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Emergency Department closed reduction of dislocated THR: the REDDTHR Prospective Multi-centre Study. 急诊室全车脱位闭合复位术:REDDTHR 前瞻性多中心研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI: 10.1177/11207000241251696
Saima Waseem, Albert Ngu, Jason Patel

Introduction: Dislocation is a potentially devastating complication severely affecting outcomes post total hip arthroplasty (THR). We aimed to assess the efficacy and safety of closed reduction of a dislocated THR within the Emergency Department (ED).

Methods: A prospective multi-centre study was conducted over a 1-year period from November 2020 to December 2021 within 10 hospitals based in the East of England. Collected data included patient demographics, agent used for sedation, hospital length of stay, implant type and discharge destination. Patients were analysed according to whether successful reduction was performed in the ED or not. The primary outcome was length of stay, with secondary outcomes including discharge destination and pain post-procedure.

Results: We studied 99 patients with an average age of 77.02 years, with 39 (39%) patients being male. 11 patients had revision hip replacements and 88 patients had primary THRs. 57 (57.6%) underwent closed reduction in the Emergency department, of which 44 (77.2%) were successful. Successful closed reduction was significantly associated with lower patient age (p = 0.02), lower American society of Anesthesiologists (ASA) score (p < 0.01) and use of propofol (p < 0.01). Patients who underwent successful ED closed reduction had a lower hospital stay than those that did not (1 vs. 3 days, p < 0.01), however there was no significant difference in discharge destination.

Conclusions: When adopted, success following closed reduction is increased in younger patients with less comorbidities following use of propofol sedation. Following sedation, patients have a significantly shorter hospital stay. Increasing uptake of closed reduction of THR dislocation within the ED in suitable patients with evidence-based best practice protocols will maximise patient outcomes whilst allowing efficient resource utilisation.

简介:脱位是一种潜在的破坏性并发症,严重影响全髋关节置换术(THR)后的疗效。我们旨在评估在急诊科(ED)内对脱位的全髋关节置换术进行闭合复位的有效性和安全性:从 2020 年 11 月到 2021 年 12 月,我们在英格兰东部的 10 家医院开展了一项为期 1 年的前瞻性多中心研究。收集的数据包括患者的人口统计学特征、镇静剂、住院时间、植入物类型和出院目的地。根据患者是否在急诊室成功实施减张术进行分析。主要结果是住院时间,次要结果包括出院目的地和术后疼痛:我们共研究了 99 名患者,平均年龄为 77.02 岁,其中 39 名(39%)患者为男性。11名患者接受了翻修髋关节置换术,88名患者接受了初次髋关节置换术。57例(57.6%)患者在急诊科接受了闭合复位术,其中44例(77.2%)手术成功。闭合复位术的成功与患者年龄较小(P = 0.02)、美国麻醉医师协会(ASA)评分较低(P P P 结论:采用异丙酚镇静后,合并症较少的年轻患者闭合复位的成功率更高。使用镇静剂后,患者的住院时间明显缩短。在急诊室对合适的患者采用以证据为基础的最佳实践方案,增加THR脱位闭合复位术的使用率,将最大限度地提高患者的治疗效果,同时实现资源的有效利用。
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引用次数: 0
Lateral femoral wall thickness in trochanteric hip fractures: a systematic review. 股骨转子间髋部骨折的股骨外侧壁厚度:系统性综述。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-08-26 DOI: 10.1177/11207000241267708
Amr Selim, Nikhil Ponugoti, Ahmed Daoub, Sarah Johnson-Lynn, Shin Jae Rhee

Background: Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS).

Methods: A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test.

Results: Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD -1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29-19.10 mm.

Conclusions: A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm.

