Aims.
Purpose. The purpose of this study was to evaluate the effect of common
Obesity and the diseases linked to it such as diabetes have been associated with higher complication rates and increased medical costs following total hip arthroplasty (THA). Due to the rising prevalence of obesity and the adverse impact it has on the development of osteoarthritis, there has been a worldwide surge in the number of obese patients presenting for THA procedures, including those morbidly obese (BMI > 40) and those who are super-obese (BMI > 50). The Reward. When THA is successful (as is true for the majority of morbidly obese patients) the operation is just as dramatically effective as it is for other patients. Excellent pain relief and dramatically improved function is the result, even though obese patients generally achieve a lower overall level of function than non-obese patients. Morbidly obese patients with a successful THA and without early complications are some of the most grateful of patients. This is especially true if they have been denied surgery for prolonged periods due to their weight and have had to bear severe joint changes and symptoms during a long period of time leading up to arthroplasty. The Risks. There is a nonlinear increase in complications, reoperations, and especially infection with increasing BMI that begins between a BMI of 25 to 30, and rises thereafter with a relative inflection point in some incidence curves for complications at around a BMI of 40. This has caused some surgeons to suggest a BMI of 40 as an upper limit for elective hip arthroplasty. Risks continue to rise after a BMI of 40 and when the BMI is over 50, in our series 52% of patients had at least one complication. Of these 24% had at least one major complication and 33% at least one minor complication with some suffering more than one complication overall. These data make it reasonable to ask whether the outcomes in some morbidly obese patients might be improved by weight loss, bariatric surgical intervention and other measures aimed at optimizing the multiple companion comorbidities and medical conditions (such as diabetes) that often accompany excess weight. Unfortunately there has been limited information to date on the best means for optimizing of these patients, and as important the effectiveness of these interventions, so that the timing and performance of the eventual arthroplasty procedures might have the highest possible success rate. The Costs. The adverse impact of obesity on medical resource utilization and costs associated with THA has been well documented, Due to longer initial length of stay, greater resource utilization, higher early complication rates and any readmissions and reoperations the costs for even a single individual patient can climb dramatically. In a review of data on primary THA patients from our institution, even after adjusting for age, sex, type of surgery, and other comorbidities, for every 5 unit increase in BMI beyond 30 kg/m2 there was an associated $500 higher cost of hospitalization and an increase of $900 in 90-day total costs (p=0.0001). The Future. The numbers of morbidly obese patients with severe osteoarthritis presenting for possible THA will only continue to increase in the years ahead. Comprehensive multidisciplinary programs are urgently needed to better manage obese patients with weight reduction options, optimization of
Introduction. Functional scores are used to clinically assess total hip arthroplasty (THA) and for comparative purposes in the orthopaedic literature. Previous research has highlighted patient age, gender and underlying diagnosis as potential sources of bias but comorbidity has not been considered. The Functional
Background/Purpose of study. The increasing aging of the population will see a growing number of patients presenting for spine surgery with appropriate indications but numerous
Functional scores are used to clinically assess total hip arthroplasty (THA) and for comparative purposes in orthopaedic literature. Previous pilot work has highlighted patient comorbidity as a potential source of bias in addition to the often-examined factors of age, gender and underlying diagnosis. We analysed prospectively collected data relating to 217 primary THAs (Tayside Arthroplasty Audit Group database). Sample size was calculated from previous pilot data (significance level 5%, power 80%, effect size 0.25). Proportional stratified sampling was performed including all patient age groups (≤40, 41–55, 56–65, >65) and four fixation classes (cemented, hybrid, uncemented and Birmingham resurfacing). Five year Harris Hip Function Score (HHFS) was the dependent variable; age, sex, underlying diagnosis, BMI, pre-operative HHFS and comorbidity (Functional
In a recent study, 54.5% of patients reporting to arthroplasty clinics in the US were obese. We performed a recent literature review to determine how obesity impacts outcomes in total hip and knee arthroplasty and what must be done to improve outcomes in the obese arthroplasty patient. Specifically, obese patients have shown increased rates of infection, dislocation, need for revision, wound dehiscence, increased operative time and prolonged hospital stay. Additionally, obese TKA patients have been shown to have increased rates of aseptic loosening, thromboembolic events, wound complications, and cardiopulmonary events. Worsening severity of obesity seems to correlate with worsening outcomes and super obesity (BMI>50) has been identified as an independent risk factor for complications. Patients with BMI>35 have shown to be 6.7 times more likely to develop infection after TKA. Patients with BMI>40 have a 3.35 times higher rate of revision for deep infection than those with BMI<35. The odds ratio for major complications increases dramatically beyond BMI>45. How can we improve outcomes in the obese patient? Preoperative care for the obese patient involves nutritional counseling, incorporating weight loss methods, physical therapy, metabolic workup and diagnosis and management of frequent comorbid conditions (OSA, DM2, HTN, HLD, malnutrition, renal failure). Identifying and managing comorbidities is especially important given that some comorbidities such as malnutrition have been shown to be as strong or even stronger an independent risk factor for postoperative TJA complications than obesity. In some cases higher complications were seen which some authors attribute to bariatric patients remaining in a catabolic state after weight loss. We know that obesity and its associated comorbid conditions do have worse outcomes and increased complications in TJA patients. We also know that complications proportionately increase with increasing severity of obesity. The super-obese population is at the greatest risk of complication following TJA and preoperative screening and management is essential in reducing complications. Although weight loss is important, bariatric data has shown that it does not solve the problem of obesity in itself and the patient's metabolic state is likely a more important issue. Implant selection is important and strong consideration should be given to avoiding direct anterior approach in the THA obese patient. Understanding of obesity specific complications and treatment options is crucial for patient counseling and optimization to ensure successful treatment in obese TJA patients.
Aims. In the last decade, perioperative advancements have expanded the use of outpatient primary total knee arthroplasty (TKA). Despite this, there remains limited data on expedited discharge after revision TKA. This study compared 30-day readmissions and reoperations in patients undergoing revision TKA with a hospital stay greater or less than 24 hours. The authors hypothesized that expedited discharge in select patients would not be associated with increased 30-day readmissions and reoperations. Methods. Aseptic revision TKAs in the National Surgical Quality Improvement Program database were reviewed from 2013 to 2020. TKAs were stratified by length of hospital stay (greater or less than 24 hours). Patient demographic details,
Aims. The aim of this study was to perform the first population-based description of the epidemiological and health economic burden of fracture-related infection (FRI). Methods. This is a retrospective cohort study of operatively managed orthopaedic trauma patients from 1 January 2007 to 31 December 2016, performed in Queensland, Australia. Record linkage was used to develop a person-centric, population-based dataset incorporating routinely collected administrative, clinical, and health economic information. The FRI group consisted of patients with International Classification of Disease 10th Revision diagnosis codes for deep infection associated with an implanted device within two years following surgery, while all others were deemed not infected. Demographic and clinical variables, as well as healthcare utilization costs, were compared. Results. There were 111,402 patients operatively managed for orthopaedic trauma, with 2,775 of these (2.5%) complicated by FRI. The development of FRI had a statistically significant association with older age, male sex, residing in rural/remote areas, Aboriginal or Torres Strait Islander background, lower socioeconomic status, road traffic accident, work-related injuries, open fractures, anatomical region (lower limb, spine, pelvis), high injury severity, requiring soft-tissue coverage, and
Aims. Patients with a high comorbidity burden (HCB) can achieve similar improvements in quality of life compared with low-risk patients, but greater morbidity may deter surgeons from operating on these patients. Whether surgeon volume influences total hip arthroplasty (THA) outcomes in HCB patients has not been investigated. This study aimed to compare complication rates and implant survivorship in HCB patients operated on by high-volume (HV) and non-HV THA surgeons. Methods. Patients with Charlson
Aims. Two-stage exchange revision total hip arthroplasty (THA) performed in case of periprosthetic joint infection (PJI) has been considered for many years as being the gold standard for the treatment of chronic infection. However, over the past decade, there have been concerns about its safety and its effectiveness. The purposes of our study were to investigate our practice, collecting the overall spacer complications, and then to analyze their risk factors. Methods. We retrospectively included 125 patients with chronic hip PJI who underwent a staged THA revision performed between January 2013 and December 2019. All spacer complications were systematically collected, and risk factors were analyzed. Statistical evaluations were performed using the Student's t-test, Mann-Whitney U test, and Fisher's exact test. Results. Our staged exchange practice shows poor results, which means a 42% mechanical spacer failure rate, and a 20% recurrent infection rate over the two years average follow-up period. Moreover, we found a high rate of spacer dislocation (23%) and a low rate of spacer fracture (8%) compared to the previous literature. Our findings stress that the majority of spacer complications and failures is reflecting a population with high comorbid burden, highlighted by the American Society of Anesthesiology grade, Charlson
The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of
Aims. The aim of this meta-analysis was to determine the pooled incidence of postoperative urinary retention (POUR) following total hip and knee arthroplasty (total joint replacement (TJR)) and to evaluate the risk factors and complications associated with POUR. Methods. Two authors conducted searches in PubMed, Embase, Web of Science, and Scopus on TJR and urinary retention. Eligible studies that reported the rate of POUR and associated risk factors for patients undergoing TJR were included in the analysis. Patient demographic details,
Aims. The aim of this modified Delphi process was to create a structured Revision Hip Complexity Classification (RHCC) which can be used as a tool to help direct multidisciplinary team (MDT) discussions of complex cases in local or regional revision networks. Methods. The RHCC was developed with the help of a steering group and an invitation through the British Hip Society (BHS) to members to apply, forming an expert panel of 35. We ran a mixed-method modified Delphi process (three rounds of questionnaires and one virtual meeting). Round 1 consisted of identifying the factors that govern the decision-making and complexities, with weighting given to factors considered most important by experts. Participants were asked to identify classification systems where relevant. Rounds 2 and 3 focused on grouping each factor into H1, H2, or H3, creating a hierarchy of complexity. This was followed by a virtual meeting in an attempt to achieve consensus on the factors which had not achieved consensus in preceding rounds. Results. The expert group achieved strong consensus in 32 out of 36 factors following the Delphi process. The RHCC used the existing Paprosky (acetabulum and femur), Unified Classification System, and American Society of Anesthesiologists (ASA) classification systems. Patients with ASA grade III/IV are recognized with a qualifier of an asterisk added to the final classification. The classification has good intraobserver and interobserver reliability with Kappa values of 0.88 to 0.92 and 0.77 to 0.85, respectively. Conclusion. The RHCC has been developed through a modified Delphi technique. RHCC will provide a framework to allow discussion of complex cases as part of a local or regional hip revision MDT. We believe that adoption of the RHCC will provide a comprehensive and reproducible method to describe each patient’s case with regard to surgical complexity, in addition to
To evaluate comorbidity and health-related quality of life in patients with idiopathic scoliosis. 496 patients treated with Boston brace for idiopathic scoliosis were invited for long-term follow-up. 361 women and 29 men responded. Mean age was 39.2 (4.6) years; mean follow-up time 23.4 (4.3) years. 28 patients had been operated. All patients had radiographs at baseline, brace weaning, and follow-up, and filled in validated self-report questionnaires for evaluation of health-related quality of life.Purpose
Patients and methods
Further, we will present data on 90 days cause of death following primary THR and predictors for death, including age, gender and comorbidity (analyses are not finished yet).
The February 2023 Foot & Ankle Roundup360 looks at: Joint inflammatory response in ankle and pilon fractures; Tibiotalocalcaneal fusion with a custom cage; Topical application of tranexamic acid can reduce blood loss in calcaneal fractures; Risk factors for failure of total ankle arthroplasty; Pain catastrophizing: the same as pain forecasting?.
The last decade has seen a marked increase in surgical rib fracture fixation (SRF). The evidence to support this comes largely from retrospective cohorts, and adjusting for the effect of other injuries sustained at the same time is challenging. This study aims to assess the impact of SRF after blunt chest trauma using national prospective registry data, while controlling for other comorbidities and injuries. A ten-year extract from the Trauma Audit and Research Network formed the study sample. Patients who underwent SRF were compared with those who received supportive care alone. The analysis was performed first for the entire eligible cohort, and then for patients with a serious (thoracic Abbreviated Injury Scale (AIS) ≥ 3) or minor (thoracic AIS < 3) chest injury without significant polytrauma. Multivariable logistic regression was performed to identify predictors of mortality. Kaplan-Meier estimators and multivariable Cox regression were performed to adjust for the effects of concomitant injuries and other comorbidities. Outcomes assessed were 30-day mortality, length of stay (LoS), and need for tracheostomy.Aims
Methods