RESUMEN
Background: A recent National Joint Registry report suggests a higher local complication risk for dual-mobility (DM) total hip arthroplasty (THA) compared to conventional articulation THA. This report may be subject to data heterogeneity with multiple confounders. Controlling for these factors by matching demographic characteristics may give different results. We aim to compare 2-year local complication rates between matched DM and conventional THAs in primary hip osteoarthritis. Methods: Data were collected for consecutive primary THAs undertaken via a posterior approach. The conventional articulation and DM cohorts were matched 3:1 for age, gender, American Society of Anesthesiology grade, body mass index, and operative time using a propensity score and nearest neighbor matching method. Outcome measures were 2-year local complication rates, reoperation rates, systemic complication rates, and mortality rates. Demographic and outcome data were compared, and cumulative survival rates (%) were assessed using Kaplan-Meier methodology with a 2-year local complication as the endpoint. Statistical significance was set at P < .05. Results: Four hundred twelve THAs were included: 309 conventional and 103 DM articulations. There were no statistically significant differences between DM and conventional articulation THAs for local complications (7 [6.8%] vs 23 [7.4%], P = .820), reoperations (3 [2.9%] vs 4 [1.3%], P = .374), systemic complications (3 [2.9%] vs 4 [1.3%], P = .374), or 90-day mortality (1 [1%] vs 2 [0.6%], P = 1.000). Kaplan-Meier survival analysis demonstrated similar 2-year survival rates for conventional THAs compared to DM THAs (93.3% [standard error, 0.014] vs 91.9% [standard error, 0.031], P = .906). Conclusions: This matched study shows that there is no difference in local complication rates between DM and conventional THA articulations.
RESUMEN
Patients undergoing planned or unplanned orthopaedic procedures involving their upper or lower extremity can prevent them from safe and timely return to driving, where they commonly ask, 'Doctor, when can I drive?' Driving recommendations after such procedures are varied. The current evidence available is based on a heterogenous data set with varying degrees of sample size and markedly differing study designs. This instructional review article provides a scoping overview of studies looking at return to driving after upper or lower extremity surgery in both trauma and elective settings and, where possible, to provide clinical recommendations for return to driving. Medline, EMBASE, SCOPUS, and Web of Science databases were searched according to a defined search protocol to elicit eligible studies. Articles were included if they reviewed adult drivers who underwent upper or lower extremity orthopaedic procedures, were written in English, and offered recommendations about driving. A total of 68 articles were included in the analysis, with 36 assessing the lower extremity and 37 reviewing the upper extremity. The evidence available from the studies reviewed was of poor methodological quality. There was a lack of adequately powered, high quality, randomised controlled trials (RCTs) with large sample sizes to assess safe return to driving for differing subset of injuries. Many articles provide generic guidelines on return to driving when patients feel safe to perform an emergency stop procedure with adequate steering wheel control. In future, RCTs should be performed to develop definitive return to driving protocols in patients undergoing upper and lower extremity procedures.
RESUMEN
The aim of this study was to introduce a modern, engaging and easily accessible approach to medical education. A virtual journal club (VJC) was established for the orthopaedic trainees of Ethiopia using instant messaging via Viber. Group discussions included research articles, case reports and radiographs. In addition, senior participants posed quiz questions, with a leaderboard for best performance. Finally, a satisfaction survey was conducted using Google Forms. We have accumulated data from the first five months of educational activity with 73 participants. Seven articles were analysed and debated, covering a broad range of orthopaedic topics, with 56 messages per article on average and 60 quiz questions overall. Our survey received 20 responses, where 95% perceived the VJC as superior to the traditional journal club. Instant messaging is recommended as an educational tool, utilised as an effective VJC. It provides continuous interactive distance learning, without the restrictions of traditional methods.