Similar Patient Satisfaction and Quality of Life Improvement Achieved with TKA and THA According to the Goodman Scale: A Comparative Study.

Background: Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are effective treatments for severe knee and hip osteoarthritis. Historically, TKA has been associated with lower satisfaction than THA, but recent advances in knee surgery have led to lower dissatisfaction rates. This study aimed to compare the satisfaction and self-reported improvement in the quality of life of two cohorts of patients who underwent TKA and THA, respectively. Methods: This observational study compared two previously published cohorts of patients who underwent THA and TKA in a single university center. The Goodman scale was used to assess satisfaction and self-perception of improved quality of life after TKA and THA at a minimum one-year follow-up. Propensity score matching was used to balance age, gender, and follow-up between groups. Significance was set at 0.05. Results: The study included a total of 105 THAs and 131 TKAs. Both groups had high levels of satisfaction with pain relief, ability to do house/yard work, and overall satisfaction, with above 90% satisfaction rates. Regarding improvement in quality of life, both groups had 86% of patients reporting improvement as "much better." After propensity score matching, no significant difference was found between THA and TKA for any of the comparisons made using the Goodman scale. Conclusions: The study showed that both TKA and THA resulted in high levels of satisfaction and improvement in quality of life. There was no significant difference in satisfaction rates between TKA and THA, contrary to the historical trend of lower satisfaction rates for TKA.

Randomized clinical trial comparing pericapsular nerve group (PENG) block and periarticular local anesthetic infiltration for total hip arthroplasty.

BACKGROUND: This randomized trial compared pericapsular nerve group block and periarticular local anesthetic infiltration in patients undergoing primary total hip arthroplasty. We hypothesized that, compared with pericapsular nerve group block, periarticular local anesthetic infiltration would decrease the postoperative incidence of quadriceps weakness at 3 hours fivefold (ie, from 45% to 9%). METHODS: Sixty patients undergoing primary total hip arthroplasty under spinal anesthesia were randomly allocated to receive a pericapsular nerve group block (n=30) using 20 mL of adrenalized bupivacaine 0.50%, or periarticular local anesthetic infiltration (n=30) using 60 mL of adrenalized bupivacaine 0.25%. Both groups also received 30 mg of ketorolac, either intravenously (pericapsular nerve group block) or periarticularly (periarticular local anesthetic infiltration), as well as 4 mg of intravenous dexamethasone.Postoperatively, a blinded evaluator carried out sensory assessment and motor assessment (knee extension and hip adduction) at 3, 6 and 24 hours. Furthermore, the blinded observer also recorded static and dynamic pain scores at 3, 6, 12, 18, 24, 36 and 48 hours; time to first opioid request; cumulative breakthrough morphine consumption at 24 hours and 48 hours; opioid-related side effects; ability to perform physiotherapy at 6, 24 and 48 hours; as well as length of stay. RESULTS: There were no differences in quadriceps weakness at 3 hours between pericapsular nerve group block and periarticular local anesthetic infiltration (20% vs 33%; p=0.469). Furthermore, no intergroup differences were found in terms of sensory block or motor block at other time intervals; time to first opioid request; cumulative breakthrough morphine consumption; opioid-related side effects; ability to perform physiotherapy; and length of stay. Compared with pericapsular nerve group block, periarticular local anesthetic infiltration resulted in lower static pain scores (at all measurement intervals) and dynamic pain scores (at 3 and 6 hours). CONCLUSION: For primary total hip arthroplasty, pericapsular nerve group block and periarticular local anesthetic infiltration result in comparable rates of quadriceps weakness. However, periarticular local anesthetic infiltration is associated with lower static pain scores (especially during the first 24 hours) and dynamic pain scores (first 6 hours). Further investigation is required to determine the optimal technique and local anesthetic admixture for periarticular local anesthetic infiltration. TRIAL REGISTRATION NUMBER: NCT05087862.

The role of anterior supra-acetabular external fixator as definitive treatment for anterior ring fixation in unstable pelvic fractures.

