The aim of this study was to compare the rate of perioperative
complications following aseptic revision total hip arthroplasty
(THA) in patients aged ≥ 80 years with that in those aged <
80
years, and to identify risk factors for the incidence of serious
adverse events in those aged ≥ 80 years using a large validated
national database. Patients who underwent aseptic revision THA were identified in
the 2005 to 2015 National Surgical Quality Improvement Program (NSQIP)
database and stratified into two age groups: those aged <
80
years and those aged ≥ 80 years. Preoperative and procedural characteristics
were compared. Multivariate regression analysis was used to compare
the risk of postoperative complications and readmission. Risk factors
for the development of a serious adverse event in those aged ≥ 80
years were characterized.Aims
Patients and Methods
Charcot neuroarthropathy is a rare but serious complication of diabetes, causing progressive destruction of the bones and joints of the foot leading to deformity, altered biomechanics and an increased risk of ulceration. Management is complicated by a lack of consensus on diagnostic criteria and an incomplete understanding of the pathogenesis. In this review, we consider recent insights into the development of Charcot neuroarthropathy. It is likely to be dependent on several interrelated factors which may include a genetic pre-disposition in combination with diabetic neuropathy. This leads to decreased neuropeptides (nitric oxide and calcitonin gene-related peptide), which may affect the normal coupling of bone formation and resorption, and increased levels of Receptor activator of nuclear factor kappa-B ligand, potentiating osteoclastogenesis. Repetitive unrecognized trauma due to neuropathy increases levels of pro-inflammatory cytokines (interleukin-1β, interleukin-6, tumour necrosis factor α) which could also contribute to increased bone resorption, in combination with a pre-inflammatory state, with increased autoimmune reactivity and a profile of monocytes primed to transform into osteoclasts - cluster of differentiation 14 (CD14). Increased blood glucose and loss of circulating Receptor for Advanced Glycation End-Products (AGLEPs), leading to increased non-enzymatic glycation of collagen and accumulation of AGLEPs in the tissues of the foot, may also contribute to the pathological process. An understanding of the relative contributions of each of these mechanisms and a final common pathway for the development of Charcot neuroarthropathy are still lacking.
Surgical site infection can be a devastating complication of
hemiarthroplasty of the hip, when performed in elderly patients
with a displaced fracture of the femoral neck. It results in a prolonged
stay in hospital, a poor outcome and increased costs. Many studies
have identified risk and prognostic factors for deep infection.
However, most have combined the rates of infection following total
hip arthroplasty and internal fixation as well as hemiarthroplasty, despite
the fact that they are different entities. The aim of this study
was to clarify the risk and prognostic factors causing deep infection
after hemiarthroplasty alone. Data were extracted from a prospective hip fracture database
and completed by retrospective review of the hospital records. A
total of 916 patients undergoing a hemiarthroplasty in two level
II trauma teaching hospitals between 01 January 2011 and
01 May 2016 were included. We analysed the potential peri-operative
risk factors with univariable and multivariable logistic regression
analysis.Aims
Patients and Methods
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
The primary aim of this study was to assess the reproducibility of the recalled preoperative Oxford Hip Score (OHS) and Oxford Knee Score (OKS) one year following arthroplasty for a cohort of patients. The secondary aim was to assess the reliability of a patient’s recollection of their own preoperative OHS and OKS one year following surgery. A total of 335 patients (mean age 72.5; 22 to 92; 53.7% female) undergoing total hip arthroplasty (n = 178) and total knee arthroplasty (n = 157) were prospectively assessed. Patients undergoing hip and knee arthroplasty completed an OHS or OKS, respectively, preoperatively and were asked to recall their preoperative condition while completing the same score one year after surgery.Objectives
Methods
The aim of this study was to evaluate antegrade autologous bone
grafting with the preservation of articular cartilage in the treatment
of symptomatic osteochondral lesions of the talus with subchondral
cysts. The study involved seven men and five women; their mean age was
35.9 years (14 to 70). All lesions included full-thickness articular
cartilage extending through subchondral bone and were associated
with subchondral cysts. Medial lesions were exposed through an oblique
medial malleolar osteotomy, and one lateral lesion was exposed by
expanding an anterolateral arthroscopic portal. After refreshing
the subchondral cyst, it was grafted with autologous cancellous
bone from the distal tibial metaphysis. The fragments of cartilage
were fixed with 5-0 nylon sutures to the surrounding cartilage.
