The World Health Organization (WHO) and the Centre
for Disease Control and
Objectives. Osteoporosis has become an increasing concern for older people as it may potentially lead to osteoporotic fractures. This study is designed to assess the efficacy and safety of ten therapies for post-menopausal women using network meta-analysis. Methods. We conducted a systematic search in several databases, including PubMed and Embase. A random-effects model was employed and results were assessed by the odds ratio (OR) and corresponding 95% confidence intervals (CI). Furthermore, with respect to each outcome, each intervention was ranked according to the surface under the cumulative ranking curve (SUCRA) value. Results. With respect to preventing new vertebral fractures (NVF), all ten drugs outperformed placebo, and etidronate proved to be the most effective treatment (OR 0.24, 95% CI 0.14 to 0.39). In addition, zoledronic acid and parathyroid hormone ranked higher compared with the other drugs. With respect to preventing clinical vertebral fractures (CVF), zoledronic acid proved to be the most effective drug (OR = 0.25, 95% CI 0.08 to 0.92), with denosumab as a desirable second option (OR = 0.48, 95% CI 0.22 to 0.96), when both were compared with placebo. As for adverse events (AE) and severe adverse events (SAE), no significant difference was observed. According to SUCRA, etidronate ranked first in preventing CVF; parathyroid hormone and zoledronic acid ranked highly in preventing NVF and CVF. Raloxifene was safe with a high rank in preventing AEs and SAEs though performed unsatisfactorily in efficacy. Conclusions. This study suggests that, taking efficacy and safety into account, parathyroid hormone and zoledronic acid had the highest probability of satisfactory performance in preventing osteoporotic fractures. Cite this article: G. Wang, L. Sui, P. Gai, G. Li, X. Qi, X. Jiang. The efficacy and safety of vertebral fracture
In 1994 a cerebral palsy (CP) register and healthcare
programme was established in southern Sweden with the primary aim
of preventing dislocation of the hip in these children. The results from the first ten years were published in 2005 and
showed a decrease in the incidence of dislocation of the hip, from
8% in a historical control group of 103 children born between 1990
and 1991 to 0.5% in a group of 258 children born between 1992 and
1997. These two cohorts have now been re-evaluated and an additional
group of 431 children born between 1998 and 2007 has been added. By 1 January 2014, nine children in the control group, two in
the first study group and none in the second study group had developed
a dislocated hip (p <
0.001). The two children in the first study
group who developed a dislocated hip were too unwell to undergo
preventive surgery. Every child with a dislocated hip reported severe pain,
at least periodically, and four underwent salvage surgery. Of the
689 children in the study groups, 91 (13%) underwent preventive
surgery. A population-based hip surveillance programme enables the early
identification and preventive treatment, which can result in a significantly
lower incidence of dislocation of the hip in children with CP. Cite this article:
We performed a systematic review and meta-analysis
to compare the efficacy of intermittent mechanical compression combined
with pharmacological thromboprophylaxis, against either mechanical
compression or pharmacological prophylaxis in preventing deep-vein
thrombosis (DVT) and pulmonary embolism in patients undergoing hip
or knee replacement. A total of six randomised controlled trials,
evaluating a total of 1399 patients, were identified. In knee arthroplasty,
the rate of DVT was reduced from 18.7% with anticoagulation alone
to 3.7% with combined modalities (risk ratio (RR) 0.27, p = 0.03;
number needed to treat: seven). There was moderate, albeit non-significant,
heterogeneity (I2 = 42%). In hip replacement, there was
a non-significant reduction in DVT from 8.7% with mechanical compression
alone to 7.2% with additional pharmacological prophylaxis (RR 0.84)
and a significant reduction in DVT from 9.7% with anticoagulation
alone to 0.9% with additional mechanical compression (RR 0.17, p
<
0.001; number needed to treat: 12), with no heterogeneity (I2 =
0%). The included studies had insufficient power to demonstrate
an effect on pulmonary embolism. We conclude that the addition of intermittent mechanical leg
compression augments the efficacy of anticoagulation in preventing
DVT in patients undergoing both knee and hip replacement. Further
research on the role of combined modalities in thromboprophylaxis
in joint replacement and in other high-risk situations, such as fracture
of the hip, is warranted.
