Aims. To assess the variation in pre-fracture quality of life (QoL) within the UK hip fracture population, and quantify the nature and strength of associations between QoL and other routinely collected patient characteristics and treatment choices. Methods. The World Hip Trauma Evaluation (WHiTE) study, an observational
This prospective study reports longitudinal, within-patient, patient-reported outcome measures (PROMs) over a 15-year period following cemented single radius total knee arthroplasty (TKA). Secondary aims included reporting PROMs trajectory, 15-year implant survival, and patient attrition from follow-up. From 2006 to 2007, 462 consecutive cemented cruciate-retaining Triathlon TKAs were implanted in 426 patients (mean age 69 years (21 to 89); 290 (62.7%) female). PROMs (12-item Short Form Survey (SF-12), Oxford Knee Score (OKS), and satisfaction) were assessed preoperatively and at one, five, ten, and 15 years. Kaplan-Meier survival and univariate analysis were performed.Aims
Methods
The aim of this retrospective
The benefit of using acetabular screws in primary total hip arthroplasty (THA) has been questioned in recent years. The disadvantages of using screws include increased operative time, risk of injury to surrounding neurovascular structures and metal ware breakage. Recent large registry studies have reported that screws do not confer a protective effect against acetabular loosening or the presence of osteolysis. Other studies have even described an increased risk of aseptic acetabular loosening with the selective use of screws. We report findings from a multicentre
Demand for total knee arthroplasty (TKA) is increasing as it remains the gold-standard treatment for end-stage osteoarthritis (OA) of the knee. While magnetic-resonance imaging (MRI) scans of the knee are not indicated for diagnosing knee OA, they are commonly ordered prior to the referral to an orthopaedic surgeon. The purpose of this study was to determine the proportion of patients who underwent an MRI in the two years prior to their primary TKA for OA. Secondary outcomes included determining patient and physician associations with increased MRI usage. This is a population-based
Aims. The Manchester-Oxford Foot Questionnaire (MOxFQ) is an anatomically specific patient-reported outcome measure (PROM) currently used to assess a wide variety of foot and ankle pathology. It consists of 16 items across three subscales measuring distinct but related traits: walking/standing ability, pain, and social interaction. It is the most used foot and ankle PROM in the UK. Initial MOxFQ validation involved analysis of 100 individuals undergoing hallux valgus surgery. This project aimed to establish whether an individual’s response to the MOxFQ varies with anatomical region of disease (measurement invariance), and to explore structural validity of the factor structure (subscale items) of the MOxFQ. Methods. This was a single-centre, prospective
Background. Clinical guidelines recommend epidural steroid injection (ESI) for severe sciatica but there is uncertainty of effectiveness. The POiSE study aims to identify factors, routinely collected in clinical practice that predict outcome in patients who have ESI. This presentation describes characteristics and early clinical outcomes of POiSE participants. Methods. Prospective
The growth of life expectancy during the last decades has led to an increment in age-related conditions such as hip arthritis and fractures. On the other hand, these elderly patients will present a higher incidence of mental diseases which, in some studies, have been associated with inferior results. This study aims to evaluate the differences in early complication rates between patients with cognitive impairment compared with those without this condition following total hip replacement for osteoarthritis or fracture in the context of contemporary perioperative care protocols. We conducted a retrospective
Routine post-operative bloods following all elective arthroplasty may be unnecessary. This retrospective
Radiation induced sarcoma of bone is a rare but challenging disease process associated with a poor prognosis. To date, series are limited by small patient numbers; data to inform prognosis and the optimal management for these patients is needed. We hypothesized that patients with radiation-induced pelvic bone sarcomas would have worse surgical, oncologic, and functional outcomes than patients diagnosed with primary pelvic bone sarcomas. This was a multi-institution, comparative
In 1997 the Birmingham Hip Resurfacing was introduced to address the needs of young active patients. Alternative designs were introduced to try and improve wear performance. The aim of this study was a comparative
Abstract. Introduction. Previous research has demonstrated no clinically significant benefit of arthroscopic meniscectomy in patients with a meniscal tear, however, patients included in these studies would not meet current treatment recommendations. Prior to further randomised controlled trials (RCTs) research is needed to understand a younger population in more detail. Aim. To describe the baseline characteristics of patients with a meniscal tear and explore any association between baseline characteristics and outcome. Methodology. A prospective, national multicentre
The COVID-19 pandemic presented a significant impact on orthopaedic surgical operating. This multi-centre study aimed to ascertain what factors contributed to delays to theatre in patients with shoulder and elbow trauma. A retrospective
Treatment of posterior malleolar (PM) ankle fractures remain controversial. Despite increasing recommendation for small PM fragment fixation, high quality evidence demonstrating improved clinical outcomes over the unfixated PM is limited. We describe the medium-to-long term clinical and radiographical outcomes in younger adult patients with PM ankle fractures managed without PM fragment fixation. A retrospective
After a hip fracture, infections are common, but signs of infection resemble those of systemic inflammatory response to trauma and surgery, and conventional infection markers lack specificity. Plasma-calprotectin, a novel marker of neutrophil activation, has shown potential as an infection marker in ER and ICU settings. To investigate if plasma-calprotectin is superior compared to conventional infection biomarkers after hip fracture. Prospective
Abstract. Introduction. COMPOSE describes the demographics, fracture characteristics, management and associated outcomes of knee femoral periprosthetic fractures (KFPPF). Methods. Multicentre retrospective
Primary total joint arthroplasty (TJA) is an increasingly common and safe way of treating joint disease. Robust preoperative assessment improved intraoperative techniques and holistic rehabilitation contribute to an uneventful postoperative period. Despite there being evidence against the utility of postoperative blood tests, it is still often part of routine practice. We aim to evaluate the usefulness of these tests by investigating their incidence following TJA as well as identifying preoperative risk factors for abnormal blood test results postoperatively especially pertaining to anaemia and acute kidney injury (AKI). This is a retrospective
Aim. Early fracture-related infections (FRIs) are a common entity in hospitals treating trauma patients. It is important to be aware of the consequences of FRI in order to be able to counsel patients about the expected course of their disease. Therefore, the aims of this study were to evaluate the recurrence rate, to establish the number of secondary surgical procedures needed to gain control of the initial infection, and to identify predictors for recurrence in patients with early FRI. Method. A retrospective multicentre
Hip fracture principally affects the frailest in society, many of whom are care dependent, and are disproportionately at risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England. We conducted a
Arthroscopic hip surgery is increasingly common in Australia. Hip arthroscopy is indicated for a range of diagnostic and therapeutic purposes, including labral tears, capsular laxity and femoral-acetabular impingement (FAI). Despite this, previous
Aims. There is a lack of published evidence relating to the rate of nonunion seen in occult scaphoid fractures, diagnosed only after MRI. This study reports the rate of delayed union and nonunion in a cohort of patients with MRI-detected acute scaphoid fractures. Methods. This multicentre
The purpose of this study is to evaluate risk factors for distal construct failure (DCF) in posterior spinal instrumented fusion (PSIF) in adolescent idiopathic scoliosis (AIS). We observed an increased rate of DCF when the pedicle screw in the lowest instrumented vertebra (LIV) was not parallel to the superior endplate of the LIV, however this has not been well studied in the literature. We hypothesise a more inferiorly angled LIV screw predisposes to failure and aim to find the critical angle that predisposes to failure. A retrospective
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective
Despite the current trend favoring surgical treatment of displaced intra-articular calcaneal fractures (DIACFs), studies have not been able to demonstrate superior functional outcomes when compared to non-operative treatment. These fractures are notoriously difficult to reduce. Studies investigating surgical fixation often lack information about the quality of reduction even though it may play an important role in the success of this procedure. We wanted to establish if, amongst surgically treated DIACF, an anatomic reduction led to improved functional outcomes at 12 months. From July 2011 to December 2020, at a level I trauma center, 84 patients with an isolated DIACF scheduled for surgical fixation with plate and screws using a lateral extensile approach were enrolled in this prospective
Aims. The purpose of this study was to assess the reliability and responsiveness to hip surgery of a four-point modified Care and Comfort Hypertonicity Questionnaire (mCCHQ) scoring tool in children with cerebral palsy (CP) in Gross Motor Function Classification System (GMFCS) levels IV and V. Methods. This was a population-based
Abstract. Background. The gold standard treatment for Anterior Cruciate Ligament injury is reconstruction (ACL-R). Graft failure is the concern and ensuring a durable initial graft with rapid integration is crucial. Graft augmentation with implantable devices (internal brace reinforcement) is a technique purported to reduce the risk of rupture and hasten recovery. We aim to compare the short-term outcome of ACL-R using augmented hamstring tendon autografts (internally braced with neoligament) and non-augmented hamstring autografts. Methods. This was a retrospective
Aims. Factors associated with high mortality rates in geriatric hip fracture patients are frequently unmodifiable. Time to surgery, however, might be a modifiable factor of interest to optimize clinical outcomes after hip fracture surgery. This study aims to determine the influence of postponement of surgery due to non-medical reasons on clinical outcomes in acute hip fracture surgery. Methods. This observational
Aims. The outcomes following nonoperative management of minimally displaced greater tuberosity (GT) fractures, and the factors which influence patient experience, remain poorly defined. We assessed the early patient-derived outcomes following these injuries and examined the effect of a range of demographic- and injury-related variables on these outcomes. Methods. In total, 101 patients (53 female, 48 male) with a mean age of 50.9 years (19 to 76) with minimally displaced GT fractures were recruited to a prospective observational
Aims. Dual-mobility acetabular components (DMCs) have improved total hip arthroplasty (THA) stability in femoral neck fractures (FNFs). In osteoarthritis, the direct anterior approach (DAA) has been promoted for improving early functional results compared with the posterolateral approach (PLA). The aim of this study was to compare these two approaches in FNF using DMC-THA. Methods. A prospective continuous
This study aimed to verify the hypothesis that an antibiotic loaded hydrogel, defensive antimicrobial coating (DAC), reduces overall complication and infection rates when used for high-risk primary and revision total hip arthroplasty (THA). This was a retrospective study matched
Aims. This study sought to determine the proportion of older adults with hip fractures captured by a multicentre prospective cohort, the World Hip Trauma Evaluation (WHiTE), whether there was evidence of selection bias during WHiTE recruitment, and the extent to which the WHiTE cohort is representative of the broader population of older adults with hip fractures. Patients and Methods. The characteristics of patients recruited into the WHiTE
Aims. Custom triflange acetabular components (CTACs) play an important role in reconstructive orthopaedic surgery, particularly in revision total hip arthroplasty (rTHA) and pelvic tumour resection procedures. Accurate CTAC positioning is essential to successful surgical outcomes. While prior studies have explored CTAC positioning in rTHA, research focusing on tumour cases and implant flange positioning precision remains limited. Additionally, the impact of intraoperative navigation on positioning accuracy warrants further investigation. This study assesses CTAC positioning accuracy in tumour resection and rTHA cases, focusing on the differences between preoperative planning and postoperative implant positions. Methods. A multicentre observational
Background. Optimal management of displaced intra-articular calcaneal fractures remains controversial. The aim of this prospective
Aims. The aim of this study was to report a complete overview of both incidence, fracture distribution, mode of injury, and patient baseline demographics of paediatric distal forearm fractures to identify age of risk and types of activities leading to injury. Methods. Population-based
Aims. To investigate the impact of consecutive perioperative care transitions on in-hospital recovery of patients who had primary total knee arthroplasty (TKA) over an 11-year period. Methods. This observational
Aims. The aims of this study were to describe the demographic, socioeconomic, and educational factors associated with core surgical trainees (CSTs) who apply to and receive offers for higher surgical training (ST3) posts in Trauma & Orthopaedics (T&O). Methods. Data collected by the UK Medical Education Database (UKMED) between 1 January 2014 and 31 December 2019 were used in this retrospective longitudinal
Elderly patients undergoing surgery for a hip fracture are at risk of thromboembolic events (TEV). The risk of TEV is now rare due to thromboprophylaxis. However, hip fracture treatment has evolved over the last decade. The risk of TEV may have been modified. The objective of this study was to determine the risk of symptomatic TEV following surgery for a hip fracture, in an elderly population. Retrospective
Introduction. Ankle fractures in the elderly have been increasing with an ageing but active population and bring with them specific challenges. Medical co-morbidities, a poor soft tissue envelope and a requirement for early mobilisation to prevent morbidity and mortality, all create potential pitfalls to successful treatment. As a result, different techniques have been employed to try and improve outcomes. Total contact casting, both standard and enhanced open reduction internal fixation, external fixation and most recently tibiotalocalcaneal (TTC) nailing have all been proposed as suitable treatment modalities. Over the past five years popular literature has begun to herald TTC nailing as an appropriate and contemporary solution to the complex problem of high-risk ankle fragility fractures. We sought to assess whether, within our patient cohort, the outcomes seen supported the statement that TTC has equal outcomes to more traditional open reduction internal fixation (ORIF) when used to treat the high-risk ankle fragility fracture. Materials & Methods. Results of ORIF versus TTC nailing without joint preparation for treatment of fragility ankle fractures were evaluated via retrospective
Introduction. The Te Whatu Ora Southern catchment area covers the largest geographical region in New Zealand (over 62,000 km2) creating logistical challenges in providing timely access to emergency neck of femur (NOF) fracture surgery. Current Australian and New Zealand guidelines recommend that NoF surgery be performed within 48 hours of presentation. The purpose of this study was to compare the outcomes for patients with NoF fractures who present directly to a referral hospital (Southland Hospital) compared to those are transferred from rural peripheral centres. Methods. A retrospective
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 complications after elective primary unilateral THA, and investigate whether access to elective THA differs within SES groups. Methods. We conducted a retrospective, population-based
Aims. There is increasing evidence to support the use of topical antibiotics to prevent surgical site infections. Although previous research suggests a minimal nephrotoxic risk with a single dose of vancomycin powder, fracture patients often require multiple procedures and receive additional doses of topical antibiotics. We aimed to determine if cumulative doses of intrawound vancomycin or tobramycin powder for infection prophylaxis increased the risk of drug-induced acute kidney injury (AKI) among fracture patients. Methods. This
Radial head fractures are relatively common, representing approximately one-third of all elbow fractures. Outcomes are generally inversely proportional to the amount of force involved in the mechanism of injury, with simple fractures doing better than more comminuted ones. However, the prognosis for these fractures may also be influenced by associated injuries and patient-related factors (age, body index mass, gender, tobacco habit, etc.) The purpose of this study is to evaluate which factors will affect range of motion and function in partial radial head fractures. The hypothesis is that conservative treatment yields better outcomes. This retrospective comparative
