Aims. Breast cancer survivors have known risk factors that might influence the results of total hip arthroplasty (THA) or total knee arthroplasty (TKA). This study evaluated clinical outcomes of patients with breast cancer history after primary THA and TKA. Methods. Our total joint registry identified patients with breast cancer history undergoing primary THA (n = 423) and TKA (n = 540). Patients were matched 1:1 based upon age, sex, BMI, procedure (hip or knee), and surgical year to non-breast cancer controls. Mortality, implant survival, and
Aims. To evaluate the perioperative
Aims. Iliopsoas pathology is a relatively uncommon cause of pain following total hip arthroplasty (THA), typically presenting with symptoms of groin pain on active flexion and/or extension of the hip. A variety of conservative and surgical treatment options have been reported. In this retrospective cohort study, we report the incidence of iliopsoas pathology and treatment outcomes. Methods. A retrospective review of 1,000 patients who underwent THA over a five-year period was conducted, to determine the incidence of patients diagnosed with iliopsoas pathology. Outcome following non-surgical and surgical management was assessed. Results. In all, 24 patients were diagnosed as having developed symptomatic iliopsoas pathology giving an incidence of 2.4%. While the mean age for receiving a THA was 65 years, the mean age for developing iliopsoas pathology was 54 years (28 to 67). Younger patients and those receiving THA for conditions other than primary osteoarthritis were at a higher risk of developing this
Aims. The aims of this study were to quantify health state utility
values (HSUVs) after a tibial fracture, investigate the effect of
complications, to determine the trajectory in HSUVs that result
in these differences and to quantify the quality-adjusted life years
(QALYs) experienced by patients. Patients and Methods. This is an analysis of 2138 tibial fractures enrolled in the
Fluid Lavage of Open Wounds (FLOW) and Study to Prospectively Evaluate
Reamed Intramedullary Nails in Patients with Tibial Fractures (SPRINT)
trials. Patients returned for follow-up at two and six weeks and
three, six, nine and 12 months. Short-Form Six-Dimension (SF-6D) values
were calculated and used to calculate QALYs. Results. Compared with those who did not have a
Aims. The primary aim of this study was to determine if delayed clavicular fixation results in a greater risk of operative
Aims. The aim of this study was to explore risk factors for
Aims. We aimed to investigate factors related to the technique of medial
opening wedge high tibial osteotomy which might predispose to the
development of a lateral hinge fracture. Patients and Methods. A total of 71 patients with 82 osteotomies were included in the
study. Their mean age was 62.9 years (37 to 80). The classification
of the type of osteotomy was based on whether it extended beyond
the fibular head. The level of the osteotomy was classified according
to the height of its endpoint. Results. At a mean follow-up of 20 months (6 to 52), a total of 15 lateral
hinge fractures (18.3%) were identified. A sufficient osteotomy,
in which both anterior and posterior tibial cortices were involved
with extension into the lateral aspect of the plateau in relation
to an anteroposterior line tangential to the medial edge of the
fibular head in the CT axial plane, was seen in 48 knees (71.6%)
in those without a lateral hinge fracture and in seven (46.7%) in
those with a lateral hinge fracture. An osteotomy which ended above
the level of the fibular head was seen in nine (13.4%) of the knees
without a lateral hinge fracture and seven (46.7%) of the those
with a lateral hinge fracture. There was a significant relationship
between the absence of a lateral hinge fracture and both a sufficient
osteotomy and one whose endpoint was at the level of the fibular
head (p = 0.0451 and p = 0.0214, respectively). Conclusion. A sufficient osteotomy involving both the anterior and posterior
cortices, whose endpoint is at the level of the fibular head, should
be performed when undertaking a medial opening wedge high tibial
osteotomy if a lateral hinge fracture is to be avoided as a
Aims. Medial unicompartmental knee arthroplasty (mUKA) is an advised treatment for anteromedial knee osteoarthritis. While long-term survival after mUKA is well described, reported incidences of short-term surgical
Aims. Robotic-assisted unicompartmental knee arthroplasty (R-UKA) has been proposed as an approach to improve the results of the conventional manual UKA (C-UKA). The aim of this meta-analysis was to analyze the studies comparing R-UKA and C-UKA in terms of clinical outcomes, radiological results, operating time,
Aims. Total hip arthroplasty (THA) is one of the most successful surgical procedures. The objectives of this study were to define whether there is a correlation between socioeconomic status (SES) and surgical