Introduction. Anterior Cruciate Ligament (ACL) injury
Introduction. Perception of ACL injury
Abstract. Introduction. Perception of ACL injury
Aim. One of the most severe complications of primary total knee arthroplasty (TKA) is periprosthetic joint infection (PJI). Nowadays, the use of antibiotic-loaded cement for
Aim. To provide proof of concept in an in vivo animal model for the
Anterior cruciate ligament (ACL) injuries are among the most common and debilitating knee injuries in professional athletes with an incidence in females up to eight-times higher than their male counterparts. ACL injuries can be career-threatening and are associated with increased risk of developing knee osteoarthritis in future life. The increased risk of ACL injury in females has been attributed to various anatomical, developmental, neuromuscular, and hormonal factors. Anatomical and hormonal factors have been identified and investigated as significant contributors including osseous anatomy, ligament laxity, and hamstring muscular recruitment. Postural stability and impact absorption are associated with the stabilizing effort and stress on the ACL during sport activity, increasing the risk of noncontact pivot injury. Female patients have smaller diameter hamstring autografts than males, which may predispose to increased risk of re-rupture following ACL reconstruction and to an increased risk of chondral and meniscal injuries. The addition of an extra-articular tenodesis can reduce the risk of failure; therefore, it should routinely be considered in young elite athletes.
Introduction. External fixators are attached to bones with percutaneous pins and wires inserted through soft tissues and bone increasing the risk of infections. Such infections compromise patient outcomes e.g., through pin loosening or loss, failure of fixator to stabilise the fracture, additional surgery, increased pain, and delayed mobilisation. These infections also impact the healthcare system for example, increased OPD visits, hospitalisations, treatments, surgeries and costs. Nurses have a responsibility in the care and management of patients with external fixators and ultimately in the
Periprosthetic joint infection (PJI) occurs in 0.2-2% of primary hip and knee arthroplasty and is a leading cause of revision surgery, impaired function, and increased morbidity and mortality. Topical, intrawound vancomycin administration allows for high local drug concentrations at the surgical site and has demonstrated good results in
The future of work brings several challenges and opportunities for occupational health and safety on three major drivers: the rapid progress of technological innovation; demographic changes, in particular ageing of the workforce and migration; and changes in the labour market, especially owing to new ways of per-forming jobs. Innovation technologies are leading to an overall transformation of industrial processes that offer huge developmental perspectives in the world of work and opportunities for society. In the field of
While pre-soaking grafts in vancomycin has demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection
Aims. The aim of this study was to evaluate the healthcare costs and benefits of enoxaparin compared to aspirin in the
Aim. The coronavirus disease 2019 (COVID-19) pandemic presents significant challenges to healthcare systems globally. Orthopaedic surgeons are at risk of contracting COVID-19 due to their close contact with patients in both outpatient and theatre environments. The aim of this review was to perform a literature review, including articles of other coronaviruses, to formulate guidelines for orthopaedic healthcare staff. Methods. A search of Medline, EMBASE, the Cochrane Library, World Health Organization (WHO), and Centers for Disease Control and
The aim was to analyze the efficacy of zoledronic acid (ZA) versus denosumab in the
The Pulmonary Embolism
In 1994, a register for cerebral palsy and a health-care programme were started in southern Sweden with the aim of preventing dislocation of the hip in children with cerebral palsy. It involved all children with cerebral palsy born in 1992 or later. None of the 206 affected children born between 1992 and 1997 has developed a dislocation following the introduction of the
