Archives of Orthopaedic and Trauma Surgery最新文献

Introduction

Same-day discharge total knee arthroplasty (TKA), although still only performed regularly in a few hospital trusts in England, is becoming more common. However, evidence is needed to show that same-day discharge TKA is safe. We aimed to use a nationwide administrative data source to investigate the safety of same-day discharge TKA.

Materials and methods

We extracted data from the Hospital Episodes Statistics database for the six years from 1st April 2017 to 31st March 2023. Patients undergoing primary elective TKA aged ≥ 17 years were included. The primary outcome was emergency readmission within 30 days of surgery. Average treatment effect on the treated (ATET) propensity score matching was used to compare outcomes for those operated on as same-day discharge and those with an overnight stay after adjusting for covariates.

Results

Data was available for 398,771 patients, of whom 3,718 (0.9%) were discharge on the same day that they were admitted. Rates of same-day discharge increased from 0.5% in 2017/18 to 1.6% in 2022/23. There was a significantly increased odds of all-cause 30-day readmission in same-day discharge patients across the entire six years (ATET 0.018, 95% confidence interval 0.011 to 0.025) but not for 2022/23 (ATET 0.009, 95% confidence interval (CI) -0.001 to 0.020). Complication rates (identified during index stay or 30-day emergency readmission) were significantly lower with same-day discharge across the six years (ATET − 0.008, 95% CI -0.012 to -0.003) and for 2022/23 only (ATET − 0.015, 95% CI -0.022 to -0.008). One year mortality rates (2022/23 data excluded) were not significantly different between the two groups (ATET 0.001, 95% CI -0.002 to 0.003). Comparing trusts with > 5% and 0% same-day discharge rates for 2022/23 outcomes were either no different or better in trust with a SDD rate > 5%.

Conclusions

Same-day discharge TKA is safe and outcomes have improved as the practice has become more common. Same-day discharge TKA may help to improve patient outcomes and increase the efficiency of the procedure.

Introduction

The purpose of this study was to identify the most frequent questions a patient might encounter in an internet search about robotic-assisted total knee arthroplasty (RATKA), and to identify and categorize the answers to these questions to assess the suitability of Chat Generative Pre-Trained Transformer (ChatGPT) and Google search engine as an online health information source for patients.

Methods

The 20 most frequently asked questions (FAQs) were identified by entering the search term “Robot-Assisted Total Knee Replacement” into both Google Search and ChatGPT-4. For Google, a clean search was performed, and the 20 FAQs were extracted from the “People also ask” section. For ChatGPT-4, a specific prompt was used to generate the 20 most frequently asked questions. All identified questions, along with the corresponding answers and cited references, were systematically recorded. A modified version of the Rothwell system was used to categorize questions into 10 subtopics. Each reference was categorized into the following groups: commercial, academic, medical practice, single surgeon personal, or social media. The questions and sources obtained from ChatGPT and Google were compared using Fisher’s exact test.

Results

The percentage distribution of questions by category between Google and ChatGPT was as follows: indications/management (15% vs. 25%), technical details (35% vs. 30%), evaluation of surgery (0% vs. 0%), risks/complications (5% vs. 5%), restrictions (10% vs. 0%), specific activities (15% vs. 5%), timeline of recovery (10% vs. 20%), pain (0% vs. 5%), longevity (0% vs. 0%), and cost (10% vs. 10%). Answers to questions were more frequently sourced from academic websites in ChatGPT compared to Google (70% vs. 20%; p-value = 0.0025).

Conclusion

ChatGPT offers a promising alternative to traditional search engines for patient education, particularly in the context of preparing for RATKA. Compared to Google, ChatGPT provided significantly fewer references to commercial content and offered responses that were more aligned with academic sources.

Level of evidence

Level IV, Survey study Internet sources.

Background

Painful, degenerative stiffening of the first metatarsophalangeal (MTP-1) joint, as seen in hallux rigidus, is common among athletic individuals due to repetitive microtrauma. While arthrodesis of the MTP-1 joint is considered the gold standard for advanced degeneration, the resulting loss of motion may impair sports and recreational activities. Implant arthroplasty, by preserving joint mobility, may offer functional benefits for active patients.

