In-hospital complications following primary total hip and knee arthroplasty in octogenarian and nonagenarian patients.

BACKGROUND: As life expectancy of patients increases, more elderly patients are undergoing primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). There is a general perception of increased risk of complications in elderly patients. Our objective was to analyse the incidence of in-hospital medical and surgical complications following THA and TKA in octogenarian and nonagenarians. MATERIALS AND METHODS: This was a prospective review of 202 consecutive patients aged more than 80 years who underwent total hip and total knee arthroplasty (101 THA, 101 TKA) over an 18-month period. In this single-centre observational study, collected data included patient demographics, American Society of Anethesiologists (ASA) grade, length of hospital stay and peri-operative medical and surgical complications during their hospital stay. RESULTS: Median age of patients was 83 years. Median ASA grade was 3. Mean length of hospital stay was 7.5 days. There were 14 major systemic complications in the THA group and 13 in the TKA group. While 1 major local complication occurred in each group, there were 6 minor local complications in THA and 7 in the TKA group. All the complications occurred within 5 post-operative days. There was no in-hospital mortality. CONCLUSION: In our study, we found that the incidence of peri-operative medical and surgical complications is higher in those over 80 years, compared to the published literature in patients of all age groups undergoing THA and TKA. Awareness of a higher incidence of major systemic complications should alert the treating surgeon to carry out comprehensive peri-operative management in this subset of patients, which could lead to better outcomes.

Magnifying loupes versus microscope for microdiscectomy and microdecompression.

STUDY DESIGN: Consecutive case series of 51 patients in each group--single-surgeon experience. OBJECTIVE: Comparing magnifying loupes and microscopes for microdiscectomy and microdecompression. SUMMARY OF BACKGROUND DATA: Prospective peroperative data and retrospective outcome data. METHODS: All patients had unilateral single-level magnetic resonance imaging-proven radicular pain. All relevant preoperative, peroperative, and postoperative data were collected prospectively, including operating time, complications, and return to the preprolapse functional level. Retrospective patient satisfaction, employment level, workman's compensation claim status, smoking status, pain, and functional outcome scores were collected through a telephonic interview. RESULTS: The microscope group was significantly (P < 0.05) better than the loupes group with respect to patient outcome and earlier return of the preprolapse functional level. Patient satisfaction scores, Visual Analogue Scores for pain, and rate of complications were also better in the microscope group but were not statistically significant at P < 0.05. CONCLUSIONS: Microscopes are better than loupes as they provide a much better visualization, are more comfortable for the surgeon, and are a much better teaching tool.