Introduction. Osseointegration has emerged as a promising alternative to rehabilitating with a traditional socket mounted prosthesis. Advantages have been reported to include improved functional mobility, better osseoperception, improved comfort, reduced pain, better biomechanical alignment and better gait, which all lead to a less restricted lifestyle and significantly improved quality of life. A major concern of the Osseointegrated approach lies in the risk of infections occurring from the permanent transcutaneous opening often referred to as the stoma. Several systematic reviews have indicated that the occurrence of minor infections can be quite common, serious
Aims. Postoperative
Aims. Endoprosthetic reconstruction with a distal femoral arthroplasty (DFA) can be used to treat distal femoral bone loss from oncological and non-oncological causes. This study reports the short-term implant survivorship,
Aims. It is important to understand the rate of
Aims. Posterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare
Direct anterior approach (DAA) arthroplasty has generated great interest because of its minimally invasive and muscle sparing nature. Obese patients are reported to be associated with greater incidence of
Simultaneous bilateral total hip arthroplasty (THA) in patients with bilateral hip osteoarthritis is gradually becoming attractive, as it requires a single anesthesia and hospitalization. However, there are concerns about the potential
Aims. The aim of this study was to characterize the influence of social deprivation on the rate of
Introduction. Lower limb amputation is associated with significant morbidity and mortality. Reflecting the predominance of vascular or diabetic disease as a cause for lower limb amputation, much of the available literature excludes lower limb amputation secondary to trauma in the reporting of
Aims. The aim of this study was to explore the relationship between reason for revision total hip arthroplasty (rTHA) and outcomes in terms of patient-reported outcome measures (PROMs). Methods. We reviewed a prospective cohort of 647 patients undergoing full or partial rTHA at a single high-volume centre with a minimum of two years’ follow-up. The reasons for revision were classified as: infection; aseptic loosening; dislocation; structural failure; and painful THA for other reasons. PROMs (modified Oxford Hip Score (mOHS), EuroQol five-dimension three-level health questionnaire (EQ-5D-3L) score, and visual analogue scales for pain during rest and activity),
Aims. This study aimed to investigate the risk of postoperative
Aims. The escalating demand for medical resources to address spinal diseases as society ages is an issue that requires careful evaluation. However, few studies have examined trends in spinal surgery, especially unscheduled hospitalizations or surgeries performed after hours, through large databases. Our study aimed to determine national trends in the number of spine surgeries in Japan. We also aimed to identify trends in after-hours surgeries and unscheduled hospitalizations and their impact on
Aims. Access to total knee arthroplasty (TKA) is sometimes restricted for patients with severe obesity (BMI ≥ 40 kg/m. 2. ). This study compares the cost per quality-adjusted life year (QALY) associated with TKA in patients with a BMI above and below 40 kg/m. 2. to examine whether this is supported. Methods. This single-centre study compared 169 consecutive patients with severe obesity (BMI ≥ 40 kg/m. 2. ) (mean age 65.2 years (40 to 87); mean BMI 44.2 kg/m. 2. (40 to 66); 129/169 female) undergoing unilateral TKA to a propensity score matched (age, sex, preoperative Oxford Knee Score (OKS)) cohort with a BMI < 40 kg/m. 2. in a 1:1 ratio. Demographic data, comorbidities, and
Aim. By gaining insight into the Quality of Life (QoL) status and occurrence of
Aims. The aim of this study was to evaluate medium-term outcomes and
Aims. The risk of postoperative
The results of total hip arthroplasty (THA) revisions to correct leg length discrepancy (LLD) are not clear, with only two former limited series (< 25 patients). Therefore, we conducted a retrospective study of THA revisions for LLD to determine: 1) the change in LLD, 2) the function outcomes and whether obtaining equal leg lengths influenced function, 3) the
This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall
Aims. The aim of this study was to investigate the association between additional rehabilitation at the weekend, and in-hospital mortality and
Aims. The aim of this study was to reassess the rate of neurological, psoas-related, and abdominal
MPFL reconstruction has demonstrated a very high success rate with improved patella stability, physical function, and patient-reported outcomes. However technical error and a lack of consideration of anatomic risk factors have been shown to contribute to failure after MPFL reconstruction. Previous research has also reported a
