Acromial morphology has been implicated as a
Aim. Fracture-related infection (FRI) is a severe post-traumatic complication which can be accompanied with a soft-tissue defect or an avital soft-tissue envelope. In these cases, a thoroughly planned orthoplastic approach is imperative since a vital soft-tissue envelope is mandatory to achieve fracture union and infection eradication. The aim of our study was to analyse plastic surgical aspects in the management of FRIs, including the type and outcome of soft-tissue reconstruction (STR), and to investigate the long-term outcome of FRI after STR. Method. Patients with a lower leg FRI requiring STR that were treated from 2010 to 2018 at our center were included in this retrospective analysis. STR involved the use of local, pedicled and free flaps. The primary outcome was the success rate of STR, and the secondary outcome was long-term fracture consolidation and cure of infection. Results. Overall, 145 patients with lower leg FRI were identified, of whom 58 (40%) received STR. Muscle flaps were applied in 38, fascio-cutaneous flaps in 19 and a composite osteo-cutaneous flap in one case. All patients underwent successful STR (primary STR in 51/58 patients, 7/58 patients needed secondary STR). A high Charlson Comorbidity Index Score was a significant
Surgical site infections (SSIs) after spinal fusion surgery increase healthcare costs, morbidity and mortality. Routine measures of obesity fail to consider site specific fat distribution. We aimed to assess the association between the spine adipose index and deep surgical site infection and determine a threshold value for spine adipose index that can assist in preoperative risk stratification in patients undergoing posterior instrumented lumbar fusion (PILF). A multicentre retrospective case-control study was completed. We reviewed patients who underwent PILF from January 1, 2010 to December 31, 2018. All patients developing a deep primary incisional or organ-space SSI within 90 days of surgery as per US Centre for Disease Control and Prevention criteria were identified. We gathered potential pre-operative and intra-operative deep infection
Malnutrition is an important consideration during the perioperative period and albumin is the most common laboratory surrogate for nutritional status. The purpose of this study is to identify if preoperative serum albumin measurements are predictive of infection following arthroscopic procedures. Patients undergoing knee, shoulder or hip arthroscopy between 2006–2016 were identified in the American College of Surgeons National Surgical Quality Improvement Program database. Patients with an arthroscopic current procedural terminology code and a preoperative serum albumin measurement were included. Patients with a history of prior infection, including a non-clean wound class, pre-existing wound infection or systemic sepsis were excluded. Independent t-tests where used to compare albumin values in patients with and without the occurrence of a postoperative infection. Pre-operative albumin levels were subsequently evaluated as predictors of infection with logistic regression models. There were 31,906 patients who met the inclusion criteria. The average age was 55.7 years (standard deviation (SD) 14.62) and average BMI was 31.7 (SD 7.21). The most prevalent comorbidities were hypertension (49.2%), diabetes (18.4%) and smoking history (16.9%). The average preoperative albumin was 4.18 (SD 0.42). There were 45 cases of superficial infection (0.14%), 10 cases of wound dehiscence (0.03%), 17 cases of deep infection (0.05%), 27 cases of septic arthritis or other organ space infection (0.08%) and 95 cases of any infection (0.30%). The preoperative albumin levels for patients who developed septic arthritis (mean difference (MD) 0.20, 95% CI, 0.038, 0.35, P = 0.015) or any infection (MD 0.14, 95% CI 0.05, 0.22, P = 0.002) were significantly lower than the normal population. Additionally, disseminated cancer, Hispanic race, inpatient status and smoking history were significant independent
The incidence of total shoulder arthroplasty (TSA) in increasing. Evidence in primary hip and knee arthroplasty suggest that preoperative opioid use is a
Introduction. Failure of acetabular components has been reported to lead to large bone defects, which determine outcome and management after revision total hip arthroplasty (THA). Although Kerboull-type (KT) plate (KYOCERA Medical Corporation, Kyoto, Japan) has been used for compensating large bone loss, few studies have identified the critical
Aim. Success rate of debridement, antimicrobial and implant retention (DAIR) in high suspicion of early PJI after primary arthroplasty is 70–80%. No studies have been performed focusing on outcome of DAIR after revision arthroplasty of the hip (THA) or knee (TKA). The aim of this study is to investigate the outcome of DAIR in suspected early PJI after revision THA or TKA and to identify
