We compared thromboembolic events, major haemorrhage
and death after total hip replacement in patients receiving either
aspirin or low-molecular-weight heparin (LMWH). We analysed data from
the National Joint Registry for England and Wales linked to an administrative
database of hospital admissions in the English National Health Service.
A total of 108 584 patients operated on between April 2003 and September 2008
were included and followed up for 90 days. Multivariable risk modelling
and propensity score matching were used to estimate odds ratios
(OR) adjusted for baseline risk factors. An OR <
1 indicates
that rates are lower with LMWH than with aspirin. In all, 21.1%
of patients were prescribed aspirin and 78.9% LMWH. Without adjustment, we
found no statistically significant differences. The rate of pulmonary
embolism was 0.68% in both groups and 90-day mortality was 0.65%
with aspirin and 0.61% with LMWH (OR 0.93; 95% CI 0.77 to 1.11).
With risk adjustment, the difference in mortality increased (OR
0.84; 95% CI 0.69 to 1.01). With propensity score matching the mortality difference
increased even further to 0.65% with aspirin and 0.51% with LMWH
(OR 0.77; 95% CI 0.61 to 0.98). These results should be considered
when the conflicting recommendations of existing guidelines for
thromboprophylaxis after
In recent years, there has been increasing interest in the use of simultaneous
Aims. The aim of this study was to perform a systematic review of the evidence for the use of intraoperative cell salvage in patients undergoing revision
The trend towards more minimal access has led to a series of instruments being developed to enable adequate access for Direct Anterior Approach (DAA) for
Climbers and mountaineers will present to arthroplasty surgeons in need of
Aims. With increasing burden of revision
The aim of this study was to systemically review the evidence for the use of intra-operative cell salvage (ICS) among patients undergoing revision
Aims. Acetabular edge-loading was a cause of increased wear rates in metal-on-metal hip arthroplasties, ultimately contributing to their failure. Although such wear patterns have been regularly reported in retrieval analyses, this study aimed to determine their in vivo location and investigate their relationship with acetabular component positioning. Methods. 3D CT imaging was combined with a recently validated method of mapping bearing surface wear in retrieved hip implants. The asymmetrical stabilizing fins of Birmingham
Aims. One-stage revision
Aims. There is an increasing demand for
We obtained pre-operative and six-month post-operative
Oxford hip (OHS) and knee scores (OKS) for 1523 patients who underwent
total
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 cohort study involving 202 hospitals in Ontario, Canada, over a 17-year period. Patients were divided into income quintiles based on postal codes as a proxy for personal economic status. Multivariable logistic regression models were then used to primarily assess the relationship between SES and surgical complications within one year of index THA. Results. Of 111,359 patients who underwent elective primary THA, those in the lower SES groups had statistically significantly more comorbidities and statistically significantly more postoperative complications. While there was no increase in readmission rates within 90 days, there was a statistically significant difference in the primary and secondary outcomes including all revisions due (with a subset of deep wound infection and dislocation). Results showed that those in the higher SES groups had proportionally more cases performed than those in lower groups. Compared to the highest SES quintile, the lower groups had 61% of the number of
The rising prevalence of osteoarthritis, associated with an ageing population, is expected to deliver increasing demand across Scotland for arthroplasty services in the future. Understanding the scale of potential change to operative workflow is essential to ensure adequate provision of services and prevent prolonged waiting times that can cause patient harm. This future service demand for primary and revision
Patients may be able to return to higher level activities following
Aims. The aim of this study was to determine satisfaction rates after hip and knee arthroplasty in patients who did not respond to postoperative patient-reported outcome measures (PROMs), characteristics of non-responders, and contact preferences to maximize response rates. Methods. A prospective cohort study of patients planned to undergo
Objectives. We used the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man (NJR) to investigate the risk of revision due to prosthetic joint infection (PJI) for patients undergoing primary and revision
Increased collection of patient-reported outcome measures (PROM) in registries enables international comparison of patient-centered outcomes after knee and
We investigated the capacity of patient warming
devices to disrupt the ultra-clean airflow system. We compared the effects
of two patient warming technologies, forced-air and conductive fabric,
on operating theatre ventilation during simulated hip replacement
and lumbar spinal procedures using a mannequin as a patient. Infection
data were reviewed to determine whether joint infection rates were
associated with the type of patient warming device that was used. Neutral-buoyancy detergent bubbles were released adjacent to
the mannequin’s head and at floor level to assess the movement of
non-sterile air into the clean airflow over the surgical site. During
simulated
Aims. This study describes the variation in the annual volumes of revision
Obesity is a known risk factor for hip osteoarthritis. The aim of this study was to compare the incidence of obesity in Australians undergoing
Aims. Femoral cement-in-cement revision is a well described technique to reduce morbidity and complications in hip revision surgery. Traditional techniques for septic revision of
Ideally the
Aims. The purpose of this study was to evaluate unexpected positive cultures in total hip arthroplasty (THA) revisions for presumed aseptic loosening, to assess the prevalence of low-grade infection using two definition criteria, and to analyze its impact on implant survival after revision. Methods. A total of 274 THA revisions performed for presumed aseptic loosening from 2012 to 2016 were reviewed. In addition to obtaining intraoperative tissue cultures from all patients, synovial and sonication fluid samples of the removed implant were obtained in 215 cases (79%) and 101 cases (37%), respectively. Histopathological analysis was performed in 250 cases (91%). Patients were classified as having low-grade infections according to institutional criteria and Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) 2013 criteria. Low-grade infections according to institutional criteria were treated with targeted antibiotics for six weeks postoperatively. Implant failure was defined as the need for re-revision resulting from periprosthetic joint infection (PJI) and aseptic reasons. The mean follow-up was 68 months (26 to 95). Results. Unexpected positive intraoperative samples were found in 77 revisions (28%). Low-grade infection was diagnosed in 36 cases (13%) using institutional criteria and in nine cases (3%) using MSIS ICM 2013 criteria. In all, 41 patients (15%) had single specimen growth of a low-virulent pathogen and were deemed contaminated. Coagulase-negative Staphylococcus and anaerobes were the most commonly isolated bacteria. Implant failure for PJI was higher in revisions with presumed contaminants (5/41, 12%) compared to those with low-grade infections (2/36, 6%) and those with negative samples (5/197, 3%) (p = 0.021). The rate of all-cause re-revision was similar in patients diagnosed with low-grade infections (5/36, 14%) and those with presumed contaminants (6/41, 15%) and negative samples (21/197, 11%) (p = 0.699). Conclusion. Our findings suggest that the presumption of culture contamination in aseptic revision
Successful estimation of postoperative PROMs prior to a joint replacement surgery is important in deciding the best treatment option for a patient. However, estimation of the outcome is associated with substantial noise around individual prediction. Here, we test whether a classifier neural network can be used to simultaneously estimate postoperative PROMs and uncertainty better than current methods. We perform Oxford hip score (OHS) estimation using data collected by the NJR from 249,634
Objectives. Modular dual-mobility (MDM) constructs are used to reduce dislocation rates after total hip replacement (THR). They combine the advantages of dual mobility with the option of supplementary acetabular screw fixation in complex revision surgery. However, there are concerns about adverse reaction to metal debris (ARMD) as a result of fretting corrosion between the metal liner and shell. Methods: The aim of this systematic review was to find and review all relevant studies to establish the outcomes and risks associated with MDM
This study investigates the use of the Metabolic Equivalent of Task (MET) score in a
Abstract. Objectives. Evidence supporting the use of immersive virtual reality (iVR) training in orthopaedic procedures is rapidly growing. However, the impact of the timing of delivery of this training is yet to be tested. This study investigated whether spaced iVR training is more effective than massed iVR training for novices learning
Abstract. Objective. Short-stem total hip arthroplasty (THA) aims to preserve the proximal bone stock for future revisions, so that the first revision should resemble a primary intervention rather than a revision. This study aimed to compare the clinical and radiological outcomes in revision THA after failed short stem versus after failed conventional stem THA. Methods. This study included forty-five patients with revision THA divided into three groups (15 each); group A: revision after short stem, group B: revision after conventional cementless stem and group C revision after conventional cemented stem. The studied groups were compared regarding 31 variables including demographic data, details of the primary and revision procedures, postoperative radiological subsidence, hospital stay, time for full weight bearing (FWB), preoperative and postoperative clinical scores. Results. Early stem subsidence (40%) was the main indication of revision in group A compared to peri-prosthetic