Abstract. Background. Aim of this study is to determine the difference between re-operation rates after conventional Methods of fixation of patella fractures using Metallic implants and novel technique of all suture fixation using Ethibond or fiber tape. Methods. This is a retrospective comparative analysis involving 62 patients who had a transverse patellar fracture and underwent surgery between January 2013 to December 2021. Selected patients were divided, based on different fixation methods used, into four groups - TBW group, CC screw group, Encirclage group and Suture Fixation Group. Patients were followed till bone union was evident on radiographs. Number of patients in Metallic implant group undergoing repeat operation were compared with the patients who underwent patella fracture fixation using all suture technique. Mean and standard deviation (SD) were calculated for all continuous variables. Mean of the two groups was compared using unpaired t-test. Results. TBW was the most common method of fixation used in 41(66.1%) patients. 7 patients each underwent surgery using CC screw, Encirclage +/− TBW, and suture fixation respectively. Bone union was seen in about 85% of patients in all the groups suggesting all treatment modalities lead to good fracture healing. 15 patients(36.6%) of patients in TBW group and 3 patients(42.9%) in encirclage group had implant removal because of hardware-related
Aims. In cases of severe periprosthetic joint infection (PJI) of the knee, salvage procedures such as knee arthrodesis (KA) or above-knee amputation (AKA) must be considered. As both treatments result in limitations in quality of life (QoL), we aimed to compare outcomes and factors influencing
Aims. We assessed the value of the Clinical Frailty Scale (CFS) in the prediction of adverse outcome after hip fracture. Methods. Of 1,577 consecutive patients aged > 65 years with a fragility hip fracture admitted to one institution, for whom there were complete data, 1,255 (72%) were studied. Clinicians assigned CFS scores on admission. Audit personnel routinely prospectively completed the Standardised Audit of Hip Fracture in Europe form, including the following outcomes: 30-day survival; in-hospital
Aims. Although internal hemipelvectomy is associated with a high incidence of morbidity, especially wound
Aims. Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and
Aims. The aim of this study was to compare the functional and radiological outcomes and the
Aims. To achieve the functional benefits of the direct anterior (DA) approach and the fixation benefits of cemented replacement, this study combined the two techniques posing the following questions: does the limited access of the DA approach adversely affect the cement technique?; and does such a cementing technique reduce the incidence of cementless
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
Aims. The aim of this study was to report the incidence of implant-related
Aims. The aim of this study was to determine the impact of the severity of anaemia on postoperative
Novel oral anticoagulant (NOAC) use in Australia has increased significantly since their introduction to the Pharmaceutical Benefits Scheme (PBS). Currently, there are no specific guidelines regarding recommencement of NOAC therapy post-operatively for patients concurrently on a NOAC and undergoing arthroplasty. To address this gap in the literature, the aim of this study was to compare the clinical and patient-reported outcomes in a patient cohort recommencing a therapeutic dose of NOAC within 24 hours of total hip or knee arthroplasty. Data was retrieved from a prospective registry (ACTRN1262000079698) containing hip and knee arthroplasties. Cases were labelled based on whether they presented on a therapeutic dose of NOAC prior to surgery or not. Descriptive statistics were used to summarise patient outcomes. Of 291 patients undergoing 331 primary arthroplasties, 9.3% were undertaking NOAC therapy prior to their surgery. In the NOAC cohort, there was a 34.5% adverse event rate, however on closer analysis of each event, it was found that none of these events were
Revision knee arthroplasty is a complex procedure with the number and cost of knee revision procedures performed per year expected to rise. Few studies have examined adverse events following revision arthroplasty. The objective of this study was to determine rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications) and to compare these with primary arthroplasty and re-revision arthroplasty. Patients undergoing primary knee arthroplasty were identified in the UK Hospital Episode Statistics. Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes including infection (undergoing surgery), pulmonary embolism, myocardial infarction, stroke. Urgent indications for revision arthroplasty were defined as infection or fracture, and all other indications were included in the elective indications cohort. 939,021 primary knee arthroplasty cases were included of which 40,854 underwent subsequent revision arthroplasty, and 9,100 underwent re-revision arthroplasty. Revision surgery for elective indications was associated with a 90-day rate of mortality of 0.44% (135/30,826; 95% CI 0.37-0.52) which was comparable to primary knee arthroplasty (0.46%; 4,292/939,021; 95% CI 0.44-0.47). Revision arthroplasty for infection, however, was associated with a much higher mortality of 2.04% (184/9037; 95% CI 1.75-2.35; odds ratio [OR] 3.54; 95% CI 2.81-4.46), as was revision for periprosthetic fracture at 5.25% (52/991; 95% CI 3.94-6.82; OR 6.23; 95% CI 4.39-8.85). Higher rates of pulmonary embolism, myocardial infarction, and stroke were also observed in the infection and fracture cohort. These findings highlight the burden of