Introduction. Urinary catheterisation can cause bacteraemia and therefore may be associated with a risk of infection in hip and knee arthroplasty. However postoperative urinary retention can be distressing for the patient. This study investigates the factors that might predict the need for postoperative catheterisation in order to help develop a protocol to decide who should be electively catheterised. Methods. A prospective blinded study of 128 consecutive patients undergoing lower limb arthroplasty was carried out. No patient underwent perioperative catheterisation. Data obtained included sex, age, joint (hip or knee replacement), prostate score (IPSS), previous urinary retention, comorbidities and residual bladder volume after attempted complete voiding measured using an ultrasound bladder scanner. The type of anaesthesia and the requirement for urinary catheterisation postoperatively were recorded. Predictive
Background:. There is limited evidence regarding HIV infection as a
Anthropometric anatomical factors may influence mechanical and functional stability of joints. An increased posterior tibial slope places the anterior cruciate ligament at a theroretical biomechanical disadvantage. An increased posterior tibial slope can potentially alter forces during landing tasks by either increasing anterior tibial translation and/or ACL loading. The purpose of this study is to investigate the relationship between posterior tibial slope and anterior cruciate ligament injuries. It is hypothesised that subjects with an ACL injury have an increased posterior tibial slope compared to a normal population. Posterior tibial slope in 211 patients (154 male, 57 female), aged 15–49, who underwent anterior cruciate ligament reconstruction was measured using the posterior tibial cortex as reference. A matched control group was used for comparison. The average posterior tibial slope in the ACLR population was 6.1 degrees, whilst the control group had average values of 5.4 degrees. This finding nearly reached statistical significance (p=0.057). In the male population, average values were 5.5 degrees in the ACLR group and 5.9 in the control group. This was not significant (p=0.21). However, there was a significant difference (p=0.04) in the female group. ACLR females had higher values 6.5 degrees whereas the control group had average values of 5.2 degrees. Increased posterior tibial slope decreases the inclination of the ACL and potentially decreases vector force during dynamic tasks. We could not confirm the results of previous studies demonstrating an increased degree of posterior tibial slope in ACL injured patients. However, we demonstrated a significant difference in tibial slope in females. Based on our results, an increased posterior tibial slope is not a
Background. There is a lack of information on the independent preoperative predictors of perioperative mortality, including the influence of previous stroke and acute coronary syndromes (myocardial infarction + unstable angina, ACS). Previous studies have grouped variables under the umbrella term “ischaemic heart disease”. In this study, we investigated the influence of vascular
Introduction. The global rapid growth of the aging population has some likelihood to create a serious crisis on health-care and economy at an unprecedented pace. To extend Healthy Life Expectancy (HALE) in a number of countries, it is desired more than ever to investigate characteristic and prognosis of numerous diseases. This enlightenment and recent studies on patient-reported outcome measures (PROMs) will drive the increasing interest in the quality of life among the world. The demand for primary THAs by 2030 would rise up to 174% in USA. It is expected that the number of the elderly will surge significantly in the future, thus more septuagenarian and octogenarian are undergoing THA. Moreover, HALE of Japanese female near the age of 75 years, followed to Singapore, is still increasing. Therefore, concerns exist about the PROMs of performing THA in this age-group worldwide. Nevertheless almost the well-established procedure, little agreement has been reached to the elderly. We aimed to clarify the mid-term PROMs after THA over 75-year old. Methods. Between 2005 and 2013, we performed 720 consecutive primary cemented THAs through a direct lateral approach. Of these, 503 female patients (655 hips) underwent THA for treatment of osteoarthritis, with a minimum follow-up of 5 years, were retrospectively enrolled into the study. We excluded 191 patients (252 hips) aged less than 65-year at the time of surgery and 58 patients (60) because of post-traumatic arthritis or previous surgery (37), or lack of data (23). Thus, 343 hips remained eligible for our study, contributed by 254 patients. We investigated Quality-adjusted life year (QALY), EuroQol 5-Dimension 5-Level scale (EQ-5D) and the Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ, which was a disease-specific and self-administered questionnaire, reflecting the specificity of the Japanese cultural lifestyle) in patients aged 75 years or older (154 hips, Group-E) compared with those aged 65 to 74 years (189 hips, Group-C) retrospectively. We evaluated the association between patients aged 75 years or older and the following potential