To determine whether pre-operative cessation of anticoagulant or antiplatelet medication is necessary for patients undergoing total shoulder arthroplasty (TSA) or reverse total shoulder arthroplasty (RTSA). A prospectively maintained database was used to identify 213 consecutive patients treated with TSA or RTSA performed by a single surgeon across 3 centres. This cohort included 24 patients on an anticoagulant agent (warfarin, apixaban, rivaroxaban, dabigatran), 52 patients on an antiplatelet agent (aspirin, clopidogrel), and a control group of 137 patients not on anticoagulant or antiplatelet medication. Patients on anticoagulant or antiplatelet medications continued these agents peri-operatively. Outcomes included haemoglobin drop, intra-operative blood loss, operative time, transfusion requirements and post-operative complications. The mean age of the cohort was 74.3 years (range 47 – 93) and 75 (35.2%) of the patients were male. TSA was performed in 63 cases and RTSA in 150 cases. The mean haemoglobin drop in the control group was 17.3 g/L, compared to 19.3 g/L in the anticoagulant group (p = 0.20) and 15.6 g/L in the anti-platelet group (p = 0.14). The mean intra-operative blood loss in the control group was 107.8 mL, compared to 143.0 mL in the anticoagulant group (p = 0.03) and 134.3 mL in the anti-platelet group (0.02). The mean operative time in the control group was 49.3 minutes, compared to 47.1 minutes in the anticoagulant group (p = 0.56) and 50.3 minutes in the anti-platelet group (p = 0.78). Post-operatively no patients developed a wound infection or haematoma requiring intervention. Three patients not on anticoagulant or antiplatelet medication developed pulmonary embolism. Continuing anticoagulant or antiplatelet medication was associated with higher intra-operative blood loss, but produced no statistically significant differences in haemoglobin drop, operative time, transfusion requirements or post-operative complications. We now do not routinely stop any anticoagulant or antiplatelet medication for patients undergoing total shoulder arthroplasty.
Aims. Several studies have reported that patients presenting during the evening or weekend have poorer quality healthcare. Our objective was to examine how timely surgery for patients with severe open tibial fracture varies by day and time of presentation and by type of hospital. This
Background. There remains a paucity of clinical studies on the effects of coronavirus on perioperative outcomes, with no existing trials reporting on risk factors associated with increased risk of postoperative mortality in these patients. The objectives of this study were to assess perioperative complications and identify risk factors for increased mortality in patients with coronavirus undergoing surgery. Methods. This multicentre
Aims. The aim of this study was to investigate the potentially increased risk of dislocation in patients with neurological disease who sustain a femoral neck fracture, as it is unclear whether they should undergo total hip arthroplasty (THA) or hemiarthroplasty (HA). A secondary aim was to investgate whether dual-mobility components confer a reduced risk of dislocation in these patients. Methods. We undertook a longitudinal
Purpose: We conducted the first, multicentre, prospective
Malnutrition is often associated with the advanced age and can be influenced by physical, mental, social and environmental changes. Hip fracture is a major issue and a prior poor nutritional status is associated with higher rates of perioperative complications and prolonged hospital length of stay. Prospective observational
Total hip arthroplasty (THA) is one of the most successful and effective treatments for advanced hip osteoarthritis (OA). Over the last 5 years, Canada has seen a 17.8% increase in the number of hip replacements performed annually, and that number is expected to grow along with the aging Canadian population. However, the rise in THA surgery is associated with an increased number of patients at risk for the development of an infection involving the joint prosthesis and adjacent deep tissue – periprosthetic joint infections (PJI). Despite improved hygiene protocols and novel surgical strategies, PJI remains a serious complication. No previous population-based studies has investigated PJI risk factors using a time-to-event approach and none have focused exclusively on patients undergoing THA for primary hip OA. The purpose of this study is to determine risk factors for PJI after primary THA for OA using a large population-based database collected over 15 years. Our secondary objective is to determine the incidence of PJI, the time to PJI following primary THA, and if PJI rates have changed in the past 15 years. We performed a population-based
Introduction. Non-union is agonising for patients, complex for surgeons and a costly burden to our healthcare service; as such, its management must be well defined. There is debate as to the requirements for the successful treatment of such patients, in particular, the need for additional biological therapies to ensure union. This study's primary aim was to determine if operative treatment alone was an effective treatment for the non-union of long bones in the upper and lower limbs compared to the pre-existing literature using biological therapies. Materials and Methods. A single-centre retrospective
Recurrent anterior shoulder instability (RASI) is related to progressive bone loss on the glenoid and on the humeral head. Bone deficit magnitude is a well-recognized predictor of recurrence of instability after an arthroscopic Bankart surgery, but the best way to measure it is unknown. In this study, we want to determine which measurement method is the best predictor of recurrence of instability and function. For 10 years now, all patients undergoing surgery for RASI in 4 centers are included in a prospective study: the LUXE cohort. Patients with a pre-operative CT-scan and a minimum of 1-year follow-up were included. ISIS score was used to stratify patients. WOSI and Quick-Dash questionnaires were used to characterise function. Bone defects were assessed using the Clock method, the Glenoid Ratio, the Humeral Ratio, the Glenoid Track method and the angle of engagement in the axial plane. A total of 262 patients are now included in the LUXE study. One hundred and three patients met the inclusion criteria for analysis with a majority of male (79%) and a mean age is 28 years old. The median number of dislocations prior to surgery was 6. Seventy patients had an arthroscopic Bankart repair and 33 patients underwent an open Latarjet procedure. The ISIS score for these groups were of 2.7 and 4.8 respectively (p<0.001). The mean bone defect on the glenoid was of 1h51 with the Clock method (range: 0h-4h48; SD=1h46) and of 9% for the glenoid ratio (0–37%, 10%). On the humeral side, the bone defect was of 1h59 (0h-4h08; 0h49) for the Humeral clock method, 15% (0–36%; 6%) with the ratio method and 71 degrees of external rotation (SD=30 degrees) with the angle of engagement measurement. On the combined evaluations, 53 patients presented an off-track lesion, with mean combined hours of 3h53 (SD= 2h13). The greatest correlation obtained was between the glenoid ratio and the glenoid clock method (r=0.919, p<0.001). Eighteen patients had a recurrence of shoulder dislocation after the initial surgery, leading to a recurrence rate of 23% in arthroscopic surgery versus six percent after a Latarjet (OR= 4.6, p=0.034). No bone defect was correlated to Latarjet failure. For the arthroscopic group, the risk of recurrence was related to a smaller angle of engagement of the Hill-Sachs (p=0.05), a smaller Humeral clock measurement (p=0.034) and a longer follow-up (p=0.006). No glenoid or combined measurements were correlated with arthroscopic procedure failure. Recurrence of dislocation was associated to worst function according to the WOSI (1036 vs 573, p=0.002) and DASH (32 vs 15, p=0.03). Even with lower ISIS score, arthroscopic procedures are still leading to high risk of recurrence in this “all comer” consecutive
Aim. Tedizolid is an oxazolidinone antibiotic that: (i) is recommended at the dose of 200 once daily in patients with skin and soft tissue infection; (ii) seems to have a better long-term hematological and neurological safety profile in comparison with linezolid; (iii) remains active on multidrug-resistant (MDR) Gram-positive pathogens. Consequently, it might represent an option as suppressive antimicrobial treatment (SAT) in patients with complex implant-associated bone and joint infection (BJI) due to MDR Gram-positive pathogens. Method. We performed a
Radial head fractures are common and mainly require a functional conservative treatment. About 20% of patients will present an unsatisfactory final functional result. There is, however, little data allowing us to predict which patients are at risk of bad evolve. This makes it difficult to optimize our therapeutic strategies in these patients. The aim of this study is to determine the personal and environmental factors that influence the functional prognosis of patients with a radial head fracture. We realized over a 1-year period a prospective observational longitudinal
