Frequency of primary total hip (THA) and total knee (TKA) arthroplasty procedures is increasing, with a subsequent rise in revision procedures. This study aims to describe timing and excess surgical mortality associated with revision THA and TKA compared to those on the waiting list. All patients from 2003–2013 in a single institution who underwent revision THA and TKA, or added to the waiting list for the same procedure were recorded. Mortality rates were calculated at cutoffs of 30- and 90-days post-operation or addition to the waiting list.Background
Methods
Aims. To address the natural history of severe post-tuberculous (TB)
kyphosis, with focus upon the long-term neurological outcome, occurrence
of restrictive lung disease, and the effect on life expectancy. . Patients and Methods. This is a retrospective clinical review of prospectively collected
imaging data based at a single institute. A total of 24 patients
of Southern Chinese origin who presented with spinal TB with a mean
of 113° of kyphosis (65° to 159°) who fulfilled inclusion criteria
were reviewed. Plain radiographs were used to assess the degree
of spinal deformity. Myelography, CT and MRI were used when available
to assess the integrity of the spinal cord and canal. Patient demographics,
age of onset of spinal TB and interventions, types of surgical procedure,
intra- and post-operative complications, and neurological status
were assessed. . Results. All except one of the 24 patients were treated with anti-TB chemotherapy
when they were first diagnosed with spinal TB. They subsequently
received surgery either for neurological deterioration, or deformity
correction in later life. The mean follow-up was 34 years (11 to
59) since these surgical interventions. Some 16 patients (66.7%) suffered
from late neurological deterioration at a mean of 26 years (8 to
49) after the initial drug treatment. The causes of neurological
deterioration were healed disease in nine patients (56.2%),
re-activation in six patients (37.5%) and adjacent level spinal
stenosis in one patient (6.3%). The result of surgery was worse
in healed disease. Eight patients without neurological deterioration
received surgery to correct the kyphosis. The mean correction ranged
from 97° to 72°. Three patients who were clinically quiescent with
no neurological deterioration were found to have active TB of the
spine. Solid fusion was achieved in all cases and no patient suffered
from neurological deterioration after 42 years of follow-up. On
final follow-up, six patients were noted to have deceased (age range:
47 years to 75 years). Conclusion. Our study presents one of the longest assessments of spinal TB
with severe kyphosis. Severe post-TB kyphosis may lead to significant
health problems many years following the initial drug treatment.
Early surgical correction of the kyphosis, solid fusion and regular
surveillance may avoid late complications. Paraplegia, restrictive
lung disease and early onset kyphosis might relate to
Abstract. Introduction. There is paucity of evidence in predicting outcomes following cervical decompression in patients in octogenerians with cervical myelopathy. Our aim is to analyse the predictive value of Charlson comorbidity index (CCI) on clinical outcomes in this group. Methods. All patients age >80 years who underwent cervical decompression+/−stabilisation between January 2006-December 2021 at University Hospitals of Derby & Burton were included. Logistic regression analysis was performed using JASP. Results. Total 72 patients (n=32 male, n=28 female). Mean age 83.44 ± 3.21 years. 67 patients underwent posterior decompression+ stabilisation & 5 patients had posterior decompression alone. Mean CCI was 5; graded moderate in 32 (44%, CCI=<4) and severe in 40 (55.5%, CCI>4). Mean age and preoperative Nurick grade was similar between moderate and severe groups. Postoperative Nurick grade improved equally in both groups by 0.67 and 0.68 respectively (p=0.403). Mean LOS 16±16.12 days. 5 complications in the moderate group (21.8%) and 8 complications in severe group (21.6%); wound infection (n=7), other infection (n=2), electrolyte derangement (n=2), AKI (n=1), blood transfusion (n=1) and
Aims. 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. Methods. 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. Results. Overall, 3,909 patients presenting with uFNFs were included. Of these patients, 3,604 were treated with IF and 305 with primary arthroplasty. There were no relevant differences in age, sex, or comorbidities between groups. In the IF group 58% received cannulated screws and 39% hook pins. In the arthroplasty group 81% were treated with hemiarthroplasty and 19% with total hip arthroplasty. At one year, 32% were dead or had been reoperated in both groups. The reoperation-free survival time over one year of follow-up was 288 days (95% confidence interval (CI) 284 to 292) in the IF group and 279 days (95% CI 264 to 295) in the arthroplasty group, with p = 0.305 for the difference. Mortality was 26% in the IF group and 31% in the arthroplasty group at one year. Reoperation rates were 7.1% in the IF group and 2.3% in the arthroplasty group. Conclusion. In older patients with a uFNF, reoperation-free survival at one year seems similar, regardless of whether IF or arthroplasty is the primary surgery. However, this comparison depends on the choice of follow-up time in that reoperations were more common after IF. In contrast, we found more