背景:据研究,股骨外侧壁薄是转子髋部骨折不稳定的一个信号,需要进行外侧壁重建或使用头髓内钉(CMN)。目前已提出了各种临界值来指导植入物的选择。本综述旨在确定股骨转子间骨折患者股骨侧壁厚度(LWT)的临床意义,并确定使用动态髋螺钉(DHS)时增加侧壁(LW)骨折风险的最佳临界值:方法:对截至 2023 年 7 月的 Medline、Embase 和 Cochrane 图书馆等数据库进行了全面检索。采用预先确定的策略,使用非随机研究方法指数(MINORS)标准对 5 项符合条件的研究进行了严格评估。评估结果包括LWT在LW骨折组和非LW骨折组之间的标准化平均差值(SMD)、LW骨折组的LWT总平均值,以及利用卡方检验(chi-square test)得出的AO/OTA骨折类型与LW骨折之间的关系:在 5 项研究的 481 名患者中,112 人术后出现 LW 骨折,369 人术后未出现 LW 骨折。分析表明,LW骨折组的LWT明显较低(SMD -1.13,I² = 41.3%,p = 0.146)。LW骨折组的平均LWT为18.2毫米,95%置信区间为17.29-19.10毫米:结论:在使用 DHS 时,术前股骨外侧壁过薄是导致固定失败和功能预后不理想的关键因素。对术前和术后X光片进行全面评估至关重要。在有LWT测量值的病例中,建议使用CMN而非DHS
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引用次数: 0
Ankylosing spondylitis in patients undergoing total hip arthroplasty increases the risk of medical and implant-related complications: a case control analysis. 接受全髋关节置换术的患者患强直性脊柱炎会增加医疗和植入物相关并发症的风险:病例对照分析。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-08-16 DOI: 10.1177/11207000241267706
Kevin L Mekkawy, Hugo C Rodriguez, Gino Mercadal, Raul G Gosthe, Harpal S Khanuja, Arturo Corces, Martin W Roche

Introduction: Ankylosing spondylitis (AS) is an inflammatory spondyloarthropathy, often involving the spine and sacroiliac joints. Total hip arthroplasty (THA) has been shown to be effective in improving pain and function in patients with AS with hip involvement. However, extraskeletal manifestations and altered mechanics in those with AS leads to increased complications. Thus, the aims of this study were to assess the effects that AS has on medical and implant complications, falls, length of stay, and readmissions following THA.

Methods: A retrospective review of the Mariner private insurance claims database was conducted from 2010 to 2020. All cases of THA and those with AS were identified using Current Procedural Terminology, and International Classification of Disease 9th and 10th revision codes. Patients who underwent THA with a diagnosis of AS were matched to non-AS patients 1:5 based on demographic and comorbidity profiles. 90-day medical complications, falls, and readmission rates, as well as 2-year implant complications were compared between cohorts.

Results: A total of 6509 AS patients were matched to 32,489 control patients. The AS group had significantly higher rates of myocardial infarction, cerebrovascular accident, deep vein thrombosis, pulmonary embolism, urinary tract infection, wound complications, acute kidney injury, pneumonia, sepsis, transfusions, and falls when compared to the control group. The AS group had significantly higher rates of prosthetic joint infection, dislocation, mechanical loosening, and periprosthetic fracture (all p < 0.0001). Likewise, mean length of stay and readmissions were significantly greater in the AS group.

Conclusions: Ankylosing spondylitis in patients undergoing THA is associated with significant risk of medical and implant complications, as well as fall risk, length of stay, and readmission rates. These findings may allow orthopaedic surgeons to be more attentive in identifying those patients at risk and allow for more educated patient counseling and perioperative planning.

简介:强直性脊柱炎(AS)是一种炎症性脊柱关节病:强直性脊柱炎(AS)是一种炎症性脊柱关节病,常累及脊柱和骶髂关节。事实证明,全髋关节置换术(THA)可有效改善髋关节受累的强直性脊柱炎患者的疼痛和功能。然而,强直性脊柱炎患者的骨骼外表现和力学改变会导致并发症增加。因此,本研究旨在评估强直性脊柱炎对医疗和植入并发症、跌倒、住院时间和THA术后再入院的影响:方法:2010 年至 2020 年期间,对 Mariner 私人保险索赔数据库进行了回顾性审查。所有 THA 病例和有 AS 的病例均使用《当前手术术语》和《国际疾病分类》第 9 版和第 10 版修订代码进行识别。根据人口统计学和合并症特征,将接受 THA 手术并诊断为 AS 的患者与非 AS 患者进行 1:5 匹配。对不同组群的90天医疗并发症、跌倒和再入院率以及2年植入并发症进行了比较:共有6509名强直性脊柱炎患者与32489名对照组患者进行了配对。与对照组相比,强直性脊柱炎组的心肌梗死、脑血管意外、深静脉血栓、肺栓塞、尿路感染、伤口并发症、急性肾损伤、肺炎、败血症、输血和跌倒发生率明显更高。强直性脊柱炎组的假体关节感染、脱位、机械性松动和假体周围骨折发生率明显高于对照组(P均<0.0001)。同样,强直性脊柱炎组的平均住院时间和再住院率也明显高于对照组:强直性脊柱炎与接受全髋关节置换术的患者的医疗和植入并发症风险、跌倒风险、住院时间和再入院率密切相关。这些发现可能会让矫形外科医生更加注意识别有风险的患者,并为患者提供更有针对性的咨询和围手术期计划。
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引用次数: 0
Return to surfing following hip arthroplasty. 髋关节置换术后恢复冲浪。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-08-07 DOI: 10.1177/11207000241254802
Garrett K Berger, Canhnghi N Ta, Michael Hachadorian, Cooper B Ehlers, Ryan O'Leary, Pradyumna Gurusamy, Scott T Ball

Background: To date, no previous studies have explored return to surfing after hip arthroplasty. The objective of this study is to analyse return to a risky activity following hip arthroplasty.

