Several different algorithms attempt to estimate life expectancy for patients with metastatic spine disease. The Skeletal Oncology Research Group (SORG) has recently developed a nomogram to estimate survival of patients with metastatic spine disease. Whilst the use of the SORG nomogram has been validated in the international context, there has been no study to date that validates the use of the SORG nomogram in New Zealand. This study aimed to validate the use of the SORG nomogram in Aotearoa New Zealand. We collected data on 100 patients who presented to Waikato Hospital with a diagnosis of spinal metastatic disease. The SORG nomogram gave survival probabilities for each patient at each time point. Receiver Operating Characteristic (ROC) Area Under Curve (AUC) analysis was performed to assess the predictive accuracy of the SORG score. A calibration curve was also performed, and Brier scores calculated. A multivariate Cox regression analysis was performed. The SORG score was correlated with 30 day (AUC = 0.72) and 90-day mortality (AUC = 0.71). The correlation between the SORG score and 90-day mortality was weaker (AUC = 0.69). Using this method, the nomogram was correct for 79 (79%) patients at 30-days, 59 patients (59%) at 90-days, and 42 patients (42%) at 365-days. Calibration curves demonstrated poor forecasting of the SORG nomogram at 30 (Brier score = 0.65) and 365 days (Brier score = 0.33). The calibration curve demonstrated borderline forecasting of the SORG nomogram at 90 days (Brier score = 0.28). Several components of the SORG nomogram were not found to be correlated with mortality. In this New Zealand cohort the SORG nomogram demonstrated only acceptable discrimination at best in predicting life 30-, 90- or 356-day mortality in patients with metastatic spinal disease

Arthrofibrosis is a less common complication following anterior cruciate ligament (ACL) reconstruction and there are concerns that undergoing early surgery may be associated with arthrofibrosis. The aim of this study was to identify the patient and surgical risk factors for arthrofibrosis following primary ACL reconstruction. Primary ACL reconstructions prospectively recorded in the New Zealand ACL Registry between April 2014 and December 2019 were analyzed. The Accident Compensation Corporation (ACC) database was used to identify patients who underwent a subsequent reoperation with review of operation notes to identify those who had a reoperation for “arthrofibrosis” or “stiffness”. Univariate Chi-Square test and multivariate Cox regression analysis was performed. Hazard ratios (HR) with 95% confidence intervals (CI) were computed to identify the risk factors for arthrofibrosis. 9617 primary ACL reconstructions were analyzed, of which 215 patients underwent a subsequent reoperation for arthrofibrosis (2.2%). A higher risk of arthrofibrosis was observed in female patients (adjusted HR = 1.67, 95% CI 1.22 – 2.27, p = 0.001), patients with a history of previous knee surgery (adjusted HR = 1.97, 95% CI 1.11 – 3.50, p = 0.021) and when a transtibial femoral tunnel drilling technique was used (adjusted HR = 1.55, 95% CI 1.06 – 2.28, p = 0.024). Patients who underwent early ACL reconstruction within 6 weeks of their injury did not have a higher risk of arthrofibrosis when compared to patients who underwent surgery more than 6 weeks after their injury (3.5% versus 2.1%, adjusted HR = 1.56, 95% CI 0.97 – 2.50, p = 0.07). Age, graft type and concomitant meniscal injury did not influence the rate of arthrofibrosis. Female sex, a history of previous knee surgery and a transtibial femoral tunnel drilling technique are risk factors for arthrofibrosis following primary ACL reconstruction

We present 346 consecutive revision procedures for aseptic loosening with acetabular impaction bone grafting (AIBG) and a cemented polyethylene cup. Defects were contained with mesh alone. Mean follow up of 6.6 years, range 8 days-13 years. The Oxford Hip (OHS) and Harris Hip (HHS) scores were collected prospectively. Radiological definition of cup failure was either > 5mm displacement, or > 5° rotation. Cox regression analysis was performed on ten separate patient and surgical factors to determine their significance on survivorship. Kaplan Meier survivorship at 10 years (42 cases remaining at risk) for aseptic loosening was 87% (95% confidence Interval (CI): 81.6 to 92.2) and 85.6% (95% CI: 80.3 to 90.9) for all revisions. These results are comparable to other reported series utilising AIBG. However, there were 88 cases (25%) that exceeded the radiological migration parameters, but their functional scores were not significantly different to the non-migrators: OHS p=0.273, HHS p=0.16. The latest post-operative mean OHS was 33 (SD 10.66). Female gender (p=0.039), increasing graft thickness (p=0.006) and the use of mesh (p=0.037) were significant risk factors for revision, but differing techniques in graft preparation, including artificial graft expanders (p=0.73), had no significant effect when analysed using Cox regression