Aims. Patients with metabolic syndrome (MetS) are known to be at increased risk of postoperative
Aims. Previous research has demonstrated increased early
Aims. A variety of surgical approaches are used for total hip arthroplasty (THA), all with reported advantages and disadvantages. A number of common
Aims. Vascular compromise due to arterial injury is a rare but serious
Aims. The aim of this study was to assess the influence of operating time on 30-day
Aims. This study, using a surgeon-maintained database, aimed to explore the risk factors for surgery-related
Our aim was to ascertain if K-wire configuration had any influence on the infection and
Aims. Increasingly, patients with bilateral hip arthritis wish to undergo staged total hip arthroplasty (THA). With the rise in demand for arthroplasty, perioperative risk assessment and counselling is crucial for shared decision making. However, it is unknown if
Abstract. Objective. In this systematic review we aim to compare wound
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
Aims. Proximal femoral endoprosthetic replacements (PFEPRs) are the most common reconstruction option for osseous defects following primary and metastatic tumour resection. This study aimed to compare the rate of implant failure between PFEPRs with monopolar and bipolar hemiarthroplasties and acetabular arthroplasties, and determine the optimum articulation for revision PFEPRs. Methods. This is a retrospective review of 233 patients who underwent PFEPR. The mean age was 54.7 years (SD 18.2), and 99 (42.5%) were male. There were 90 patients with primary bone tumours (38.6%), 122 with metastatic bone disease (52.4%), and 21 with haematological malignancy (9.0%). A total of 128 patients had monopolar (54.9%), 74 had bipolar hemiarthroplasty heads (31.8%), and 31 underwent acetabular arthroplasty (13.3%). Results. At a mean 74.4 months follow-up, the overall revision rate was 15.0%. Primary malignancy (p < 0.001) and age < 50 years (p < 0.001) were risk factors for revision. The risks of death and implant failure were similar in patients with primary disease (p = 0.872), but the risk of death was significantly greater for patients who had metastatic bone disease (p < 0.001). Acetabular-related implant failures comprised 74.3% of revisions; however, no difference between hemiarthroplasty or arthroplasty groups (p = 0.209), or between monopolar or bipolar hemiarthroplasties (p = 0.307), was observed. There was greater radiological wear in patients with longer follow-up and primary bone malignancy. Re-revision rates following a revision PFEPR was 34.3%, with dual-mobility bearings having the lowest rate of instability and re-revision (15.4%). Conclusion. Hemiarthroplasty and arthroplasty PFEPRs carry the same risk of revision in the medium term, and is primarily due to acetabular
Aims. The use of high tibial osteotomy (HTO) to delay total knee arthroplasty (TKA) in young patients with osteoarthritis (OA) and constitutional deformity remains debated. The aim of this study was to compare the long-term outcomes of TKA after HTO compared to TKA without HTO, using the time from the index OA surgery as reference (HTO for the study group, TKA for the control group). Methods. This was a case-control study of consecutive patients receiving a posterior-stabilized TKA for OA between 1996 and 2010 with previous HTO. A total of 73 TKAs after HTO with minimum ten years’ follow-up were included. Cases were matched with a TKA without previous HTO for age at the time of the HTO. All revisions were recorded. Kaplan-Meier survivorship analysis was performed using revision of metal component as the endpoint. The Knee Society Score, range of motion, and patient satisfaction were assessed. Results. Mean follow-up was 13 years (SD 3) after TKA in both groups. The 20-year Kaplan-Meier survival estimate was 98.6% in TKA post-HTO group (HTO as timing reference) and 81.4% in control group (TKA as timing reference) (p = 0.030). There was no significant difference in clinical outcomes, radiological outcomes, and
Aims. The aims of this study were to characterize the incidence and risk factors associated with stress fractures following periacetabular osteotomy, and to determine their effect on osteotomy union. Methods. We retrospectively reviewed all periacetabular osteotomies (PAOs) performed for developmental dysplasia of the hip (DDH) at one institution over a six-year period between 2012 and 2017. Perioperative factors were recorded, and included demographic and surgical data. Postoperatively, patients were followed for a minimum of one year with anteroposterior and false profile radiographs of the pelvis to monitor for evidence of stress fracture and union of osteotomies. We characterized the incidence and locations of stress fractures, and used univariate and multivariable analysis to identify factors predictive of stress fracture and the association of stress fracture on osteotomy union. Results. A total of 331 patients underwent PAO during the study period with 56 (15.4%) stress fractures: 46 fractures of the retroacetabular posterior column, five cases