Geriatric Orthopaedic Surgery & Rehabilitation最新文献

Background: Frailty is an established risk factor for adverse outcomes following total joint arthroplasty, including higher rates of prosthetic joint infection (PJI), reoperation rates, and readmission, which may be greater in the setting of revision. The purpose of this study is to compare the association of frailty indices with mortality and complications following septic revision arthroplasty.

Methods: A query from The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was performed for adult patients undergoing revision total knee or hip arthroplasty between 2015 and 2020, which records perioperative data (30 days postoperatively) for over 700 centers nationwide. PJI cases without revision arthroplasty were excluded. The RAI-rev and mFI-5 frailty scores were calculated for each patient. Outcomes included major complications, mortality, non-home discharge (NHD), DVT, readmission within 30 days, wound complications, pulmonary complications, cardiac complications, and postoperative infection. T-test and binary logistic regression assessed associations with frailty scores and outcomes. Predictability was evaluated through multivariate regression analysis, and its discriminative accuracy was measured using receiver operating curve (ROC) analysis and C-statistics.

Results: A total of 4395 patients were included (median age: 66 [IQR 59-73]). Within the cohort, 46.44% were female and 38.02% exhibited NHD. RAI-rev demonstrated increased association compared to mFI-5 with mortality (OR: 1.20 vs 1.10, CI: 95%) and NHD (OR: 1.15 vs 1.05, CI: 95%). RAI-Rev demonstrated significantly superior discriminatory accuracy when compared to mFI-5 for NHD (Cs: 0.670 vs 0.602, P < 0.001) and mortality (Cs: 0.795 vs 0.574, P < 0.001).

Conclusions: Frailty may have a distinct association with mortality and NHD following septic rTJA, especially when assessed by the revised Risk Analysis Index. This understanding is important to educate the patient and their family and provide insight into the necessary resources and surveillance needed to manage frail patients undergoing septic revision total joint arthroplasty.

Purpose: To examine five-year trends in 30-day readmission and length of stay (LOS) among the geriatric population after surgical fixation for hip fracture in a large database model.

Methods: Patients ≥ 65 years of age in the American College of Surgeons National Surgical Quality Improvement Program Targeted Hip Fracture (ACS-NSQIP THF) were identified using Current Procedural Terminology (CPT®) codes 27 236, 27 244, 27 245 for intramedullary nailing or Open Reduction and Internal Fixation (ORIF) of fractures involving the femoral head, neck, peritrochanteric, intertrochanteric, and subtrochanteric regions. The primary outcome was incidence of ≥1 30-day hospital readmission and secondary outcome was total hospital length of stay in trend analysis.

Results: Overall, there were 64 794 patients who met inclusion criteria, of which 7.85% (95% CI: 7.64% to 8.05%) were readmitted within 30 days of hip fracture surgical fixation. The proportion of patients with ≥1 30-day readmission were presented over time and Cochran-Armitage Trend Testing indicated a statistically significant decreasing trend in the 30-day readmission incidence from 2016-2021 (P < 0.0001). The mean absolute change in incidence from year-to-year was -0.24% (mean relative change, 0.97) and the total absolute difference in incidence from 2016 to 2021 was -1.20% (relative difference, 0.85). LOS data were missing for 1048 cases (1.62%). Mean and median length of stay data was similar across all years.

Conclusion: The probability of having ≥1 30-day readmission decreased 0.85-times from 2016 to 2021, with a statistically significant downward trend over time. There were no meaningful changes in length of stay. Healthcare providers, policymakers, and stakeholders can utilize these findings to implement initiatives that enhance value-based care in hip fracture management and benchmark institutional metrics, ultimately improving patient outcomes and optimizing healthcare resources.

Background: The functional outcome in patients with preexisting osteoarthritis after surgically treated trochanteric fracture is not yet fully elucidated. As the global population ages, the coexinsting of degenerative joint osteoarthritis and fragility fractures is increasing. Consequently, it is imperative to provide affected patients with information regarding the anticipated clinical outcomes. The objective of this study is to examine the impact of preexisting hip osteoarthritis in elderly patients on the clinical outcome following trochanteric fracture fixation.

