Trends in the Use of Total Hip Arthroplasty in the Pediatric Population: A Review of the Literature.

Current literature shows that the utilization of total hip arthroplasty (THA) to address pediatric hip pathology has seen a significant rise worldwide in recent decades. However, performing THA in pediatric patients presents unique challenges due to their increased activity levels, varying skeletal maturity, and diverse medical conditions. These challenges have relegated THA to a secondary option for young patients. Nonetheless, despite these difficulties, recent studies have demonstrated a growing prevalence of THA in pediatrics. Consequently, there is an urgent need for a comprehensive review of the existing literature on this topic. In this study, we examined large database and single-institution studies involving pediatric patients aged 21 years and under who underwent THA. The primary indications for THA in this population were osteoarthritis, osteonecrosis, and inflammatory arthritis. To ensure informed decision-making for pediatric patients, it is crucial to gather consolidated information on trends and outcomes related to THA indications. This review aims to provide insights into these trends and facilitate better decision-making for the treatment of pediatric patients.

Comparison of Arthroscopy versus Open Arthrotomy for Treatment of Septic Arthritis of the Native Knee: Analysis of 90-Day Postoperative Complications.

Septic arthritis is an orthopaedic emergency, often necessitating surgical debridement, and the knee joint is most frequently affected. Arthroscopic and open irrigation and debridement (I&D) are the two commonest surgical treatments for septic arthritis of the native knee. Several studies have compared outcomes of open and arthroscopic management without coming to a clear conclusion which yields superior outcomes. The purpose of this study was to compare the results of these two surgical techniques to treat septic arthritis of the native knee using a large nationwide database. Patients who underwent arthroscopic or open I&D as treatment for knee septic arthritis from 2010 to 2019 were identified using a national insurance database. The primary outcome was the 90-day reoperation rate. Secondary outcomes included surgical site infection, readmission, and other postoperative complications. A total of 1,139 patients were identified, 618 of whom (54%) underwent open treatment and 521 (46%) underwent arthroscopic treatment. The two groups did not differ significantly by age, gender, or most comorbidities. There was no significant difference in 90-day reoperation rate between the groups (15.0.% open and 18.0% arthroscopic, p = 0.174). Patients who underwent open treatment had increased odds of readmission to the hospital (odds ratio [OR] = 1.46 [1.14-1.86]; p = 0.003), postoperative anemia (OR = 1.71 [1.08-2.75]; p = 0.025), and blood transfusion (OR = 1.76 [1.04-3.06]; p = 0.040) compared with those who underwent arthroscopic surgery. Using administrative claims data, we found that arthroscopic and open I&D have similar rates of reoperation and most 90-day postoperative outcomes. Lower rates of readmission, postoperative anemia, and blood transfusion were found with arthroscopic I&D, suggesting that arthroscopy may be preferable to open treatment in the management of septic arthritis of the native knee in cases in which other case- and surgeon-specific factors do not otherwise dictate the best treatment modality.

Developmental delay: is this pediatric patient population at risk for complications following open treatment of femoral shaft fracture?

PURPOSE: Femoral shaft fractures are common in the pediatric population, accounting for over 20% of inpatient pediatric fractures. Patients with developmental delays are a population group whose medical care and recovery come with a unique set of considerations and challenges. The purpose of this study was to evaluate the impact of developmental delay on outcomes following open treatment of femoral shaft fractures in the pediatric population. METHODS: Pediatric patients undergoing open treatment of femoral shaft fracture from 2012 to 2019 were identified in the National Surgical Quality Improvement Program-Pediatric database. Patients were divided into two groups: patients with developmental delay and patients without developmental delay. Patient demographics, comorbidities, and various postoperative outcomes were compared between the two groups using bivariate and multivariate analyses. RESULTS: Of the 5896 pediatric patients who underwent open treatment of femoral shaft fracture, 5479 patients (92.9%) did not have developmental delay whereas 417 (7.1%) had developmental delay. Patients with developmental delay were more likely to have other medical comorbidities. Following adjustment on multivariable regression analysis to control for the baseline differences between the two groups, patients with developmental delay had an increased risk of readmission to the hospital (OR 4.762; p = 0.014). CONCLUSION: Developmental delay in the pediatric population was found to be an independent risk factor for hospital readmission following open treatment of femoral shaft fractures. Taking these patients into special consideration when evaluating the optimal treatment plan can be beneficial to reduce the risks of readmission, which can decrease costs for both the patient and the hospital.