Chronic osteomyelitis reflects a progressive inflammatory process of destruction and necrosis affecting bone architecture. It presents a challenge to manage, requiring multi-stage multidisciplinary interventions, and the literature reports a wide variety of treatment strategies. This systematic scoping review aims to map and summarise existing literature on treatment of chronic osteomyelitis of the femur and tibia and investigates the full range of treatments reported in order to enhance the reader's understanding of how to manage this complex condition. A comprehensive computer-based search was conducted in PubMed, EMBASE, MEDLINE, Emcare and CINAHL for articles reporting treatment of chronic tibial/femoral osteomyelitis. Two reviewers independently performed a two-stage title/abstract and full-text screening, followed by data collection. Studies were included if they described any treatment strategy including at least one surgical intervention. Key information extracted included causative pathogens, treatment protocol and outcome i.e. both success rate, defined as remission achieved following initial treatment with no recurrence during followup, and recurrence rate.Aim
Method
Previous registry studies of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) have focused on revision outcomes following primary surgery. Less is known about the effect of ceramic bearings on infection, dislocation, and mortality as outcomes following primary total hip arthroplasty (THA) for the Medicare population. We asked (1) does the use of C-PE bearings influence outcomes following THA as compared with metal-on-polyethylene (M-PE); and (2) does the use of COC bearings influence outcomes following THA as compared with M-PE? A total of 315,784 elderly Medicare patients (65+) who underwent primary THA between 2005 and 2014 with known bearing types were identified from the Medicare 100% inpatient sample administrative database. Outcomes of interest included relative risk of 90-day readmission, infection, dislocation, revision, or mortality at any time point after primary surgery. Propensity scores were developed to adjust for selection bias in the choice of bearing type at index primary surgery. Cox regression incorporating propensity score stratification (10 levels) was then used to evaluate the impact of bearing surface selection on outcomes, after adjusting for patient-, hospital-, and surgeon-related factors.Introduction
Methods
Previous studies of ceramic-on-polyethylene (C-PE) and ceramic-on-ceramic (COC) hip bearings have focused on outcomes following primary surgery. Less is known about the utilization or outcomes of ceramic bearings in revision total hip arthroplasty (R-THA) for the Medicare population in the US. We asked (1) what is the utilization of ceramic bearings for R-THA in the Medicare population and how has it evolved over time; (2) does the use of C-PE bearings influence outcomes following R-THA as compared with metal-on-polyethylene (M-PE); and (3) does the use of COC bearings influence outcomes following R-THA as compared with M-PE? A total of 31,809 Medicare patients (aged > 65y) who underwent R-THA between 2005 and 2013 with known bearing types were identified from the Medicare 100% inpatient sample administrative database. Outcomes of interest included relative risk of readmission (90 days) or infection, dislocation, rerevision, or mortality at any time point after revision. Propensity scores were developed to adjust for selection bias in the choice of bearing type at revision surgery. Cox regression incorporating propensity score stratification (10 levels) was then used to evaluate the impact of bearing surface selection on outcomes, after adjusting for patient-, hospital-, and surgeon-related factors.Introduction
Methods