Methods: In this retrospective single-center study elderly patients aged ≥70 years who underwent intramedullary nailing between January 2016 and March 2023 have been analysed. The severity of hip osteoarthritis was stratified into two categories: grade 0-II and grade III-IV, according to the Kellgren-Lawrence classification system. Radiological signs of consolidation were ascertained. A comprehensive evaluation of the patients' demographics and patient-reported outcome measures (Oxford Hip Score, WOMAC-score, and SF-36-score) was conducted, followed by a thorough statistical analysis, with a significance set at P < 0.05.

Results: 21 patients with 23 affected hips were included (mean age 81 ± 7.5 years; 81% female) with a mean follow-up duration of 15.1 ± 13.8 months. Patients with advanced OA (KL III-IV) reported significantly lower Oxford Hip Scores (33.3 ± 6.3 vs 43.1 ± 6.7; P = 0.003), and higher total WOMAC and WOMAC pain scores (P = 0.016 and P = 0.003).

Conclusion: The severity of pre-existing osteoarthritis of the hip in patients with intertrochanteric fractures is a significant risk factor, potentially leading to a diminished quality of life postoperatively. Further studies are necessary to provide therapeutic guidance.

Introduction: This study's purpose was to use a postoperative ICU geriatric prediction score (PIGS) to determine the appropriateness of postoperative ICU/SDU admission or unnecessary use of advanced care services in geriatric femur fracture patients at our Level III trauma center.

Methods: This is a retrospective review of 142 patients, age 65 years or older, at a level III trauma center from 3/2021-9/2022 that required surgical fixation of a femur fracture. Collected data included demographics, injury characteristics, postoperative complications, hospital charges, and admission to ICU or SDU.

Results: Average age was 81.5 years. 32% of patients were male and 40% were femoral neck fractures. The average PIGS score was 7.1. 17% of patients admitted to the SDU met the PIGS threshold for ICU transfer. 7% were transferred to the ICU after being admitted to the SDU postoperatively, 0% of whom met criteria for ICU admission at the level 1 trauma center. Predictive factors for their transfer to the ICU at the level 3 trauma center was postoperative blood transfusion (OR:4.11;CI 1.09,15.45;P = 0.036) and history of cancer or organ transplant (OR:5.86;CI 1.2926.58; P = 0.022). Predictive factor of postoperative death (aside from transfer to ICU) was a history of cancer or organ transplant (OR:13.90;CI 7.65,25.25;P = 0.007). Average gross charges per patient admitted to the floor and the SDU were $80,383 and $82,590, respectively,P = 0.372.

Conclusion: The geriatric population with a femur fracture is often unnecessarily admitted to advanced care units postoperatively. The PIGS system has been validated for use in a level 1 trauma center in the geriatric population undergoing hip fracture surgery. Here, we validate its use in the geriatric population undergoing femur fracture surgery at a level III trauma center, where majority of patients may not meet the criteria for advanced care and could be cared for more cost-effectively.

Introduction: Revision arthroplasty is an invasive procedure with increased morbidity relative to primary joint arthroplasty. Therefore, patients with metastatic cancer (Met) undergoing revision total joint arthroplasty (rTJA) may be at greater risk. This study assesses early postoperative outcomes among Met patients undergoing rTJA.

Materials and methods: We reviewed the National Surgical Quality Improvement Program (NSQIP) database from 2015 to 2020 to evaluate rTHA/rTKA with Met and Non-Met. Univariate analysis and multivariate logistic regression were used to evaluate associations of Met patients compared with outcomes using odds ratio (OR) and 95% confidence interval (CI). Discriminatory accuracy was assessed using Receiver operating characteristic (ROC) curve and quantified using C-statistic.

Results: Adjusted analysis revealed Met patients undergoing rTKA were more likely to experience any complication (OR: 2.56, CI: [1.48-4.43]), major complication (OR: 2.17, CI: [1.24-3.82]), and mortality (OR: 7.99, CI: [2.70-23.65]). Met patients undergoing rTHA had higher associations with any complication (OR: 2.40, CI: [1.65-3.49]), major complication (OR: 2.19, CI: [1.47-3.25]), DVT (OR: 4.82, CI: [1.92-12.10]), and mortality (OR: 3.67, CI: [1.43-9.41]). Frailty had superior predictability of extended length of stay (C: 0.625 [0.619-0.630]) and mortality (C: 0.851 [0.824-0.880]).

Conclusions: Patients with metastatic cancer have elevated risk of complications after revision arthroplasty but may have moderate predictability by frailty assessment. Surgeons can utilize this information to emphasize protective strategies to mitigate risk during and following total joint arthroplasty.

