Infection following total hip or knee arthroplasty is a serious
complication. We noted an increase in post-operative infection in
cases carried out in temporary operating theatres. We therefore
compared those cases performed in standard and temporary operating
theatres and examined the deep periprosthetic infection rates. A total of 1223 primary hip and knee arthroplasties were performed
between August 2012 and June 2013. A total of 539 (44%) were performed
in temporary theatres. The two groups were matched for age, gender,
body mass index and American Society of Anesthesiologists grade.Aims
Patients and methods
In the time since Letournel popularised the surgical
treatment of acetabular fractures, more than 25 years ago, there
have been many changes within the field, related to patients, surgical
technique, implants and post-operative care. However, the long-term
outcomes appear largely unchanged. Does this represent stasis or
have the advances been mitigated by other negative factors? In this
article we have attempted to document the recent changes within
the surgery of patients with a fracture involving the acetabulum,
outline contemporary management, and identify the major problem
areas where further research is most needed. Cite this article:
We wished to assess the feasibility of a future randomised controlled
trial of parathyroid hormone (PTH) supplements to aid healing of
trochanteric fractures of the hip, by an open label prospective
feasibility and pilot study with a nested qualitative sub study.
This aimed to inform the design of a future powered study comparing
the functional recovery after trochanteric hip fracture in patients
undergoing standard care, We undertook a pilot study comparing the functional recovery
after trochanteric hip fracture in patients 60 years or older, admitted
with a trochanteric hip fracture, and potentially eligible to be
randomised to either standard care or the administration of subcutaneous
PTH for six weeks. Our desired outcomes were functional testing
and measures to assess the feasibility and acceptability of the
study.Aims
Patients and Methods
We assessed the age-related differences in the
use of total shoulder arthroplasty (TSA) and outcomes, and associated
time-trends using the United States Nationwide Inpatient Sample
(NIS) between 1998 and 2010. Age was categorised as <
50, 50
to 64, 65 to 79 and ≥ 80 years. Time-trends in the use of TSA were
compared using logistic regression or the Cochran Armitage test. The overall use of TSA increased from 2.96/100 000 in 1998 to
12.68/100 000 in 2010. Significantly lower rates were noted between
2009 and 2010, compared with between 1998 and 2000, for: mortality,
0.1% The rates of use of TSA/100 000 by age groups, <
50, 50 to
64, 65 to 79 and ≥ 80 years were: 0.32, 4.62, 17.82 and 12.56, respectively
in 1998 (p <
0.001); and 0.65, 17.49, 75.27 and 49.05, respectively
in 2010 (p <
0.001) with an increasing age-related difference
over time (p <
0.001). Across the age categories, there were
significant differences in the proportion: discharged to an inpatient
facility, 3.2% In a nationally representative sample, we noted a time-related
increase in the use of TSA and increasing age-related differences
in outcomes indicating a changing epidemiology of the use of TSA.
Age-related differences in outcomes suggest that attention should
focus on groups with the worst outcomes. Cite this article:
A trial-based comparison of the use of resources, costs and quality
of life outcomes of arthroscopic and open surgical management for
rotator cuff tears in the United Kingdom NHS was performed using
data from the United Kingdom Rotator Cuff Study (UKUFF) randomised
controlled trial. Using data from 273 patients, healthcare-related use of resources,
costs and quality-adjusted life years (QALYs) were estimated at
12 months and 24 months after surgery on an intention-to-treat basis
with adjustment for covariates. Uncertainty about the incremental
cost-effectiveness ratio for arthroscopic Aims
Patients and Methods
Tranexamic acid (TXA) is an antifibrinolytic agent used as a blood-sparing technique in total knee arthroplasty (TKA), and is routinely administered by intravenous (IV) or intra-articular (IA) injection. Recently, a novel method of TXA administration, the combined IV and IA application of TXA, has been applied in TKA. However, the scientific evidence of combined administration of TXA in TKA is still meagre. This meta-analysis aimed to investigate the efficacy and safety of combined IV and IA TXA in patients undergoing TKA. A systematic search was carried out in PubMed, the Cochrane Clinical Trial Register (Issue12 2015), Embase, Web of Science and the Chinese Biomedical Database. Only randomised controlled trials (RCT) evaluating the efficacy and safety of combined use TXA in TKA were identified. Two authors independently identified the eligible studies, extracted data and assessed the methodological quality of included studies. Meta-analysis was conducted using Review Manager 5.3 software.Objectives
Materials and Methods
Fractures of the distal femur are an important cause of morbidity.