Purpose. Glenoid version has been correlated with tears within the rotator cuff. Cuff tear arthropathy is an evolution of multiple unhealed tendons ultimately resulting in pseudoparalysis. Although several factors are critical to allow tendon healing, we have observed that there is less glenoid version in patients with cuff tear arthropathy. This was compared to those with osteoarthritis where rotator cuff tears are uncommon. We hypothesize that patients undergoing inverse prosthesis generally have a near neutral glenoid. Method. A single surgeons practice (JPW) was retrospectively reviewed for all cuff tear arthropathy and osteoarthritis patients undergoing primary shoulder arthroplasty. (Zimmer, Warsaw, IN). Glenoid version was measured by 2 fellowship trained shoulder surgeons. Inter and intra-class correlation was measured. Results. The axial CT scans of 84 patients (cuff tear arthropathy and osteoarthritis) were evaluated. Inter and intra-class correlation was excellent (0.96, 0.97). Glenoid version was between 4.1 +/− 3.6 and 16.5 +/− 8.6 degrees for cuff tear arthropathy and osteoarthritis, respectively (p < 0.0001). Conclusion. Our observation of near neutral glenoid version in patients with cuff tear arthropathy has not been reported in the literature. The anatomical version of the glenoid may be a
Introduction. The goal of treating artificial joint infection is to relieve the infection quickly and re-establish joint function, but many patients have underlying diseases, and treatment is often made problematic by the diversity of the causative bacteria. In this study we assessed the factor that enabled revision arthroplasty in patients with infection after artificial hip arthroplasty, including bipolar hip arthroplasty, in our hospital. Subjectives and Methods. The subjects were the 16 patients (16 hips) with infection after hip arthroplasty who were treated in our hospital during the past 10 years. There were 7 males and 9 females, and their mean age was 69.8 years. Primary total hip arthroplasty had been performed in 6 hips, revision hip arthroplasty in 8 hips, and bipolar hip arthroplasty in 2 hips. Infected implants were removed as soon as possible and delayed reimplantations with an interval antibiotic spacer were attempted in all patients. 9 hips were successful in reimplantation (reimplantation group) and 7 hips were impossible (No reimplantation group). In this study we investigated age, complications, body mass index (BMI), body temperature, pain, rate of resistant bacteria, number of hip surgery prior to infection and clinical manifestations compared to two groups. Results. Age, rate of resistant bacteria, body temperature and number of surgery were not significantly different compared to two groups. In no reimplantation group BMI was significantly low. Also, local heat, redness and fistula as clinical manifestations had been observed in most no reimplantation hips. Conversely there were no associations with the presence or absence of swelling, tenderness and pain in initial consultation. Discussion. Garvin et al. have reported a two-stage reimplantation success rate for infected artificial joints of 91%. However, our results comparatively showed lower successful rate. It is suggested that lower BMI, presence of local heat, redness and fistulation were
Introduction. Excessive soft tissue swelling will delay surgery for a proportion of patients admitted with ankle fractures. Surgical and anesthetic teams may waste time assessing patients destined to be cancelled due to swelling. The aim of this investigation was to determine factors associated with cancellation. Methods. Case notes of 87 patients (46 male, 41 female), mean age 43 years (range, 13 to 80) who underwent ankle fracture fixation were retrospectively analysed. 31 of 87 ankles (36%) were unsuitable for day after admission surgery due to swelling. Factors investigated included age, gender, mechanism of injury, fracture configuration and necessity for reduction on arrival in the emergency department due to dislocation; each factor was independently analysed for significance using Fisher's exact test. Results. Ankle fractures associated with a higher energy injury such as sports, falls from height and road traffic accidents were significantly more likely than simple slips to be cancelled due to excess swelling the following morning (p = 0.053). Tri- or bi-malleolar ankle injuries and fracture dislocations requiring manipulation in the emergency department were also significant
Background. Sciatic nerve palsy is a relatively rare, but one of the serious complications after total hip arthroplasty (THA). The prevalence of nerve palsy after THA has been reported to range from 0.3% to 3.7%. Previous authors have speculated that causes could include overlengthening, compression from a hematoma, from extruded metylmethacrylate, or from retractor placement, or laceration from a screw used in the acetabular component. Leg lengthening more than 4 cm was associated with sciatic nerve palsy in the past literature. But there is no report about maximum safety leg lengthening to prevent sciatic nerve palsy significantly. The purpose of this study was to identify the safety rage of leg lengthening to prevent sciatic nerve palsy in THA for the patients with adult hip dislocation. Methods. Forty two consecutive patients47 jointswith Crowe type â?¢ or â?£ were performed THA. Nine joints were Crowe type â?¢ and thirty eight joints were type â?£ in this study. All patients were female. The average age at the time of surgery was 63.3 years (range, 40–77 years). The average patient body weight was 50.5 kg and the average height was 150 cm (body mass index: 22.3 kg/m. 2). The average follow-up was 9.9 years (range, 1–21). See Table1 The socket was placed at the level of the original acetabulum, and femoral shortening osteotomy was performed in 27 joints. Leg lengthening (LL) was defined the vertical distance from the tip of greater trochanter to the tear drop line. The mean LL was 3.1 cm (range, 1.5–6.7 cm). Clinical Harris hip score and sciatic nerve palsy was retrospectively assessed from the patients records. The correlation between LL, the percent LL (cm) divided by body height (cm) (%LL/BH) and the incidence of sciatic nerve palsy was investigated. Results. There were two sciatic nerve palsy (4.3%). These leg lengthening were 5.2 cm and 6.7 cm, respectively. These patients had complete recovery of neurological function. A significant correlation between the amount of LL and the incidence of sciatic nerve palsy was identified. LL more than 5 cm and %LL/BH â?§ 3.6 were significant
Introduction/Aim. Flexor tendon injuries of the hand are common with an incidence of over 3000 per annum in the UK. These injuries can affect hand function significantly. Early treatment with optimal repair is crucial to prevent disability. This study aimed at investigating the re-rupture rate following primary flexor tendon repair at our institution and to identify potential
To evaluate the proportion of microbial associations causing PJI, diversity of their strains and impact on treatment failure after the removal of the hip implant and insertion of a spacer. Spectrum of pathogens in 189 cases of PJI was studied retrospectively. Strains were isolated from the joint aspirates, tissue samples and removed orthopedic devices. The cohort comprised 144 cases of PJI after primary THA and 45 cases after the hip replacement revision surgery. All patients underwent first stage of two-stage revision procedure which involves the removal of a hip implant, debridement of infected periprosthetic tissues and subsequent insertion of a bone cement spacer. There were 92 males and 97 females (median age of 57 yrs). Statistical analysis of the results was performed with GraphPad Prism 6.0 (California, USA). Microbial associations were detected in 28.6% (n=54) of PJI cases. Gram-positive bacteria prevailed in both groups with mono- and polymicrobial etiology. There were 52.5% of S. aureus isolates in monomicrobial group and 25% isolates in polymicrobial group (p=0.0002). This also included 8.4 and 20.6% isolates of MRSA, respectively (p<0.0001). CNS were detected in 20.1% of mono- and 27.9% of polymicrobial infection isolates, including about 40% of MRSE in both groups. Gram-negative pathogens accounted for 25.7% of isolates in polymicrobial group and 14.1% in monomicrobial group (p=0.022). Non-fermenting bacteria prevailed among Gram-negative strains presented in associations. Acinetobacter sp. and P. aeruginosa were identified in 7.4% (p=0.043) and 5.1% (p=0.56) of polymicrobial isolates. The percentage of treatment failure after the removal of the hip implant and insertion of a spacer was considerably higher (p<0.0001) in patients with polymicrobial than monomicrobial infection: 72.2 vs 25.2%, respectively. The proportion of isolates in microbial associations involving Gram-negative pathogens was 61.5% in patients with infection recurrence and 26.7% in patients with a successful outcome of the surgery (p=0.033). Microbial associations were found in 28.6% of PJI cases after hip arthroplasty. They posed a significant risk for treatment failure after removal of the hip implant and insertion of a spacer. The multidrug-resistant strains (MRSA, Acinetobacter sp. and P. aeruginosa) were often isolated in microbial associations. Our results suggest that further study of the
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. A multicentre retrospective study was conducted of all patients presenting to nine centres over a 50-day period during the COVID-19 pandemic (1 March 2020 to 19 April 2020) with a minimum of 50 days follow-up. Patient demographics, American Society of Anesthesiologists (ASA) grade, priority (urgent or elective), procedure type, COVID-19 status, and postoperative mortality were recorded.Aims
Methods
Introduction. Peak incidence of pulmonary embolism (PE) typically occurs weeks after total hip (THA) or knee (TKA) arthroplasty, long after hospital discharge. We investigated