Methods: A retrospective chart review was conducted on all primary total hip arthroplasties (THA) and hip resurfacing arthroplasties (HRA) performed by the senior author from 2014 to 2021. Patients identified as surfers were contacted to complete a survey including surfing history and patient-reported outcomes.

Results: 83 hips in 67 patients were contacted. There were 66 THAs and 17 HRAs. 81 hips were performed through a posterior approach and 2 through an anterior approach. At an average of 67 months, there were no dislocations and no patients reported hip pain while surfing. Time to resume surfing was a median of 16 (range 8-144) weeks. Among 13 patients who did not return to surfing, 8 cited new lifestyle restrictions, 4 attributed it to other arthritic joints, and only 1 patient attributed their limitation to the replaced hip. This group had taken significantly more time off from surfing prior to surgery.

Conclusions: Return to surfing following THA and HRA is common and safe in our study population with no complications and specifically no dislocations. Patients with other sites of arthritis and patients who have more extensive time away from surfing prior to surgery are less likely to return to sport. While surfing is clearly not without risk, patients can generally expect a high rate of successful return to surfing after hip arthroplasty.

背景:迄今为止,还没有研究探讨过髋关节置换术后重返冲浪运动的问题。本研究的目的是分析髋关节置换术后恢复高风险活动的情况:对资深作者在 2014 年至 2021 年期间实施的所有初次全髋关节置换术 (THA) 和髋关节置换术 (HRA) 进行了回顾性病历审查。与被确认为冲浪者的患者取得联系,让他们填写一份调查表,内容包括冲浪史和患者报告的结果:结果:共联系了 67 名患者的 83 个髋关节。共有 66 例 THAs 和 17 例 HRA。81例髋关节手术采用后路,2例采用前路。在平均67个月的时间里,没有发生脱位,也没有患者报告冲浪时髋部疼痛。恢复冲浪的时间中位数为16周(8-144周)。在 13 位未能恢复冲浪运动的患者中,8 位患者表示受到了新的生活方式限制,4 位患者表示是其他关节炎引起的,只有 1 位患者表示是髋关节置换造成的。这组患者在手术前停止冲浪的时间明显更长:结论:在我们的研究人群中,髋关节置换术和髋关节置换术后恢复冲浪是常见且安全的,没有并发症,尤其是没有脱臼。患有其他部位关节炎的患者以及术前离开冲浪运动时间较长的患者恢复运动的可能性较小。虽然冲浪运动显然不是没有风险,但一般来说,患者在髋关节置换术后恢复冲浪运动的成功率很高。
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引用次数: 0
Which factors are associated with a successful outcome following total hip arthroplasty in patients with early radiographic osteoarthritis? 哪些因素与早期放射性骨关节炎患者接受全髋关节置换术后的成功结果有关?
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-03-11 DOI: 10.1177/11207000241235892
Martin Sharrock, Tim N Board

Background: It is unclear which factors are associated with a successful total hip arthroplasty (THA) in patients with early radiographic osteoarthritis (OA).

Methods: 70 patients with early OA (Kellgren and Lawrence [KL] grades 0-2) who underwent THA were compared with 200 patients with advanced OA (KL grades 3-4). Outcomes were Oxford Hip Scores (OHS), EQ-5D and EQ-VAS scores; compared preoperatively with 1 year postoperatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THA (postoperative OHS ⩾42).

Results: The early OA group were significantly younger (61 vs. 66 years; [p= 0.0035). There were no significant differences in BMI, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% vs. 50.4%; p< 0.0001) and improvement in EQ-5D (0.151 vs. 0.002; p< 0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, 16/70 (22.9%) patients had a 'successful' THA. Patients who had a 'successful' THA were significantly more likely to have subchondral cysts on CT/MRI (91.7% vs. 57.7%; p= 0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% vs. 38.2%; p= 0.0353). The combination of cysts and joint space width <1 mm was associated with a PoPC of 68%.

Conclusions: THA in patients with early OA (KL grades 0-2) on plain radiographs should be indicated with caution. We advocate preoperative cross-sectional imaging in these patients. In the absence of cysts on CT/MRI, a THA seems unlikely to provide a satisfactory outcome.