Introduction. Robotic-assisted total knee arthroplasty (TKA) was introduced to improve limb alignment, component positioning, and soft-tissue balance, yet the effect of adoption of this technology has not been established. This study was designed to evaluate whether robotic-assisted TKA leads to improved patient reported outcome measures (PROMs) and patient satisfaction as compared to conventional TKA at 3 and 12 months. Methods. This IRB-approved single-surgeon retrospective
Tranexamic Acid (TXA) is widely used to decrease bleeding by its antifibrinolytic mechanism. Its use is widespread within orthopaedic surgery, with level one evidence for its efficacy in total hip and knee replacement surgery; significantly reducing transfusion rates without increased thromboembolic disease. There is limited evidence for its use during hip fracture surgery, and we therefore sought to investigate its effects with a prospective
Introduction and Objective. Hip fractures represent one of the most challenging injuries in orthopaedic practice due to the associated morbidity, mortality and the financial burden they impose on the health care systems. By many still considered as the gold standard in the management of intertrochanteric fractures, the Dynamic Hip Screw utilizes controlled collapse during weight bearing to stabilize the fracture. Despite being a highly successful device, mechanical failure rate is not uncommon. The most accepted intraoperative indicator for lag screw failure is the tip apex distance (TAD), yet lateral femoral wall thickness (LWT) is another evolving parameter for detecting the potential for lateral wall fracture with subsequent medialization and implant failure. The aim of this study is to determine the mean and cut off levels for LWT that warrant lateral wall fracture and the implications of that on implant failure, revision rates and implant choice. Materials and Methods. This prospective
Introduction. In the United States, cementless femoral fixation remains the dominant mode of fixation for femoral neck fractures, despite strong worldwide registry data that supports cemented fixation. The reason for this discrepancy remains unknown, controversial and often difficult to compare due to multiple variables. The purpose of this study was to evaluate a matched cohort of patients undergoing arthroplasty for femoral neck fractures and assess outcomes of revisions, periprosthetic fractures and mortality. Methods. This is an exact matched
Aim. Periprosthetic joint infections (PJI) are a rare, but devastating complication. Diagnostic approaches to PJI vary greatly between different centers. Most commonly tissue biopsies and synovial fluid sampling are recommended for identification pathogens causing PJI. However, sensitivity and specificity of those techniques have been shown to be highly dependent on preanalytical factors like time and conditions of transportation, location of sampling, as well as analytical approaches and prolonged incubation for up to 14days. Sonication of explanted orthopedic devices has been shown to be more than only an addition in the diagnosis of PJI. The goal of this study was to evaluate the diagnostic value of sonication in PJI. Method. Retrospective
Aims. Our study aimed to 1) Describe the changes in spinopelvic mobility when transitioning from standing, to ‘relaxed-seated’ and thereafter to ‘deep-seated’ position and 2) Determine the change in spinopelvic mobility types 1 year post-THA compared to preoperatively. Methods. This prospective diagnostic
Introduction. We investigated predictors of poor outcomes following metal-on-metal hip arthroplasty (MoMHA) revision surgery performed for adverse reactions to metal debris (ARMD), to help inform the revision threshold and type of reconstruction. Patients and Methods. A retrospective
Recent technological advancements have led to the introduction of robotic-assisted total knee arthroplasty to improve the accuracy and precision of bony resections and implant position. However, the in vivo accuracy is not widely reported. The primary objective of this study is to determine the accuracy and precision of a cut block positioning robotic arm. Seventy-seven patients underwent total knee arthroplasty with various workflows and alignment targets by three arthroplasty-trained surgeons with previous experience using the ROSA® Knee System. Accuracy and precision were determined by measuring the difference between various workflow time points, including the final pre-operative plan, validated resection angle, and post-operative radiographs. The mean difference between the measurements determined accuracy, and the standard deviation represented precision.Introduction
Method
Aims. To investigate the benefits of denosumab in combination with nerve-sparing surgery for treatment of sacral giant cell tumours (GCTs). Methods. This is a retrospective
Introduction. Patients with reduced lumbar spine mobility are at higher risk of dislocation after THA as their hips have to compensate for spinal stiffness. Therefore our study aimed to 1) Define the optimal protocol for identifying patients with mobile hips and stiff lumbar spines and 2) Determine clinical and standing radiographic parameters predicting high hip and reduced lumbar spine mobility. Methods. This prospective diagnostic
Introduction. Periprosthetic joint infection (PJI) is a serious problem and requires great effort and cost for its treatment. Treatment options may vary from resection arthroplasty, retention of prosthesis with debridement, one stage revision and two stage revision with handmade antibiotic impregnated cement spacer or with prefabricated antibiotic loaded cement spacer. Two stage revision remains the gold standard for the treatment of periprosthetic joint infection after Total Hip Arthroplasty (THA). This study was aimed to find the efficacy and cost effectiveness of handmade antibiotic impregnated articulating cement spacer over commercially available prefabricated antibiotic loaded cement spacer for the treatment of deep PJI of hip prosthesis and to evaluate its functional outcome. Material and methods. A total of 23 PJI patients were enrolled in this prospective
Rifampicin as a biofilm-active antibiotic drug has a significant role in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study aimed to evaluate the prevalence of rifampicin resistant staphylococci over time and its association with infection-free survival after PJI in a single centre in Sweden. We included 238 PJIs in 238 patients who had undergone PJI revision surgery from 2001 to 2020 on whom the causative bacteria were staphylococci, and the agent was tested for rifampicin resistance. Data regarding agents, rifampicin resistance, treatment and outcome was obtained. Kaplan-Meier survival analysis and a Cox regression model with adjustment for age, sex, localisation (hip or knee) and type of prosthesis (primary or revision) were used to calculate infection-free survival rates and adjusted risk ratios (HRs) of the risk of treatment failure. Treatment failure was defined as any reoperation or suppression treatment with antibiotics due to prolonged infection.Aim
Methods
Reduction of length of stay (LOS) without compromising quality of care is a trend observed in orthopaedic departments. To achieve this goal the pathway needs to be optimised. This requires team work than can be supported by e-health solutions. The objective of this study was to assess the impact of reduction in LOS on complications and readmissions in one hospital where accelerated discharge was introduced due to the pandemic. 317 patients with primary total hip and total knee replacements treated in the same hospital between October 2018 and February 2021 were included. The patients were divided in two groups: the pre-pandemic group and the pandemic group. The discharge criteria were: patient feels comfortable with going back home, patient has enough support at home, no wound leakage, and independence in activities of daily living. No face-to-face surgeon or nurse follow-up was planned. Patients’ progress was monitored via the mobile application. The patients received information, education materials, postoperative exercises and a coaching via secure chat. The length of stay (LOS) and complications were assessed through questions in the app and patients filled in standard PROMs preoperatively, at 6 weeks and 3 months. Before the pandemic, 64.8% of the patients spent 3 nights at hospital, whereas during the pandemic, 52.0% spent only 1 night. The median value changed from 3 days to 1 day. The complication rate before the pandemic of 15% dropped to 9 % during the pandemic. The readmission rate remained stable with 4% before the pandemic and 5 % during the pandemic. No difference were observed for PROMS between groups. The results of this study showed that after a hip and knee surgery, the shortening of the LOS from three to one night resulted in less complications and a stable rate of readmissions. These results are in line with literature data on enhanced recovery after hip and knee arthroplasty. The reduction of LOS for elective knee and hip arthroplasty during the pandemic period proved safe. The concept used in this study is transferable to other hospitals, and may have economic implications through reduced hospital costs.
