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BACKGROUND: Manufacturers of implants and materials in the field of orthopaedics use significant amounts of funding to produce informational material to influence the decision-making process of orthopaedic surgeons with regards to choice between novel implants and techniques. It remains unclear how far orthopaedic surgeons are really influenced by the materials supplied by companies or whether other, evidence-based publications have a higher impact on their decision-making. The objective was to evaluate the subjective usefulness and usage of different sources of information upon which orthopaedic surgeons base their decisions when acquiring new implants or techniques. METHODS: We undertook an online survey of 1174 orthopaedic surgeons worldwide (of whom n = 305 were head of their department). The questionnaire included 34 items. Sequences were randomized to reduce possible bias. Questions were closed or semi-open with single or multiple answers. The usage and relevance of different sources of information when learning about and selecting orthopaedic treatments were evaluated. Orthopaedic surgeons and trainees were targeted, and were only allowed to respond once over a period of two weeks. Baseline information included country of workplace, level of experience and orthopaedic subspecialisation. The results were statistically evaluated. RESULTS: Independent scientific proof had the highest influence on decisions for treatment while OEM (Original Equipment Manufacturer) driven activities like newsletters, white papers or workshops had the least impact. Comparison of answers from the three best-represented countries in this study (Germany, UK and USA) showed some significant differences: Scientific literature and congresses are significantly more important in the US than in the UK or Germany, although they are very important in all countries. CONCLUSIONS: Independent and peer-reviewed sources of information are preferred by surgeons when choosing between methods and implants. Manufacturers of medical devices in orthopaedics employ a considerable workforce to inform or influence hospital managers and leading doctors with marketing activities. Our results indicate that it might be far more effective to channel at least some of these funds into peer-reviewed research projects, thereby assuring significantly higher acceptance of the related products.
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Acceso a la Información , Conducta de Elección , Técnicas de Apoyo para la Decisión , Procedimientos Ortopédicos , Selección de Paciente , Actitud del Personal de Salud , Distribución de Chi-Cuadrado , Educación Médica Continua , Medicina Basada en la Evidencia , Encuestas de Atención de la Salud , Conocimientos, Actitudes y Práctica en Salud , Humanos , Internet , Procedimientos Ortopédicos/educación , Procedimientos Ortopédicos/instrumentación , Procedimientos Ortopédicos/métodos , Encuestas y CuestionariosRESUMEN
This retrospective cohort study of a National Joint Registry data examines survival time to revision following the commonest brand of primary hybrid THA, exploring risk factors independently associated with failure. Overall 5-year revision was 1.56%. In the final adjusted model, revision risk was significantly higher with standard polyethylene (PE) liners (metal-on-PE: hazard ratio [HR]=2.52, P=0.005, ceramic-on-PE: HR=2.99, P=0.025) when compared to metal-on-highly-cross-linked (XL) PE. Risk of revision with ceramic-on-ceramic bearings was borderline significant (HR=1.86, P=0.061). A significant interaction between age and acetabular shell type (solid or multi-hole) was found (P=0.022), suggesting that solid shells performed significantly better in younger patients. In summary, we found that there were significant differences in implant failure between different bearing surfaces and shell types after adjusting for a range of covariates.
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Artroplastia de Reemplazo de Cadera/métodos , Prótesis de Cadera , Reoperación/estadística & datos numéricos , Anciano , Cerámica , Femenino , Humanos , Masculino , Metales , Polietileno , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Diseño de Prótesis , Falla de Prótesis , Infecciones Relacionadas con Prótesis/epidemiología , Infecciones Relacionadas con Prótesis/cirugía , Sistema de Registros , Estudios Retrospectivos , Factores de Riesgo , Tasa de Supervivencia , Reino Unido/epidemiologíaRESUMEN
Recurrence of anterior instability after a Latarjet procedure with persistent glenoid bone loss can be related to coracoid bone block resorption, migration, or malposition. Multiple options are available to address anterior glenoid bone loss, including autograft bone transfers (such as iliac crest graft, distal clavicle autograft) or allografts (distal tibia allograft). Here, we present the use of the remnant coracoid process as an option for consideration in the treatment of glenoid bone loss after failed Latarjet procedure with persistent glenoid bone loss. The remnant coracoid autograft is harvested and transferred inside the glenohumeral joint, through the rotator interval, and fixed using cortical buttons. This arthroscopic procedure includes using 1) glenoid and coracoid drilling guides to optimize graft positioning and making the procedure more reproducible and safer and 2) a suture tensioning device to provide intraoperative graft compression and ensure bone graft healing.
