The Changing Characteristics of Arthroplasty Patients: A Retrospective Cohort Study.

BACKGROUND: Total joint arthroplasty (TJA) is among the most common operations performed worldwide, with global volumes on the rise. It is important to understand if the characteristics of this patient population are changing over time for resource allocation and surgical planning. The purpose of this study is to examine how this patient population has changed between 2003 and 2017. METHODS: A retrospective review of a prospective TJA database was conducted. Age, gender, body mass index, comorbidities, American Society of Anesthesiologists class, responsible diagnoses, and comorbidities were compared over 5-year intervals between 2003 and 2017. All patients undergoing primary, elective TJA were included. RESULTS: Overall, 17,138 TJAs were included. Mean body mass index increased over the study period for total hip arthroplasty (THA; 29.4-30.4 kg/m2, P < .0001) and total knee arthroplasty (TKA; 32.0-3.1 kg/m2, P < .0001) patients. THA patients were significantly younger in more recent years (68.0-66.8 years old, P = .0026); this trend was not observed among TKA patients. Over the study period, a significantly higher proportion of patients were American Society of Anesthesiologists class III/IV for THA (50.5%-72.3%) and TKA (57.5%-80.7%) (P < .00001). Prevalence of common comorbidities did not change significantly. CONCLUSION: The key findings of this retrospective analysis of a large prospective database are that patients undergoing TJA are becoming younger and more obese. It is unclear whether patients are becoming more medically complex. These trends paint a concerning picture of a population that is increasingly complex, and may require a greater allocation of resources in the future. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Management of lower limb fractures in patients with spinal cord injuries.

BACKGROUND: Low-energy fractures of the lower limb in patients post spinal cord injury (SCI) present significant management challenges. This is the first Australian study to review the experience from a tertiary referral SCI centre and aims to identify trends and suggest therapeutic options. METHODS: Retrospective review over a 5-year period in patients with SCI treated for a lower limb fragility fracture. Patient demographics, spinal injury severity scores, fracture characteristics and treatment were assessed. Time to union, length of stay and treatment-related complications were also examined. RESULTS: A total of 38 SCI patients with 42 lower extremity fractures met inclusion criteria. Mean age was 55.7 years and mean duration post-SCI at fracture was 22.5 ± 12.7 years. The femur (73.8%) was more commonly fractured than the lower leg (26.2%), with extra-articular distal femoral fractures most prevalent (35.7%). A total of 25 (60%) fractures were managed operatively, and 17 (40%) non-operatively. The majority of femoral fractures were managed with intramedullary nailing. Tibial fractures were more commonly managed non-operatively. Eight cases (19.1%) experienced complications, with a significant difference between frequency of complications in non-operative (35.3%) and operative (8.0%) groups; P = 0.045. All fractures united except one; time to union was shorter in patients treated surgically (13.6 ± 6.4 weeks) compared to those managed non-operatively (19.1 ± 8.1 weeks). CONCLUSIONS: Lower limb fragility fractures in patients with SCI can be managed successfully via either operative or non-operative measures. In this series, fewer complications and shorter time to union were found in patients managed operatively.

Cost Comparison of Collagenase Clostridium Histolyticum and Fasciectomy for Treatment of Dupuytren's Contracture in the Australian Health System.

BACKGROUND: Dupuytren's disease results in contracted cords in the hand that lead to deformity and disability. Current treatment options include fasciectomy and an injectable, collagenase clostridium histolyticum. No cost comparison studies have been published within the Australian health care environment. METHODS: A retrospective review of all patients treated for Dupuytren's disease in a major teaching hospital was undertaken to compare the costs of treatment by fasciectomy or collagenase injection. RESULTS: Eighteen patients underwent fasciectomy and 21 collagenase clostridium histolyticum injections were performed during the study period and were eligible for inclusion under the review criteria. Of the 39 patients, 36 were male and 3 were female with an average age 66.4 years (50-85). Twenty-five digits were treated by fasciectomy in 18 patients, and 23 digits were treated by collagenase in 21 patients. The fasciectomy group attended an average 9.2 visits (5-22), incurring an average costing of US$5738.12 per patient ($3181.18-$9618.10). The collagenase group attended an average 3.8 visits (3-8), incurring an average costing of US$2076.83 per patient ($1842.24-$3929.57). CONCLUSIONS: Collagenase treatment of Dupuytren's contracture represents a significant reduction in cost relative to fasciectomy, with 64% savings, length of follow up and number of visits. This is a similar finding to studies in other countries.