Post-traumatic elbow stiffness is a disabling condition that remains challenging for upper limb surgeons. Open elbow arthrolysis is commonly used for the treatment of stiff elbow when conservative therapy has failed. Multiple questions commonly arise from surgeons who deal with this disease. These include whether the patient has post-traumatic stiff elbow, how to evaluate the problem, when surgery is appropriate, how to perform an excellent arthrolysis, what the optimal postoperative rehabilitation is, and how to prevent or reduce the incidence of complications. Following these questions, this review provides an update and overview of post-traumatic elbow stiffness with respect to the diagnosis, preoperative evaluation, arthrolysis strategies, postoperative rehabilitation, and
Aims: Secondary
Aim. The incidence of early periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) is between 1 and 2 percent. In our department approximately 700 primary THAs and TKAs are performed annually. In 2015 and 2016 the incidence of early PJIs was nearly 3%. The aim of this study was to see if it was possible to reduce the incidence of infection by employing a bundle of measures by involving staff from all aspects of patient flow and addressing preventing measures in every step of the patients´ course throughout the hospital. Method. The Arthroplasty surgeon team reviewed the Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection of 2013. Issues where literature had shown a significant effect on
Aim. Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin resistant Enterococci (VRE) have emerged as multi-drug resistant Gram-negative pathogens associated with Periprosthetic Joint Infections (PJI). In this study, we evaluated the efficacy of antibiotic-loaded calcium sulfate beads (ABLCB) to inhibit bacterial growth, biofilm formation and eradicate preformed biofilms of K. pneumoniae and E. faecalis. Method. Three strains of K. pneumoniae (carbapenem resistant BAA1705, New Delhi metallo-beta-lactamase producing BAA2146 [NDM-1], a carbapenemase producing BAA2524) and a vancomycin resistant strain of E. faecalis (ATCC51299) were used. 4.8mm diameter ABLCBs (Stimulan Rapid Cure, Biocomposites) were loaded with vancomycin (VAN) & gentamicin (GEN) at 500 and 240 mg/10cc pack or VAN & rifampicin (RIF) at 1000 and 600 mg/10cc pack respectively and placed onto tryptic soy agar (TSA) plates spread with each of the four strains independently and incubated for 24 hours at 37°C. The beads were transferred daily onto fresh TSA medium spread with the test cultures. The zone of inhibition was recorded until no inhibition was observed. Biofilm
Introduction. In Japan, edoxaban has been used for the
Introduction: Osteoporotic fracture care is on the increase in healthcare systems worldwide. In the UK the British Orthopaedic Association (BOA) recommends all patients >
60 presenting with fragility fracture (FF) should be evaluated for osteoporosis by axial Dual Energy X-ray Absortiometry (DEXA) scan. All patients <
60 should be assessed for osteoporosis risk factors and DEXA scanned if present. The National Institute for Clinical Excellence (NICE) recommends all woman >
75 with FF should be prescribed secondary
Objectives: Injury is a major cause of morbidity in children, but can be prevented if at-risk groups are identified and proper precautions taken. Our study aims to identify the patterns of paediatric fractures in terms of at-risk bone, age, type of fracture, seasonal variations and attempts to look at the role of
Introduction: Fragility fractures are taking up an increasing amount of resources within Trauma departments. Women have a 1 in 3, men a 1 in 12 lifetime risk of sustaining an osteoporotic fracture with a previous fracture being the strongest independent predictor of sustaining a further fragility fracture, often within one year. Secondary
