Objectives. Although most joint surgeons have reached a consensus that preoperative risk assessment and appropriate medical intervention for elderly patients of primary total hip arthrplasty (PTHA) could significantly reduce postoperative complications and mortality, there is still lack of a detailed and comprehensive approach for risk stratifying and a systematic method for risk allaying. We aimed to explore the risk factors related to the aggravation of preoperative complications and the appearance of complications post-operation of primary total hip arthrplasty (PTHA) in elderly patients for hip fracture. Patients and methods. We retrospectively reviewed the demographic and clinical data of 156 patients who underwent PTHA for hip fracture from January 2014 to December 2016, of which there were 61 male (39.1%) and 95 female (60.9%) patients; 111 patients aged 60–79 years (71.2%) and 45 patients ≥ 80 years old (28.8%); 125 patients of femoral neck fracture (80.1%) and 31 patients of inter-trochanteric fracture (19.9%); 109 patients of spinal anesthesia (69.9%) and 48 patients of general anesthesia (30.1%); 85 patients undergoing surgery within 3 days (54.5%) and 71 patients operated ≥ 4 days (45.5%) since admission. We evaluated the correlations among gender, age, type of fracture, methods of anesthesia, time of operation since admission, the aggravation of preoperative complications and the appearance of postoperative complications post PTHA using the IBM SPSS Statistics (version 21) and the Exce1 2016. Results. The appearance of postoperative complications were statistically correlated with age, time of operation since admission, and type of anesthesia. The appearance of postoperative complication were significantly more in patients operated ≥ 4 days since admission (P < 0.05), and patients with general anesthesia (P < 0.05). Age ≥ 80 years old was not only statistically correlated with the aggravation of three kind of preoperative complications, hypertension, heart disease and respiratory tract infection (P < 0.05), also statistically correlated with the postoperative exacerbation of respiratory tract infection (P < 0.01), the appearance of anemia (P < 0.01), hypoalbuminemia (P < 0.01), water and electrolyte balance disorder (P < 0.05), and gastrointestinal reaction (P < 0.05). Age ≥ 80 years old was neither significantly correlated with postoperative aggravation of diabetes mellitus, urinary tract infection and abnormal liver and kidney function (P > 0.05), nor with postoperative urinary retention (P > 0.05). Conclusion. The occurrence of postoperative complications of elderly patients post PTHA for hip fracture was correlated with age ≥ 80 years old, delayed surgery longer than 4 days since admission, and general anesthesia. Much more attention should be paid to the patients with preoperative diseases of hypertension, heart diseases, and respiratory tract infection, especially age ≥ 80 years patients with respiratory tract infection. Specific postoperative attention should be paid to correct anemia, supplement albumin, regulate the imbalance of water and electrolyte, and treat the digestive tract response for PTHA patients aged ≥ 80 years

Hip fractures are estimated to cost the NHS over £2 billion per year and, with an ageing society, this is likely to increase. Rehabilitation and discharge planning in this population can be met with significant delays and prolonged hospital stay leading to bed shortages for acute and elective admissions. Planning care for these patients relies on a multidisciplinary approach with allied healthcare providers. The number of hip fracture patients in our hospital averages between 450–500/annum, the second largest number in the North West. The current average length of stay for the hip fracture patients is 22.9 days. We evaluated the impact and performance of a pilot early supported discharge service (ESD) for patients admitted with a hip fracture. The pilot period commenced 22 September 2014 for 3 months and included an initial phase to set up the service and supporting processes, followed by the recruitment of 20 patients during the pilot period. The length of stay and post-discharge care was reviewed. The journey of 20 patients was evaluated. The length of stay was dramatically reduced from an average of 22.9 days to 8.8 days in patients on the ESD pathway. Family feedback showed excellent results with communication regarding the ESD pathway and relatives felt the ESD helped patients return home (100% positive feedback). Prolonged recumbency adversely affects the long-term health of these patients leading to significant morbidity such as pressure sores, respiratory tract infections and loss of muscle mass leading to weakness. Mortality is also a significant risk for these patients. Longer hospital stays lead to disorientation, institutionalisation and loss of motivation. Enhancing self-efficacy has been shown to improve balance, confidence, independence and physical activity. This pilot has proven that the Fracture Neck of Femur ESD service can significantly reduce the length of hospital stay and also deliver excellent patient and family feedback. The benefits of patients with a lower length of stay, with effective rehabilitation in hospital and within the home, will provide significant benefits to the Wirral healthcare economy