of ischiopubic stress fracture, and five cases of concurrent ischiopubic and retroacetabular stress fractures. Overall, 86% (48/56) healed without intervention. Univariate analysis revealed that stress fractures occurred more frequently in females (p = 0.040), older patients (mean age 27.6 years (SD 8.4) vs 23.8 (SD 9.0); p = 0.003), and most often with the use of the broad Mast chisel (28.5%; p < 0.001). Multivariable analysis revealed that increasing age (odds ratio (OR) 1.04; 95% CI 1.01 to 1.07; p = 0.028) and use of the broad Mast chisel (OR 5.1 (95% CI 1.3 to 19.0) compared to narrow Ganz chisel; p = 0.038) and surgeon (p = 0.043) were associated with increased risk of stress fracture. Patients with stress fractures were less likely to have healed osteotomies after one-year follow-up (76% vs 96%; p < 0.001). Conclusion. Stress fracture of the posterior column may be an under-recognized
This study aims to assess the relationship between history of pseudotumour formation secondary to metal-on-metal (MoM) implants and periprosthetic joint infection (PJI) rate, as well as establish ESR and CRP thresholds that are suggestive of infection in these patients. We hypothesized that patients with a pseudotumour were at increased risk of infection. A total of 1,171 total hip arthroplasty (THA) patients with MoM articulations from August 2000 to March 2014 were retrospectively identified. Of those, 328 patients underwent metal artefact reduction sequence MRI and had minimum two years’ clinical follow-up, and met our inclusion criteria. Data collected included demographic details, surgical indication, laterality, implants used, history of pseudotumour, and their corresponding preoperative ESR (mm/hr) and CRP (mg/dl) levels. Multivariate logistic regression modelling was used to evaluate PJI and history of pseudotumour, and receiver operating characteristic curves were created to assess the diagnostic capabilities of ESR and CRP to determine the presence of infection in patients undergoing revision surgery.Aims
Methods
Aims. As the population ages and the surgical complexity of lumbar spinal surgery increases, the preoperative stratification of risk becomes increasingly important. Understanding the risks is an important factor in decision-making and optimizing the preoperative condition of the patient. Our aim was to determine whether the modified five-item frailty index (mFI-5) and nutritional parameters could be used to predict postoperative
Advantages of osseointegration have been reported to include improved functional mobility, better osseoperception, improved comfort, reduced pain, better biomechanical alignment and gait, which all lead to a less restricted lifestyle and significantly improved quality of life. A major concern of the Osseointegrated approach lies in the risk of infections occurring from the permanent transcutaneous opening often referred to as the stoma. Detailed analysis has been performed on all osseointegration surgeries performed by the Osseointegration Group of Australia and it's affiliates since 2010. All events leading to a re-admission and subsequent re-operation have been identified through hospital operation records and pooled together for meta-analysis. Events identified include: revision of implants, periprosthetic fracture fixation, surgical debridement due to infections, neurectomies and soft- tissue refashioning.Introduction
Materials and Methods
Aims. Limb salvage for pelvic sarcomas involving the acetabulum is a major surgical challenge. There remains no consensus about what is the optimum type of reconstruction after resection of the tumour. The aim of this study was to evaluate the surgical outcomes in these patients according to the methods of periacetabular reconstruction. Methods. The study involved a consecutive series of 122 patients with a periacetabular bone sarcoma who underwent limb-salvage surgery involving a custom-made prosthesis in 65 (53%), an ice-cream cone prosthesis in 21 (17%), an extracorporeal irradiated autograft in 18 (15%), and nonskeletal reconstruction in 18 (15%). Results. The rates of major
Introduction. Previous research has demonstrated increased early
The aim of this study is to compare the effectiveness and safety of thromboprophylactic treatments in patients undergoing primary total knee arthroplasty (TKA). Using nationwide medical registries, we identified patients with a primary TKA performed in Denmark between 1 January 2013 and 31 December 2018 who received thromboprophylactic treatment. We examined the 90-day risk of venous thromboembolism (VTE), major bleeding, and all-cause mortality following surgery. We used a Cox regression model to compute hazard ratios (HRs) with 95% confidence intervals (CIs) for each outcome, pairwise comparing treatment with dalteparin or dabigatran with rivaroxaban as the reference. The HRs were both computed using a multivariable and a propensity score matched analysis.Aims
Methods
Aims. High body mass index (BMI) is associated with increased rates of
Aims. It has been shown that the preoperative modification of risk factors associated with obesity may reduce