Their optimal management remains controversial. Contemporary implants
include angular-stable anatomical locking plates and locked intramedullary
nails (IMNs). We compared the long-term patient-reported functional
outcome of fixation of fractures of the distal femur using these
two methods of treatment. A total of 297 patients were retrospectively identified from
a State-wide trauma registry in Australia: 195 had been treated
with a locking plate and 102 with an IMN. Baseline characteristics
of the patients and their fractures were recorded. Health-related
quality-of-life, functional and radiographic outcomes were compared
using mixed effects regression models at six months and one year.Aims
Patients and Methods
This study examined spinal fractures in patients
admitted to a Major Trauma Centre via two independent pathways,
a major trauma (MT) pathway and a standard unscheduled non-major
trauma (NMT) pathway. A total of 134 patients were admitted with
a spinal fracture over a period of two years; 50% of patients were
MT and the remainder NMT. MT patients were predominantly male, had
a mean age of 48.8 years (13 to 95), commonly underwent surgery
(62.7%), characteristically had fractures in the cervico-thoracic
and thoracic regions and 50% had fractures of more than one vertebrae,
which were radiologically unstable in 70%. By contrast, NMT patients
showed an equal gender distribution, were older (mean 58.1 years;
12 to 94), required fewer operations (56.7%), characteristically
had fractures in the lumbar region and had fewer multiple and unstable
fractures. This level of complexity was reflected in the length
of stay in hospital; MT patients receiving surgery were in hospital
for a mean of three to four days longer than NMT patients. These
results show that MT patients differ from their NMT counterparts
and have an increasing complexity of spinal injury. Cite this article:
This study investigated the influence of body mass index (BMI)
on the post-operative fall in the level of haemoglobin (Hb), length
of hospital stay (LOS), 30-day re-admission rate, functional outcome
and quality of life, two years after total knee arthroplasty (TKA). A total of 7733 patients who underwent unilateral primary TKA
between 2001 and 2010 were included. The mean age was 67 years (30
to 90). There were 1421 males and 6312 females. The patients were
categorised into three groups: BMI <
25.0 kg/m2 (normal);
BMI between 25.0 and 39.9 kg/m2 (obese); and BMI ≥ 40.0
kg/m2 (morbidly obese).Aims
Patients and Methods
The aim of the study was to investigate the controversial issue
of whether the pelvic ring should be reconstructed following resection
of the sarcomas of the ilium. From our database, we identified 64 patients who underwent excision
of a tumour involving the ilium between 1976 and 2015. A total of
35 underwent complete resection, of whom 24 were reconstructed with
a non-vascularised fibula graft, and four with extracorporeal irradiation
and reimplantation. A total of 29 patients had a partial resection.
The mean follow-up was 9.2 years (1.1 to 25.6). Functional outcomes
were assessed using the Toronto Extremity Salvation Score (TESS)
at final follow-up. In all, 32 patients (50%) had a chondrosarcoma.Aims
Patients and Methods
Since redesign of the Oxford phase III mobile-bearing unicompartmental
knee arthroplasty (UKA) femoral component to a twin-peg design,
there has not been a direct comparison to total knee arthroplasty
(TKA). Thus, we explored differences between the two cohorts. A total of 168 patients (201 knees) underwent medial UKA with
the Oxford Partial Knee Twin-Peg. These patients were compared with
a randomly selected group of 177 patients (189 knees) with primary
Vanguard TKA. Patient demographics, Knee Society (KS) scores and
range of movement (ROM) were compared between the two cohorts. Additionally,
revision, re-operation and manipulation under anaesthesia rates
were analysed.Aims
Patients and Methods
The aim of this study was to determine whether
obesity affects pain, surgical and functional outcomes following lumbar
spinal fusion for low back pain (LBP). A systematic literature review and meta-analysis was made of
those studies that compared the outcome of lumbar spinal fusion
for LBP in obese and non-obese patients. A total of 17 studies were
included in the meta-analysis. There was no difference in the pain
and functional outcomes. Lumbar spinal fusion in the obese patient resulted
in a statistically significantly greater intra-operative blood loss
(weighted mean difference: 54.04 ml; 95% confidence interval (CI)
15.08 to 93.00; n = 112; p = 0.007) more complications (odds ratio:
1.91; 95% CI 1.68 to 2.18; n = 43858; p <
0.001) and longer duration
of surgery (25.75 mins; 95% CI 15.61 to 35.90; n = 258; p <
0.001). Obese
patients have greater intra-operative blood loss, more complications
and longer duration of surgery but pain and functional outcome are
similar to non-obese patients. Based on these results, obesity is
not a contraindication to lumbar spinal fusion. Cite this article:
Obesity is a global epidemic of 2.1 billion people and a well known cause of osteoarthritis. Joint replacement in the obese attracts more complications, poorer outcomes and higher revision rates. It is a reversible condition and the fundamental principles of dealing with reversible medical conditions prior to elective total joint replacement should apply to obesity. The dilemma for orthopaedic surgeons is when to offer surgery in the face of a reversible condition, which if treated may obviate joint replacement and reduce the risk and severity of obesity related disease in both the medical arena and the field of orthopaedics.
Our aim was to examine the clinical and radiographic outcomes
in 257 consecutive Oxford unicompartmental knee arthroplasties (OUKAs)
(238 patients), five years post-operatively. A retrospective evaluation was undertaken of patients treated
between April 2008 and October 2010 in a regional centre by two
non-designing surgeons with no previous experience of UKAs. The
Oxford Knee Scores (OKSs) were recorded and fluoroscopically aligned
radiographs were assessed post-operatively at one and five years.Aims
Patients and Methods
The August 2015 Knee Roundup360 looks at: Two days as good as three in TKA; Bilateral TKA: minimising the risks; Tranexamic acid in knee arthroplasty: everyone should be using it, but how?; Initial follow-up for knee arthroplasty?; Navigation finds its niche?; Another take on navigation?; Multimodal care for early knee osteoarthritis; ACL graft fixation methods under the spotlight