Aim. Surgical site infection (SSI) is associated with substantial morbidity, mortality and economic burden. Management of spinal SSI is becoming more challenging especially in instrumented cases, but is not well recognized as high risk procedure. The objective of this study was to determine the impact of procedure type comparing SSI risk with arthroplasties among all orthopaedic procedures. Method. Using prospectively collected data of consecutive samples in multi-center orthopedic SSI surveillance, we explored the differences in SSI rates within 30 days after surgery by procedure types. Patients who underwent surgery of single site between November 2013 and May 2016 were enrolled. SSI was our primary outcome. Urinary tract infection (UTI), and respiratory tract infection (RTI) were also evaluated. The definition of SSI was based on the CDC definition with slight modifications. All patients were followed for 30 days postoperatively. Multivariate logistic regression analyses were done, and variables were carefully selected for adjustments. Results. In total 8,907 single site surgeries were analyzed. There were four major procedure types, fracture repair 31%, arthroplasty 30%, spinal surgery without instrumentation 14.7% and spinal instrumentation surgery 13%. Patient backgrounds were male 41.4%, diabetes 13.5%, rheumatoid arthritis 3.8 %, present smoker 13.4%, mean BMI 23+4, and operative time 144+92 minutes. Cefazolin was administered in more than 98% of all cases, and were administered appropriately before surgery. SSI occurred in 102 cases (1.2%), and the SSI rates were 2.5% in spinal instrumentation surgery and 0.6% in arthroplasty. After adjustment with several clinically relevant variables such as age, sex, diabetes and ASA, spinal instrumentation surgery was the only procedure which remained significant with adjusted odds ratio (aOR) of 3.3 (1.8–6.2, P<0.01) compared with arthroplasties. The risk remained stable after adding further clinically relevant variables (aOR of 2.2 to 3.3). The risk was not significant for spinal surgery without instrumentation (aOR, 1.8; 0.9–3.5, P=0.10). Moreover, the risk of spinal instrumentation surgery was highest for UTI (aOR, 4.7; 2.9–7.6), P<0.01) and RTI (aOR, 3.7; 1.6–8.9), P<0.01) among all procedures. Conclusions. From our study, spinal instrumentation surgery was the only procedure to be significant after multivariate analysis, and the risk for SSI remained 2.2 to 3.3 fold higher compared with arthroplasties. The risk was also highest for several other major healthcare-associated infections. Considering the disastrous consequences, more interests and improvements in total perioperative care are needed for this procedure

Infection is a potentially disastrous complication of total knee arthroplasty (TKA). Although advances in surgical technique and antibiotic prophylaxis have reduced the incidence of infection to approximately 1% in primary TKA, there is still a substantial number of patients. Treatment options include antibiotic suppression, irrigation and debridement with component retention (with or without polyethylene exchange), one-stage or two-stage revision, resection arthroplasty and rarely arthrodesis or amputation. Salvage of prostheses has always been associated with low rates of success. It was reported a success rate of 27% for open debridement. It is suitable for selective cases where infection occurs within the first 4–6 weeks of primary TKA or in the setting of acute hematogenous gram positive infection with stable implants. With the advances in arthroscopic technique, arthroscopy after TKA has become an accepted method to assess and manage the complications of TKA. Arthroscopic treatment for infected TKA was reported and the successful rate was similar or better than open debridement in selected situations. We used arthroscopic debridement combined with continuous antibiotic irrigation and suction to treat acute presentation of infected TKA with acceptable result. From 2010∼2013, we has performed arthroscopic debridement and continuous antibiotic irrigation system for seven patients with infected TKA. All of the seven patients had no open wounds nor sinuses and no radiological evidence of prosthetic instability or evidence of osteomyelitis. Most of the surgical intervention was performed within two weeks from the onset of symptoms. Arthroscopic debridement was performed with a shaver using a multiportal technique (anterolateral, anteromedial, superolateral, superomedial, posterolateral, posteromedial) and a continuous antibiotic irrigation system was used to dilutes concentration of the causative microorganism and keep high local bactericidal concentration of antibiotics. We evaluated the efficacy by using follow up of the C-reactve protein (CRP) test, erythrocyte sedimentation rate (ESR) test and physical examination. Successful treatment was defined as prosthesis retention without recurrent infection by the final follow-up. Six of seven infected TKA were cured without recurrence at a mean follow-up of 23 months (range, 6–41 months). One case with rheumatoid arthritis under long-term steroid therapy had recurred after episode of upper respiratory tract infection for 3 times. However, the infection was controlled by arthroscopic debridement and retention of the prosthesis was achieved. We emphasize the importance of posterior portal to ensure adequate arthroscopic debridement. It is imperative to make early diagnosis and treatment for infected TKA. We should make more effort to preserve the prosthesis in acute infection(within 2 weeks). With the advantage of minimal morbidity, arthroscopic treatement shoulder be an alternative to open debridement

Primary Care Trusts across the country are being encouraged to ration service provision due to austerity measures. Obesity has been suggested as a rationing tool with poor clinical outcomes sited as justification. There is, however, a lack of evidence in the literature pertaining to clinical outcomes post elective foot and ankle surgery in patients with an increased Body Mass Index (BMI). All patients undergoing elective foot and ankle surgery at Queen Alexandra Hospital, Portsmouth are entered into a prospective database, which includes their BMI at time of assessment in clinic. From this, we analysed the notes of all patients with a BMI ≥30, excluding any not operated on between July 2007 and August 2009 or with a BMI of <30 at time of surgery, to determine whether there was an increased incidence of peri- or post-operative complications. Included in the study were 109 patients with a mean age of 54 (range 21 - 79). Female patients accounted for 63% of those notes reviewed and the mean BMI was 34 (range 30 - 50). A mixture of hindfoot and forefoot procedures were carried out (20 different procedures). Median length of stay was 0 nights (range 0 – 15 days). The causes for excessive length of stays (>4 nights) included a pre operative Lower Respiratory Tract Infection missed prior to intubation and the initiation of CPAP post operatively in a patient with known Obstructive Sleep Apnoea. We found 3 cases of post operative Venous Thrombo-embolism within 3 months of surgery and 1 proven wound infection in a non-insulin dependent diabetic patient. Also noted were 3 non-unions, all requiring further surgery. Based on our historical evidence of infective and thrombo-embolic complications in patients with a BMI <30, we conclude that peri- and post-operative complications in obese patients occur no more frequently than in a patient population with a BMI <30

Aims

Orthopaedic infection is a potentially serious complication of elective and emergency trauma and orthopaedic procedures, with a high associated burden of morbidity and cost. Optimization of vitamin D levels has been postulated to be beneficial in the prevention of orthopaedic infection. This study explores the role of vitamin D in orthopaedic infection through a systematic review of available evidence.