with underlying neuromuscular disorders due to the perceived increased risks of dislocation, implant loosening, and lack of information about the functional outcomes and potential benefits of these procedures in these patients. Modular femoral components and alternative bearings which facilitate the use of large femoral heads, constrained acetabular components and perhaps more importantly, a better understanding about the complications and outcomes of THR in the patient with neuromuscular disorders, make this option viable. This paper will review the current literature and our experience with THR in the more frequently encountered neuromuscular disorders.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):27–31.

In this paper, we will consider the current role of simultaneous-bilateral TKA. Based on available evidence, it is our opinion that bilateral one stage TKR is a safe and efficacious treatment for patients with severe bilateral arthritic knee disease but should be reserved for selected patients without significant medical comorbidities.

Introduction: Compromised by pre-existing medical co-morbidities, weakened by the second hit of surgery, elderly patients with hip fractures are amongst the most challenging cases to manage appropriately in the acute hospital setting. Aim: To document the frequency and outcome of post operative medical complications in elderly patients following surgery for hip and proximal femoral fractures. Methods: Retrospective analysis of acute admissions to a University teaching hospital with hip and pertrochanteric fractures over an 18 month period. Medical records and radiographs were reviewed for details relating to location of fracture, in-patient morbidity, mortality and length of stay. In-patient fracture referrals and patients under 65 years of age were excluded. Results: From a total of 438 fracture fixation procedures or prosthetic replacements, 368 patients were eligible for analysis. The mean age of patients was 83.6 years. The mean length of stay was 14.2 days. 142 patients experienced significant postoperative morbidity consisting of 24 myocardial infarctions, 46 respiratory tract infections, 33 urinary tract infections, 3 cerebral vascular accidents and 36 exacerbations of congestive cardiac failure. There was no correlation between morbidity and location or type of fracture. The mean age (86.1 yrs) and length of stay (26 days) was greater in the morbidity group (p< 0.05). The overall post operative in-patient mortality rate was 9%, rising to 50% in those who suffered a myocardial infarction and 33% in those with exacerbations of congestive cardiac failure. Conclusion: This study reinforces the poor prognosis conferred by a hip fracture on the elderly patient both in terms of morbidity and mortality. As the population ages and life expectancy increases, health services will come under ever more pressure to cater for the expansion in numbers of hip fracture patients. Greater resources and dedicated professional medical staff are required in order that the best possible care and outcome may be achieved for these patients

Purpose: To analyze the long-term functional outcome of vertical shear fractures to other forms of severe pelvic injuries: APC-III, LC-III, and complex acetabular fractures. Patients and Methods: Out of 561 patients with pelvic ring injuries we identified 31 vertical shear fractures in 29 consecutive patients (4 female). A retrospective chart analysis was performed and the following data was recorded: age, sex, mechanism of injury, associated injuries, Injury Severity Score (ISS), resuscitation requirements, method of stabilization, intensive care unit (ICU) or high dependency unit (HDU) stay, duration of hospital stay, urogenital injuries, neurological injury, systemic complications, time to union and mortality. The same parameters were assessed and analyzed in a control group comprising of 98 patients: 34 patients with APC–III, 32 patients with LC-III and 32 patients with complex (at least bicolumnar) ace-tabular fractures. All patients in the control group were matched for age and sex with the vertical shear fracture group. The mean follow up was 62 months. At final follow up, functional outcome was assessed in all patients using the following generic outcome measurement tools: Euro-Qol 5D (EQ), SF36 v2 (Short form), VAS (Visual analogue score), SMFA (Short musculoskeletal functional assessment) and Majeed score. In addition Merle d’ Aubignæ and Postel scores (Matta modification – 1986) and radiologic degenerative hip scores (Matta 994) were used to assess patients with acetabular fractures. Results: The mean age of all the patients in the study was 43.5 years (16–71) and the median injury severity score was 22 (12–32). Motor vehicle accidents accounted for 79% of the injuries. All patients had their pelvic ring stabilized at least temporarily within 24 hours and all acetabular fractures were reduced and stabilized by 7 days. The mean hospital stay was 26 (9–176) days. Functional outcome was assessed in all patients of the control group and in 28/29 patients of the vertical shear fracture group (1 patient died as a result of a cerebral vascular accident 11 months after injury). In the vertical shear fracture group, 35% of the patients have returned to their previous jobs (49% in control group), 30% have changed their professions (30% in control group) and 25% (14% in control group) have retired from regular work. In the acetabular group, 10 (31%) patients had neurologic injury (6 sciatic, 3 common peroneal, 1 femoral). Of these, 4 were iatrogenic. 6 patients had complete neurologic recovery. Heterotopic ossification was seen in 19 (59%) patients (12 had Brooker Grade 1, four had Grade 2, three had Grade 3). Three patients (9%) with acetabular fractures (all had associated posterior wall fracture) had total hip replacements at 29,40,51months (2 secondary osteoarthritis and 1 osteonecrosis). The clinical outcome (Matta modification-1986 of Merle d’ Aubignæ and Postel scores) of patients in the acetabular fracture group was: 5 excellent (3 THA), 4 good, 13 fair and 10 poor. The radiologic score of degenerative hip disease (Matta 1994) for the acetabular fracture group was: 4 excellent, 8 good, 14 fair and 3 poor. Conclusion: Patients with vertical shear fractures represent the spectrum of high-energy pelvic disruption. The functional outcome is significantly better in patients with APC III and LC III fractures when compared to vertical shear and complex acetabular fractures thus reflecting the severity of the injury. Secondary osteoarthritis and neurologic injury appear to contribute to the poor outcome of acetabular fractures. Sound reconstruction of the pelvic ring is not always associated with good results probably due to the extensive pelvic floor trauma as seen in this series of patients. Younger individuals seem to have a relatively better outcome when compared to the older age group