PURPOSE: Management of anterior ring injuries is still a matter of discussion, and there are only few studies reporting anterior external fixator as definitive treatment for unstable pelvic injuries. This study aimed to describe the clinical and radiological outcomes of a consecutive series of mechanically unstable pelvic injuries that were treated with definitive anterior supra-acetabular external fixator for the anterior ring, and to identify risk factors for failure. METHODS: We included a consecutive series of patients with unstable pelvic ring fractures who underwent anterior supra-acetabular external fixation for definitive treatment, between January 2012 and January 2020. All demographics, associated injuries and procedures, injury mechanism, and complications were analysed. Pelvic fracture was classified based on Orthopaedic Trauma Association/Tile AO (OTA/AO) and Young-Burgess classifications. Complications associated with the external fixator were revised. All patients were functionally evaluated at final follow-up and asked to report their clinical outcomes using the Majeed score. RESULTS: A total of 47 patients were included, of which 25 were females. The median age was 44 years (interquartile range 23-59). Median follow-up duration was 14 months (interquartile range 6-31). The most frequent aetiology was motor vehicle accident (35), followed by fall from height (8). All fractures required posterior pelvic ring fixation. The median time during which patients had external fixation in situ was 11 weeks (interquartile range 9-13). All patients achieved healing of pelvic fracture at median time of 10 weeks (interquartile range 8-12). At final follow-up, the median displacement of the anterior pelvis was 6 mm (interquartile range 0-11). Superficial infection was the most common complication (n = 7). No washout procedures were needed. No major complication was reported. No patient required reoperation for anterior ring fracture. The median Majeed score was 88 points (range 60-95; interquartile range 80-90) at final follow-up. CONCLUSION: Our findings suggest that the use of supra-acetabular external fixator is safe and effective for definitive treatment of the anterior ring in unstable pelvic fractures. It is a method with high proportion of excellent results, regardless of the type of fracture. The rate of complications is low, and it does not compromise functional results.

Scissor Position of the Orthopedic Table for the Resolution of Intertrochanteric and Subtrochanteric Hip Fractures.

During the surgical resolution of intertrochanteric and subtrochanteric hip fractures on an orthopedic table, a fluoroscope needs to be used in orthogonal planes. This requires that the contralateral leg does not obstruct the radioscopic view, so patients are often placed in a hemilithotomy position. This position, also called the Lloyd-Davis position, involves hip flexion, hip abduction, hip external rotation, and knee flexion. However, rare complications, such as acute leg posterior compartment syndrome, have been described. In addition, patients with severe osteoarthritis and joint stiffness or a history of total hip arthroplasty may have difficulty achieving this position, and the well leg may be at risk of injury in a hemilithotomy position. A previously described position called the "scissor position" is, in our opinion, a safer and more efficient technique for placing the well leg on the orthopedic table, using only a pillow and a self-adhesive compression bandage. This simple position allows a lateral fluoroscopic view of the injured femur without overlapping or interference from the other limb.

Validation of the Spanish version of the Goodman score in total hip arthroplasty.

PURPOSE: Currently, patient-reported outcome measures (PROMs) are the standard instruments used to compare arthroplasty results. Goodman et al. recently published a well-constructed scale with excellent psychometric properties that can be quickly administered. The main objective of our study was to translate, culturally adapt, and validate a Spanish version of the Goodman questionnaire in patients who underwent total hip arthroplasty (THA). METHODS: The original Goodman scale was translated into Spanish and cross-culturally adapted. Then, the data from this version were tested for psychometric quality. We designed a cross-sectional study for data collection. This study enrolled 2 institutions. Patients who underwent hip replacement due to primary osteoarthritis secondary to dysplasia between 1 January 2018 and 31 December 2019 were included. A total of 153 patients were contacted twice to record the Goodman and Oxford hip scales (OHS) to assess the validity of the questionnaire. Reliability was tested using the Cronbach's alpha, Concordance using 3 test: intraclass correlation coefficient (ICC), Lin's concordance correlation coefficient (CCC), and the Bradley-Blackwood F test. The spearman correlation was used to asses correlation between the OHS and the Spanish-adapted Goodman scale. RESULTS: The overall satisfaction after THA was reported to be "very satisfied" by 137 patients (75%), and only 14 patients reported some degree of dissatisfaction (6%). The improvement in quality of life was reported to be "more than I ever dreamed possible" by 41% patients. Cronbach's alpha was acceptable, reaching a coefficient of 0.95 (95% confidence interval, 0.82-1). No statistical difference (t test, p = 0.55) was found in the original version, with great internal validity. Test re-test concordance was optimal among the 3 tests used. A moderate correlation was found between the OHS and the Spanish-adapted Goodman scale. CONCLUSION: The Spanish version of the Goodman questionnaire in THA is a reliable, consistent, and feasible scale to evaluate patient satisfaction and improvement in the quality of life in Spanish speakers.