Aims. The early mortality in patients with hip fractures from bony metastases is unknown. The objectives of this study were to quantify 30- and 90-day mortality in patients with proximal femoral metastases, and to create a mortality prediction tool based on biomarkers associated with
Objectives: Behind armour blunt trauma (BABT) to the thorax results from motion of the body wall arising from the defeat of high-energy projectiles by body armour. NATO predicts that BABT will increase in future conflicts. This study aims to define biomechanical tolerance levels for BABT to the lateral thorax. Methods: Terminally anaesthetised pigs (n=19) were subjected to 4 levels of severity of BABT (Table). Two types of armour plates were used. Group 1 were subjected to a 7.62 mm round (INIBA armour) whilst group 2 was subjected to a 12.7 mm round (EBA armour) the latter group being further subdivided by the presence or absence of two thicknesses of trauma attenuating backing (TAB). Accelerometers were attached to the pleural aspect of ribs 7, 8 and 9 mid-way between the spine and the sternum. Results: Outcome was assessed by classifying severity of injury, in terms of mortality, into 3 groups – survivors (animals surviving to 6 h post-impact), early (0–30 min) and late deaths (>
30 min–6 h). The peak acceleration values were obtained from the accelerometer closest to the point of impact. Mean peak acceleration was significantly higher in the
Early mortality in patients with hip fractures due to bony metastases is unknown. The aim was to quantify 30 and 90-day mortality in patients with metastatic hip fractures and identify markers associated with
Total femoral arthroplasty (TFA) is a rare procedure used in cases of significant femoral bone loss, commonly from cancer, infection, and trauma. Low patient numbers have resulted in limited published work on long-term outcomes, and even less regarding TFA undertaken for non-oncological indications. The aim of this study was to evaluate the long-term clinical outcomes of all TFAs in our unit. Data were collected retrospectively from a large tertiary referral revision arthroplasty unit’s database. Inclusion criteria included all patients who underwent TFA in our unit. Preoperative demographics, operative factors, and short- and long-term outcomes were collected for analysis. Outcome was defined using the Musculoskeletal Infection Society (MSIS) outcome reporting tool.Aims
Methods
National hip fracture registries audit similar aspects of care but there is variation in the actual data collected; these differences restrict international comparison, benchmarking, and research. The Fragility Fracture Network (FFN) published a revised minimum common dataset (MCD) in 2022 to improve consistency and interoperability. Our aim was to assess compatibility of existing registries with the MCD. We compared 17 hip fracture registries covering 20 countries (Argentina; Australia and New Zealand; China; Denmark; England, Wales, and Northern Ireland; Germany; Holland; Ireland; Japan; Mexico; Norway; Pakistan; the Philippines; Scotland; South Korea; Spain; and Sweden), setting each of these against the 20 core and 12 optional fields of the MCD.Aims
Methods
There is comprehensive data addressing the 6 to 18-month survival in patients with pathological neck of femur (NOF) fractures due to bony metastases. However, little is known about early mortality in this group. The aim was to quantify 30 and 90-day mortality in patients with pathological NOF lesions/fractures and identify biochemical markers associated with
Hip fracture commonly affects the frailest patients, of whom many are care-dependent, with a disproportionate risk of contracting COVID-19. We examined the impact of COVID-19 infection on hip fracture mortality in England. We conducted a cohort study of patients with hip fracture recorded in the National Hip Fracture Database between 1 February 2019 and 31 October 2020 in England. Data were linked to Hospital Episode Statistics to quantify patient characteristics and comorbidities, Office for National Statistics mortality data, and Public Health England’s SARS-CoV-2 testing results. Multivariable Cox regression examined determinants of 90-day mortality. Excess mortality attributable to COVID-19 was quantified using Quasi-Poisson models.Aims
Methods
We reviewed the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, at 6 weeks, 6 and 12 months, and annually until 10 years post-op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis (16), primary osteoarthritis (12) and post-traumatic osteoarthritis (2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 20 out of the remaining 24 were available for follow-up. Complications included lateral malleoli fracture (3), superficial peroneal nerve injury (2), one