It is not known whether preservation of the capsule of the hip positively affects patient-reported outcome measures (PROMs) in total hip arthroplasty using the direct anterior approach (DAA-THA). A recent randomized controlled trial found no clinically significant difference at one year postoperatively. This study aimed to determine whether preservation of the anterolateral capsule and anatomical closure improve the outcome and revision rate, when compared with resection of the anterolateral capsule, at two years postoperatively. Two consecutive groups of patients whose operations were performed by the senior author were compared. The anterolateral capsule was resected in the first group of 430 patients between January 2012 and December 2014, and preserved and anatomically closed in the second group of 450 patients between July 2015 and December 2017. There were no other technical changes between the two groups. Patient characteristics, the Charlson Comorbidity Index (CCI), and surgical data were collected from our database. PROM questionnaires, consisting of the Oxford Hip Score (OHS) and Core Outcome Measures Index (COMI-Hip), were collected two years postoperatively. Data were analyzed with generalized multiple regression analysis.Aims
Methods
The goal of the study was to describe the features of the aseptic loosening of the cup in CoC THR and to determine factors that affect the time to revision. It is a retrospective study including all patients who had a revision of CoC THR for aseptic failure fixation of the cup, between 2007 and 2017. 55 patients (27 women, 28 men) (56 hips) were included in the study. Eight hips (13 %) had also a stem exchange. At the primary T HR, the mean age of the patients was 47.9 years (17–72), 28 press fit cups had screws, the mean diameter of the cup was 51.2 mm (46–62) and the mean inclination was 52° (37–67). Clinical and radiological data were retrospectively recorded by an observer different to the initial operators. The mean age of the patients at the revision was 55.4 years (26–84). The mean time to revision was 90.1 months (14–240), and was significantly greater in patients aged less than 52 years, in cups without screws and with a 28mm head. The trend curve of the time to cup revision showed a bimodal distribution at three and ten years. 20 cups had migrated (33%). Bone loss was rated type 1 in 41 hips (73.0%), type 2 in 12 hips and type 3 in three hips). The mean diameter of the new cup was 52.3 mm (46–64). It was inferior to that of the initial cup in 26 hips (46.4%). 31 cups were impacted (55.5%) and 25 needed to be cemented (45.5%). No macroscopic wear was detected on the ceramic implant. Aseptic loosening of the cup in CoC THA does not appear to increase over time, supporting the fact that the failure is unrelated to wear and is not due to a biological mechanism. The occurrence of two peaks of frequency over time may suggest that different mechanisms occur.
The purpose of this population-based study was to determine the association between morbid obesity and 10-year mortality and
Aims. To explore the effect of different types of articulating antibiotic-loaded cement spacers in two-stage revision for chronic hip prosthetic joint infection (PJI). Methods. A retrospective cohort study was performed involving 36 chronic PJI patients treated with different types of articulating antibiotic-loaded cement spacers between January 2014 and December 2017. The incidence of
Aims. Plate and screw fixation has been the standard treatment for painful conditions of the wrist in non-rheumatoid patients in recent decades. We investigated the
Aims. While interdisciplinary protocols and expedited surgical treatment improve the management of hip fractures in the elderly, the impact of such interventions on patients specifically undergoing arthroplasty for a femoral neck fracture is not clear. We sought to evaluate the efficacy of an interdisciplinary protocol for the management of patients with a femoral neck fracture who are treated with an arthroplasty. Methods. In 2017, our institution introduced a standardized interdisciplinary hip fracture protocol. We retrospectively reviewed adult patients who underwent hemiarthroplasty (HA) or total hip arthroplasty (THA) for femoral neck fracture between July 2012 and March 2020, and compared patient characteristics and outcomes between those treated before and after the introduction of the protocol. Results. A total of 157 patients were treated before the introduction of the protocol (35 (22.3%) with a THA), and 114 patients were treated after its introduction (37 (32.5%) with a THA). The demographic details and medical comorbidities were similar in the two groups. Patients treated after the introduction of the protocol had a significantly reduced median time between admission and surgery (22.8 hours (interquartile range (IQR) 18.8 to 27.7) compared with 24.8 hours (IQR 18.4 to 43.3) (p = 0.042), and a trend towards a reduced mean time to surgery (24.1 hours (SD 10.7) compared with 46.5 hours (SD 165.0); p = 0.150), indicating reduction in outliers. Patients treated after the introduction of the protocol had a significantly decreased rate of major