背景:方法:将 70 名接受全髋关节置换术的早期 OA(Kellgren 和 Lawrence [KL] 0-2 级)患者与 200 名晚期 OA(KL 3-4 级)患者进行比较。结果包括牛津髋关节评分(OHS)、EQ-5D 和 EQ-VAS 评分;术前与术后 1 年进行比较。我们研究了哪些临床和放射学(X光平片、CT、MRI)特征可预测THA的成功(术后OHS ⩾42):结果:早期 OA 组明显更年轻(61 岁对 66 岁;[p = 0.0035])。体重指数(BMI)、ASA 分级或性别无明显差异。在对混杂因素进行调整后,晚期 OA 组在 OHS(75.8% 对 50.4%;P 0.0001)和 EQ-5D 改善(0.151 对 0.002;P 0.0001)方面的可能变化百分比(PoPC)明显更高。在并发症、复发率或再入院率方面没有明显差异。在早期 OA 组中,16/70(22.9%)名患者的 THA 获得了 "成功"。成功 "THA的患者在CT/MRI上出现软骨下囊肿的几率明显更高(91.7% vs. 57.7%; p = 0.0362)。CT/MRI上出现囊肿与OHS的PoPC明显增加有关(61.6% vs. 38.2%; p = 0.0353)。结论:囊肿和关节间隙宽度的组合对早期 OA 患者的 THA 治疗具有重要意义:对于平片显示为早期 OA(KL 0-2 级)的患者,应慎用 THA。我们主张对这些患者进行术前横断面成像。如果 CT/MRI 检查未发现囊肿,THA 似乎不太可能带来令人满意的结果。
{"title":"Which factors are associated with a successful outcome following total hip arthroplasty in patients with early radiographic osteoarthritis?","authors":"Martin Sharrock, Tim N Board","doi":"10.1177/11207000241235892","DOIUrl":"10.1177/11207000241235892","url":null,"abstract":"<p><strong>Background: </strong>It is unclear which factors are associated with a successful total hip arthroplasty (THA) in patients with early radiographic osteoarthritis (OA).</p><p><strong>Methods: </strong>70 patients with early OA (Kellgren and Lawrence [KL] grades 0-2) who underwent THA were compared with 200 patients with advanced OA (KL grades 3-4). Outcomes were Oxford Hip Scores (OHS), EQ-5D and EQ-VAS scores; compared preoperatively with 1 year postoperatively. We investigated which clinical and radiographic (plain x-ray, CT, MRI) features predicted successful THA (postoperative OHS ⩾42).</p><p><strong>Results: </strong>The early OA group were significantly younger (61 vs. 66 years; [<i>p</i> <i>=</i> 0.0035). There were no significant differences in BMI, ASA grade or gender. After adjusting for confounders, the advanced OA group had a significantly greater percentage of possible change (PoPC) in OHS (75.8% vs. 50.4%; <i>p</i> <i><</i> 0.0001) and improvement in EQ-5D (0.151 vs. 0.002; <i>p</i> <i><</i> 0.0001). There were no significant differences in complication, revision or readmission rates. In the early OA group, 16/70 (22.9%) patients had a 'successful' THA. Patients who had a 'successful' THA were significantly more likely to have subchondral cysts on CT/MRI (91.7% vs. 57.7%; <i>p</i> <i>=</i> 0.0362). The presence of cysts on CT/MRI was associated with a significantly greater PoPC in OHS (61.6% vs. 38.2%; <i>p</i> <i>=</i> 0.0353). The combination of cysts and joint space width <1 mm was associated with a PoPC of 68%.</p><p><strong>Conclusions: </strong>THA in patients with early OA (KL grades 0-2) on plain radiographs should be indicated with caution. We advocate preoperative cross-sectional imaging in these patients. In the absence of cysts on CT/MRI, a THA seems unlikely to provide a satisfactory outcome.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"588-595"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140093848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre. 手术治疗髋关节假体周围骨折的治疗策略和临床疗效:来自一个高流量中心的分析。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-06-11 DOI: 10.1177/11207000241256873
Fabio Mancino, Ben Wall, Thomas A Bucher, Gareth H Prosser, Piers J Yates, Christopher W Jones

Background: Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making.

Methods: This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. P-values <0.05 were considered significant.

Results: 282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions.

Conclusions: PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.