Introduction. Dislocation is one of the most important complications after primary total hip replacement (THR). The low incidence of this finding makes it difficult to analyse the possible risk factors. The surgical technique can also influence this rate through cup position or an adequate reconstruction of the hip. We assessed the demographic data and radiological reconstruction of the hip related to the appearance of dislocation after primary THR. Material and Methods. 1414 uncemented THRs were recorded from our Local Joint Registry. The mean age of the patients was 60.1 years old (range, 14 to 95), and the mean weight was 73.3 kg (42 to 121). There were 733 men and 974 patients were classified with an activity level of 4 or 5 according to Devane. The most frequent diagnosis was primary osteoarthritis, 795 hips, followed by avascular necrosis 207 hips. An alumina-on-alumina THR was implanted in 703 hips and a metal-on-polyethylene THR in 711 hips. A femoral head size of 28 mm was used in 708 hips and 32 mm in 704. Radiological cup position was assessed using the acetabular abduction angle, the height of the center of the hip, and the horizontal distance of the cup. Cup anteversion was measured according to Widmer and the reconstruction of the center of rotation of the hip according to Ranawat. The radiographic reconstruction of the abductor mechanism was measured using two variables: the lever arm and the height of the greater trochanter. Results. There were 38 dislocations (2.6%) and 11 hips were revised for recurrent instability (0.8%). The probability of not having a dislocation at 20 years was 97.3%. 22 hips that had dislocated were within a box for a cup position of a version between 10º to 25º and an acetabular abduction angle between 35º to 55º (p<0.001). The probability of not having a dislocation at 20 years was 98.48% for the cups within the box and 93.9% for cups outside the box (p<0.001, Log Rank test). 21 hips that had dislocated were within a box for a height of the greater trochanter between −2 mm to 5 mm and a lever arm between 56 to 64 mm (p<0.001). The probability of not having a dislocation at 20 years was 98.33% for the hips within the box and 94.6% for hips outside the box (p<0.001, Log Rank test). Adjusted Cox regression analysis showed that alumina-on alumina THR tended to dislocate less than metal-on-polyethylene THRs (p=0.061, Hazard Ratio: 2.238, Confidence Interval 95% 0.964–5.195), and hips outside the box evaluated for cup position and outside the lever arm and height of the greater trochanter box) had a higher risk for dislocation (p<0.001, HR: 3.418, CI 95% 1.784–6.549, and, p<0.001, HR:2.613, CI 95% 1.357–5.032, respectively). Conclusions. A proper reconstruction of the hip is essential to decrease the risk for dislocation after primary THR. The choice of the bearing surface may affect this risk. The weakness of the abductor muscles of the hip may be one of the most important causes for dislocation

Background. Red cell distribution width (RDW), an automated measure of variability in red blood cell size on full blood count (FBC), has recently emerged as a strong independent predictor of mortality in large population studies as well as several disease states. We wanted to determine the prognostic value of RDW in patients following a hip fracture - a condition associated with high mortality. This relationship has not been assessed to date. Methods. We examined the relationship between admission RDW and all-cause mortality on 1-year follow-up, in consecutive hip fracture cases who presented between January 2007 and November 2009. We used Cox regression analysis to adjust for baseline Haemoglobin (Hb), Mean corpuscular Volume (MCV), creatinine, age, gender, ASA grade, Charlson index, pre-morbid independence level, Mental test score (MTS), delay to surgery and post-operative cardio-respiratory complication. Results. Of 577 consecutive patients there were 377 females, 199 males; median age 81.4y. Seventeen (3%) were lost to follow-up at 1-year but were coded as survivor. One-year mortality was 23% overall. Unadjusted mortality was 12%, 15%, 29% and 35% in quartiles of increasing RDW. Along with age, gender, MTS, post-op cardiac or respiratory complication, Charlson index and ASA score, RDW remained a significant independent predictor of 120-day mortality (adjusted hazard ratio (HR): 1.211, 95% CI: 1.062–1.380, p=.004), as well as 1-year mortality (HR: 1.142, 95% CI: 1.032–1.263, p=.01). We repeated analysis excluding those lost to follow-up and this did not alter its predictive value. A third analysis in non-anaemic patients (n=464) showed that RDW remained an independent predictor of mortality on multivariate analysis (HR: 1.201, 95% CI: 1.039–1.389, p=.013). Conclusion. RDW, a widely-available parameter on full blood count, is a significant independent predictor of short and long-term mortality following hip fracture, regardless of age, co-morbidity or anaemia status

Objectives. To determine whether a delay to surgery (>36Hours) affects mortality rate, length of stay and post-operative complications following hip fracture surgery. Methods. Data collected by dedicated Audit staff using a proforma designed in accordance with the ‘Standardised Audit of Hip Fractures in Europe’ (SAHFE). A prospective Observational Study, all patients (n=7207) admitted and who underwent surgery during a 10-year period from May 1999 to May 2009 have been considered. Chi square tests and independent sample t tests were used for basic statistical analyses. Mortality data were analysed using Kaplan Meier survival analysis and cox regression analysis. p < 0.05 was considered significant. Results. The 30-day mortality was 9.5%. At 90 days, mortality was 18.9% and at 1 year it was 31.4%. In patients declared fit for surgery on admission (n=5665), 30-day mortality was 7.5% in those operated on without delay, rising to 10.3% at over 4 days delay (p=0.117). However, in those operated on after 5 days delay, 30-day mortality equalled 13.6% (p=0.009). Those declared fit for surgery on admission stayed a total 14.5 days if operated within 36 hours, rising to 16 days with over 36 hours delay (p< 0.001). An increase in the rate of urinary tract infection (3.9 vs. 5.9%, p< 0.001) was seen in patients delayed by over 36 hours. However, when considering all patients together, an increase in both urinary tract infection (3.9% vs. 6.1%, p< 0.001) and chest infections (7.9% vs. 11.3%, p< 0.001) was seen with over 36 hours delay to surgery. Conclusions. The 30-day mortality following hip fracture surgery is 9.5%. Patients admitted without co-morbidities have significantly increased mortality when surgery is delayed by over 5 days. A 36 hour delay to surgery significantly increases length of stay. Urinary tract infection was the only post-operative morbidity to rise with delay to surgery in fit patients

Aims

The aim of this study was to analyze the prevalence of culture-negative periprosthetic joint infections (PJIs) when adequate methods of culture are used, and to evaluate the outcome in patients who were treated with antibiotics for a culture-negative PJI compared with those in whom antibiotics were withheld.

Aims

The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period.