Methods

In accordance with PRISMA guidelines, a comprehensive literature search was conducted using PubMed, LIVIVO, the Cochrane Controlled Trials Library, Science Direct, CINHAL and Scopus. Studies reporting on sports function after MTP-1 arthrodesis or implant arthroplasty for degenerative arthritis were included. Fifteen studies with 1,103 procedures met the inclusion criteria. Sport-specific outcomes and functional scores were extracted and analyzed.

Results

Data on sports function following MTP-1 arthrodesis and implant arthroplasty are heterogeneous, limiting direct comparison. Arthrodesis studies reported return-to-sport rates of up to 100%, with a shift from high-impact to in-line activities. Implant arthroplasty showed similar return-to-sport rates, with potential short-term functional benefits. However, long-term superiority could not be demonstrated, and higher complication rates must be considered.

Conclusion

MTP-1 arthrodesis remains a reliable treatment for end-stage hallux rigidus, offering satisfactory long-term sports function. Implant arthroplasty may provide short-term advantages in active patients but carries a higher risk of complications and has not shown superior long-term outcomes in sports participation.

Introduction

This study aimed to examine the influence of temperature, humidity, and seasonal trends on periprosthetic joint infections (PJI) following total knee arthroplasty (TKA) over a 12-year period in a Mediterranean climate.

Methods

A retrospective cohort study was conducted on 5520 patients who underwent TKA between January 1, 2011, and December 31, 2022. Data were collected on patient demographics, surgical details, and PJI incidence, which were defined by Musculoskeletal Infection Society (MSIS) criteria. Meteorological data on daily average temperature and relative humidity were obtained for the same period. Statistical analyses were performed to assess the associations between PJI incidence, seasonal variations, temperature, and humidity.

Results

The overall incidence of PJI was 1.4%, with a significant downward trend over the 12 years (β coefficient= -0.115; p = 0.011). The highest PJI incidence (2%) was observed in winter, but no significant association was found between PJI incidence and seasonal variations (p = 0.080). The temperature range ≤ 5 °C had the highest PJI rate (6.7%), while the 20–25 °C range showed the lowest rate (0.4%). No significant effect of humidity levels on PJI incidence was identified (p = 0.174).

Conclusion

The study demonstrates a general decline in PJI incidence over time and suggests that colder temperatures are associated with higher PJI rates, with ≤ 5 °C posing the most significant risk. However, humidity and seasonal variations did not significantly influence infection rates. These findings underscore the importance of considering environmental factors like temperature when planning TKA procedures, particularly in regions with Mediterranean climates.

Level of evidence

Level III, Retrospective cohort study.

Anticholinergic burden is common in older adults and has been associated with adverse outcomes such as cognitive impairment and functional decline. Its long-term effect on surgical recovery after hip fracture, however, remains unclear. This study aimed to evaluate the association between anticholinergic burden at hospital admission and postoperative outcomes, including mortality, functional recovery, and readmissions, in older adults undergoing hip fracture surgery.

This retrospective observational study included patients aged ≥ 70 years who underwent surgical treatment for hip fracture between January 2017 and December 2018. Anticholinergic burden was quantified using the Anticholinergic Cognitive Burden (ACB) scale based on pre-admission medications, and patients were classified into two groups: low burden (ACB 0–2) and high burden (ACB ≥ 3). The primary outcome was 5-year all-cause mortality. Secondary outcomes included in-hospital complications, readmissions, and ambulatory recovery at 30 days and 6 months.