背景:全髋关节置换术(THA)后髋关节假体周围骨折(PPF)越来越普遍。其处理主要取决于骨折类型和植入物的稳定性。本研究旨在提供一个高产量中心手术治疗 PPF 的结果,以帮助指导未来的决策:这是一项回顾性研究,收集了 2008 年 1 月至 2021 年 1 月期间的前瞻性数据。研究收集了患者的人口统计学特征、植入物的具体细节和固定策略。收集的并发症包括感染、再次手术、再次骨折、再次修补。评估了 3 个月和 1 年的短期死亡率。P 值 结果:共发现 282 例经手术治疗的 PPF。52% 的病例以温哥华 B2 型为主。单纯翻修和翻修加额外固定是最常见的治疗方法,共 168 例(60%)。20%的病例出现了需要再次手术的并发症,其中以感染最为常见(8.5%)。3个月和1年的死亡率分别为7.8%和15.7%,其中B2型的死亡率明显较低。采用骨水泥柄治疗的B2型骨折的1年死亡率明显低于远端翻修:结论:PPF的并发症发生率较高。结论:PPF的并发症发生率较高,对于B2/B3型骨折,单纯翻修和翻修加额外固定仍是首选方法,但骨水泥翻修可获得相似的结果,且短期死亡率较低。考虑到高风险的老年和体弱患者,需要一个多学科团队来改善治疗效果并降低死亡率。
{"title":"Treatment strategy and clinical outcomes of surgically managed hip periprosthetic fractures: analysis from a high-volume centre.","authors":"Fabio Mancino, Ben Wall, Thomas A Bucher, Gareth H Prosser, Piers J Yates, Christopher W Jones","doi":"10.1177/11207000241256873","DOIUrl":"10.1177/11207000241256873","url":null,"abstract":"<p><strong>Background: </strong>Hip periprosthetic fractures (PPF) after total hip arthroplasty (THA) are becoming increasingly prevalent. Their management is secondary to the fracture type and the stability of the implant. This study aimed to provide the outcomes of operatively managed PPF from a high-volume centre to help guide future decision making.</p><p><strong>Methods: </strong>This was a retrospective study of prospectively collected data from January 2008 to January 2021. Patient demographics, implant specific details, and fixation strategy were collected. Complications including infection, reoperation, re-fracture, re-revision, were collected. Short-term mortality was evaluated at 3 months and 1 year. <i>P</i>-values <0.05 were considered significant.</p><p><strong>Results: </strong>282 surgically managed PPF were identified. Vancouver B2 were predominant in 52% of the cases. Revision alone and revision with additional fixation were the most frequent strategies in 168 cases (60%). Complications requiring reoperation occurred in 20% of the cases, with infection as the most frequent (8.5%). Mortality rate was 7.8% at 3 months and 15.7% at 1 year, with significantly lower rates in B2 type. B2 fractures treated with cemented stems had a significantly lower 1-year mortality than distal fit revisions.</p><p><strong>Conclusions: </strong>PPF is associated with a high complication rate. Revision alone and revision with additional fixation remain the preferred method in B2/B3 type fractures, however, cemented revision can yield similar outcomes with lower short-term mortality. Considering the high-risk elderly and frail category of patients, a multidisciplinary team is necessary to improve outcomes and reduce mortality.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"641-651"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Early surgery within 48 hours of admission for hip fracture did not improve 1-year mortality in Japan: a single-institution cohort study. 在日本,髋部骨折患者入院 48 小时内尽早手术并不能改善 1 年死亡率:一项单一机构队列研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-21 DOI: 10.1177/11207000241248836
Hiroki Iida, Yasuhiko Takegami, Yoshihito Sakai, Tsuyoshi Watanabe, Yusuke Osawa, Shiro Imagama

Introduction: Early surgery for hip fracture, within 48 hours of hospital admission, is effective in reducing mortality. However, the average preoperative waiting time for hip fractures in Japan is 4.5 days and the 1-year mortality rate after a hip fracture is 10% in Japan. This study aimed to investigate whether early surgery, within 48 hours, could reduce the 1-year mortality rate in patients with hip fractures in Japan.

Methods: This cohort study involved 402 consecutive patients with hip fractures who underwent surgical treatment between January 2013 and September 2019. The exclusion criteria were an age of <60 years and in-hospital injury. A total of 389 patients were included in this study. The patients were divided into two groups: those who underwent early surgery within 48 hours of admission (early group) and those who di not undergo early surgery (delayed group). We compared patient characteristics and treatment outcomes between the 2 groups.

