Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement.

BACKGROUND: Due to demographic change, the number of older people in Germany and worldwide will continue to rise in the coming decades. As a result, the number of elderly and frail patients undergoing total hip and knee arthroplasty is projected to increase significantly in the coming years. In order to reduce risk of complications and improve postoperative outcome, it can be beneficial to optimally prepare geriatric patients before orthopaedic surgery and to provide perioperative care by a multiprofessional orthogeriatric team. The aim of this comprehensive interventional study is to assess wether multimorbid patients can benefit from the new care model of special orthopaedic geriatrics (SOG) in elective total hip and knee arthroplasty. METHODS: The SOG study is a registered, monocentric, prospective, randomized controlled trial (RCT) funded by the German Federal Joint Committee (GBA). This parallel group RCT with a total of 310 patients is intended to investigate the specially developed multimodal care model for orthogeriatric patients with total hip and knee arthroplasty (intervention group), which already begins preoperatively, in comparison to the usual orthopaedic care without orthogeriatric co-management (control group). Patients ≥70 years of age with multimorbidity or generally patients ≥80 years of age due to increased vulnerability with indication for elective primary total hip and knee arthroplasty can be included in the study. Exclusion criteria are age < 70 years, previous bony surgery or tumor in the area of the joint to be treated, infection and increased need for care (care level ≥ 4). The primary outcome is mobility measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are morbidity, mortality, postoperative complications, delirium, cognition, mood, frailty, (instrumental) activities of daily living, malnutrition, pain, polypharmacy, and patient reported outcome measures. Tertiary outcomes are length of hospital stay, readmission rate, reoperation rate, transfusion rate, and time to rehabilitation. The study data will be collected preoperative, postoperative day 1 to 7, 4 to 6 weeks and 3 months after surgery. DISCUSSION: Studies have shown that orthogeriatric co-management models in the treatment of hip fractures lead to significantly reduced morbidity and mortality rates. However, there are hardly any data available on the elective orthopaedic care of geriatric patients, especially in total hip and knee arthroplasty. In contrast to the care of trauma patients, optimal preoperative intervention is usually possible. TRIAL REGISTRATION: German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.

Radiological outcome of postoperative sagittal balance on standing radiographs in comparison to intraoperative radiographs in prone position when performing lumbar spinal fusion.

PURPOSE: Aim of this study is to show the outcome of postoperatively measured lumbar lordosis in upright position in comparison to the intraoperatively estimated lumbar lordosis in prone position, as the lumbar lordosis is one of the most important factors for the clinical outcome after spinal fusion. MATERIALS AND METHODS: Eighty-two patients, receiving lumbar fusion were included in this retrospective study. Intraoperative radiographs were scanned. Then radiographs of the whole spine pre- and postoperatively, as well as 1 year after surgery were measured by a spine surgeon and a radiologist. The visible segment lordosis angles were measured and compared (L2-S1, L3-S1, L4-S1, L5-S1). In addition, the pelvic parameters pelvic incidence, pelvic tilt and sacral slope were measured pre- and postoperatively. RESULTS: The intraobserver reliability was almost perfect. The mean lordosis angle L4-S1 was 32.6° ± 7.8° intraoperatively and 29° ± 10.8° postoperatively. A linear correlation of these two measurements can be seen. In mean, the postoperative lordosis is 4° smaller than intraoperatively. This trend can also be seen in the level L3-S1. In levels L2-S1 and L5-S1 the postoperative values were slightly higher than intraoperatively, but without any significance. Also, 1 year after surgery there were no significant changes in global lumbar lordosis. CONCLUSION: Measuring lordosis angles intraoperatively resulted in almost the same values as measurements in standing plane radiographs postoperatively, despite prone position. These findings could especially be shown for the level L4-S1. The intraobserver reliability was almost perfect for both, intra- and postoperative measurements. In conclusion, the intraoperative measurement of a lumbar lordosis angle can perfectly predict the postoperative result.