Aims. Medial unicompartmental knee arthroplasty (mUKA) is an advised treatment for anteromedial knee osteoarthritis. While long-term survival after mUKA is well described, reported incidences of short-term surgical complications vary and the effect of surgical usage on complications is less established. We aimed to describe the overall occurrence and treatment of surgical complications within 90 days of mUKA, as well as occurrence in high-usage centres compared to low-usage centres. Methods. mUKAs performed in eight
Aims. The aim of this prospective multicentre study was to describe trends in length of stay and early complications and readmissions following unicompartmental knee arthroplasty (UKA) performed at eight different centres in Denmark using a
Bilateral simultaneous total knee replacement (TKR) has been considered by some to be associated with increased morbidity and mortality. Our study analysed the outcome of 150 consecutive, but selected, bilateral simultaneous TKRs and compared them with that of 271 unilateral TKRs in a standardised
Introduction. Deep venous thrombosis (DVT) is a potentially serious complication after total hip (THA) and knee (TKA) arthroplasty, traditionally justifying aggressive prophylaxis with low molecular weight heparin (LMWH) or direct oral anticoagulants (DOA) at the cost of an increased risk of bleeding. However,
Purpose. The hip fracture has been increasing as the aging population continues to grow. Hip fracture patients are more susceptible to blood loss and venous thromboembolism (VTE). The objective of this study was to assess the efficacy and safety of tranexamic acid (TXA) in fracture patients undergoing
The incidence of hip fractures is rising, and at the same time the patients are getting increasingly frail and elderly. Patients in Europe have a median hospitalization time of as much as 28 days, and the peri-operative morbidity and mortality is high. 1. Most interventional studies have been unimodal with very heterogeneous results and at present, limited data are available from multimodal intervention according to the established principles of
Patients with fractured neck of femur have historically received less attention than they deserve and have high morbidity and mortality. Literature suggests that speed to theatre reduces length of in-patient stay and complications. Using patients' expressed needs as a basis to redesign the service, a multidisciplinary project team mapped the current process of admission, simulated and mapped an ideal process. This resulted in a fast admission process for patients with suspected fractured proximal femur. Paramedics call a trauma coordinator based on the specialist ward who meets the patient at the door of the Emergency Department, escorting them to X-ray. The fracture is confirmed remotely by an experienced surgeon using PACS. Patients are taken to an optimisation area in the theatre complex for consultant orthopaedic and anaesthetic assessment prior to surgery the same day (utilising spare time on elective and trauma lists), or early the following day. Fascia-iliaca blocks are provided by trauma coordinators to improve pain control and reduce sedative effects of opiates, aiding early mobilisation. Measures include time to theatre, length of stay, and patient experience. Meaningful mortality and morbidity data will become available later.Background
Methodology
Clinicians need knowledge about early and valid predictors of short-term outcome of patients with hip fracture, to adjust and plan rehabilitation. The concept of multimodal rehabilitation has proven effective. Still, some patients do not regain basic mobility independency in the acute orthopaedic setting. The aim was to examine the predictive value of age, sex, prefracture functional level, mental and health status, and fracture type of in-hospital basic mobility outcome, and discharge destination after hip fracture surgery. A total of 213 consecutive patients (157 women and 56 men) with a median age of 82 (25–75% quartile, 75–88) years, admitted from their own home, and following a multimodal rehabilitation concept, were included. Fifty percent of patients had a high prefracture functional level, evaluated by the New Mobility Score (NMS), 77 and 62% had respectively, a high mental and health status, and the distribution of cervical versus intertrochanteric fractures were equally divided.Purpose
Subjects
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 cohort study used electronic health record data from all patients undergoing preoperative screening for primary TKA at a Northern Netherlands hospital between 2009 and 2020. In this timeframe, three perioperative care transitions were divided into four periods: Baseline care (Joint Care, n = 171; May 2009 to August 2010), Function-tailored (n = 404; September 2010 to October 2013),
We present detailed information about early morbidity
after aseptic revision knee replacement from a nationwide study.