Results: A comparison of patient characteristics revealed that the early group had lower hemoglobin levels (P=0.046), lower C-reactive protein levels (P = 0.031), lower numbers of patients with weekend hospitalization, lower numbers of patients with a history of using medications that may cause bleeding (P < 0.01), and who received general anaesthesia (P < 0.01). However, there were no significant differences with regard to the other variables between the 2 groups. A treatment outcome analysis showed that the early group had shorter waiting times for surgery (P < 0.01) and shorter stays in acute-care wards (P < 0.01). However there were no differences in the total hospital stay, Barthel index at discharge, home discharge rates, in-hospital mortality rates, and 1-year mortality.

Conclusion: Our findings indicate that early surgery did not reduce the 1-year mortality rate in older patients with hip fractures in Japan.

简介入院 48 小时内尽早进行髋部骨折手术可有效降低死亡率。然而,日本髋部骨折患者术前平均等待时间为 4.5 天,髋部骨折后 1 年的死亡率为 10%。本研究旨在探讨在 48 小时内尽早手术是否能降低日本髋部骨折患者的 1 年死亡率:这项队列研究涉及 402 名在 2013 年 1 月至 2019 年 9 月期间接受手术治疗的连续髋部骨折患者。排除标准为年龄不超过 50 岁:对患者特征进行比较后发现,早期手术组患者的血红蛋白水平较低(P=0.046),C反应蛋白水平较低(P=0.031),周末住院的患者人数较少,有可能导致出血的药物使用史的患者人数较少(P P P P 结论:我们的研究结果表明,早期手术并不会对髋部骨折患者的健康造成影响:我们的研究结果表明,早期手术并未降低日本老年髋部骨折患者的 1 年死亡率。
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引用次数: 0
Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases. 髋关节发育不良风险因素的发生率:对 18954 个病例的回顾性研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-09-01 Epub Date: 2024-05-20 DOI: 10.1177/11207000241248416
Gaetano Caruso, Edoardo Gambuti, Elisa Spadoni, Sara Filipponi, Achille Saracco, Francesca Artioli, Ambra Galla, Leo Massari

Background: DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH.

Aim: To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH.

Materials and methods: This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4).

Results: 18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (n = 10,629) were females and 44% (n = 8325) were males. According to Graf classification, 34.9% (n = 6621) were 1A, 52.7% (n = 9999) were 1B, 4.0% (n = 753) were 2A+, 2.5% (n = 478) were 2A-, 1.5% (n = 284) were 2B, 1% (n = 196) were 2C, 1.3% (n = 243) were 2D, 1% (n = 193) were 3 and 1.0% (n = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60).

Conclusions: Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.

