Dementia and Hip Fractures: A Comprehensive Review of Management Approaches.

¼ The elderly population is the fastest growing demographic, and the number of dementia cases in the United States is expected to double to 10 million by 2050.¼ Patients with dementia are at 3× higher risk of hip fractures and have higher morbidity and mortality after hip fractures.¼ Hip fracture patients with dementia benefit from early analgesia and timely surgical fixation of fracture.¼ Early and intensive inpatient rehabilitation is associated with improved postoperative outcomes in patients with dementia.¼ Coordination of care within a "orthogeriatric" team decreases mortality, and fracture liaison services show potential for improving long-term outcomes in hip fracture patients with dementia.

Cemented total knee arthroplasty provides greater knee range of motion at 2 years than cementless technique.

INTRODUCTION: Optimal fixation method between cemented, cementless, and hybrid techniques for total knee arthroplasty (TKA) is still debated. The purpose of this study is to evaluate the clinical outcomes of patients undergoing cemented versus cementless TKA. METHODS: We reviewed 168 patients who underwent a primary TKA at a single academic institution between January 2015 and June 2017. Patients were categorized into cemented (n = 80) or cementless (n = 88) groups. Only patients with greater than or equal to 2-year follow-up were included in the study. Multivariate regressions were performed to analyze the relationship between the surgical fixation technique and the clinical outcomes. RESULTS: There were no differences in demographics or baseline operative characteristics between the two groups. The cemented group had fewer manipulations under anesthesia (MUA) (4 vs. 15, p = 0.01), longer intraoperative tourniquet times (101.30 vs. 93.55 min, p = 0.02), and increased knee range of motion (ROM) at final follow-up (111.48 vs. 103.75°, p = 0.02) compared to the cementless group. DISCUSSION AND CONCLUSION: Both cemented and cementless component fixation are viable options for (TKA). This study found that patients who underwent a cemented TKA required fewer MUA's and had greater final ROM compared to patients undergoing cementless TKA. Additional research is required regarding cementless and cemented fixation. We believe that the choice of which fixation technique to use ultimately comes down to patient characteristics and surgeon preference.

A comparison of outcomes for above-knee-amputation and arthrodesis for the chronically infected total knee arthroplasty: a systematic review.

INTRODUCTION: Several strategies have been shown to have some efficacy in the chronically infected total knee arthroplasty (TKA): chronic antibiotic suppression, a second two-stage revision, arthrodesis, and above-the-knee amputation (AKA). We conducted a systematic review to determine the efficacy of these treatments in patients who had previously received a two-stage revision. METHODS: A systematic review of the literature was performed which investigated PubMed, Embase, Scopus, and Web of Science Databases. Chronic infection was defined as a persistent infection of a TKA after a previous two-stage revision. Studies were independently evaluated by two reviewers. Quality appraisal was performed using MINORS Criteria. RESULTS: 14 studies were included for the final review. For chronically infected TKA, a second two-stage revision was often sufficient to control infection. If revision failed, the most common next procedure was either a repeat revision or AKA. AKA patients had less pain and higher quality of life scores compared to arthrodesis, but a higher five-year mortality rate. DISCUSSION AND CONCLUSION: Chronic infection in TKA offers a multitude of challenges for orthopedic surgeons. We found that arthrodesis and AKA were not significantly different in rates of infection eradication or quality of life. We recommend clinicians to actively discuss options with patients to find a procedure most suitable for them.

Association Between Parental Understanding of Pitch Smart Guidelines and Youth Baseball Player Injuries.