All aseptic revision knee replacements undertaken between 1st October
2009 and 30th September 2011 were analysed using the Danish National
Patient Registry with additional information from the Danish Knee
Arthroplasty Registry. The 1218 revisions involving 1165 patients
were subdivided into total revisions, large partial revisions, partial
revisions and revisions of unicondylar replacements (UKR revisions).
The mean age was 65.0 years (27 to 94) and the median length of
hospital stay was four days (interquartile range: 3 to 5), with
a 90 days re-admission rate of 9.9%,
re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges
of 51 to 55 years (p = 0.018), 76 to 80 years (p <
0.001) and ≥ 81
years (p <
0.001) were related to an increased risk of re-admission.
The age ranges of 76 to 80 years (p = 0.018) and the large partial
revision subgroup (p = 0.073) were related to an increased risk
of re-operation. The ages from 76 to 80 years (p <
0.001), age ≥ 81
years (p <
0.001) and surgical time >
120 min (p <
0.001)
were related to increased length of hospital stay, whereas the use
of a tourniquet (p = 0.008) and surgery in a low volume centre (p
= 0.013) were related to shorter length of stay. In conclusion, we found a similar incidence of early post-operative
morbidity after aseptic knee revisions as has been reported after
primary procedures. This suggests that a length of hospital stay ≤ four
days and discharge home at that time is safe following aseptic knee
revision surgery in Denmark. Cite this article:
After implementation of a ‘fast-track’ rehabilitation
protocol in our hospital, mean length of hospital stay for primary
total hip arthroplasty decreased from 4.6 to 2.9 nights for unselected
patients. However, despite this reduction there was still a wide
range across the patients’ hospital duration. The purpose of this
study was to identify which specific patient characteristics influence
length of stay after successful implementation of a ‘fast-track’
rehabilitation protocol. A total of 477 patients (317 female and
160 male, mean age 71.0 years; 39.3 to 92.6, mean BMI 27.0 kg/m2;18.8
to 45.2) who underwent primary total hip arthroplasty between 1
February 2011 and 31 January 2013, were included in this retrospective
cohort study. A length of stay greater than the median was considered
as an increased duration. Logistic regression analyses were performed
to identify potential factors associated with increased durations.
Median length of stay was two nights (interquartile range 1), and
the mean length of stay 2.9 nights (1 to 75). In all, 266 patients
had a length of stay ≤ two nights. Age (odds ratio (OR) 2.46; 95%
confidence intervals (CI) 1.72 to 3.51; p <
0.001), living situation
(alone Cite this article:
The primary aim of this study was to investigate the effect of
an enhanced recovery program (ERP) on the short-term functional
outcome after total hip arthroplasty (THA). Secondary outcomes included
its effect on rates of dislocation and mortality. Data were gathered on 1161 patients undergoing primary THA which
included 611 patients treated with traditional rehabilitation and
550 treated with an ERP. Aims
Patients and Methods
Data on early morbidity and complications after
revision total hip replacement (THR) are limited. The aim of this nationwide
study was to describe and quantify early morbidity after aseptic
revision THR and relate the morbidity to the extent of the revision
surgical procedure. We analysed all aseptic revision THRs from 1st
October 2009 to 30th September 2011 using the Danish National Patient
Registry, with additional information from the Danish Hip Arthroplasty
Registry. There were 1553 procedures (1490 patients) performed in
40 centres and we divided them into total revisions, acetabular
component revisions, femoral stem revisions and partial revisions.