Introduction. Total knee arthroplasty (TKA) is a successful treatment for degenerative end stage knee arthritis. Younger patients who undergo TKA may face multiple revisions during their lifetime due to aseptic loosening, infection, and instability. The purpose of this study was to compare the early
The objective of this study was to determine rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision and compare these with primary knee arthroplasty. Primary and revision arthroplasty procedures were identified in the national Hospital Episode Statistics and were linked by patient and side. A logistic regression model was used to investigate factors associated with 90-day mortality (primary outcome) and secondary serious adverse outcomes. Urgent indications for revision arthroplasty were defined as infection or fracture; other indications (e.g. loosening, instability, wear) were included in the elective cohort.Abstract
Introduction
Methodology
Background. Robotic assistance is being increasingly utilised in the surgical field in an effort to minimise human error. In this study, we report minimum two-year outcomes and
Patellofemoral
Aims. The aims of this study were to validate the outcome of total elbow arthroplasty (TEA) in patients with rheumatoid arthritis (RA), and to identify factors that affect the outcome. Methods. We searched PubMed, MEDLINE, Cochrane Reviews, and Embase from between January 2003 and March 2019. The primary aim was to determine the implant failure rate, the mode of failure, and risk factors predisposing to failure. A secondary aim was to identify the overall
Aims. The aim of this study was to investigate mortality and risk of intraoperative medical
There is currently no standardised
We compared the incidence and severity of
Aim. The incidence of prosthetic joint infections can be severe to monitor, as they are rare events. Recent publications from National registries points toward a significant underestimation of reported infections. The aim of this project was to develop a
INTRODUCTION. Shoulder arthroplasty (SA) is an effective procedure for managing patients with shoulder pain secondary to degenerative joint disease or end stage arthritis that has failed conservative treatment. Insurance status has been shown to be an indicator of patient morbidity and mortality. The objective of the current study is to evaluate the effect of patient insurance status on outcomes following shoulder replacement surgery. METHODS. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing shoulder arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical and surgical
Introduction. Knee arthroplasty is one of the most common inpatient surgeries procedures performed every year however
Introduction. Hip arthroplasty is one of the most common procedures performed every year however
The purpose of this study was to compare reoperation and revision rates of double plating (DP), single plating using a lateral locking plate (SP), or distal femoral arthroplasty (DFA) for the treatment of periprosthetic distal femur fractures (PDFFs). All patients with PDFF primarily treated with DP, SP, or DFA between 2008 and 2022 at a university teaching hospital were included in this retrospective cohort study. The primary outcome was revision surgery for failure following DP, SP, or DFA. Secondary outcome measures included any reoperation, length of hospital stay, and mortality. All basic demographic and relevant implant and injury details were collected. Radiological analysis included fracture classification and evaluation of metaphyseal and medial comminution.Aims
Methods
Background. Advances in surgical and anesthetic technique have resulted in a reducing length of stay for lumbar decompression, with the first day case procedure published in the literature in 1980. Current evidence suggests day case surgery is associated with improved patient satisfaction, faster recovery, reduced infection rates and financial savings. Following the introduction of a locally agreed day case protocol for lumbar microdiscectomy, we reviewed our 30-day postoperative
To compare rates of serious adverse events in patients undergoing revision knee arthroplasty with consideration of the indication for revision (urgent versus elective indications), and compare these with primary arthroplasty and re-revision arthroplasty. Patients undergoing primary knee arthroplasty were identified in the national Hospital Episode Statistics (HES) between 1 April 1997 to 31 March 2017. Subsequent revision and re-revision arthroplasty procedures in the same patients and same knee were identified. The primary outcome was 90-day mortality and a logistic regression model was used to investigate factors associated with 90-day mortality and secondary adverse outcomes, including infection (undergoing surgery), pulmonary embolism, myocardial infarction, and stroke. Urgent indications for revision arthroplasty were defined as infection or fracture, and all other indications (e.g. loosening, instability, wear) were included in the elective indications cohort.Aims
Methods
Aims. There is inconsistent evidence on whether prior spinal fusion surgery adversely impacts outcomes following total hip arthroplasty (THA). We conducted a systematic review and meta-analysis to assess the association between pre-existing spinal fusion surgery and the rate of