We aimed to review the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, then at 6 weeks, 6 and 12 months, and annually until 10 years post op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. Case notes were reviewed to determine intra and post-operative complications. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis(16), primary osteoarthritis(12) and post-traumatic osteoarthritis(2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 22 out of the remaining 24 were available for follow-up. Intra operative complications included lateral malleoli fracture(3) and superficial peroneal nerve injury(2). Post operative complications included 1
We aimed to review the outcome of Agility total ankle replacements carried out in our institution between 2002 and 2006. Follow-up consisted of clinical and radiological review pre-operatively, then at 6 weeks, 6 and 12 months, and annually until 10 years post op. Clinical review included the American Orthopaedic Foot and Ankle Score, satisfaction and pain scores. Case notes were reviewed to determine intra and post-operative complications. 30 arthroplasties were performed in 30 consecutive patients. Pre-operative diagnosis was rheumatoid arthritis(16), primary osteoarthritis(12) and post-traumatic osteoarthritis(2). After a mean follow up of 6.2 years (1.4–10.1), 4 patients had died, and 22 out of the remaining 24 were available for follow-up. Intra operative complications included lateral malleoli fracture(3) and superficial peroneal nerve injury(2). Post operative complications included 1
1. Of fifty consecutive double hemiarthroplasties of the knee for rheumatoid arthritis using Maclntosh prostheses, forty-six were available for detailed assessment in thirty-six patients after one to six years. 2. Two
Complete fractures through bone affected by Paget's disease may not deserve their innocent reputation. This retrospective study of 182 such femoral fractures, the largest reported series to date, was carried out to discover the behaviour of these fractures in the absence of specific therapy for the Paget's disease. Most previous series have concluded that healing is uneventful but the findings in these patients from the West Midlands do not bear this out. After exclusion of the
This study aims to assess prospectively whether measurement of perioperative Troponin T is a useful predictor of potential morbidity and mortality in patients undergoing surgery for fractured neck of femur. All patients aged 65 years and over presenting with a fractured neck of femur over a 4-month period were initially included. Exclusion criteria were renal failure, polymyositis and conservative fracture management. Troponin T levels were measured on admission, day 1 and 2 post-surgery. According to local protocol, a level of >0.03ng/mL was considered to be raised. Outcome measures adverse were cardiorespiratory events (myocardial infarction, congestive cardiac failure, unstable angina, major arrhythmias requiring treatment and pulmonary embolism), death and length of inpatient stay. 108 patients were recruited after application of the exclusion criteria. 42 (38.9%) showed a rise in Troponin T >0.03ng/mL in at least one sample. Of these, 25 (59.5%) sustained at least outcome complication, as opposed to 7 (10.6%) from the group with no Troponin T rise (p<0.001). The mean length of stay was 25.7 days for patients with elevated Troponin T levels, compared with 18.3 days in the normal group (p<0.012). There were 9 deaths in the raised Troponin group (21.4%), and 5 (7.6%) in the group with no rise (p<0.05). The principal causes of
1. Chronic tuberculous osseous lesions were induced consistently in eight- to ten-week-old unvaccinated guinea-pigs by the insertion of Gelfoam impregnated with mycobacterium tuberculosis into the metaphysial region through a drill hole in the distal part of the femur. Typical tuberculous lesions developed by three weeks and many of them were followed for twelve weeks or more. 2. This experimental model establishes a reliable method of producing a localised lesion at a predetermined site without
We have reviewed 41 patients with malignant extradural tumours of the spine treated by anterior decompression for cord compression, or uncontrolled back pain or both. An anterior operation alone was performed in 37 cases, four had combined or staged anterior and posterior decompression. An anterior operation on its own achieved major neurological recovery in 18 of the 33 cases with neurological loss (56%); only four remained unchanged. Eleven had minor improvement but not enough to allow them to walk or to regain bladder function. No patient with complete paraplegia gained a useful neurological recovery. Back pain was improved in 30 of the 41 patients (73%), sound internal fixation being important in this respect. There were four
Aims: To elicit the predisposing factors responsible for