Level of evidence: III.

Objective: To quantify rotational displacement following intramedullary nail fixation for intertrochanteric femoral fractures using three-dimensional (3D) CT imaging, analyze associated risk factors, and evaluate its clinical significance.

Methods: This study enrolled a cohort of 252 patients who underwent intramedullary nail fixation for intertrochanteric femoral fractures between 2019 and 2023. All participants underwent postoperative three-dimensional computed tomography (3D CT) and were followed for a minimum of 1 year. Postoperative femoral anteversion on the affected side was quantitatively assessed. An analysis was conducted to evaluate its correlation with potential risk factors, including age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) classification, nail length, type of internal fixation, reduction quality, AO Foundation/Orthopaedic Trauma Association (AO/OTA) fracture classification, presence of medial cortical defect, bone mineral density (T-score), Singh's index, relative lateral wall thickness (rLWT), tip-apex distance (TAD), neck-shaft angle, and fracture classification. The impact of differences in anteversion on long-term clinical outcomes, including Visual Analog Scale (VAS) pain scores and Harris Hip Scores (HHS), was assessed through follow-up evaluations.

Results: After screening for exclusion criteria, a total of 210 patients were enrolled in the study: 33 patients (15.7%) exhibited differences in anteversion exceeding 15°; 177 patients (84.3%) were under 15°. In the subgroup with version deviations <15°, precise anatomical restoration (anteversion ≤5°) was achieved in 138 cases (77.9%), consistent with optimal biomechanical reconstruction targets; functionally compensated malrotation (5° < anteversion <15°) occurred in 39 patients (22.1%), within the tolerance range for gait adaptation without clinical impairment. Single-nail fixation, medial cortical defects, T-score >2.5, rLWT and fracture classification were identified as the primary factors contributing to rotational displacement exceeding 15°. At the 1-year follow-up, patients with smaller rotational displacement demonstrated better functional recovery, as reflected by improved Visual Analog Scale (VAS) pain scores and Harris Hip Scores (HHS).The multivariate linear regression analysis demonstrated that the rLWT showed significant correlation with rotational displacement of fracture fragments after intramedullary nail fixation.

Conclusion: Bone rotation and displacement are frequently observed following intramedullary nail fixation for intertrochanteric fractures. The rLWT is closely associated with these complications. Therefore, meticulous attention to surgical technique is essential to minimize complications and optimize outcomes.

Objective: The presenting research aimed to assess the clinical results of hip pericapsular nerve group block (PENGB) combined with stellate ganglion block (SGB) on postoperative pain management and early rehabilitation in total hip arthroplasty (THA) patients.

Methods: There were 50 THA cases at our hospital inluded in the study. Twenty-five patients in the experimental group received general anesthesia combined with PENGB and SGB, while the remaining 25 patients in the control group received conventional general anesthesia. Mean arterial pressure and heart rate were recorded 30 min after the start of surgery and immediately postoperatively. The Numeric Rating Scale (NRS) scores for pain at rest and during movement were recorded at baseline (T0), 30 min (T1), 6 h (T2), 24 h (T3), and 48 h (T4) after the combined block was administered. The Athens Insomnia Scale (AIS) scores were recorded for 2 consecutive days postoperatively. Additionally, the number of analgesic pump presses, the time to first mobilization, patient satisfaction scores, and postoperative complications were documented.

Results: Compared with the control group, the experimental group exhibited more stable hemodynamics 30 min after the start of the operation and immediately postoperatively (P < 0.05). At T0, the 2 groups had no significant difference in NRS scores (P > 0.05). However, from T1 to T4, the experimental group had significantly lower NRS scores at rest and during movement, AIS scores for 2 consecutive days post-surgery, achieved earlier mobilization, shorter hospital stays, and reported higher overall satisfaction with hospitalization, all of which were statistically significant (P < 0.05). The postoperative complications rate of the 2 groups were similar (P > 0.05).

Conclusion: PENGB combined with SGB significantly enhances postoperative pain management, shortens hospital stay, and improves early rehabilitation outcomes in elderly patients undergoing total hip arthroplasty compared to conventional general anesthesia.