Fracture dislocation of the knee involves disruption of two or more knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee(IKDC) score and Knee Injury & Osteoarthritis Outcome Score(KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements & complications.Abstract
Background
Methods
INTRODUCTION. To test whether there are differences in postoperative mechanical and component alignment, and in functional results, between conventional, navigated and patient-specific total knee arthroplasties in a low-volume centre?. MATERIAL AND METHODS. Retrospective
Whilst short and mid-term activity levels after a Total Knee Replacement (TKR) have been reported in the literature; there is an over simplification of the reporting and longer-term activity levels are unknown. The aim of this study was to map the long-term trajectories of patients’ physical activity levels postoperatively to identify meaningful subgroups and explore associations with preoperative variables. This was a secondary analysis of a single centre longitudinal cohortstudy using group-based trajectory modelling (GBTM) of the University of California, Los Angeles (UCLA) physical activity score over ten years. Multinomial logistic regression models (both adjusted and unadjusted) were used to test associations between preoperative variables and trajectory group membership.Abstract
Aims
Methods
Fracture dislocation of the knee involves disruption of knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee (IKDC) score and Knee Injury & Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements and complications.Abstract
Background
Methods
Aim. Over the past three years, roughly 100,000 hip and knee replacements have been performed by the Brazilian Public Healthcare System. Prosthetic joint infection (PJI) is expected to range between 1% to 10% after primary and revisions joint arthroplasties, respectively. So far, there have been no published national PJI data which would be helpful at developing local preventive strategies and guide surgeons and clinicians. We aimed at describing the epidemiological, clinical and microbiological PJI results of a national and collaboration study among infectious diseases specialists and orthopaedic surgeons, including academic, public and private institutions. Method. We prospectively enrolled patients with PJI in a national
Aim. Diagnosing Fracture-Related Infections (FRI) is challenging. White blood cell (WBC) scintigraphy is considered the best nuclear imaging technique to diagnose FRI; a recent study by our group found a diagnostic accuracy of 92%. However, many centers use . 18. F-fluorodeoxyglucose positron emission tomography/computed tomography (. 18. F-FDG-PET/CT) which has several logistic advantages. Whether . 18. F-FDG-PET/CT has better diagnostic performance than white blood cell (WBC) scintigraphy is uncertain. Therefore, we aimed: 1) to determine the diagnostic performance of . 18. F-FDG-PET/CT for diagnosing FRI (defined as infection following an open fracture or fracture surgery) and 2) to determine cut-off values of standardized uptake values (SUV) that result in optimal diagnostic performance. Method. This retrospective
Background. Periprosthetic joint infection (PJI) remains challenging as a “gold standard” for diagnosis has not yet been established. The aim of this study was to evaluate the accuracy of synovial fluid procalcitonin (SF-PCT) and serum procalcitonin as diagnostic biomarker for PJI and compared their accuracy with standard methods. Materials and Methods. A single-centered prospective
Introduction: To report the 11-year follow-up of patients of contaminated femoral heads donated at primary total hip replacement from a
There is no agreement as to the superiority or specific indications for cast treatment, percutaneous pinning or open fracture fixation for Bennett's fractures of the thumb metacarpal. We undertook this study to compare the outcomes of treatment for patients treated for Bennett's fracture in the medium term. We reviewed 33 patients treated in our unit for a bennett's fracture to the thumb metacarpal with closed reduction and casting. Each patient was matched with a patient treated surgically. Patients were matched for sex, age, Gedda grade of injury and hand dominance. Patients were reviewed at a minimum of 5-years and 66-patients were reviewed in total. Patients were examined clinically and also asked to complete a DASH questionnaire score and the brief Michigan hand questionnaire. Follow up plain radiographs were taken of the thumb and these were reviewed and graded for degenerative change using the Eaton-Littler score. Sixty-six patients were included in the study, with 33 in the surgical and non-surgical cohorts respectively. The average age was 39 years old. In each cohort, 12/33 were female, 19/33 were right-handed with 25% of individuals injuring their dominant hand. In each coort there were 16 Grade 1 fractures, 4 Grade 2 and 13 Grade 3 fractures. There was no difference between the surgically treated and cast-treatment cohorts of patients when radiographic arthritis, pinch grip, the brief Michigan Hand Questionnaire and pain were assessed at final review. The surgical cohort had significantly lower DASH scores at final follow-up. There was no significant difference in the normalised bMHQ scores. Our study was unable to demonstrate superiority of either operative or non-operative fracture stabilization. Patients in the surgical cohort reported superior satisfaction and DASH scores but did not demonstrate any superiority in any other objectively measured domain.
Low back pain can lead to neuroplastic changes in the central nervous system, known as nociplastic pain. As nociplastic pain may be provoked by premorbid sensory profiles, such profiles may be prognostic in the development of nociplastic pain over time. To investigate whether four sensory profiles are prognostic in the development of symptoms of nociplastic pain in people with acute low back pain.Background
Objectives
Frame configuration for the management of complex tibial fractures is highly variable and is dependent not only on fracture pattern and soft tissue condition but also surgeon preference. The optimal number of rings to use when designing a frame remains uncertain. Traditionally, larger, stiffer constructs with multiple rings per segment were thought to offer optimal conditions for bone healing, however, the concept of reverse dynamisation questions this approach. We compared clinical outcomes in 302 consecutive patients with tibial fractures treated in our unit with either a two-ring circular frame or a three-or-more-ring (3+) frame. The primary outcome measure was time spent in frame. Secondary outcomes were the incidence of malunion and the need for further surgical procedures to achieve bone union. The groups were evenly matched for age, co-morbidities, energy of injury mechanism, fracture classification, post-treatment alignment and presence of an open fracture.Introduction
Materials & Methods
Treatment of staphylococcal prosthetic joint infection (PJI) usually consists of surgical debridement and prolonged rifampicin combination therapy. Tailored antimicrobial treatment alternatives are needed due to frequent side effects and drug-drug interactions with rifampicin combination therapy. We aimed to assess the effectiveness of several alternative antibiotic strategies in patients with staphylococcal PJI. In this prospective, multicenter registry-based study, all consecutive patients with a staphylococcal PJI, treated with DAIR or one-stage revision surgery between January 1st, 2015 and November 3rd, 2020, were included. Patients were treated according to a predefined protocol for PJI. Antimicrobial treatment strategies differed between centers, which was accepted and used as pseudorandomization. Depending on the hospital patients were admitted to, they were treated with either a long-term rifampicin strategy (consisting of 12 weeks rifampicin combination therapy) ore one of several short-term rifampicin strategies, consisting of only five days of rifampicin combination treatment, started immediately postoperative, followed by clindamycin, flucloxacillin or vancomycin monotherapy. Patients were stratified in different groups, depending on the used antimicrobial strategy. Cox proportional hazards models were used to compare outcome between the groups.Background
Methods
Periprosthetic joint infection (PJI) causes significant morbidity. Methicillin sensitive Our hospital trust introduced MSSA screening and decolonisation prior to hip and knee arthroplasty in 2010. Data was prospectively collected since 2013, including all MSSA carriers, decolonisation treatment received, MSSA status at time of surgery and all PJIs. Prior to 2017 MSSA carriers received nasal mupirocin or neomycin, from August 2017 until August 2019 nasal octenidine was used. During the study period 15,958 primary hip and knee replacements were performed. 3,200 (20.1%) were MSSA positive at preoperative screening and received decolonisation treatment, 698 mupirocin, 1,210 neomycin and 1,221 octenidine. Mupirocin (89.1%) and neomycin (90.9%) were more effective at decolonisation than octenidine (50.0%, P<0.0001). There was no difference in S. aureus PJI rates (P=0.452). Of those negative at original screening 9.1% were positive on the day of surgery (1,164/12,758). MSSA decolonisation is an effective method to decrease PJI rates but there is little research into the best treatment. Both mupirocin and neomycin are more effective than octenidine at achieving MSSA decolonisation. There was poor correlation between the MSSA status after treatment and PJI rates. There is debate if treatment should be targeted by screening or if all patients she be treated without screening. Global decolonisation without screening is supported by the 26.7% of carriers that were negative at original screening in our study. Further research is needed comparing decolonisation treatments to reduce PJI rates and avoid the risk of drug resistance.
Aim. Current guidelines recommend the combination of vancomycin with either piperacillin-tazobactam (PT) or a third generation cephalosporin (3GC) as empirical antimicrobial therapy of PJI, immediately after surgery. However, clinical and biological safeties of such high dose-combinations are poorly known. Method. All patients managed in a reference center in France between 2011 and 2016 receiving an empirical antimicrobial therapy for PJI were included in a prospective
Aims. Our study aimed to 1) determine if there was a difference for the HOOS-PS score between patients with stiff/normal/hypermobile spinopelvic mobility and 2) to investigate if functional sagittal cup orientation affected patient reported outcome 1 year post-THA. Methods. This prospective diagnostic
Pelvic discontinuity is a rare but increasingly common complication of total hip arthroplasty (THA). This single-centre study evaluated the performance of custom-made triflange acetabular components in acetabular reconstruction with pelvic discontinuity by determining: 1) revision and overall implant survival rates; 2) discontinuity healing rate; and 3) Harris Hip Score (HHS). Retrospectively collected data of 38 patients (39 hips) with pelvic discontinuity treated with revision THA using a custom-made triflange acetabular component were analyzed. Minimum follow-up was two years (mean 5.1 years (2 to 11)).Aims
Methods
Diabetic foot problems are a common cause for hospitalisation in this group and up to 25% of diabetic patients will be affected. Prevalence of diabetes is rising, currently affecting 680000000 people worldwide. The enormity of this problem mandates any strategy that shortens therapeutic period and enhances success rates. Cerament G has been used in our unit as a treatment adjunct in diabetic foot treatment. Successful treatment is viewed as eradication of infection and a functional foot. Retrospective review of 40 months practice with 115 patients. Inclusion: all diabetic feet requiring surgery Cerament G used, protocol driven Microbiology pathway. Exclusion: Primary closure not possible. Cerament G not used. Outcome assessed in three groups: Total failure (further surgery required); slow to heal (healing by secondary intention); healed without problems. Healed 99 (eradication of infection and return to function), failure to heal 16 (success rate: 86.1%). Infection was the cause of failure in only in 2.6% (13 failures due to patient noncompliance or poor vascularity). Accepted success rate in treating osteomyelitis in diabetic feet is 68% (medical treatment only), combination of surgery and medical is 86%. Eradication of infection is the only end point return to function is not addressed. This study shows Cerament G with surgery/systemic antibiotics provides a 97.4% success rate. Therapeutic drivers in this field have been determined traditionally by Physicians and Vascular Surgeons (resection rather than reconstructive surgery.) Our assertion is that eradicating infection in a functionally useless foot is a waste of health resources. Our strategy is always the delivery of an intact functional foot residuum. Cerament G as an adjunct allows this goal in a cost-effective manner.
The use of total hip arthroplasty in adolescents for end-stage degenerative hip disease is controversial with few reported outcomes in the literature. The purpose of the study was to report the outcomes of total hip arthroplasty in a cohort of adolescents managed by a multidisciplinary team of paediatric and adult orthopaedic surgeons from a single centre. A multidisciplinary clinic consisting of paediatric and adult hip surgeons was established in 2013 to identify, treat and prospectively follow adolescents who would potentially beneift from a total hip arthoplasty. To date 29 consecutive adolescent patients (20 female, 9 male, 32 hips) with end stage degenerative hip disease have undergone cementless primary total hip arthroplasty. Mean age at decision to treat was 15.7 years (age 11.4–18.5). Ten different underlying paediatric specific pathologies were documented including DDH, cerebral palsy, JIA, skeletal dysplasias, SCFE and idiopathic chondrolysis. Three patients had bilateral staged procedures. Clinical baseline and outcomes were measured using Oxford Hip Score (OHS), WOMAC score and ASKp scores. Radiographic follow-up was conducted at 6 weeks, 6 months and yearly thereafter. Post-operative complications were recorded. Twenty-five hips were eligible for minimum 2-year follow-up scoring at a mean 2.7 years (2.0–3.6 years). No intraoperative complications occurred. One case of recalcitrant postoperative psoas tendonitis occured. OHS improved from 25 (7–43) to 41 (23–48). WOMAC improved from 48 (12–8) to 12 (1–44), and ASKp improved from 78% (33–98%) to 93% (73–100%). Radiographic review revealed acceptable alignment of all components with no signs of loosening or wear. No revision of components was required. One patient died at 6 months post op from an unrelated condition. The early term results of total hip arthroplasty in adolescents from our multidisciplinary program are encouraging. Improvements in quality of life to normal values were seen as were hip scores consistent with satisfactory joint function. Depite the range of complex and varied causes of arthritis seen in this population the establishment of combined paediatric and adult orthopaedic surgical teams appears to be a successful model to manage end-stage degenerative hip disease in adolescents.
