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
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
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
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
Single-stage revision total knee arthroplasty (rTKA) is gaining popularity in treating chronic periprosthetic joint infections (PJIs). We have introduced this approach to our clinical practice and sought to evaluate rates of reinfection and re-revision, along with predictors of failure of both single- and two-stage rTKA for chronic PJI. A retrospective comparative cohort study of all rTKAs for chronic PJI between 1 April 2003 and 31 December 2018 was undertaken using prospective databases. Patients with acute infections were excluded; rTKAs were classified as single-stage, stage 1, or stage 2 of two-stage revision. The primary outcome measure was failure to eradicate or recurrent infection. Variables evaluated for failure by regression analysis included age, BMI, American Society of Anesthesiologists grade, infecting organisms, and the presence of a sinus. Patient survivorship was also compared between the groups.Aims
Methods
Many patients undergoing total knee arthroplasty (TKA) have severe osteoarthritis (OA) in both knees and may consider either simultaneous or staged bilateral TKA. The implications of simultaneous versus staged bilateral TKA for return to work are not well understood. We hypothesized that employed patients who underwent simultaneous bilateral TKA would have significantly fewer days missed from work compared with the sum of days missed from each operation for patients who underwent staged bilateral TKA. The prospective arthroplasty registry at the Hospital for Special Surgery was used. Baseline characteristics and patient-reported outcome scores were evaluated. We used a linear regression model, adjusting for potential confounding variables including age, sex, preoperative BMI, and type of work (sedentary, moderate, high activity, or strenuous), to analyze time lost from work after simultaneous compared with staged bilateral TKA.Aims
Methods
The success rates of two-stage revision arthroplasty for infection have evolved since their early description. The implementation of internationally accepted outcome criteria led to the readjustment of such rates. However, patients who do not undergo reimplantation are usually set aside from these calculations. The aim of this study was to investigate the outcomes of two-stage revision arthroplasty when considering those who do not undergo reimplantation, and to investigate the characteristics of this subgroup. A retrospective cohort study was conducted. Patients with chronic hip or knee periprosthetic joint infection (PJI) treated with two-stage revision between January 2010 and October 2018, with a minimum follow-up of one year, were included. Variables including demography, morbidity, microbiology, and outcome were collected. The primary endpoint was the eradication of infection. Patients who did not undergo reimplantation were analyzed in order to characterize this subgroup better.Aims
Methods
We studied the safety and efficacy of multimodal thromboprophylaxis in patients with a history of venous thromboembolism (VTE) who undergo total hip arthroplasty (THA) within the first 120 postoperative days, and the mortality during the first year. Multimodal prophylaxis includes discontinuation of procoagulant medications, VTE risk stratification, regional anaesthesia, an intravenous bolus of unfractionated heparin prior to femoral preparation, rapid mobilization, the use of pneumatic compression devices, and chemoprophylaxis tailored to the patient’s risk of VTE. Between 2004 to 2018, 257 patients with a proven history of VTE underwent 277 primary elective THA procedures by two surgeons at a single institution. The patients had a history of deep vein thrombosis (DVT) (186, 67%), pulmonary embolism (PE) (43, 15.5%), or both (48, 17.5%). Chemoprophylaxis included aspirin (38 patients), anticoagulation (215 patients), or a combination of aspirin and anticoagulation (24 patients). A total of 50 patients (18%) had a vena cava filter in situ at the time of surgery. Patients were followed for 120 days to record complications, and for one year to record mortality.Aims
Methods
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
There is not adequate evidence to establish whether external
fixation (EF) of pelvic fractures leads to a reduced mortality.
We used the Japan Trauma Data Bank database to identify isolated
unstable pelvic ring fractures to exclude the possibility of blood
loss from other injuries, and analyzed the effectiveness of EF on
mortality in this group of patients. This was a registry-based comparison of 1163 patients who had
been treated for an isolated unstable pelvic ring fracture with
(386 patients) or without (777 patients) EF. An isolated pelvic
ring fracture was defined by an Abbreviated Injury Score (AIS) for
other injuries of <
3. An unstable pelvic ring fracture was defined
as having an AIS ≥ 4. The primary outcome of this study was mortality.