Mortality after hip or knee arthroplasty for osteoarthritis in Chile: A survival analysis.

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.

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.

Survival After Hip Fracture: A Comparative Analysis Between a Private and a Public Health Center in Chile.

Purpose The purpose of the study is to compare the survival after hip fracture in patients older than 50 years after hip fracture between a private and a public health center in Chile. We hypothesize that treatment at a private health center (PRH) may be associated with lower one-year mortality and longer median survival time after hip fracture (adjusted by gender and age) compared to a public health center (PLH). Methods PRH and PLH patients who were coded with a diagnosis of hip fracture were included in this study. PRH patients were included between 2002 to 2018, and PLH patients were included from 2012 to 2018. One-year mortality was estimated by logistic regression; meanwhile, median survival time was estimated by exponential regression. A survival analysis study was designed and approved by our institutional ethics review board. Results A total of 2130 patients were included in the PLH cohort, and a total of 1110 patients were included in the PRH. The one-year mean mortality, adjusted by age and gender, was 0.23 (range: 0.21 to 0.25) in the PLH and 0.16 (range: 0.13 to 0.18) in the PRH cohort. The median survival time, adjusted by age and gender, was 4.2 years (range: 4.1 to 4.4) in the PLH and 6.8 years (range: 6.3 to 7.29) in the PRH cohort. Conclusion Patients older than 50 years treated in a private health center have a higher median survival time and a lower probability of dying one year after a hip fracture.

Periacetabular osteotomy with concomitant hip arthroscopy: A case series with 24 months minimum follow-up.

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.

OBJETIVO: Describir los resultados funcionales, radiológicos y la tasa revisión a artroplastia total de cadera en una cohorte de pacientes con displasia de cadera que requirió osteotomía periacetabular como tratamiento aislado o concomitante con artroscopia de cadera. MÉTODO: Estudio de series de casos. Fueron incluidos pacientes intervenidos quirúrgicamente entre 2014 y 2017. Los criterios de inclusión fueron dolor en la cadera y un ángulo lateral de centro borde ≤ 20°. Los criterios de exclusión fueron esqueleto maduro, edad de 40 años o más, cirugía previa de cadera, enfermedad concomitante relacionada con el tejido conectivo y coxartrosis grado ≥ 1 de Tönnis. Todos los pacientes fueron estudiados antes de la cirugía con una radiografía anteroposterior de pelvis, radiografía de falso perfil y resonancia magnética. En caso de pesquisar una lesión intrarticular en resonancia magnética se realizó una artroscopia concomitante a osteotomía periacetabular. La prueba mediana no paramétrica para datos no pareados se utilizó para comparar medidas radiológicas (ángulo del borde central anterior y lateral, ángulo de Tönnis e índice de extrusión) antes y después de la cirugía. El análisis de sobrevida se realizó utilizando la revisión de la artroplastia total de cadera como fracaso. Se estimó la curva de Kaplan Meier. Los datos se procesaron con Stata. RESULTADOS: Fueron incluidos un total de 15 pacientes consecutivos; Siete pacientes (47%) se sometieron a artroscopia de cadera concomitante, tres de ellos (47%) fueron bilaterales (10 caderas). La mediana de seguimiento fue de 3.5 años (rango, 2 a 8 años). La mediana de edad fue de 20 (rango 13 a 32). El ángulo de cobertura lateral preoperatorio era de 12° (rango, -29° a 19°) y posterior a la cirugía fue de 25° (rango, 8° a 34°), logrando una mediana de corrección de 16° (rango, 7° a 53°). El labrum fue reparado en seis casos (60%). Tres pacientes (15%) requirieron revisión con artroplastia de cadera, y no se informan complicaciones relacionadas con la artroscopia en esta serie. CONCLUSIÓN: Realizar una artroscopia concomitante con osteotomía periacetabular no afectó la corrección acetabular, ni el resultado clínico. Hoy en día, debido a la falta de evidencia concluyente, el realizar una artroscopía es una decisión que debe ser tomada caso a caso para un tratamiento integral.