646 patients were included in the study; 206 (31.9%) had a high anticholinergic burden. Compared to those with low burden, high burden patients had greater comorbidity (Charlson Index 3.1 vs. 2.6, p = 0.005), poorer baseline function (Barthel Index 65.7 vs. 79.1, p < 0.001), and more frequent severe polypharmacy (≥ 10 drugs: 45.1% vs. 7.4%, p < 0.001). They experienced more in-hospital complications (56.8% vs. 47.5%, p = 0.028), and major complications (56.3% vs. 44.8%, p = 0.006). Functional recovery was significantly reduced, with fewer patients ambulatory at 30 days (59.7% vs. 72.8%, p = 0.002) and at 6 months (71.5% vs. 83.0%, p = 0.002). Readmissions were more frequent (2.2 vs. 1.7 per patient, p = 0.015). Five-year mortality was higher in the high burden group (71.8% vs. 47.0%, p < 0.001), with an adjusted HR of 1.56 (95% CI: 1.22–2.00). Median follow-up time was 1.425 days (IQR 450–1825).

High anticholinergic burden at admission is independently associated with increased long-term mortality, complications, readmissions, and poorer functional recovery after hip fracture surgery in older adults.

Purpose

Lateral locking-plate fixation is commonly used for distal femur fractures. Pre-contoured plates attempt to match the bony anatomy of the target patient population. However, plate fit is highly variable due to inter-subject morphological differences. If plate misfit is not recognised and addressed, axial malalignment may arise. This study evaluates the effects of age, sex, height, ethnicity, and femoral bowing on the anatomical fit of a distal femur plate.

Methods

Unilateral 3D models of 80 (40 male, 40 female) Caucasian and 79 (34 male, 45 female) Vietnamese femora were utilised. Both cohorts consisted of young (< 65 years) and old (≥ 65 years) subjects, with 40 young and 40 old Caucasian, and 36 young and 43 old Vietnamese. The plate undersurfaces of 9-, 11- and 13-hole LCP Distal Femur plate 3D models were positioned on bone models and anatomical fitting was assessed through application of developed clinical criteria.

Results

Satisfactory plate conformity was achieved from plate head up to hole 6, with most measurement locations fitting 52–100% of bones from both ethnicities. There was tendency towards proximal plate misfit from hole 8 onwards with 0–41% fit achieved in this region, and mean distances of 11.6 mm and 16.3 mm being observed at the proximal plate tip for Caucasians and Vietnamese respectively (p ≤ 0.017). Patient sex, height, ethnicity, and femoral bowing all had significant impacts on fit, while the effect of age was limited. Sex and ethnicity related height differences would suggest that patient height and femoral bowing are the main variables affecting fit.

Conclusions

The observed proximal plate misfit for both Caucasians and Vietnamese suggests LCP Distal Femur plates may exhibit less anatomical conformity than generally assumed. Where plates are used as a reduction tool, pre-operative templating of the intact contralateral femur may help identify plate misfit.

Introduction

This study investigated the association between medication status and total hip arthroplasty (THA) complications in patients with inflammatory bowel disease (IBD), considering varying illness severities.

Materials and methods

This retrospective analysis of the National Health Insurance Review and Assessment Service database in South Korea, included patients undergoing unilateral THA between 2012 and 2022, specifically those diagnosed with IBD. Propensity score matching was used to adjust for baseline characteristics between IBD and non-IBD cohorts, with a matching ratio of 1:10.

Results

There was a significant difference between the IBD (n = 962) and non-IBD matched groups (n = 9,620) in terms of chronic periprosthetic joint infection (PJI) (2.1 vs. 1.3%, P= 0.03) but not with acute PJI or other surgical complications (periprosthetic fracture, dislocation, and aseptic loosening). While medication use overall was not associated with PJI, only corticosteroid use among IBD medications was significantly associated with PJI among IBD medications (OR: 2.79 [1.03–10.68], P = 0.04). Specifically, multivariable analysis revealed that corticosteroid use within one year before THA was associated with a significant increase in PJI risk (OR: 3.30 [1.21–10.86], P = 0.02). Patients with IBD who were not using steroids did not show an increased risk of PJI.

Conclusions

While IBD increased the risk of chronic PJI, the risk was remarkable in patients using steroids, particularly in the context of poorly controlled IBD and acute flares-up. Preoperative steroid use within one year before THA conferred the greatest risk. Attention should be directed towards recognizing the risk of steroid use before THA.