Function was assessed at a mean follow-up of 25.3 months (15 to
50), using the American Orthopaedic Foot and Ankle Society (AOFAS)
ankle-hindfoot outcome score. The radiological outcome was assessed
using MRI and CT scans.Aims
Patients and Methods
We aimed to retrospectively assess the accuracy and safety of
CT navigated pedicle screws and to compare accuracy in the cervical
and thoracic spine (C2-T8) with (COMB) and without (POST) prior
anterior surgery (anterior cervical discectomy or corpectomy and
fusion with ventral plating: ACDF/ACCF). A total of 592 pedicle screws, which were used in 107 consecutively
operated patients (210 COMB, 382 POST), were analysed. The accuracy
of positioning was determined according to the classification of
Gertzbein and Robbins on post-operative CT scans.Aims
Patients and Methods
We aimed to characterise the effect of expeditious hip fracture
surgery in elderly patients within 24 hours of admission on short-term
post-operative outcomes. Patients age 65 or older that underwent surgery for closed femoral
neck and intertrochanteric hip fractures were identified from the
American College of Surgeons National Surgical Quality Improvement
Program between 2011 and 2014. Multivariable propensity-adjusted
logistic regressions were performed to determine associations between early
surgery within 24 hours and post-operative complications, controlling
for selection bias in patients undergoing early surgery based on
observable characteristics.Aims
Patients and Methods
Positive ulnar variance is an established risk factor for idiopathic
ulnar impaction syndrome (UIS). However, not all patients with positive
ulnar variance develop symptomatic UIS and other factors, including
the morphology of the lunate, may be involved. The aim of this study
was to clarify the relationship between lunate morphology and idiopathic
UIS. A cohort of 95 patients with idiopathic UIS (UIS group) was compared
with 95 asymptomatic controls with positive ulnar variance. The
shape of the lunate was measured using the capitate-triquetrum distance
(CTD), ulnar coverage ratio (UCR), radiolunate distance and radiolunate
angle. The association of radiographic parameters and lunate types
with the development of UIS was investigated in univariable and
multivariable analyses. Receiver operating characteristic curves
were used to estimate a cutoff for any statistically significant
variables.Aims
Patients and Methods
The purpose of the present study was to evaluate the impact of
intravenous tranexamic acid on the reduction of blood loss, transfusion
rate, and early post-operative clinical outcome in total shoulder
arthroplasty. A randomised, placebo-controlled trial which included 54 patients
undergoing unilateral primary stemless anatomical or stemmed reverse
total shoulder arthroplasty was undertaken. Patients received either
100 ml saline (placebo, n = 27), or 100 ml saline together with
1000 mg of tranexamic acid (TXA, n = 27) intravenously prior to
skin incision and during wound closure. Peri-operative blood loss
via an intra-articular drain was recorded and total blood loss was
calculated. The post-operative transfusion rate was documented.
Assessment of early clinical parameters included the visual analogue
scale for pain (VAS), documentation of haematoma formation and adverse events.Aims
Patients and Methods
The aim of this study was to evaluate the clinical and radiological
outcome of using an anatomical short-stem shoulder prosthesis to
treat primary osteoarthritis of the glenohumeral joint. A total of 66 patients (67 shoulders) with a mean age of 76 years
(63 to 92) were available for clinical and radiological follow-up
at two different timepoints (T1, mean 2.6 years, Aims
Patients and Methods
The aim of the study was to analyze the results of primary tendon
reinsertion in acute and chronic distal triceps tendon ruptures
(DTTRs) in the general population. A total of 28 patients were operated on for primary DTTR reinsertions,
including 21 male patients and seven female patients with a mean
age of 45 years (14 to 76). Of these patients, 23 sustained an acute
DTTR and five had a chronic injury. One patient had a non-simultaneous
bilateral DTTR. Seven patients had DTTR-associated ipsilateral fracture
or dislocation. Comorbidities were present in four patients. Surgical
treatment included transosseous and suture-anchors reinsertion in
22 and seven DTTRs, respectively. The clinical evaluation was performed
using Mayo Elbow Performance Score (MEPS), the modified American
Shoulder and Elbow Surgeons Score (m-ASES), the Quick Disabilities
of the Arm, Shoulder and Hand score (QuickDASH), and the Medical
Research Council (MRC) Scale.Aims
Patients and Methods
Positive cultures are not uncommon in cases of revision total
knee and hip arthroplasty (TKA and THA) for presumed aseptic causes.
The purpose of this study was to assess the incidence of positive
intra-operative cultures in presumed aseptic revision of TKA and
THA, and to determine whether the presence of intra-operative positive cultures
results in inferior survival in such cases. A retrospective cohort study was assembled with 679 patients
undergoing revision knee (340 cases) or hip arthroplasty (339 cases)
for presumed aseptic causes. For all patients three or more separate
intra-operative cultures were obtained. Patients were diagnosed
with a previously unsuspected prosthetic joint infection (PJI) if two
or more cultures were positive with the same organism. Records were
reviewed for demographic details, pre-operative laboratory results
and culture results. The primary outcome measure was infection-free
implant survival at two years.Aims
Patients and Methods
The Corail stem has good long-term results. After four years
of using this stem, we have detected a small group of patients who
have presented with symptomatic metaphyseal debonding. The aim of
this study was to quantify the incidence of this complication, to
delineate the characteristics of patients presenting with this complication
and to compare these patients with asymptomatic controls to determine
any important predisposing factors. Of 855 Corail collarless cementless stems implanted for osteoarthritis,
18 presented with symptomatic metaphyseal debonding. A control group
of 74 randomly selected patients was assembled. Clinical and radiological
parameters were measured and a logistic regression model was created
to evaluate factors associated with metaphyseal debonding.Aims
Patients and Methods
The aims of this study were to examine the rate at which the
positioning of the acetabular component, leg length discrepancy
and femoral offset are outside an acceptable range in total hip
arthroplasties (THAs) which either do or do not involve the use
of intra-operative digital imaging. A retrospective case-control study was undertaken with 50 patients
before and 50 patients after the integration of an intra-operative
digital imaging system in THA. The demographics of the two groups
were comparable for body mass index, age, laterality and the indication
for surgery. The digital imaging group had more men than the group without.
Surgical data and radiographic parameters, including the inclination
and anteversion of the acetabular component, leg length discrepancy,
and the difference in femoral offset compared with the contralateral
hip were collected and compared, as well as the incidence of altering
the position of a component based on the intra-operative image.Aims
Patients and Methods
The aim of this study was to determine whether the sequential
application of povidone iodine-alcohol (PVI) followed by chlorhexidine
gluconate-alcohol (CHG) would reduce surgical wound contamination
to a greater extent than PVI applied twice in patients undergoing
spinal surgery. A single-centre, interventional, two arm, parallel group randomised
controlled trial was undertaken, involving 407 patients who underwent
elective spinal surgery. For 203 patients, the skin was disinfected before surgery using
PVI (10% [w/w (1% w/w available iodine)] in 95% industrial denatured
alcohol, povidone iodine; Videne Alcoholic Tincture) twice, and
for 204 patients using PVI once followed by CHG (2% [w/v] chlorhexidine
gluconate in 70% [v/v] isopropyl alcohol; Chloraprep with tint).
The primary outcome measure was contamination of the wound determined
by aerobic and anaerobic bacterial growth from samples taken after
disinfection.Aims
Patients and Methods
This systematic review examines the current literature regarding surgical techniques for restoring articular cartilage in the hip, from the older microfracture techniques involving perforation to the subchondral bone, to adaptations of this technique using nanofractures and scaffolds. This review discusses the autologous and allograft transfer systems and the autologous matrix-induced chondrogenesis (AMIC) technique, as well as a summary of the previously discussed techniques, which could become common practice for restoring articular cartilage, thus reducing the need for total hip arthroplasty. Using the
The objective of this study was to develop a test for the rapid (within 25 minutes) intraoperative detection of bacteria from synovial fluid to diagnose periprosthetic joint infection (PJI). The 16s rDNA test combines a polymerase chain reaction (PCR) for amplification of 16s rDNA with a lateral flow immunoassay in one fully automated system. The synovial fluid of 77 patients undergoing joint aspiration or primary or revision total hip or knee surgery was prospectively collected. The cohort was divided into a proof-of-principle cohort (n = 17) and a validation cohort (n = 60). Using the proof-of-principle cohort, an optimal cut-off for the discrimination between PJI and non-PJI samples was determined. PJI was defined as detection of the same bacterial species in a minimum of two microbiological samples, positive histology, and presence of a sinus tract or intra-articular pus.Objectives
Methods
The purpose of this study was to evaluate trends in opioid use
after unicompartmental knee arthroplasty (UKA), to identify predictors
of prolonged use and to compare the rates of opioid use after UKA,
total knee arthroplasty (TKA) and total hip arthroplasty (THA). We identified 4205 patients who had undergone UKA between 2007
and 2015 from the Humana Inc. administrative claims database. Post-operative
opioid use for one year post-operatively was assessed using the
rates of monthly repeat prescription. These were then compared between
patients with and without a specific variable of interest and with
those of patients who had undergone TKA and THA.Aims
Materials and Methods
The aim of this study was to present a series of patients with
aseptic failure of a total ankle arthroplasty (TAA) who were treated
with fusion of the hindfoot using a nail. A total of 23 TAAs, in 22 patients, were revised for aseptic
loosening and balloon osteolysis to a hindfoot fusion by a single
surgeon (NH) between January 2012 and August 2014. The procedure
was carried out without bone graft using the Phoenix, Biomet Hindfoot
Arthrodesis Nail. Preoperative investigations included full blood
count, CRP and ESR, and radiological investigations including plain
radiographs and CT scans. Postoperative plain radiographs were assessed
for fusion. When there was any doubt, CT scans were performed.Aims
Patients and Methods