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PURPOSE: To compare a 3-dose cefuroxime regimen with a single-dose gentamicin and amoxicillin regimen as antibiotic prophylaxis for hip hemiarthroplasty in terms of microbiological outcome. METHODS: Records of 2 matched groups of patients who underwent hip hemiarthroplasty for femoral neck fractures were reviewed. 29 men and 84 women (mean age, 82 years) who received a 3-dose cefuroxime regimen in 2006 were compared with 23 men and 84 women (mean age, 83 years) who received a single-dose gentamicin and amoxicillin regimen in 2008. Patient demographics, antibiotics prescribed in the peri- and immediate postoperative period, microbiological evidence for Clostridium difficile 'infection', length of hospital stay, mortality, as well as biochemical and haematological findings were reviewed. RESULTS: The 3-dose cefuroxime group was significantly higher in terms of the mean length of hospital stay (17 vs. 13 days, p=0.043) and the percentage of patients receiving postoperative antibiotics (88% vs. 68%, p<0.001) and having C difficile 'infection' (6% vs. 0%, p=0.016). If patients with C difficile 'infection' were excluded, there was no significant difference in the length of hospital stay. CONCLUSION: The single-dose gentamicin and amoxicillin regimen was associated with a lower C difficile 'infection' rate.
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Amoxicilina/administración & dosificación , Profilaxis Antibiótica/métodos , Cefuroxima/administración & dosificación , Infecciones por Clostridium/prevención & control , Gentamicinas/administración & dosificación , Fracturas de Cadera/cirugía , Infección de la Herida Quirúrgica/prevención & control , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/microbiología , Relación Dosis-Respuesta a Droga , Quimioterapia Combinada , Femenino , Fijación Interna de Fracturas/efectos adversos , Humanos , Tiempo de Internación/tendencias , Masculino , Infección de la Herida Quirúrgica/microbiología , Resultado del TratamientoRESUMEN
BACKGROUND: All hip fracture patients with a cardiac murmur have an echocardiogram as a part of their preoperative work-up in our unit. We performed a retrospective audit to assess the impact of obtaining a pre-operative echocardiogram on the management of hip fracture patients. METHODS: All hip fracture patients (N = 349) between 01/06/08 and 01/06/09 were included in the study. 29 patients had pre-operative echocardiogram (echo group). A computer generated randomised sample of 40 patients was generated from N, 'non-echo' group. Data was obtained from medical records and the Hospital Information Support System (HISS). The groups were compared using Student's t test. Approval was obtained locally from the clinical governance department for this project. RESULTS: Age and gender distribution were similar in both groups. Indication for echo was an acute cardiac abnormality in 4 cases. 25 patients had echo for no new cardiac problem (indication being cardiac murmur in 23 patients and extensive cardiac history in 2 cases). Cardiology opinion was sought in 5 cases. No patient required cardiac surgery or balloon angioplasty preoperatively. Patients having pre-operative echo had significant delay to surgery (average 2.7 days, range 0-6 days) compared to 'non-echo' group (average 1.1 days, range 0-3 days), (p < 0.001). There was no significant difference in length of stay (p = 0.14) and mortality at 30 days (p = 0.41) between the groups. CONCLUSION: We have developed departmental guidelines for expediting echo requests in hip fracture patients with cardiac murmur. A liaison has been established with our cardiology department to prioritise such patients on the Echocardiography waiting list, to prevent unnecessary avoidable delay. Careful patient selection for pre-operative echocardiography is important to avoid unnecessary delay to surgery.
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Auditoría Clínica , Fijación de Fractura , Soplos Cardíacos/diagnóstico por imagen , Fracturas de Cadera/cirugía , Periodo Preoperatorio , Anciano , Anciano de 80 o más Años , Ecocardiografía/normas , Femenino , Cardiopatías/diagnóstico por imagen , Humanos , Masculino , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Factores de TiempoRESUMEN
We report a 20-year-old man who sustained lumbar fractures involving 5 vertebrae following a road traffic accident. He was initially treated non-operatively to allow multiple pedicles to heal. He developed post-traumatic kyphosis for which corrective osteotomy and posterior spinal instrumented fusion was performed. He achieved a good functional outcome. We emphasise the need for careful radiological evaluation in patients with high-energy trauma, and the option of treating such complex injuries by non-operative means. If post-traumatic kyphosis develops, it can be dealt with later and the most mobile segments of the lumbar spine can be preserved.
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Vértebras Lumbares/lesiones , Traumatismo Múltiple/cirugía , Osteotomía , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral , Accidentes de Tránsito , Adulto , Humanos , Cifosis/etiología , Cifosis/cirugía , Vértebras Lumbares/diagnóstico por imagen , Masculino , Fracturas de la Columna Vertebral/diagnóstico por imagen , Tomografía Computarizada por Rayos XRESUMEN
Fracture of the coracoid process is a rare injury. It can be easily missed when associated with other injuries to the shoulder girdle, for instance, acromioclavicular joint (ACJ) dislocation. Clinical attention is easily drawn to the more obvious ACJ dislocation, hence, the need for further radiological evaluation. We report an unusual case of fracture of the base of coracoid process associated with a true acromioclavicular joint dislocation in a 12 year old boy, with no separation of the epiphyseal plate, as one might expect. Treatment also remains controversial. Our patient underwent open reduction internal fixation of the acromioclavicular joint and coracoid process. He subsequently made an uneventful progress with pain free full range of shoulder movement at 5 months, and was discharged at 9 months.