背景:DDH 是导致儿童残疾的最重要原因之一。新生儿期可通过奥托拉尼(Ortolani)和巴洛(Barlow)手法诊断出DDH不稳定。然而,临床检查虽然特异性很高,但与超声检查相比灵敏度较低。对于是否有必要对所有新生儿进行发育不良的普遍筛查,还是对有不稳定性临床表现或已知 DDH 危险因素的新生儿进行选择性筛查,目前还存在争议:这是一项横断面研究,对象是2000年1月至2019年12月期间在意大利费拉拉马里诺-奥托拉尼中心连续接受检查的婴儿。格拉夫分类法的前3种类型被认为是生理性的(1A、1B、2A+),而后6种是病理性的(2A-、2B、2C、2D、3、4):18954 名婴儿符合纳入标准,因此被认为符合研究条件。在这 18954 名婴儿中,56%(n = 10629)为女性,44%(n = 8325)为男性。根据格拉夫分类,34.9%(n = 6621)为 1A,52.7%(n = 9999)为 1B,4.0%(n = 753)为 2A+,2.5%(n = 478)为 2A-,1.5%(n = 284)为 2B,1%(n = 196)为 2C,1.3%(n = 243)为 2D,1%(n = 193)为 3,1.0%(n = 187)为 4。最重要的风险因素是女性(OR 5.36;95% CI,4.63-6.20),其次是家族史(OR 2.35;95% CI,2.08-2.65),然后是骨骼病变(OR 2.04;95% CI,1.21-3.42)、少水胎儿(OR 1.75;95% CI,1.44-2.13),最后是臀先露(OR 1.42:95% CI,1.27-1.60):根据我们的数据,家族史、肌肉骨骼疾病、少水胎儿和臀先露是导致 DDH 的主要风险因素,女性也是风险因素之一。
{"title":"Incidence of risk factors in developmental dysplasia of the hip: a retrospective study on 18,954 cases.","authors":"Gaetano Caruso, Edoardo Gambuti, Elisa Spadoni, Sara Filipponi, Achille Saracco, Francesca Artioli, Ambra Galla, Leo Massari","doi":"10.1177/11207000241248416","DOIUrl":"10.1177/11207000241248416","url":null,"abstract":"<p><strong>Background: </strong>DDH is 1 of the most important causes of childhood disability. A diagnosis of instability can be made in the neonatal period via the Ortolani and Barlow manoeuvres. However, clinical examination, although highly specific, has poor sensitivity as compared to ultrasound. There is controversy between the necessity of universal screening for dysplasia of all newborns or selective screening reserved for those with clinical signs of instability or known risk factors of DDH.</p><p><strong>Aim: </strong>To analyse the risk factors of congenital hip dysplasia in a consecutive case series of children referred for diagnosis and treatment of DDH.</p><p><strong>Materials and methods: </strong>This was a cross-sectional study on infants consecutively examined between January 2000 and December 2019 at the Marino Ortolani Centre in Ferrara, Italy. The first 3 types on Graf's classification were considered physiological (1A, 1B, 2A+), while the last 6 pathological (2A-, 2B, 2C, 2D, 3, 4).</p><p><strong>Results: </strong>18,954 infants met the inclusion criteria and were therefore considered eligible for the study. Of these 18,954 infants, 56% (<i>n</i> = 10,629) were females and 44% (<i>n</i> = 8325) were males. According to Graf classification, 34.9% (<i>n</i> = 6621) were 1A, 52.7% (<i>n</i> = 9999) were 1B, 4.0% (<i>n</i> = 753) were 2A+, 2.5% (<i>n</i> = 478) were 2A-, 1.5% (<i>n</i> = 284) were 2B, 1% (<i>n</i> = 196) were 2C, 1.3% (<i>n</i> = 243) were 2D, 1% (<i>n</i> = 193) were 3 and 1.0% (<i>n</i> = 187) were 4. The most significant risk factor was the female gender (OR 5.36; 95% CI, 4.63-6.20) followed by a family history (OR 2.35; 95% CI, 2.08-2.65), then skeletal pathologies (OR 2.04; 95% CI, 1.21-3.42), oligohydramnios (OR 1.75; 95% CI, 1.44-2.13), and finally breech presentation (OR 1.42: 95% CI, 1.27-1.60).</p><p><strong>Conclusions: </strong>Based on our data, family history, musculoskeletal disease, oligohydramnios and breech presentation are the main risk factors for DDH development, as is the female sex.</p>","PeriodicalId":12911,"journal":{"name":"HIP International","volume":" ","pages":"628-632"},"PeriodicalIF":1.3,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141064725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Predictors and risk factors of pulmonary embolism after total hip arthroplasty: an NSQIP study. 全髋关节置换术后肺栓塞的预测因素和风险因素:NSQIP 研究。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-08-22 DOI: 10.1177/11207000241270205
Halil Bulut, Maria Jose Maestre, Daniel Tomey

Introduction: Pulmonary embolism (PE) is a well-known contributor to morbidity after total hip arthroplasty (THA). Considerable efforts have been invested in reducing PE occurrence through pharmacological and perioperative interventions. Nonetheless, the effectiveness of these strategies in reducing the incidence and overall mortality associated with pulmonary embolism events remains a matter of debate. Therefore, identifying risky patients has been gaining importance.

Methods: We utilised data from the National Surgical Quality Improvement Program (NSQIP) participant usage file (PUF) database spanning the years 2016 to 2021. All preoperative parameters were analysed with chi-square afterwards, meaningful ones were run with logistic regression test.

Results: A study examined factors influencing pulmonary embolism (PE) prevalence in 235,393 total hip arthroplasty patients. Univariate analysis identified significant associations between PE and female gender, diabetes, smoking, dyspnea, CHF, COPD, hypertension (HT), bleeding disorders, disseminated cancer, steroid use, and functional health status. Multivariate analysis revealed male gender as protective, while COPD, hypertension, and disseminated cancer increased PE risk. Notably, smoking appeared protective. PE patients had higher return-to-operation rates (41.7% vs. 2.2%) but similar 30-day mortality (0.2% vs. 0.04%), though mortality's odds ratio was not significant.

Conclusions: Our findings suggest that certain patient characteristics, such as COPD and metastatic malignancy, significantly influence the likelihood of PE development.