Mortalidad de los pacientes intervenidos de artroplastia de rodilla y cadera en Chile: análisis de sobrevida / Mortality after hip or knee arthroplasty for osteoarthritis in Chile: a survival analysis

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.

Periacetabular osteotomy with concomitant hip arthroscopy: a case series with 24 months minimum follow-up

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.

Survival analysis after hip fracture: higher mortality than the general population and delayed surgery increases the risk at any time.

PURPOSE: To estimate survival curves in patients with hip fracture according to gender, age, type of fracture, and waiting time for surgery and to compare them with the life expectancy of the general population. The study hypothesis is that survival after hip fractures is significantly lower than in the general population, especially in cases that underwent delayed surgery, regardless of age and gender. METHODS: A survival analysis study was designed and approved by our institutional ethics review board. All patients who were coded with a diagnosis of hip fracture from 2002 to 2018 were included in the study. A total of 1176 patients were included, and the median age was 81 years (18-105 years). Kaplan-Meier curves and log-rank tests were performed to compare survival curves between those who underwent surgery on time and those with surgical delays. An exponential multivariate regression model was estimated, and a hazard ratio (HR) was reported for age, gender, and wait time for surgery. A significance of 5% was used, and a confidence interval level of 95% was reported. RESULTS: The Kaplan-Meier curves for delayed surgery (log-rank, p = 0.00) and the age group (log-rank, p = 0.00) were significantly different. Exponential regression estimated an HR 1.05 (1.05-1.07) for age, HR 1.80 (1.51-2.13) for men, and HR 1.93 (1.61-2.31) for each day of wait for surgery. CONCLUSIONS: The 2 significant findings of this study are that hip fracture patients over 40 years old have a higher risk of dying at any time compared to the general population and that the waiting time for surgery (a modifiable factor) decreases survival rates at any time.

Incidence, risk factors and case fatality rate for hip fracture in Chile: A cross-sectional study based on 2017 national registries. / Incidencia, factores de riesgo y letalidad de la fractura de cadera en Chile: estudio transversal sobre registros nacionales de 2017.

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.

Incidencia, factores de riesgo y letalidad de la fractura de cadera en Chile: estudio transversal sobre registros nacionales de 2017 / Incidence, risk factors and case fatality rate for hip fracture in Chile: a cross-sectional study based on 2017 national registries

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.

Surgical Treatment of Intrapelvic Pseudotumour after Hip Resurfacing Arthroplasty: Case Report and Literature Review.

Hip replacement is the surgery of the last century due to its impact on the quality of life. A pseudotumour is a rare complication of hip arthroplasty, and it is related to a metal-bearing surface. Pseudotumour is a challenging scenario for hip surgeons due to poor clinical outcomes. The patient consulted for hip pain and paresthesia in the left lower extremity, and analyses showed that the cause was a sizeable intrapelvic pseudotumour. A multidisciplinary team surgery was planned. At first, an infraumbilical approach was made to resect the intrapelvic-retroperitoneum portion of the pseudotumour. Then, a posterolateral hip approach was performed, to resect the remaining portion of the pseudotumour and revision arthroplasty. At five years of follow-up, there are no clinical or imaging signs of recurrence of the pseudotumour. Treatment evidence is limited to a series of cases and expert opinions; we encourage complete resection and revision arthroplasty.

Are There Benefits In Early Diagnosis Of Prosthetic Joint Infection With Multiplex Polymerase Chain Reaction?