Introduction. The purpose of this study was to establish whether men and women with a fragility hip fracture were equally investigated and treated for osteoporosis. Methods. A retrospective review was carried out including 91 patients (48 females, 43 males) who were admitted with a fragility hip fracture between March 2003 and April 2004. Data about age, sex, investigations and medication were collected from the case notes, GP surgeries and the bone densitometry database. Investigations and treatment were compared with current guideline recommendations (SIGN 2003, NICE 2005). Data were analysed using SPSS Version 13.0. Results. According to the guidelines patients < 75 years of age should be investigated and patients > 75 years should be treated for osteoporosis. In our review 33% of women and only 8% of men < 75 years were investigated with a DEXA scan following their hip fracture (Fishers Exact Test, p = 0.32). In patients > 75 years 25% of women and only 6% of men were treated with bisphosphonates (Chi-square = 4.18, p < 0.05). There was also a statistically significant difference in overall treatment including bisphosphonates and calcium/vitamin D between the sexes (Chi-square = 6.81, p < 0.05). Conclusion. This study shows that there is clearly a need for improvement in secondary
Background: Osteoporosis is a significant cause of morbidity and disability through an increase in bone fragility and susceptibility to fracture. In March 2001 guidelines were produced by The Clinical Resource Efficiency Support Team (CREST) on the
Introduction. Today, Uganda has the second highest rate of road accidents in Africa and the world after Ethiopia. According to the World Health Organization's Global Status Report on Road Safety 2013, Uganda is named among countries with alarmingly high road accident rates. If such trend of traffic accidents continues to increase, the health losses from traffic injuries may be ranked as the second to HIV/AIDS by 2020. These road traffic accidents often result in terrible open injuries. Open fractures are complex injuries of bone and soft tissue. They are orthopedic emergencies due to risk of infection secondary to contamination and compromised soft tissues and sometimes vascular supply and associated healing problems. Any wound occurring on the same limb should be suspected as result of open fracture until proven otherwise. The principles of management of open fracture are initial evaluation and exclusion of life threatening injuries,
Periprosthetic joint infection (PJI) following total knee arthroplasty (TKA) is a devastating complication. It is associated with high morbidity and mortality. It remains, unfortunately, one of the most common modes of failure in TKA. Much attention has been paid to the treatment of PJI once it occurs. Our attention, however, should focus on how to reduce the risk of PJI from developing in the first place. Infection
Patients most at risk of osteoporosis are post-menopausal women. However, for many such women, presentation of osteoporosis is only made following their first fragility fracture. Often in the UK, osteoporosis investigation occurs following discharge, and any subsequent secondary
Periprosthetic fractures around the femur during and after total hip arthroplasty (THA) remain a common mode of failure. It is important therefore to recognise those factors that place patients at increased risk for development of this complication.
Introduction. Back pain is one of the most common health problems in the industrialized world. Although using insoles appears to be common clinical practice, there is no hard data to support its effectiveness in
Purpose: Periprosthetic ossification is a frequent complication of total hip arthroplasty and can have a major functional impact. Non-steroidal anti-inflammatory drugs (NSAID) can provide effective
Introduction. Venous thromboembolism (VTE), including pulmonary embolism (PE) resulting from deep vein thrombosis (DVT), remains a well-known serious complication after femoral fractures. The low molecular heparin is widely used to prevent VTE. This study compared the effectiveness of VTE
Purpose. The
Heterotopic ossification (HO) is the formation of bone at extra-skeletal sites. Genetic diseases, traumatic injuries, or severe burns can induce this pathological condition and can lead to severe immobility. While the mechanisms by which the bony lesions arise are not completely understood, intense inflammation associated with musculoskeletal injury and/or highly invasive orthopaedic surgery is thought to induce HO. The incidence of HO has been reported between 3% and 90% following total hip arthroplasty. While the vast majority of these cases are asymptomatic, some patients will present decreased range of motion and painful swelling around the affected joints leading to severe immobility. In severe cases, ectopic bone formation may be involved in implant failure, leading to costly and painful revision surgery. The effects of surgical-related intraoperative risk factors for the formation of HO can also play a role. Prophylactic radiation therapy, and anti-inflammatory and biphosphonates agents have shown some promise in preventing HO, but their effects are mild to moderate at best and can be complicated with adverse effects. Irradiation around surgery could decrease the incidence of HO. However, high costs and the risk of soft tissue sarcoma inhibit the use of irradiation. Increased trials have demonstrated that nonsteroidal anti-inflammatory drugs (NSAID) are effective for the
ProFaNE,
Background. Venous thromboembolism (VTE) is a common, costly, and morbid complication following TJA. Consequently, the current standard of care recommends that all TJA candidates receive some form of thromboprophylaxis postoperatively. Chemoprophylaxis, however, is not without its own risks and has been associated with greater risk of perioperative complications such as major bleeding, infection, stroke, and increased wound drainage. Mechanical compression devices serve as an alternative to chemoprophylaxis. Compression devices are thought to function by decreasing venous stasis and activating fibrinolysis. Intermittent pneumatic compression devices (IPCD) function by providing pressure at a constant cycle; whereas continuous enhanced circulation therapy (CECT) devices such as ActiveCare portable system (Medical Compression Systems, Or Akiva, Israel) function in a synchronized manner with the patient's own respiratory cycles. While both of these systems are widely utilized, there is scarce data comparing their effectiveness as thromboprophylatic agents following TJA. The purpose of this meta-analysis is to comparatively evaluate the efficacy of ActiveCare to IPCDs in the
We examined whether a selective cyclooxygenase-2 (COX-2) inhibitor (celecoxib) was as effective as a non-selective inhibitor (ibuprofen) for the
Hip instability is one of the most common complications after total hip arthroplasty (THA). Among the possible techniques to treat and prevent hip dislocation, the use of constrained liners is a well-established option. However, there is concern regarding the longevity of these devices due to higher mechanical stress caused by limited hip motion. The primary aim of this paper is to analyze the failure rate of a specific constrained liner in a series of consecutive cases. This study is a retrospective consecutive case series of THA and revision hip arthroplasty (RHA), in which a constrained polyethylene insert was used to treat or prevent hip instability. Patients were divided in 3 different groups (THA for hip fracture, THA for osteoarthrosis, and RHA). Survival analysis was performed for failure, defined as at least one episode of hip dislocation or radiographical signs of acetabular loosening. Logistical regression was used to investigate risk factors for failure. A total of 103 patients were included in the study. Fourteen patients (13,6%) were THA for osteoarthrosis, 60 (58,3%) were THA for hip fracture, and 29(28,2%) were RHA. The median follow-up was 28 months (ranging 12 − 173 months). Failure occurred in 4 cases (3,9%) comprehending 2 dislocations (1,9%) and 2 early acetabular loosening (1,9%). Amongst the groups, there were no cases of failures in the THA due to osteoarthrosis, in the THA for hip fracture there were 3 cases (5%) and in the RHA one case (3,4%). Failure-free survival was not statistically different between groups. There were no risk factors statistically related to failure. The use of constrained acetabular insert to prevent or treat instability achieved an adequate survival time with a low rate of complications. Further studies are necessary to corroborate our findings.