Aims. We conducted a systematic review and meta-analysis to compare the mortality, morbidity, and functional outcomes of cemented versus uncemented hemiarthroplasty in the treatment of intracapsular hip fractures, analyzing contemporary and non-contemporary implants separately. Methods. PubMed, Medline, EMBASE, CINAHL, and Cochrane Library were searched to 2 February 2020 for randomized controlled trials (RCTs) comparing the primary outcome, mortality, and secondary outcomes of function, quality of life, reoperation, postoperative
Introduction. Managing open tibial fractures according to national guidelines is a primary focus for major trauma centres, however pressures of capacity and expertise limit the capability to achieve all of these standards for every patient. Debate remains over the impact of particular aspects of guidance, especially in relation to the timing of surgical interventions. Evaluation of these tenants of care predominantly hinge on trends derived from low level scientific evidence, mainly due to the difficulty in completing high level studies. The aim of this study is to assess the
Major wound
Aim: To quantify the
Introduction. While knee arthrodesis is a salvage option for recalcitrant total knee arthroplasty (TKA) periprosthetic joint infection (PJI) it is used relatively uncommonly and contemporary data are limited. We sought to determine the reliability, durability and safety of knee arthrodesis as the definitive treatment for complex, persistently infected TKA in a modern series of patients. Methods. We retrospectively identified 41 knees treated from 2002–2016 with a deliberate, two-stage knee arthrodesis protocol (TKA resection, high-dose antibiotic spacer, targeted IV antibiotics and followed by subsequent knee arthrodesis) in patients with complex TKA PJI. Mean age was 64 years & mean BMI was 39 kg/m. 2. Mean follow-up was 4 years. The extensor mechanism was deficient in 66% of knees, and flap coverage was required in 34% of knees. The majority of patients were host grade B (56%) or C (29%), and extremity grade of 3 (71%). Twenty-nine percent had poly-microbial infections, and 49% had multi-drug resistant organisms. Fixation included intramedullary nail (61%), external fixator (24%), and dual plating (15%). Results. Two patients (5%) required amputation for persistently infected non-unions; therefore, limb salvage was accomplished in 95% of patients. After initial treatment, there were non-unions in 24% and persistent infection in 17%. Non-union was significantly correlated with persistent infection, with 50% of non-unions having persistent infection compared with just 6% of united knees (p=0.006). External fixation was a significant risk factor for non-union (70%) compared to intramedullary fixation (8%; p=0.005). Overall, twenty-seven
Management of pseudotumours associated with MoM THA can be difficult and
Aim. Prosthetic joint infections (PJI) after failed knee arthroplasty, especially in complicated courses with persisting or recurrent infections, may result in a considerable destruction of bone substance, the extensor apparatus and the surrounding soft tissue. In these cases reconstruction of a proper knee function may be impossible and the only solutions are: knee arthrodesis or above-the-knee amputation (AKA). However, both methods are associated with considerable functional deficits and high
The purpose of this study was to examine the
complications and outcomes of total hip replacement (THR) in super-obese
patients (body mass index (BMI) >
50 kg/m. 2. ) compared
with class I obese (BMI 30 to 34.9 kg/m. 2. ) and normal-weight
patients (BMI 18.5 to 24.9 kg/m. 2. ), as defined by the
World Health Organization. A total of 39 THRs were performed in 30 super-obese patients
with a mean age of 53 years (31 to 72), who were followed for a
mean of 4.2 years (2.0 to 11.7). This group was matched with two
cohorts of normal-weight and class I obese patients, each comprising
39 THRs in 39 patients. Statistical analysis was performed to determine differences
among these groups with respect to
Obesity is a risk factor for
Aims: To quantify the
Tranexamic Acid (TA) has been shown to reduce transfusion rates in Total Knee Replacement (TKR) without
Aims. Fretting and corrosion at the modular head/neck junction, known
as trunnionosis, in total hip arthroplasty (THA) is a cause of adverse
reaction to metal debris (ARMD). We describe the outcome of revision
of metal-on-polyethylene (MoP) THA for ARMD due to trunnionosis
with emphasis on the risk of major
Using general practitioner records, hospital medical notes and through direct telephone conversation with patients, we investigated the accuracy of nine patient-reported
Over a two-year period, 265 Norwegian orthopaedic surgeons working at 71 institutions performed 63 484 operations under a tourniquet. Their replies to a questionnaire revealed that they mostly followed modern guidelines in their use of the tourniquet. Most felt that the tourniquet could be left on for two hours, and that it could be re-applied after 15 minutes. A total of 26