简介:众所周知,肺栓塞(PE)是导致全髋关节置换术(THA)后发病率的一个因素。为了通过药物治疗和围手术期干预来减少肺栓塞的发生,人们付出了巨大的努力。然而,这些策略能否有效降低肺栓塞事件的发生率和总死亡率仍存在争议。因此,识别高危患者变得越来越重要:我们利用了国家外科质量改进计划(NSQIP)参与者使用文件(PUF)数据库中的数据,时间跨度为 2016 年至 2021 年。之后对所有术前参数进行了卡方分析,对有意义的参数进行了逻辑回归测试:研究调查了235393名全髋关节置换术患者肺栓塞(PE)发病率的影响因素。单变量分析发现,肺栓塞与女性性别、糖尿病、吸烟、呼吸困难、慢性心力衰竭、慢性阻塞性肺病、高血压(HT)、出血性疾病、播散性癌症、类固醇使用和功能健康状况之间存在明显关联。多变量分析显示,男性具有保护作用,而慢性阻塞性肺病、高血压和播散性癌症会增加 PE 风险。值得注意的是,吸烟具有保护作用。PE患者的手术返回率较高(41.7% vs. 2.2%),但30天死亡率相似(0.2% vs. 0.04%),尽管死亡率的几率比并不显著:我们的研究结果表明,某些患者特征(如慢性阻塞性肺病和转移性恶性肿瘤)会显著影响发生 PE 的可能性。
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引用次数: 0
The anterior femoral cortical window as an alternative to an extended trochanteric osteotomy in revision hip arthroplasty surgery: the evolution of the surgical technique and outcomes in 22 consecutive cases. 在翻修髋关节置换手术中,股骨皮质前窗可替代延长转子截骨术:手术技术的演变和 22 例连续病例的疗效。
IF 1.3 4区 医学 Q3 ORTHOPEDICS Pub Date : 2024-08-20 DOI: 10.1177/11207000241267704
David Morley, Michael C Wyatt, John van Dalen

Background: The anterior femoral cortical window is an attractive alternative to the extended trochanteric osteotomy when removing femoral cement in revision hip arthroplasty. CT-based additive manufacturing technology has now permitted the creation of patient-specific instrumented (PSI) jigs to facilitate this. The jig simplifies creation of the window, potentiating medullary exposure through an optimally-sized window and therefore cement removal. Between 2006 and 2021 this technique was used in 22 cases at a regional hospital in New Zealand (mean age 74; range 44 to 89 years). 16 cases were for aseptic loosening and 6 for infection. We describe the technique and our case series. Bone incorporation for the cortical window was assessed in all cases using CT imaging. Oxford scores were obtained at a minimum of 6 months after revision surgery. Of the 6 septic cases 5 went onto successful stage-2 procedures, the other to a Girdlestone procedure.

Results: The mean rectangular shaped window size was 8 × 1.5 cm and in each case, this provided adequate intramedullary access. On average at minimum 5 months post-surgery, 84% bone incorporation of the cortical window occurred on CT (40-100%). The functional outcome Oxford hip score was 37 (range 22-48) for 10 cases. There were 2 cases with femoral component subsidence which then stabilised.

Conclusions: This technique description and retrospective case series has shown the effectiveness of removing a distal femoral cement mantle in revision hip arthroplasty using an anterior femoral cortical window, recently optimised using a PSI jig. This technique is a straightforward alternative to a trochanteric osteotomy. Reliable bony integration of the cortical window occurred and functional outcomes were comparable with the mean score for revision hip procedures reported in the New Zealand Joint Registry.

背景:在翻修髋关节置换术中清除股骨骨水泥时,股骨皮质前窗是一种极具吸引力的替代方法。目前,基于 CT 的快速成型技术已能制造出患者特异性器械夹具 (PSI),以实现这一目的。该夹具简化了开窗过程,通过最佳尺寸的开窗使髓质暴露更充分,从而达到清除骨水泥的目的。2006 年至 2021 年间,新西兰一家地区医院在 22 个病例(平均年龄 74 岁;44 至 89 岁不等)中使用了这种技术。其中16例为无菌性松动,6例为感染。我们将介绍这项技术和我们的病例系列。所有病例均通过CT成像评估了皮质窗的骨结合情况。翻修手术后至少 6 个月进行牛津评分。在6例化脓性病例中,5例成功进行了第二阶段手术,另1例进行了Girdlestone手术:平均矩形窗口大小为 8 × 1.5 厘米,每个病例都能提供足够的髓内通道。手术后至少 5 个月,CT 显示皮质窗的平均骨结合率为 84%(40%-100%)。10例患者的牛津髋关节功能评分为37分(范围为22-48分)。有2例股骨组件下沉,但随后趋于稳定:该技术描述和回顾性病例系列显示了在翻修髋关节置换术中使用股骨皮质前窗去除股骨远端骨水泥套的有效性,最近使用PSI夹具对该技术进行了优化。该技术可直接替代股骨转子截骨术。皮质窗实现了可靠的骨整合,功能结果与新西兰关节登记处报告的翻修髋关节手术平均得分相当。
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引用次数: 0
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HIP International
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