A subgroup analysis was carried out for patients who required blood
transfusion within 24 hours of arrival in the Emergency Department
and those who had massive blood loss (AIS code: 852610.5). Propensity-score
matching was used to identify a cohort like the EF and non-EF groups.Aim
Patients and Methods
This study investigates the reporting of health-related quality of life (HRQoL) in patients following hip fracture. We compare the relative merits and make recommendations for the use for two methods of measuring HRQoL; (i) including patients who died during follow-up and (ii) including survivors only. The World Hip Trauma Evaluation has previously reported changes in HRQoL using EuroQol-5D for patients with hip fractures. We performed additional analysis to investigate the effect of including or excluding those patients who died during the first four months of the follow-up period.Objectives
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
Periprosthetic fracture is a significant complication of total
hip and knee arthroplasty. This study aimed to describe the survival
of patients sustaining periprosthetic femoral fractures and compare
this with that of the general population, as well as to identify
the factors that influence survival. A total of 151 patients (women: men 116:35, mean age 74.6 years,
standard deviation 11.5) that sustained a periprosthetic fracture
between January 2005 and October 2012 were retrospectively analysed.
Epidemiological data, comorbidities, type of surgical management,
type of implant, and mortality data were studied.Aims
Patients and Methods
It is widely held that most Baker’s cysts resolve after treatment
of the intra-articular knee pathology. The present study aimed to
evaluate the fate of Baker’s cysts and their associated symptoms
after total knee arthroplasty (TKA). In this prospective cohort study, 102 patients with (105 were
included, however three were lost to follow-up) an MRI-verified
Baker’s cyst, primary osteoarthritis and scheduled for TKA were
included. Ultrasound was performed to evaluate the existence and
the gross size of the cyst before and at one year after TKA. Additionally,
associated symptoms of Baker's cyst were recorded pre- and post-operatively.Aims
Patients and Methods
We undertook a prospective non-randomised radiological study
to evaluate the preliminary results of using magnetically-controlled
growing rods (MAGEC System, Ellipse technology) to treat children
with early-onset scoliosis. Between January 2011 and January 2015, 19 children were treated
with magnetically-controlled growing rods (MCGRs) and underwent
distraction at three-monthly intervals. The mean age of our cohort
was 9.1 years (4 to 14) and the mean follow-up 22.4 months (5.1
to 35.2). Of the 19 children, eight underwent conversion from traditional growing
rods. Whole spine radiographs were carried out pre- and post-operatively:
image intensification was used during each lengthening in the outpatient
department. The measurements evaluated were Cobb angle, thoracic kyphosis,
proximal junctional kyphosis and spinal growth from T1 to S1.Aims
Patients and Methods
Many different designs of total hip arthroplasty
(THA) with varying performance and cost are available. The identification
of those which are the most cost-effective could allow significant
cost-savings. We used an established Markov model to examine the
cost effectiveness of five frequently used categories of THA which differed
according to bearing surface and mode of fixation, using data from
the National Joint Registry for England and Wales. Kaplan–Meier
analyses of rates of revision for men and women were modelled with
parametric distributions. Costs of devices were provided by the
NHS Supply Chain and associated costs were taken from existing studies.
Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and
the probability of a device being cost effective at a willingness
to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant
were extremely small (<
0.0039 QALYs for men or women over the
patient’s lifetime) and differences in cost were also marginal (£2500
to £3000 in the same time period). As a result, the probability
of any particular device being the most cost effective was very
sensitive to small, plausible changes in quality of life estimates
and cost. Our results suggest that available evidence does not support
recommending a particular device on cost effectiveness grounds alone.
We would recommend that the choice of prosthesis should be determined
by the rate of revision, local costs and the preferences of the
surgeon and patient. Cite this article:
We report the incidence of and risk factors for
complications after scoliosis surgery in patients with Duchenne muscular
dystrophy (DMD) and compare them with those of other neuromuscular
conditions. We identified 110 (64 males, 46 females) consecutive patients
with a neuromuscular disorder who underwent correction of the scoliosis
at a mean age of 14 years (7 to 19) and had a minimum two-year follow-up.
We recorded demographic and peri-operative data, including complications
and re-operations. There were 60 patients with cerebral palsy (54.5%) and 26 with
DMD (23.6%). The overall complication rate was 22% (24 patients),
the most common of which were deep wound infection (9, 8.1%), gastrointestinal
complications (5, 4.5%) and hepatotoxicity (4, 3.6%). The complication
rate was higher in patients with DMD (10/26, 38.5%) than in those
with other neuromuscular conditions (14/84, 16.7% (p = 0.019). All
hepatotoxicity occurred in patients with DMD (p = 0.003), who also
had an increased rate of deep wound infection (19% In our series, correction of a neuromuscular scoliosis had an
acceptable rate of complications: patients with DMD had an increased
overall rate compared with those with other neuromuscular conditions.
These included deep wound infection and hepatotoxicity. Hepatotoxicity
was unique to DMD patients, and we recommend peri-operative vigilance
after correction of a scoliosis in this group. Cite this article: