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
Patients seeking cervical spine surgery are thought to be increasing
in age, comorbidities and functional debilitation. The changing
demographics of this population may significantly impact the outcomes
of their care, specifically with regards to complications. In this
study, our goals were to determine the rates of functionally dependent
patients undergoing elective cervical spine procedures and to assess
the effect of functional dependence on 30-day morbidity and mortality
using a large, validated national cohort. A retrospective analysis of the American College of Surgeons
National Surgical Quality Improvement Program data files from 2006
to 2013 was conducted to identify patients undergoing common cervical
spine procedures. Multivariate logistic regression models were generated
to analyse the independent association of functional dependence
with 30-day outcomes of interest.Aims
Patients and Methods
Unicompartmental knee arthroplasty (UKA) has
numerous advantages over total knee arthroplasty (TKA) and one disadvantage,
the higher revision rate. The best way to minimize the revision
rate is for surgeons to use UKA for at least 20% of their knee arthroplasties.
To achieve this, they need to learn and apply the appropriate indications
and techniques. This would decrease the revision rate and increase
the number of UKAs which were implanted, which would save money
and patients would benefit from improved outcomes over their lifetime. Cite this article:
A high rate of suicide has been reported in patients who sustain
fractures, but the association remains uncertain in the context
of other factors. The aim of this study was to examine the association
between fractures and the risk of suicide in this contextual setting. We performed a case-control study of patients aged 40 years or
older who died by suicide between 2000 and 2011. We included patients’
demographics, physical and mental health problems, and socioeconomic
factors. We performed conditional logistic regression to evaluate
the associations between fractures and the risk of suicide.Aims
Patients and Methods
Surgical site infection (SSI) is a common complication of surgery
with an incidence of about 1% in the United Kingdom. Sutures can
lead to the development of a SSI, as micro-organisms can colonize
the suture as it is implanted. Triclosan-coated sutures, being antimicrobical,
were developed to reduce the rate of SSI. Our aim was to assess
whether triclosan-coated sutures cause a reduction in SSIs following
arthroplasty of the hip and knee. This two-arm, parallel, double-blinded study involved 2546 patients
undergoing elective total hip (THA) and total knee arthroplasty
(TKA) at three hospitals. A total of 1323 were quasi-randomized
to a standard suture group, and 1223 being quasi-randomized to the
triclosan-coated suture group. The primary endpoint was the rate
of SSI at 30 days postoperatively.Aims
Patients and Methods
Studies reporting specifically on squeaking in total hip arthroplasty have focused on cementless, and not on hybrid, fixation. We hypothesised that the cement mantle of the femur might have a damping effect on the sound transmitted through the metal stem. The objective of this study was to test the effect of cement on sound propagation along different stem designs and under different fixation conditions. An Objectives
Methods
The aims of this study were to compare the efficacy of two agents,
aspirin and warfarin, for the prevention of venous thromboembolism
(VTE) after simultaneous bilateral total knee arthroplasty (SBTKA),
and to elucidate the risk of VTE conferred by this procedure compared
with unilateral TKA (UTKA). A retrospective, multi-institutional study was conducted on 18
951 patients, 3685 who underwent SBTKA and 15 266 who underwent
UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient
was assigned an individualised baseline VTE risk score based on
a system using the Nationwide Inpatient Sample. Symptomatic VTE,
including pulmonary embolism (PE) and deep vein thrombosis (DVT),
were identified in the first 90 days post-operatively. Statistical
analyses were performed with logistic regression accounting for
baseline VTE risk.Aims
Patients and Methods
Our aim was to determine whether, based on the current literature,
bariatric surgery prior to total hip (THA) or total knee arthroplasty
(TKA) reduces the complication rates and improves the outcome following
arthroplasty in obese patients. A systematic literature search was undertaken of published and
unpublished databases on the 5 November 2015. All papers reporting
studies comparing obese patients who had undergone bariatric surgery
prior to arthroplasty, or not, were included. Each study was assessed
using the Downs and Black appraisal tool. A meta-analysis of risk ratios
(RR) and 95% confidence intervals (CI) was performed to determine
the incidence of complications including wound infection, deep vein
thrombosis (DVT), pulmonary embolism (PE), revision surgery and
mortality.Aims
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
We report our experience of performing an elbow
hemiarthroplasty in the treatment of comminuted distal humeral fractures
in the elderly patients. A cohort of 42 patients (three men and 39 women, mean age 72;
56 to 84) were reviewed at a mean of 34.3 months (24 to 61) after
surgery. Functional outcome was measured with the Mayo Elbow Performance
Score (MEPS) and range of movement. The disabilities of the arm,
shoulder and hand questionnaire (DASH) was used as a patient rated
evaluation. Complications and ulnar nerve function were recorded.
Plain radiographs were obtained to assess prosthetic loosening,
olecranon wear and heterotopic bone formation. The mean extension deficit was 23.5° (0° to 60°) and mean flexion
was 126.8° (90° to 145°) giving a mean arc of 105.5° (60° to 145°).
The mean MEPS was 90 (50 to 100) and a mean DASH score of 20 (0
to 63). Four patients had additional surgery for limited range of
movement and one for partial instability. One elbow was revised
due to loosening, two patients had sensory ulnar nerve symptoms,
and radiographic signs of mild olecranon wear was noted in five
patients. Elbow hemiarthroplasty for comminuted intra-articular distal
humeral fractures produces reliable medium-term results with functional
outcome and complication rates, comparable with open reduction and
internal fixation and total elbow arthroplasty. Cite this article:
Using a systematic review, we investigated whether there is an
increased risk of post-operative infection in patients who have
received an intra-articular corticosteroid injection to the hip
for osteoarthritis prior to total hip arthroplasty (THA). Studies dealing with an intra-articular corticosteroid injection
to the hip and infection following subsequent THA were identified
from databases for the period between 1990 to 2013. Retrieved articles
were independently assessed for their methodological quality.Aims
Methods
Patellofemoral arthroplasty (PFA) has experienced significant
improvements in implant survivorship with second generation designs.
This has renewed interest in PFA as an alternative to total knee
arthroplasty (TKA) for younger active patients with isolated patellofemoral
osteoarthritis (PF OA). We analysed the cost-effectiveness of PFA We used a Markov transition state model to compare cost-effectiveness
between PFA and TKA. Simulated patients were aged 60 (base case)
and 50 years. Lifetime costs (2015 United States dollars), quality-adjusted
life year (QALY) gains and incremental cost-effectiveness ratio
(ICER) were calculated from a healthcare payer perspective. Annual rates
of revision were derived from the National Joint Registry for England,
Wales, Northern Ireland and the Isle of Man. Deterministic and probabilistic
sensitivity analysis was performed for all parameters against a
$50 000/QALY willingness to pay. Aims
Patients and Methods
The aim of the study was to compare measures of the quality of
life (QOL) after resection of a chordoma of the mobile spine with
the national averages in the United States and to assess which factors
influenced the QOL, symptoms of anxiety and depression, and coping
with pain post-operatively in these patients. A total of 48 consecutive patients who underwent resection of
a primary or recurrent chordoma of the mobile spine between 2000
and 2015 were included. A total of 34 patients completed a survey
at least 12 months post-operatively. The primary outcome was the
EuroQol-5 Dimensions (EQ-5D-3L) questionnaire. Secondary outcomes were
the Patient-Reported Outcome Measurement Information System (PROMIS)
anxiety, depression and pain interference questionnaires. Data which
were recorded included the indication for surgery, the region of
the tumour, the number of levels resected, the status of the surgical
margins, re-operations, complications, neurological deficit, length
of stay in hospital and rate of re-admission.Aims
Patients and Methods
The aim of this study was to compare the effectiveness of a femoral
nerve block and a periarticular infiltration in the management of
early post-operative pain after total knee arthroplasty (TKA). A pragmatic, single centre, two arm parallel group, patient blinded,
randomised controlled trial was undertaken. All patients due for
TKA were eligible. Exclusion criteria included contraindications
to the medications involved in the study and patients with a neurological
abnormality of the lower limb. Patients received either a femoral
nerve block with 75 mg of 0.25% levobupivacaine hydrochloride around
the nerve, or periarticular infiltration with 150 mg of 0.25% levobupivacaine
hydrochloride, 10 mg morphine sulphate, 30 mg ketorolac trometamol
and 0.25 mg of adrenaline all diluted with 0.9% saline to make a
volume of 150 ml.Aims
Patients and Methods
Data on early morbidity and complications after
revision total hip replacement (THR) are limited. The aim of this nationwide
study was to describe and quantify early morbidity after aseptic
revision THR and relate the morbidity to the extent of the revision
surgical procedure. We analysed all aseptic revision THRs from 1st
October 2009 to 30th September 2011 using the Danish National Patient
Registry, with additional information from the Danish Hip Arthroplasty
Registry. There were 1553 procedures (1490 patients) performed in
40 centres and we divided them into total revisions, acetabular
component revisions, femoral stem revisions and partial revisions.
The mean age of the patients was 70.4 years (25 to 98) and the median
hospital stay was five days (interquartile range 3 to 7). Within 90
days of surgery, the readmission rate was 18.3%, mortality rate
1.4%, re-operation rate 6.1%, dislocation rate 7.0% and infection
rate 3.0%. There were no differences in these outcomes between high-
and low-volume centres. Of all readmissions, 255 (63.9%) were due
to ‘surgical’ complications Cite this article:
Multimodal infiltration of local anaesthetic provides effective
control of pain in patients undergoing total knee arthroplasty (TKA).
There is little information about the added benefits of posterior
capsular infiltration (PCI) using different combinations of local
anaesthetic agents. Our aim was to investigate the effectiveness
of the control of pain using multimodal infiltration with and without
infiltration of the posterior capsule of the knee. In a double-blind, randomised controlled trial of patients scheduled
for unilateral primary TKA, 86 were assigned to be treated with
multimodal infiltration with (Group I) or without (Group II) PCI.
Routine associated analgesia included the use of bupivacaine, morphine,
ketorolac and epinephrine. All patients had spinal anaesthesia and patient-controlled
analgesia (PCA) post-operatively. A visual analogue scale (VAS)
for pain and the use of morphine were recorded 24 hours post-operatively.
Side effects of the infiltration, blood loss, and length of stay
in hospital were recorded.Aims
Patients and Methods
The aim of this study was to compare the operating
time, length of stay (LOS), adverse events and rate of re-admission
for elderly patients with a fracture of the hip treated using either
general or spinal anaesthesia. Patients aged ≥ 70 years who underwent
surgery for a fracture of the hip between 2010 and 2012 were identified
from the American College of Surgeons National Surgical Quality
Improvement Program (ACS-NSQIP) database. Of the 9842 patients who
met the inclusion criteria, 7253 (73.7%) were treated with general
anaesthesia and 2589 (26.3%) with spinal anaesthesia. On propensity-adjusted
multivariate analysis, general anaesthesia was associated with slightly increased
operating time (+5 minutes, 95% confidence interval (CI) +4 to +6,
p <
0.001) and post-operative time in the operating room (+5
minutes, 95% CI +2 to +8, p <
0.001) compared with spinal anaesthesia.
General anaesthesia was associated with a shorter LOS (hazard ratio
(HR) 1.28, 95% CI 1.22 to 1.34, p <
0.001). Any adverse event
(odds ratio (OR) 1.21, 95% CI 1.10 to 1.32, p <
0.001), thromboembolic
events (OR 1.90, 95% CI 1.24 to 2.89, p = 0.003), any minor adverse
event (OR 1.19, 95% CI 1.09 to 1.32, p <
0.001), and blood transfusion
(OR 1.34, 95% CI 1.22 to 1.49, p <
0.001) were associated with
general anaesthesia. General anaesthesia was associated with decreased
rates of urinary tract infection (OR 0.73, 95% CI 0.62 to 0.87,
p <
0.001). There was no clear overall advantage of one type
of anaesthesia over the other, and surgeons should be aware of the
specific risks and benefits associated with each type. Cite this article:
We present detailed information about early morbidity
after aseptic revision knee replacement from a nationwide study.
All aseptic revision knee replacements undertaken between 1st October
2009 and 30th September 2011 were analysed using the Danish National
Patient Registry with additional information from the Danish Knee
Arthroplasty Registry. The 1218 revisions involving 1165 patients
were subdivided into total revisions, large partial revisions, partial
revisions and revisions of unicondylar replacements (UKR revisions).
The mean age was 65.0 years (27 to 94) and the median length of
hospital stay was four days (interquartile range: 3 to 5), with
a 90 days re-admission rate of 9.9%,
re-operation rate of 3.5% and mortality rate of 0.2%. The age ranges
of 51 to 55 years (p = 0.018), 76 to 80 years (p <
0.001) and ≥ 81
years (p <
0.001) were related to an increased risk of re-admission.
The age ranges of 76 to 80 years (p = 0.018) and the large partial
revision subgroup (p = 0.073) were related to an increased risk
of re-operation. The ages from 76 to 80 years (p <
0.001), age ≥ 81
years (p <
0.001) and surgical time >
120 min (p <
0.001)
were related to increased length of hospital stay, whereas the use
of a tourniquet (p = 0.008) and surgery in a low volume centre (p
= 0.013) were related to shorter length of stay. In conclusion, we found a similar incidence of early post-operative
morbidity after aseptic knee revisions as has been reported after
primary procedures. This suggests that a length of hospital stay ≤ four
days and discharge home at that time is safe following aseptic knee
revision surgery in Denmark. Cite this article:
Several studies have reported the rate of post-operative
mortality after the surgical treatment of a fracture of the hip,
but few data are available regarding the delayed morbidity. In this
prospective study, we identified 568 patients who underwent surgery
for a fracture of the hip and who were followed for one year. Multivariate
analysis was carried out to identify possible predictors of mortality
and morbidity. The 30-day, four-month and one-year rates of mortality
were 4.3%, 11.4%, and 18.8%, respectively. General complications
and pre-operative comorbidities represented the basic predictors
of mortality at any time interval (p <
0.01). In-hospital, four-month
and one-year general complications occurred in 29.4%, 18.6% and
6.7% of patients, respectively. After adjusting for confounding variables,
comorbidities and poor cognitive status determined the likelihood
of early and delayed general complications, respectively (p <
0.001). Operative delay was the main predictor of the length of
hospital stay (p <
0.001) and was directly related to in-hospital
(p = 0.017) and four-month complications (p = 0.008). Cite this article:
