High reoperation and mortality rate after distal femoral replacement for periprosthetic knee fracture in the elderly.

PURPOSE: To analyze the outcomes of elderly patients with periprosthetic fractures around the knee operated on with a distal femur replacement (DFR). METHODS: We performed a retrospective case series study of eleven elderly patients who underwent DFR due to a periprosthetic fracture. Mean follow-up was 30.1 months (SD 28.1). Demographic, clinical and radiological data were reviewed. A descriptive analysis and a study of survival were conducted. Then, a comparative analysis between the patients who needed reoperation and did not need reoperation, and the patients who died and the patients who were alive during the follow-up was performed. RESULTS: Mean age was 77.1 years (SD 13.9). Reoperation rate was 36%, being infection the most common complication (27%). The risk of reoperation increased with a longer time between fracture and surgery. The 36.4% of patients died during the follow-up. Older age, need of blood transfusion and need of early reoperation were related to a higher risk of mortality. CONCLUSION: DFR could be a valuable option for knee periprosthetic fractures in elderly patients. However, surgeons should be aware of the high reoperation and mortality rate.

Preoperative mechanical axis has no influence on reoperation rate in primary rotating-hinge knee arthroplasty.

Background: The purpose of the study is to evaluate reoperation rate and its relationship to preoperative mechanical axis of rotating-hinge TKA used as the primary implant in complex knees. Methods: Patients subjected to primary TKA with a rotating-hinge knee prosthesis due to primary osteoarthritis between 2010 and 2019 were retrospectively reviewed. Preoperative mechanical axis was measured using the last preoperative telemetry x-ray image. Preoperative axis was classified according to the type of deformity (varus or valgus) and its magnitude (0-15°, 16-25° or >25°). Reoperation rate (with or without implant removal) was the primary outcome of the current study. We studied if the preoperative mechanical axis (either varus-valgus, or magnitude of malalignment) was related to implant survival rate. Results: Forty-two patients were included in the study. Mean follow-up was 51.42 ± 31.88 months. The 83.3% of patients presented a valgus axis while the 16.7% presented a varus axis. Need of reoperation occurred in eight patients (19.0%). However, no patients (0%) required implant removal with revision TKA. No association was seen between the preoperative mechanical axis and risk of reoperation (p = 0.16). Conclusion: In selected situations that do not permit less constrained implants, primary rotating-hinge arthroplasty could be a good alternative. Risk of reoperation does not seem to depend upon the preoperative mechanical axis when using a rotating-hinge knee prosthesis for primary arthroplasty in non-tumoral complex knees.

Nosocomial infection with SARS-CoV-2 and main outcomes after surgery within an orthopaedic surgery department in a tertiary trauma centre in Spain.

AIMS: The purpose of the present study is to analyse clinical data of a series of cases who developed nosocomial infection with SARS-CoV-2 in an orthopaedic and traumatology department. PATIENTS AND METHODS: In this non-interventional retrospective study, carried out at a tertiary hospital within the Spanish National Health System, all adult patients who were admitted in the Orthopaedic Surgery and Traumatology Department between March 9th and May 4th, 2020, were included. Clinical, biological and radiological data, as well as mortality rates, were collected from hospital medical records. RESULTS: A total of 293 periods of hospitalization were analysed in 288 patients. Mean age was 66.1 years old and 57.3% were females. Nineteen patients (6.48%) met the inclusion criteria to be categorized as a nosocomial infection with SARS-CoV-2. In a comparison between patients with and without nosocomial infection, age, mortality and hospital length of stay were statistically significant (p < 0.05). The median time from admission to diagnosis of SARS-CoV-2 infection in our cohort was 16 days (6-86 days). No statistically significant differences were found in sex, living situation, reason of admission or period of admission (even if we observed that most of the nosocomial infections (78.9%) occurred in March). CONCLUSION: We have found a 6.48% of nosocomial infection with SARS-CoV-2, but with an important reduction of it after undergoing preventing protocols that included screening RT-PCR test for COVID-19. Age and hospital length stay were statistically significant risk factors for nosocomial infection with SARS-CoV-2. For the progressive restoration of the surgical activity, we recommend to correctly select the patients in elective surgery and to encourage fast-track programs and early discharge of patients with fractures.