The mean age of the patients was 70.4 years (25 to 98) and the median
hospital stay was five days (interquartile range 3 to 7). Within 90
days of surgery, the readmission rate was 18.3%, mortality rate
1.4%, re-operation rate 6.1%, dislocation rate 7.0% and infection
rate 3.0%. There were no differences in these outcomes between high-
and low-volume centres. Of all readmissions, 255 (63.9%) were due
to ‘surgical’ complications Cite this article:
During the last decade primary total hip arthroplasty surgery (THA) has increased with 30% in Sweden. Current law guarantees the patient a right to treatment within 90 days. The public health system has had difficulties meeting the increasing demand. Therefore, in 2012 a systematic review of the patients planned for THA was initiated at Sahlgrenska University Hospital's joint replacement unit. In late 2013 the value-based health care (VBHC) management was introduced in our unit. In 2012 a systematic approach based on the
The outcome after total hip replacement has improved
with the development of surgical techniques, better pain management
and the introduction of enhanced recovery pathways. These pathways
require a multidisciplinary team to manage pre-operative education,
multimodal pain control and accelerated rehabilitation. The current economic
climate and restricted budgets favour brief hospitalisation while
minimising costs. This has put considerable pressure on hospitals
to combine excellent results, early functional recovery and shorter
admissions. In this review we present an evidence-based summary of some common
interventions and methods, including pre-operative patient education,
pre-emptive analgesia, local infiltration analgesia, pre-operative
nutrition, the use of pulsed electromagnetic fields, peri-operative
rehabilitation, wound dressings, different surgical techniques, minimally
invasive surgery and
The August 2023 Knee Roundup360 looks at: Curettage and cementation of giant cell tumour of bone: is arthritis a given?; Anterior knee pain following total knee arthroplasty: does the patellar cement-bone interface affect postoperative anterior knee pain?; Nickel allergy and total knee arthroplasty; The use of artificial intelligence for the prediction of periprosthetic joint infection following aseptic revision total knee arthroplasty; Ambulatory unicompartmental knee arthroplasty: development of a patient selection tool using machine learning; Femoral asymmetry: a missing piece in knee alignment; Needle arthroscopy – a benefit to patients in the outpatient setting; Can lateral unicompartmental knees be done in a day-case setting?
The June 2023 Foot & Ankle Roundup360 looks at: Nail versus plate fixation for ankle fractures; Outcomes of first ray amputation in diabetic patients; Vascular calcification on plain radiographs of the ankle to diagnose diabetes mellitus; Elderly patients with ankle fracture: the case for early weight-bearing; Active treatment for Frieberg’s disease: does it work?; Survival of ankle arthroplasty; Complications following ankle arthroscopy.
Background. North America is facing a rising epidemic involving strains of methicillin-resistant Staphylococcus aureus (MRSA) that, instead of being found almost exclusively in hospitals, are community-associated (CA-MRSA). These strains are aggressive, associated with musculoskeletal manifestations including osteomyelitis (OM), and septic arthritis (SA). We aimed to establish novel management algorithms for acute OM and SA in children. We investigated S.aureus susceptibilities to current first-line antimicrobials to determine their local efficacy. Methods. The project was conducted at Nemours Children Hospital in Florida, USA, following approval by the internal review board. A literature review was conducted. An audit of S.aureus antimicrobial sensitivities was completed over three years and compared against national standards. Susceptibilities of clindamycin, trimethoprim/sulfamethoxazole (TMP/SMX) and vancomycin were studied using local resistance ranges. Results. Two algorithms for acute OM and SA management were created adopting a multidisciplinary team approach from admission to discharge whilst differentiating higher risk patients within
Aim. North America is facing a rising epidemic involving strains of methicillin-resistant Staphylococcus aureus (MRSA) that, instead of being found almost exclusively in hospitals, are community-associated (CA-MRSA). These strains are aggressive, associated with musculoskeletal manifestations including osteomyelitis (OM), and septic arthritis (SA). We aimed to establish novel management algorithms for acute OM and SA in children. We investigated S.aureus susceptibilities to current first-line antimicrobials to determine their local efficacy. Method. The project was conducted at Nemours General Children Hospital in Florida, USA, following approval by the internal review board. A literature review was conducted. An audit of S.aureus antimicrobial sensitivities was completed over three years and compared against national standards. Susceptibilities of clindamycin, trimethoprim/sulfamethoxazole (TMP/SMX) and vancomycin were studied using local resistance ranges. Results. Two algorithms for acute OM and SA management were created adopting a multidisciplinary team approach from admission to discharge whilst differentiating higher risk patients within