Background: Life-space mobility is defined as the spatial area traversed by an individual in daily life, extending from bedroom to locations beyond the individual's hometown, considering distance, frequency, and required assistance. The Life-Space Assessment (LSA) is used to evaluate life-space mobility. It has been reported that the LSA score after total hip arthroplasty (THA) shows an improvement relative to the preoperative score in patients with hip osteoarthritis. Symptoms and walking function also improve after THA. However, the association between these improvements and an increase in the LSA score after THA remains unclear. The purpose of this study was to identify the factors associated with an increase in the LSA score after THA in females with hip osteoarthritis.

Methods: This retrospective cohort study involved females planning to undergo primary and unilateral THA for hip osteoarthritis. The LSA score, subjective hip symptoms and function (assessed using the modified Harris hip score), and walking speed were assessed preoperatively and at 6 months postoperatively. Factors associated with the postoperative change in the LSA score were investigated using multiple regression analysis.

Results: A total of 120 participants were included. Improvement in walking speed (β = 0.19, P = 0.011) was significantly associated with the postoperative increase in the LSA score. The preoperative LSA score (β = -0.67, P < 0.001), age (β = -0.17, P = 0.011), and contralateral hip osteoarthritis (β = -0.15, P = 0.017) were also associated with the change in the LSA score.

Conclusions: The recovery of maximal walking speed, preoperative life-space mobility, age, and contralateral hip osteoarthritis influenced postoperative expansion of life-space mobility. Improved walking speed may serve as a key factor contributing to the expansion of life-space mobility following THA.

Background: Surgical treatment of proximal femoral fractures typically involves fixation with intramedullary nailing or sliding hip screws, where screws inserted into the femoral head stabilize the fracture site. However, few studies have quantitatively assessed the distribution of bone density and quality within the femoral head. We investigated the distribution of bone mineral density (BMD) within the proximal femoral head, evaluated inter-patient variability, and examined associated factors based on computed tomography (CT) values.

Methods: This multicenter prospective observational study included 100 patients with femoral trochanteric fractures. Preoperative CT images were obtained from the first lumbar vertebra to the distal end of the femur. Using 3D Slicer (version 7), the proximal uninjured femur was segmented and reconstructed into a 3D model. The volume and CT values (Hounsfield units [HU]) of the proximal femur and femoral head were measured. Additionally, CT values were used to assess the bone volume and distribution of low bone-density areas (0-100 HU) and high bone-density areas (≥300 HU) in the femoral head.

Results: The average bone volume and CT values of proximal femur and femoral head were 90,641 mm³ and 94 HU, and 32,316 mm³ and 131 HU, respectively. The volume of the femoral head with CT values ≥300 HU was 2967 mm³, accounting for 9.1% of the total volume (range: 0.1%-32.6%), with a distribution observed along the central region of the femoral head, particularly along the principal compressive trabeculae. Additionally, the average CT value of the femoral head (<100 HU, ≥300 HU) correlated with bone volume.

Conclusion: A distribution of CT values within the femoral head is characteristic of patients with femoral trochanteric fractures. Using HU values from CT imaging to predict bone fragility preoperatively may aid in assessing the risk of postoperative complications.

Introduction: Osteoarthritis (OA) is a prevalent chronic joint disease affecting approximately 7% of the global population, with increasing significance in aging populations. Sarcopenia and obesity, two interconnected age-associated conditions, have potential pathogenic roles in OA development, yet their precise interactions remain incompletely understood.

Material and methods: A cross-sectional analysis was conducted using National Health and Nutrition Examination Survey (NHANES) data from 1999-2006, focusing on 2309 participants aged 65 years and older. Sarcopenia and obesity were assessed via dual-energy X-ray absorptiometry-derived body composition measures, and OA status was determined through self-reported physician diagnoses. Multiple logistic regression models were employed to investigate the correlations between sarcopenia, obesity status, and the prevalence of OA.

Results: Sarcopenia was positively associated with OA, with an adjusted OR of 1.38 (95% CI: 1.07-1.79). Obesity demonstrated a consistent positive correlation with OA (adjusted OR: 1.31, 95% CI: 1.03-1.65). Subgroup analyses revealed nuanced associations, particularly among specific demographic groups such as non-Hispanic Black individuals and those with comorbidities like hypertension and diabetes.

Conclusions: The study reveals complex interrelationships between sarcopenia, obesity, and OA prevalence in older adults. The findings underscore the importance of body composition in joint health and suggest the need for targeted interventions considering demographic and clinical variations.