Level of evidence

Level III, Prognostic.

Introduction

Lower extremity fractures are common orthopaedic injuries and often require surgical intervention, which has been shown to significantly impact both the physical recovery and psychological well-being of patients. Given the high prevalence of psychiatric disorders following lower extremity injuries, understanding the relationship between postoperative weight bearing restrictions and psychiatric outcomes is important for improving patient recovery. It was hypothesized that patients with lower extremity fractures who were allowed early weight bearing postoperatively would have lower rates of new-onset psychiatric diagnoses.

Methods

The TriNetX U.S Collaborative Network database was used to identify patients without prior psychiatric diagnoses who underwent either intramedullary nailing (IMN) or open reduction and internal fixation (ORIF) for femur and/or tibial fractures. The IMN and ORIF cohorts were matched based on age, sex, race, diabetes mellitus, and obesity. Psychiatric outcomes included depressive and anxiety disorders, substance use disorders, and psychotropic medication prescriptions. Outcomes were compared at early (1–7 days), intermediate (7 days-2 months), and long term (2 months-2 years) postoperative periods.

Results

After matching, 7410 patients per cohort were included (IMN n = 7410; ORIF n = 7410; total N = 14,820). The rates of developing a new early (1–7 days) postoperative psychiatric diagnosis did not differ significantly between the IMN and ORIF cohorts. However, IMN was associated with a significantly lower rate of depressive mood disorders during the intermediate period (0.65% vs. 1.0%, p = 0.02) and over the two-year follow-up (3.1% vs. 3.7%, p = 0.03). After two years, IMN was associated with lower opioid use disorder compared to ORIF (0.20% vs. 0.50%, p = 0.012). There were no significant differences in the rates of anxiety disorders, substance use disorders, or psychotropic medication prescriptions at any timepoints.

Conclusions

Early weight-bearing facilitated by IMN may be associated with a lower incidence of depressive mood disorders compared to delayed weight-bearing with ORIF. However, overall psychiatric outcomes were similar in this study. This suggests that other factors such as pain management and rehabilitation may play a more important role in postoperative psychiatric health.

Resection arthroplasty is a salvage procedure for uncontrolled deep infection of the shoulder. Previous studies have reported poor functional outcomes, especially in patients with rotator cuff deficiency. We hypothesized that, although overall outcomes might be limited, patients with preserved rotator cuff tendons could still achieve pain relief and functional improvement after resection arthroplasty.

Between 2001 and 2025, 69 patients underwent surgery for deep shoulder infection. Twenty-seven had resection arthroplasty, of whom 14 were excluded (infection after hemiarthroplasty, chronic infection without bone involvement, full-thickness cuff tear, or follow-up < 2 years). Thirteen patients (mean age, 57 years; range, 39–86) with native shoulders and intact or partial-thickness rotator cuff tears were analyzed. The mean follow-up was 48.8 months (range, 24–180). Pain [visual analogue scale (VAS) at rest and during motion], shoulder motion (active forward flexion, external rotation, internal rotation), and functional scores (University of California Los Angeles [UCLA], Constant) were assessed. Infection control was monitored with white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Pre- and postoperative values were compared using paired t-tests after normality testing.

VAS during motion improved from 6.5 to 2.3, and VAS at rest improved to 0.4. Forward flexion increased from 32.7° to 97.7°, and external rotation from 9.1° to 27.3° (all p < 0.01). UCLA and Constant scores improved from 9.6 to 29.4 to 25.7 and 60.6, respectively (p < 0.01). Ten of 13 patients reported satisfaction ≥ 6/10. One patient required additional debridement, but no reconstructive conversion was performed.

Resection arthroplasty in native shoulders with preserved rotator cuff tendons provided reliable infection control, substantial pain relief, and functional improvement at mid-term follow-up (24–180 months). These findings support its role as a salvage option when reverse shoulder arthroplasty is not feasible. Limitations include the retrospective design, small sample size, and heterogeneous follow-up period.

Level IV, retrospective study.