الملخص
Introducción El propósito de este estudio es determinar si los pacientes con artrosis severa intervenidos con artroplastia de rodilla o cadera ponen en riesgo su expectativa de vida. Método Se diseñó un estudio de sobrevida el cual fue aprobado por el comité de ética de nuestra institución. Los pacientes fueron incluidos si fueron intervenidos de artroplastia de rodilla y cadera por artrosis severa y tenían más de 50 años. Los pacientes fueron excluidos si la artroplastia se realizó por fractura, hemofilia o un tumor. Una regresión multiparamétrica de Weibull fue estimada, siendo reportado el hazard ratio. Un bootstrap de 200 repeticiones fue realizada para validación interna. Resultados Un total de 4094 artroplastias fueron incluidos. La curva de Kaplan-Meier estima una mayor sobrevida que la población general hasta los 12 años, luego de lo cual la mediana de sobrevida es menor que la de la población general. La regresión multiparamétrica de Weibull estimó hazard ratios de 1,53 (intervalo de confianza 95%: 1,27 a 1,84) en mujeres, de 1,09 (1,08 a 1,10) por cada año de edad y de 1,29 (1,07 a 1,53) en artroplastia de cadera. Conclusión La mortalidad después de una intervención de artroplastia de rodilla o cadera sigue un comportamiento bimodal respecto a la población general similar a series reportadas en Estados Unidos y Suecia. Inicialmente la sobrevida es mayor que la población general, pero es menor luego de 12 a 15 años.
Background The purpose of this study is to determine if patients with osteoarthritis that undergo hip or knee arthroplasty jeopardize their life expectancy in Chile. Methods A survival analysis study was designed and approved by our institutional ethics review board. Patients were included if they underwent surgery for hip or knee osteoarthritis and were 50 years or older at the time of surgery. Patients were excluded if arthroplasty was performed for fracture, hemophilia arthropathy, or tumor. A multiparametric Weibull regression was estimated, and the hazard ratio was reported. For internal validity, a bootstrap of 200 repetitions was performed. Results A total of 4 094 arthroplasties were included. The Kaplan-Meier curve estimates a higher survival than the general population up to 12 years, after which the median survival is less than the general population. The bootstrap multiparametric Weibull regression estimated a hazard ratio of 1.53 (95% confidence interval: 1.27 to 1.84) for women, 1.09 (1.08 to 1.10) for every year older, and 1.29 (1.07 to 1.53) for hip arthroplasty patients. Conclusion Mortality after hip and knee arthroplasty in Chile follows a bimodal behavior similar to reports from the United States and Europe. At first, mortality is lower than the general population but worsens after 12 to 15 years of surgery.
الموضوعات
Humans , Male , Female , Aged , Aged, 80 and over , Osteoarthritis, Hip/surgery , Arthroplasty, Replacement, Hip/mortality , Arthroplasty, Replacement, Knee/mortality , Osteoarthritis, Knee/surgery , Postoperative Complications , United States , Osteoarthritis, Hip/mortality , Survival Analysis , Chile/epidemiology , Osteoarthritis, Knee/mortality , Kaplan-Meier Estimateالملخص
PURPOSE To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. METHODS Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. RESULTS A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. CONCLUSION To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.
الموضوعات
Humans , Male , Female , Adolescent , Adult , Young Adult , Osteotomy/methods , Arthroscopy/methods , Hip Dislocation, Congenital/surgery , Acetabulum/surgery , Osteotomy/adverse effects , Follow-Up Studies , Treatment Outcome , Hip Dislocation, Congenital/diagnostic imagingالملخص
PURPOSE: To describe the incidence of hip fracture in Chile during 2017, identify risk factors for in-hospital mortality, and estimate annual case fatality rate. METHOD: The study design was cross-sectional and analytical. We obtained the registries of all patients from the Chilean Ministry of Health who were treated for hip fracture between January 1, 2017, and December 31, 2017. We used multivariate logistic regression to estimate the risk factors for in-hospital mortality. The annual case fatality rate was calculated using the probabilities obtained by estimating a logistic regression model in previous work. The estimated crude mortality rate per 100 000 persons was compared with that of cancer, as reported by the Ministry of Health. RESULTS: During 2017, 7421 hip fractures occurred, resulting in an incidence of 40 per 100 000 persons. Of these, 1574 (21.21%) cases did not undergo surgery. In-hospital mortality was found to be associated with no surgery (odds ratio 8.32, 6.20 to 11.17), and being treated in a public hospital (odds ratio 1.62, 1.00 to 2.68). The estimated annual case fatality rate was 0.30 (0.27 to 0.33), and the crude mortality rate per 100 000 persons was 10.78 (9.66 to 11.71). CONCLUSION: Hip fractures mainly affect the population over 60 years old and women. Chile has an excessively high rate of non-operated patients compared to international reports. There is a significant difference between care in a public hospital compared to private clinics in terms of volume, access to surgery, hospital stay, in-hospital mortality, and estimated case fatality rate.
OBJETIVOS: Describir la incidencia de fractura de cadera en Chile durante el año 2017, identificar factores de riesgo para mortalidad intrahospitalaria y estimar la letalidad anual. MÉTODO: Estudio transversal analítico. Se solicitó al Ministerio de Salud de Chile el registro de todos los pacientes en Chile que fueron hospitalizados por fractura de cadera entre el 1 de enero y el 31 de diciembre de 2017. Para estimar los factores de riesgo para mortalidad intrahospitalaria se estimó una regresión logística multivariada. La tasa de letalidad anual fue estimada usando las probabilidades obtenidas por estimación modelo de regresión logística de un trabajo previo. Se comparó la tasa cruda de mortalidad estimada por 100 000 habitantes con la de cáncer reportada por el Ministerio de Salud. RESULTADOS: Durante 2017 ocurrieron 7421 fracturas de cadera, obteniendo una incidencia de 40 por cada 100 000 habitantes. Un total de 1574 (intervalo de confianza 95%: 21,21%) pacientes no recibieron cirugía. La mortalidad intrahospitalaria se asocia a no cirugía (Odds ratio 8,32; intervalo de confianza 95%: 6,20 a 11,17) y a ser atendido en una institución pública (Odds ratio 1,62; intervalo de confianza 95%: 1,00 a 2,68). La tasa de letalidad al año estimada es de 0,30 (intervalo de confianza 95%: 0,27 a 0,33) y la tasa cruda de mortalidad por 100 000 habitantes es de 10,78 (intervalo de confianza 95%: 9,66 a 11,71). CONCLUSIÓN: La fractura de cadera afecta principalmente a población mayor de 60 años y mujeres. Chile presenta una alta tasa de pacientes no operados comparado con reportes internacionales. Existe una diferencia significativa entre atenderse en la red pública y privada, independiente de la previsión en términos de volumen, acceso a cirugía, estadía hospitalaria, mortalidad intrahospitalaria y tasa de letalidad estimada.