Outcomes of revision surgery for failed total ankle replacement: revision arthroplasty versus arthrodesis.

PURPOSE: To compare the short-term outcomes of surgical management of failed ankle arthroplasty with revision ankle arthroplasty and conversion to arthrodesis. METHODS: Single-centre retrospective review of revision procedures for failed ankle arthroplasty between January 2012 and June 2019. Implant survival, union rates, and PROMS data-Pain Visual Analogue Score (VAS), Ankle Osteoarthritis Score (AOS) and Manchester-Oxford Foot Questionnaire (MOxFQ)-were compared between the two groups. RESULTS: Twenty-nine patients (31 ankles) underwent surgical management for failed ankle arthroplasty, with either revision arthroplasty (n = 21) or arthrodesis (n = 10). Revision arthroplasty had 87% survival at four years. Arthrodesis had an overall union rate of 80%. Two-year PROMS showed greater results for the revision arthroplasty group compared with that for arthrodesis group (Pain VAS 10 vs 50, p = 0.03; total AOS 12 vs 87, p = 0.04; average MOxFQ 17 vs 73.5, p 0.02). CONCLUSION: Revision arthroplasty demonstrates good short-term survival data with improvements in PROMS compared with arthrodesis. Further long-term follow-up is required to monitor if these benefits continue.

Management of metacarpal shaft fractures.

Aims: The aims of this study were to describe the epidemiology of metacarpal shaft fractures (MSFs), assess variation in treatment and complications following standard care, document hospital resource use, and explore factors associated with treatment modality. Methods: A multicentre, cross-sectional retrospective study of MSFs at six centres in the UK. We collected and analyzed healthcare records, operative notes, and radiographs of adults presenting within ten days of a MSF affecting the second to fifth metacarpal between 1 August 2016 and 31 July 2017. Total emergency department (ED) attendances were used to estimate prevalence. Results: A total of 793 patients (75% male, 25% female) with 897 MSFs were included, comprising 0.1% of 837,212 ED attendances. The annual incidence of MSF was 40 per 100,000. The median age was 27 years (IQR 21 to 41); the highest incidence was in men aged 16 to 24 years. Transverse fractures were the most common. Over 80% of all fractures were treated non-surgically, with variation across centres. Overall, 12 types of non-surgical and six types of surgical treatment were used. Fracture pattern, complexity, displacement, and age determined choice of treatment. Patients who were treated surgically required more radiographs and longer radiological and outpatient follow-up, and were more likely to be referred for therapy. Complications occurred in 5% of patients (39/793). Most patients attended planned follow-up, with 20% (160/783) failing to attend at least one or more clinic appointments. Conclusion: MSFs are common hand injuries among young, working (economically active) men, but there is considerable heterogeneity in treatment, rehabilitation, and resource use. They are a burden on healthcare resources and society, thus further research is needed to optimize treatment.

Chin-on-Chest in Neck of Femur Fracture (COCNOF) sign: A simple radiographic predictor of frailty and mortality in hip fracture patients.

INTRODUCTION: Fragility fractures are a significant public health challenge often occurring as a result of frailty. Identifying patients who have increased risk of adverse outcomes can aid treating teams in managing these patients appropriately. We hypothesise that the appearance of the patient's head overlapping the lung fields (named Chin on Chest in Neck of Femur sign (COCNOF)) in the admission chest radiograph was a predictor of increased mortality at 3, 6 and 12 months. METHODS: All consecutive patients admitted with hip fracture between 1st January - 31st December 2019 were analysed. We collected patient characteristics, AMTS score, ASA grade, length of stay, place of discharge, Nottingham Hip Fracture Score, Rockwood Frailty score, Charlson Comorbidity Index and presence of COCNOF sign. The main outcome measures were mortality at 90 days, six months and 12 months following admission. RESULTS: 469 patients with a mean age of 81.9 (SD 8.4) were included. 18% of patients were COCNOF positive. Univariate analysis showed positive COCNOF sign to be associated with higher mortality at 90 days (19.1 vs 10.8%; RR 1.95, 95%CI 1.05 - 3.63,p=0.03), six months (31.5% vs 14.2%; RR 2.77, 95%CI 1.62 - 4.72, p<0.001) and twelve months (41.6% vs 17.1%; RR 3.45, 95%CI 1.62-4.72, p<0.001). In the multivariate regression models the strongest predictors of mortality were age, gender and CCI it is therefore likely that the COCNOF sign is acting as a surrogate marker of these variables within the univariate models. CONCLUSION: Our results suggest that COCNOF sign is a simple radiographic marker which can be used to identify patients with higher levels of frailty and increased risk of mortality following hip fracture.

Scoping review: Diagnosis and management of periprosthetic joint infection in shoulder arthroplasty.

BACKGROUND: The aim of this scoping review is to assess the current evidence regarding periprosthetic shoulder infection to inform development of evidence and consensus-based guidelines. METHODS: A search of Medline, Embase and PubMed was performed; two authors screened the results independently for inclusion. RESULTS: Totally 88 studies were included. Incidence of periprosthetic shoulder infection ranged from 0.7% to 7%. The most common organisms to cause periprosthetic shoulder infection were Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus. Male gender and younger age are the most reported risk factors. Erythrocyte sedimentation rate, C-reactive protein and serum/synovial biomarkers had limited diagnostic accuracy. Thirty-nine studies reported the outcome of surgical management of periprosthetic shoulder infection. Eradication rates vary from 54% to 100% for debridement procedures; 66-100% for permanent spacers; 50-100% following single-stage revision; 60-100% following two-stage revision; and 66-100% following resection arthroplasty. CONCLUSION: There is wide heterogeneity in study designs and outcomes of studies are often contradictory and due to issues with methodology and small sample sizes the optimal pathways for diagnosis and management cannot be determined from this review. Future research should be based on larger cohorts and randomised trials where feasible to provide more valid research for guiding future treatment of periprosthetic shoulder infection.