femoral fractures (PFFs) (73.3%) and aseptic loosening (53.3%) in group B and C respectively (P=0.021). The mean time to revision was significantly shorter in group A (15 months) compared to 95.33 and 189.40 months in group B and C respectively. (P=0.005). Sixty % (9 patients) in group A were revised in the first year. The mean operative time, blood loss, postoperative blood transfusion and hospital stay were significantly lower in group A compared to group B and C (P<0.001, <0.001, 0.002 and 0.001 respectively). Revisions in group A were performed using either short stems (13.3%) or conventional stems (86.7%) whilst 80% of patients needed long stems and 20% of patients needed conventional stems in group B and C (P<0.001). The mean postoperative Harris Hip Score (HHS) at the latest follow up was 87.07, 87.53 and 85.47 in group A, B and C respectively. All PFFS had excellent results according to Beal's and Tower's criteria; all fractures healed and the implants were stable. Conclusion. The most common cause of failure of short stems is early stem subsidence. Short stem THA has specific indications and patient selection is very crucial. Preoperative templating for short stems and a detailed analysis of the individual patient anatomy in anteroposterior and lateral views are mandatory to predict the correct implant size more accurately. The use of intraoperative imaging can verify the sizing, implant position, and sufficient contact with the lateral cortex. Revision of short stem THA resembled the primary THA. If a standard implant can be used in a surgical revision instead of a longer revision stem, this can be considered as an advantage for the
Venous thromboembolism (VTE) is a preventable cause of morbidity and mortality in patients undergoing elective
Successful estimation of postoperative PROMs prior to a joint replacement surgery is important in deciding the best treatment option for a patient. However, estimation of the outcome is associated with substantial noise around individual prediction. Here, we test whether a classifier neural network can be used to simultaneously estimate postoperative PROMs and uncertainty better than current methods. We perform Oxford hip score (OHS) estimation using data collected by the NJR from 249,634
Introduction. Total knee and
Aims. We investigated the long-term performance of the Tripolar Trident acetabular component used for recurrent dislocation in revision total hip arthroplasty. We assessed: 1) rate of re-dislocation; 2) incidence of complications requiring re-operation; and 3) Western Ontario and McMaster Universities osteoarthritis index (WOMAC) pain and functional scores. Patients and Methods. We retrospectively identified 111 patients who had 113 revision tripolar constrained liners between 1994 and 2008. All patients had undergone revision
This study evaluates the association between consultant and hospital volume and the risk of re-revision and 90-day mortality following first-time revision of primary hip replacement for aseptic loosening. We conducted a cohort study of first-time, single-stage revision
Ceramic bearings have several desirable properties, such as resistance to wear, hardness, and biocompatibility, that favour it as an articulating surface in
Aims. In countries with social healthcare systems, such as Canada, patients may experience long wait times and a decline in their health status prior to their operation. The aim of this study is to explore the association between long preoperative wait times (WT) and acute hospital length of stay (LoS) for primary arthroplasty of the knee and hip. Methods. The study population was obtained from the provincial Patient Access Registry Nova Scotia (PARNS) and the Canadian national hospital Discharge Access Database (DAD). We included primary total knee and
Total knee and
Introduction and Aims. There are many surgical, implant design and patient factors that should be considered in preclinical testing of
Periprosthetic femoral fracture (PFF) incidence following
The Swedish
Aims. Joint arthroplasties may be associated with a blood loss, which necessitates transfusion. Especially,
Introduction. Patients with osteonecrosis of the femoral head are typically younger, more active, and often require high rates of revision following primary total hip arthroplasty. However, outcomes of revision
Introduction. Previous reports have investigated the correlation between time to revision
Our primary aim was to assess reoperation-free survival at one year after the index injury in patients aged ≥ 75 years treated with internal fixation (IF) or arthroplasty for undisplaced femoral neck fractures (uFNFs). Secondary outcomes were reoperations and mortality analyzed separately. We retrieved data on all patients aged ≥ 75 years with an uFNF registered in the Swedish Fracture Register from 2011 to 2018. The database was linked to the Swedish Arthroplasty Register and the National Patient Register to obtain information on comorbidity, mortality, and reoperations. Our primary outcome, reoperation, or death at one year was analyzed using restricted mean survival time, which gives the mean time to either event for each group separately.Aims
Methods
Introduction. Short-stem
Introduction.