BACKGROUND: Injuries continue to rise among youth baseball players despite extensive research into prevention and the availability of throwing guidelines such as Pitch Smart. More research is needed to understand whether adherence to the current guidelines decreases injuries. PURPOSE: To understand the degree to which parents are aware of the Pitch Smart guidelines, whether parents adhere to the guidelines, and whether adherence results in decreased injuries in youth baseball players. STUDY DESIGN: Cross-sectional study. METHODS: An anonymous, internet-based survey consisting of 44 items was distributed to parents of adolescent baseball players affiliated with various youth baseball organizations across the midwestern United States; 15 items on the survey served as assessment questions of the Pitch Smart guidelines. Absolute and percentage correct scores were calculated and compared by use of a Student t test. A chi-square analysis was used to compare discrete data. A binary logistic regression analysis was conducted to determine whether showcase participation predicted player injury. RESULTS: A total of 853 parents completed the survey. The mean ± SD age of the players on whom parents reported was 11.37 ± 3.5 years (range, 6-20 years). Among the cohort, 422 players regularly pitched. Regarding Pitch Smart guidelines, the percentage of correct answers by parents was 55.44% ± 0.3% for a player with a reported injury history and 62.14% ± 0.2% for a player without an injury history (P = .012). The number of correct answers was 8.03 ± 4.0 for the group with an injury history and 9.17 ± 3.2 for the group with no history of injury (P = .004). Binary logistic regression analysis, which controlled for age, indicated that showcase participation (P = .001, ß = 1.043 ± 0.026, R2 = 0.178) was a significant predictor of player injury. CONCLUSION: Pitchers are at an increased risk of injury compared with nonpitchers. Parents who are knowledgeable about the Pitch Smart throwing guidelines and actively follow them are significantly less likely to have a child with an injury. Excessive showcase participation is predictive of player injury when the analysis controls for age.

Internal Validation of a Predictive Model for Satisfaction After Primary Total Knee Arthroplasty.

BACKGROUND: As the number of total knee arthroplasty (TKA) procedures continues to rise in the context of bundled payment models, patients dissatisfied postoperatively that require additional care will impose additional cost to the healthcare system. The purpose of this study is to internally validate a predictive model for postoperative patient satisfaction after TKA. METHODS: In total, 484 consecutive primary TKA patients between January 2014 and January 2016 were included. Patients were stratified into 4 risk tiers based on scores of a retrospectively applied, 11-component novel knee survey for postoperative satisfaction: low risk (>96.5), mild risk (75-96.4), moderate risk (60-74.9), and high risk (<60). Binary logistic and multivariate linear regression models were constructed to determine whether the survey was predictive of satisfaction. A receiver operator curve was constructed to determine a threshold score below which patients were likely to experience postoperative dissatisfaction. RESULTS: The mean (±standard deviation) age was 66.3 ± 9.2 years (range 31.7-100.1) and mean body mass index was 34.2 ± 8.2 kg/m2 (range 16.2-68.4). A knee survey score of 96.5 conferred a 97.5% sensitivity and 95.7% negative predictive value for satisfaction. Patients with higher knee survey scores had greater odds (odds ratio 1.03, 95% confidence interval 1.01-1.06, P = .003) of postoperative satisfaction. Increasing risk tier was significantly associated with decreased satisfaction (low risk 95.7%, mild risk 93.8%, moderate risk 86.4%, and high risk 80.4%; P = .007). The knee survey was not significantly correlated with complications (r = -0.43, P = .32). CONCLUSION: This novel knee survey conferred a 97.5% sensitivity and 95.7% negative predictive value in identifying at-risk patients for postoperative dissatisfaction after primary TKA.

Patient dissatisfaction following total knee arthroplasty: external validation of a new prediction model.

Tools designed to predict patient satisfaction following total knee arthroplasty (TKA) have the potential to guide patient selection. Our study aimed to validate a model that predicts patient satisfaction following TKA. Phone surveys were administered to 203 patients who underwent TKA between 2009 and 2016 at the University of Illinois. We utilized health records to document age, gender, body mass index (BMI), and comorbidities. First, we compared the descriptive variables between the satisfied and dissatisfied groups. We then performed multivariate linear regression and multiple logistic regression to assess the predictive value of the questions in the Van Onsem et al. model. The true satisfaction rate in our study was 65%. The Van Onsem et al. model predicted a satisfaction rate of 70%. The scatter plot of predicted satisfaction score versus observed satisfaction score showed poor agreement between actual satisfaction and predicted satisfaction. Comparing satisfied and dissatisfied groups, there was a significant difference with respect to pain prior to surgery and BMI. The validity of the Van Onsem et al. prediction tool was not supported. While the predicted satisfaction rate was near the measured satisfaction rate, the model misidentified which patients were likely to be satisfied. Preoperative variables including pain, anxiety/depression, and a patient's ability to control pain symptoms showed potential for inclusion in future prediction models. LEVEL OF EVIDENCE: Level III, developing a decision model.