Introduction. The impact of pseudotumours associated with metal-on-metal hip resurfacings (MoMHRs) within the second decade is unknown. We investigated: (1) the incidence and risk factors for all-cause and pseudotumour revision following MoMHR at 15-years follow-up, and (2) whether risk factors were gender specific. Patients and methods. This single-centre prospective
Purpose: Oncologic management of primary bone tumors of the spine is inconsistent, controversial and open to individual interpretation. Tumor margin violation intraoperatively increases local recurrence and mortality. The purpose of this study is to determine whether applying Enneking’s principles to the surgical management of primary bone tumors of the spine significantly decreases local recurrence and/or mortality. Method: A prospective and retrospective multicenter
The benefits of total hip arthroplasty (THA) may be significantly magnified in children, since the improvement in quality of life has a far greater exposure time and occurs during key developmental stages which may help to maximise lifetime achievement. The purpose of this study is to describe implant survival and patient reported outcomes (PROMS) in a cohort of children following THA. Retrospective cohort review of all patients treated with THA in a single centre. Routine data analysis did not require ethical approval. Survival was estimated using Kaplan-Meier and PROMs were recorded (EQ5D-S, Oxford hip score and modified Harris Hip Score) in a sub-group of patients. 66 hips in 47 patients with a median age of 16 years (range 10 to 19 years) underwent THA between 1971 and 2023. 57% (38/68) patients were female, the commonest indications were Mucopolysaccharidoses n = 15, Stills disease (n=15), and Avascular necrosis (n=12). 27 (41%) of constructs were cemented, 5 (8%) were hybrid, and 34 (51%) were cementless. 30 stems were custom made cementless stems. Median follow up was 3.8 years (range 0–34 years). Implant survival was 87% at 10 years, 61.6% at 20 years and 52.8% at 30 years. PROMS demonstrated mean preoperative OHS was 12, preoperative MHHS was 23 and EQ5Ds VAS of 38. PROMS improved steadily overtime with mean OHS of 43, MMHS of 75 and EQ5Ds VAS of 89 at one year. THA was associated with a very large change in patient reported hip function and quality of life. In this study, THA delivered a long-lasting solution to hip pain with survival similar to that seen in patients undergoing THA in the fourth and fifth decades of life. Socioeconomic benefits of THA need further investigation to establish treatment guidelines for children suffering with hip pain.
Aim. Diagnosing fracture related infections (FRI) based on clinical symptoms alone can be challenging and additional diagnostic tools such as serum inflammatory markers are often utilized. The aims of this study were 1) to determine the individual diagnostic performance of three commonly used serum inflammatory markers: C-Reactive Protein (CRP), Leukocyte Count (LC) and Erythrocyte Sedimentation Rate (ESR), and 2) to determine the diagnostic performance of a combination of these markers and their value additionally to clinical predictors for FRI. Method. This
7–20 % of the patients with a total knee arthroplasty (TKA) are dissatisfied without an indication for revision. Therapeutic options for this patient population with mostly a lack of quadriceps strength are limited. The purpose of this study is to evaluate the effect of six weeks low load resistance training with blood flow restriction (BFR) on the clinical outcome in these unhappy TKA patients. Thirty-one unhappy TKA patients (of the scheduled fifty patients) without mechanical failure were included in this prospective study since 2022. The patients participate in a supervised resistance training combined with BFR, two times a week during nine weeks. Patients were evaluated by the Knee Osteoarthritis Outcome Score (KOOS), Knee Society Score: satisfaction (KSSs) and the Pain Catastrophizing Scale (PCS). Functionality was tested using the Six Minute Walk Test (6MWT) and the 30-Second Chair Stand Test (30CST). Follow-up took place at six weeks, three months and six months after the start. Six weeks training with BFR provided statistically significant improvements in all the KOOS subscales compared to the baseline, especially for symptoms (55.1 (±15.4) versus 48.0 (±16.5); p<0.001), activities in daily living (50.3 (±21.1) versus 43.7 (±17.2); p<0.00) and quality of life (24.6 (±18.5) versus 17.3 (±13.0); p<0.001). The PCS reduced from 27.4 (±11.0) to 23.2 (±11.4) at six weeks (p<0.01), whereas the KSSs increased from 11.8 (±6.5) to 14.9 (±7.6) (p=0.021). Both the 6MWT and the 30CST improved statistically significant from respectively 319.7 (±15.0) to 341.6m (±106.5) (p<0.01) and 8.6 (±3.9) to 9.3 times (±4.5) (p<0.01). Blood flow restriction appears to enhance the quality of life and functional performance of unhappy TKA patients. Based on these preliminary results, BFR seems to be a promising and valuable alternative for these TKA patients with limited therapeutic options.
Aim. Corynebacterium is a rare etiologic agent of BJI. We aimed to describe this rare clinical condition and to assess treatment failure determinants. Method. All adult patients with proven Corynebacterium BJI (i.e. consistent clinical/radiological signs, AND ≥2 reliable positive bacteriological samples, AND treated as such) were included in a retrospective
This study aims to determine the lifetime risk of revision surgery after primary knee arthroplasty (KA). The Scottish Arthroplasty Project dataset was utilised to identify all patients undergoing primary KA during the period 1998–2019. The cumulative incidence function for revision and death was calculated and adjusted analyses utilised cause-specific Cox regression modelling to determine the influence of patient-factors. The lifetime risk was calculated for patients aged between 45–99 years using multiple decrement lifetable methodology. The lifetime risk of revision ranged between 32.7% (95% Confidence Interval (CI) 22.62–47.31) for patients aged 45–49 years and 0.63% (95%CI 0.1–4.5) for patients aged over 90 years. Adjusted analyses demonstrated the converse effect of age on revision (Hazard Ratio (HR) 0.5, 95%CI 0.5–0.6) and death (HR 3.5, 95%CI 3.4–3.7). Male sex was associated with increased risks of revision (HR 1.1, 95%CI 1.1–1.2) and death (HR 1.4, 95%CI 1.3–1.4). Patients with inflammatory arthropathy had a higher risk of death (HR 1.7, 95%CI 1.7–1.8), but were less likely to be revised (HR 0.85, 95%CI 0.74–0.98) than those treated for osteoarthritis. Patients with greater number of comorbidities and greater levels of socio-economic deprivation were at increased risk of death, but neither increased the risk of revision. The lifetime risk of revision knee arthroplasty varies depending on patient sex, age at surgery and underlying diagnosis. Patients aged between 45 and 49 years have a one in three probability of revision surgery within their lifetime. Conversely, patients aged 90 years or over were very unlikely to experience revision.