A once-daily dose of rivaroxaban 10 mg, an oral, direct Factor Xa inhibitor, was compared with enoxaparin 40 mg subcutaneously once daily for
Prosthetic joint infection (PJI) remains a serious complication that is associated with high morbidity and costs. The aim of this study was to prepare a systematic review to examine patient-related and perioperative risk factors that can be modified in an attempt to reduce the rate of PJI. A search of PubMed and MEDLINE was conducted for articles published between January 1990 and February 2018 with a combination of search terms to identify studies that dealt with modifiable risk factors for reducing the rate of PJI. An evidence-based review was performed on 12 specific risk factors: glycaemic control, obesity, malnutrition, smoking, vitamin D levels, preoperative Aims
Materials and Methods
To discover whether orthopaedic surgeons follow the BOA guidelines for secondary
Because life expectancy is increasing, the number of primary knee arthroplasties performed is projected to increase 673% by 2030, according to Westrich et al. Also, Toulson et al. in a recent study predict that the incidence of deep infection associated with primary total knee arthroplasty ranges from 1% to 2%. Periprosthetic knee infection is one of the most dramatic and difficult to manage complications following total knee arthroplasty. Therefore, periprosthetic knee infection will continue to be a significant complication and an economic burden in the future. Our objective was to identify the risk factors that may provide greater likelihood of infection and thus select high-risk patients and to take maximum
Objectives. Deep bone and joint infections (DBJI) are directly intertwined with health, demographic change towards an elderly population, and wellbeing. The elderly human population is more prone to acquire infections, and the consequences such as pain, reduced quality of life, morbidity, absence from work and premature retirement due to disability place significant burdens on already strained healthcare systems and societal budgets. DBJIs are less responsive to systemic antibiotics because of poor vascular perfusion in necrotic bone, large bone defects and persistent biofilm-based infection. Emerging bacterial resistance poses a major threat and new innovative treatment modalities are urgently needed to curb its current trajectory. Materials and Methods. We present a new biphasic ceramic bone substitute consisting of hydroxyapatite and calcium sulphate for local antibiotic delivery in combination with bone regeneration. Gentamicin release was measured in four setups: 1) in vitro elution in Ringer’s solution; 2) local elution in patients treated for trochanteric hip fractures or uncemented hip revisions; 3) local elution in patients treated with a bone tumour resection; and 4) local elution in patients treated surgically for chronic corticomedullary osteomyelitis. Results. The release pattern in vitro was comparable with the obtained release in the patient studies. No recurrence was detected in the osteomyelitis group at latest follow-up (minimum 1.5 years). Conclusions. This new biphasic bone substitute containing antibiotics provides safe
Background. Post-operative deep venous thrombosis (DVT) and subsequent pulmonary embolism (PE) remain a serious complication after total joint replacement. Although with modern chemical and mechanical prophylaxis and rapid rehabilitation the rate of symptomatic DVT and PE has reduced, isolation of pre-operative DVT, specially in patients with prior history of DVT remains a challenge. The aim of this study was to assess the use of pre-operative dopplers as a tool to detect and identify prior DVT in patients undergoing total joint replacement. Methods. Between January 2014 and December 2014, 211 elective primary and revision hip and knee arthroplasty were identified from our prospective institutional database. All cases were performed by two adult reconstruction specialists. All primary total hip arthroplasties (THA) were non-cemented and all primary total knee arthroplasties (TKA) were cemented with similar implant and technique. Prior to July 2014, only patients with prior history of DVT or PE underwent pre-operative dopplers. From July 2014, all cases underwent routine pre-operative doppler screening. All patients with clinical symptoms of calf pain underwent post-operative dopplers. Patients were followed for a minimum of 3 month post-operatively. All emergency room (ER) visits for role out DVT were identified. No patient was lost to follow. Results. 115 patients patient underwent pre-operative dopplers. Three patients had a history of prior popliteal DVT, none of which had post-operative DVT or PE. In the remaining 112 patients, none of the pre-operative dopplers were positive for DVT. 34 patients in this group (29%) underwent post-operative dopplers, either during the hospital stay or in the ER within 3 month after index surgery. Only one patient developed symptomatic PE (0.8%) after total knee arthroplasty. 96 patients did not have pre-operative dopplers, 3 of which (3%) had symptomatic DVT and PE during hospital stay, all after total knee arthroplasty. There was no statistical difference for rate of symptomatic DVT/PE between the two groups (p=0.3). There was no correlation between DVT and obesity, age, or revision versus primary cases. Discussion and Conclusions. Routine pre-operative dopplers do not significantly lower rate of symptomatic DVT/PE and are not helpful in early detection and
On the basis of observations made in recent years, it can be inferred that the incidence of venous thromboembolism (VTE) in Japan is as high as that in Western countries. Since 2007, the use of fondaparinux for the prophylaxis of VTE following lower-limb orthopedic surgery has been approved for Japanese patients. This study was performed with an aim to investigate the safety and efficacy of fondaparinux for the