Background and aim. Arthroplasty registries and consecutive series indicate significantly worse results of conventional metal-on-polyethylene total hip arthroplasty (THA) in patients younger than 50 years compared to older patients, with inferior clinical outcomes and 10-year survivorship ranging between 70 and 90%. At our institution, patients under 50 needing a THA receive either a metal-on-metal hip resurfacing (MoMHRA) or a ceramic-on-ceramic (CoC)THA. In order to evaluate the outcome of these options at minimum 10 years, we conducted a retrospective review of all MoMHRA and CoCTHA with more than 10 years follow-up implanted in patients under 50. Methods. From a single surgeon patients’ prospective database, we identified all consecutive THA performed before May 2005 in patients under 50. All patients are contacted by phone and asked to present for a clinical exam and patient reported outcome questionnaires, standard radiographs and metal ion measurements unless the
The Canadian Cardiovascular Society (CCS) recommends performing daily troponin testing on postoperative days 0 through 3 for noncardiac surgical patients to decrease the mortality rate due to myocardial injury. Indications for testing include:
->65 yo -45-64 yo with significant cardiovascular disease -a Revised Cardiac Risk Index score (RCRI) > 1 Troponin elevation > 30 ng/L is termed “myocardial injury after noncardiac surgery” (MINS). The study objective was to determine the prognostic relevance of applying CCS recommendations. 669 patients undergoing THA were included in the study. Based on the CCS recommendation there were 4 patient Groups depending on whether or not they met the MINS screening protocol criteria and whether or not it was applied:
-A - met & applied (n=181) -B - met & not applied (n=248) -C – not met & applied (n=10) -D – not met & not applied (n=230) 307 (45.8%) males and 363 (54.2%) females with an average age of 67.8 years were included. Group A- 24% incidence (43 patients) of troponin rise & 5% incidence (9 patients) of cardiac complications. Group B- 0.4% incidence (1 patient) of cardiac complications. Groups A + B – representing all patients who should have had the MINS screening protocol applied according to the CCS recommendations − 10 (2.3%) patients developed cardiac complication and one (0.2%) patient death MINS screening protocol group (A & C) LOS was 4.0 days compared to 1.4 days for those not screened (p-value: <0.001). Applying the CCS MINS screening protocol to elective THA patients added no benefit in predicting/preventing postoperative cardiac events but was associated with a significant increase in LOS. Following current CCS recommendations without more specifications and clinical evidence is unwarranted.
Aims. Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. Materials and Methods. A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed
Introduction. Robotic-assisted
Proximal femoral replacements are commonly used in oncologic limb salvage procedures. Recently, these megaprostheses have been utilized in complex revision arthroplasties where proximal femoral bone is compromised. The purpose of this study is to evaluate the clinical and radiographic survivorship of proximal femoral replacements as a salvage treatment for bone loss after