Purpose Identification of bacteria and susceptibility are fundamental in periprosthetic joint infection (PJI). Especially in the case of systemic inflammatory response syndrome (SIRS) rapid detection of pathogens is essential for proper therapy. Bacterial cultures are time consuming. The polymerase chain reaction (PCR) is a non-culture molecular method and is able to rapidly identify pathogens and their resistance genes. Multiplex PCR (mPCR) can amplify several different DNA sequences simultaneously. The aim of this study was to show the value of mPCR for early diagnosis of PJI. Methods 60 patients undergoing total hip or knee revisions were recruited in this prospective single-centre-study. Three groups were created: 26 patients with aseptic loosening (negative control), 26 patients with chronic PJI, and 8 patients with acute PJI/SIRS. We compared the results of joint aspirates obtained intraoperatively investigated by mPCR with the microbiology results of tissue specimens. Results The overall sensitivity of mPCR was 78.8% (95% CI, 61.1 - 91.0%), the specificity was 100% (95% CI, 87.2 - 100%), the negative predictive value was 79.4% (95% CI, 62.1 - 91.3%), the positive predictive value was 100% (95% CI, 86.8 - 100%), and the overall accuracy was 88.3% (95% CI, 77.4 - 95.2%). The overall accuracy in acute infections/SIRS (87.5%) was greater than in late chronic PJI (76.9%). In PJI the mPCR was able to provide the results within 5 hours whereas the mean time for cultures was 6.4 days. Conclusions Multiplex PCR is a reliable diagnostic tool in PJI management, especially in acute cases complicated with SIRS. Early diagnosis within several hours is possible, targeted antibiotic treatment can be started promptly.

Is there a pathological alpha angle for hip impingement? A diagnostic test study.

The normal value of alpha angle is controversial. The aim of this study was to compare the alpha angle in asymptomatic volunteers versus patients who had undergone surgery for symptomatic cam-type femoroacetabular impingement (FAI) and determine a diagnostic cut-off value for symptomatic cam impingement. This is a diagnostic test study. Cases were defined as those patients who had undergone surgery for symptomatic cam or mixed type FAI. Controls were defined as asymptomatic volunteers, with no history of hip pain who had undergone a computed tomography (CT) scan of the abdomen and pelvis for a non-joint or bone-related reason. In both groups, the alpha angle was measured in an oblique axial CT reconstruction of the femoral neck. A logistic regression model was first estimated and a receiver operating characteristics (ROC) curve was then calculated. The diagnostic cut-off value selected was the one that maximizes sensitivity and specificity. Data were analysed from 38 consecutive cases of cam or mixed FAI and 101 controls. The average alpha angle was 67°(±12°) among cases and 48°°(±5°) among controls. An odds ratio of 1.28 [1.18-1.39] was obtained. A ROC curve of 0.96 [0.93-0.99] was calculated, and using an alpha angle of 57° as the diagnostic cut-off value, provided a sensitivity of 92% and a specificity of 95%. If a patient complains of hip pain and an alpha angle of 57° is found in CT, strongly suggest that cam impingement is causing the pain.

Hip Morphology Characterization: Implications in Femoroacetabular Impingement in a Chilean Population.

BACKGROUND: Femoroacetabular impingement (FAI) is the result of a mechanical conflict in the hip joint, and its diagnosis is based on clinical and radiological parameters. To our knowledge, there are no published studies describing the radiologic characteristics of FAI in Latin American populations. PURPOSE: To describe the radiological features associated with FAI in an asymptomatic Chilean population. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We prospectively recruited asymptomatic patients with no history or symptoms of hip pathology who underwent abdomen-pelvis computed tomography (CT) for a nonorthopaedic indication. The acetabular and femoral parameters related to FAI were measured. RESULTS: We studied 101 subjects (202 hips) with a mean age of 36.8 ± 14.4 years. The mean center-edge angle was 39.4° ± 7.2°. The crossover sign was present in 34 cases (33.7%). The mean alpha angle was 49.7° ± 8.3°. Depending on the cut points chosen for FAI-related parameters, between 39.6% and 69.3% of an asymptomatic Chilean population were found to have morphological features related to FAI. CONCLUSION: Our findings suggest that the proposed pathological threshold values in the literature cannot be extrapolated to a Chilean population, and this must be taken into consideration when evaluating Latin American patients with hip pain.