Aim. S. aureus and coagulase-negative staphylococci are the most frequent bacteria responsible for PJI. In patients with acute PJI (i.e. <1 month following the implantation), DAIR with exchange of removal components followed by a combination of antibiotics that includes rifampin (particularly rifampin+fluoroquinolone) are recommended. Unfortunately, some patients could not receive rifampin due to drug-drug interaction or stopped it due to an adverse event. Finally, it was unclear if the dose and the duration of rifampin influenced the prognosis. Method. We performed a retrospective
Surgical site infections after total hip arthroplasty result in decreased quality of life, increased morbidity and increased health care cost. We hypothesized that the implementation of a bundle of care for total hip arthroplasty decreases the amount of surgical site infections. In this retrospective
Alcohol has been associated with up to 40% trauma-related deaths globally. In response to the Covid-19 pandemic, the United Kingdom (UK) entered a state of ‘lockdown’ on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. This study aimed to quantify the effect of lockdown on trauma admissions specifically regarding alcohol-related trauma. All adult patients admitted as ‘trauma calls’ to a London Major Trauma Centre (MTC) during April 2018 and April 2019 (pre-lockdown; N=316), and 1st April – 31st May 2020 (lockdown; N=191) had electronic patient records (EPR) analysed. Patients’ blood alcohol level (BAC) combined with records of intoxication were used to identify alcohol-related trauma. Multiple regression analyses were performed to compare pre- and post-lockdown alcohol-related trauma admissions.Abstract
Background
Methods
Acute hematogenous periprosthetic joint infection (AHI) is a diagnosis on the rise. The management is challenging and the optimum treatment is not clearly defined. The purpose of this study was to evaluate the characteristics of AHI, and to study risk factors affecting treatment outcome. We retrospectively analysed 44 consecutive episodes with AHI in a total hip or knee arthroplasty beween 2013 and 2020 at a single center. AHI was defined as abrupt symptoms of infection ≥ 3 months after implantation in an otherwise well functioning arthroplasty. We used the Delphi criteria to define treatment failure with a minimum of 1-year follow-up.Aim
Methods
There is still no clear consensus regarding which cup position might provide better functional performance for developmental dysplasia of the hip (DDH). This study aimed to evaluated the feasibility and efficacy of acetabular mirroring reconstruction for DDH in total hip arthroplasty (THA). The study reviewed 96 patients (96 hips) with unilateral Crowe type-II/III DDH undergoing either visualized navigation-assisted mirroring reconstruction with augment according to the rotation center and biomechanical structure of the contralateral normal hips (Mirroring group, 51 hips) or high hip center reconstruction (HHC group, 45 hips) in THA from 2020 to 2023. The functional and radiographic results were analyzed between the groups during a mean follow-up period of 27.5 and 28.9 months (a minimum follow-up of 12 months). The Harris hip score at the last follow-up significantly improved in both groups, while it was significantly higher in the mirroring group (P<0.001). In the HHC group, the rotation center height and greater trochanter height were significantly increased in the affected hip (P<0.001; P<0.001) and the abductor lever arm was significantly decreased in the affected hip compared to that in the contralateral normal hip (P<0.001), whereas in the mirroring group no significant statistical differences were observed between two sides. The limping occurred in 7 patients (13.7%) in the mirroring group and 14 patients (31.1%) in the HHC group (P=0.040). A multiple logistic regression demonstrated mirroring reconstruction could reduce the incidence of postoperative limping (P=0.020). Both mirroring and HHC reconstruction could improve the functional performance of THA, whereas mirroring reconstruction could offer superior biomechanical results and gait improvement as compared with HHC reconstruction, meeting the higher requirements of functional recovery.
Pelvic discontinuity (PD) is a detrimental complication following total hip arthroplasty (THA). The aim of this study was to assess the clinical and radiological results of patients with PD who were revised using a custom-made triflange acetabular component (CTAC). This is a single centre prospective study of patients with PD following THA who were treated with a CTAC. The Hip Disability and Osteoarthritis Outcome Score (HOOS), modified Oxford Hip Score (mOHS), EurQol five-dimension three-level (EQ-5D-3L) utility, and Numeric Rating Scale (NRS), including visual analogue score (VAS) for pain, were gathered at baseline, and at one- and two-year follow-up. Clinical and radiological complications, including reasons for revisions were registered. Trends over time are described and tested for significance and clinical relevance. 18 females with 22 CTACs were included with a mean age of 73.5 years (SD 7.7). There were significant improvements between baseline and final follow-up in HOOS (p<0.01), mOHS (p<0.01), EQ-5D-3L utility (p<0.01), EQ-5D-3L NRS (p<0.01), VAS pain rest (p<0.01), and VAS pain activity (p<0.01). A minimal clinically important improvement in mOHS and the HOOS was observed in 16 patients (73%) and 14 patients (64%), respectively. Definite healing of the PD was observed in 19 hips (86%). Complications included six cases with broken screws (27%), four cases (18%) with bony fractures, and one case (4.5%) with sciatic nerve paresthesia. One patient with concurrent bilateral PD had revision surgery due to recurrent dislocations. No revision surgery was performed for screw failure or implant breakage. This is the first prospective assessment in clinical outcome of patients with PD who were treated with a CTAC. We have demonstrated that CTAC in patients with THA acetabular loosening and PD can result in stable constructs with no mechanical failures. Moreover, clinically relevant improvements in health-related quality of life at two years’ follow-up was observed.
Management of deformity involving limb length discrepancy (LLD) using intramedullary devices offers significant benefits to both patients and clinicians over traditional external fixation. Following the withdrawal of the PRECICE nail, the Fitbone became the primary implant available for intramedullary lengthening and deformity correction within our service. This consecutive series illustrates the advantages and complications associated with the use of this device, and describes a novel technique modification for antegrade intramedullary lengthening nails. A retrospective cohort review was performed of patient outcomes after treatment with the Fitbone nail at two tertiary referral limb reconstruction services (one adult, one paediatric) between January 2021 to December 2023. Aetiology, indications, initial and final LLD, use of concomitant rail assisted deformity correction (ORDER), removal time and healing index were assessed. Complications of treatment were evaluated and described in detail, alongside technique modifications to reduce the rate of these complications.Introduction
Materials & Methods
With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected.Aims
Methods
Background. Coronal malalignment has been proposed as a risk factor for mechanical failure after total knee arthroplasty (TKA). In response to these concerns, technologies that provide intraoperative feedback to the surgeon about component positioning have been developed with the goal of reducing rates of coronal plane malalignment and improving TKA longevity. Imageless hand-held portable accelerometer technology has been developed to address some the limitations associated with other computer assisted navigation devices including line-of-sight problems, preoperative imaging requirements, extra pin sites, up-font capital expenditures, and learning curve. The purpose of this study was to compare the accuracy and precision of a hand-held portable navigation system versus conventional instrumentation for tibial and femoral resections in TKA. Methods. This study was a single-surgeon, retrospective