Revision surgery for chronically discharging mastoid cavities: mastoid obliteration with canal wall reconstruction versus non-obliteration surgery.

PURPOSE: To evaluate the surgical results of revision canal wall down (CWD) surgery for chronically discharging mastoid cavities and to compare the non-obliteration approach to mastoid obliteration with canal wall reconstruction. METHODS: This is a retrospective cohort study. All adult patients (≥ 18 years) who underwent revision surgery for chronically draining mastoid cavities between January 2013 and January 2020 were included. Primary outcome measures included the dry ear rate, complications and postoperative hearing. RESULTS: 79 ears were included; 56 ears received revision CWD with mastoid obliteration and posterior canal wall reconstruction and 23 ears received CWD without mastoid obliteration. The dry ear rate at the most recent outpatient clinic visit (median 28.0 months postoperative) was significantly higher in the obliteration group with 96.4% compared to 73.9% for the non-obliteration group (p = .002). There were no differences in audiological outcome and incidence of complications between the two techniques. CONCLUSION: We show that in our study population revision CWD surgery with mastoid obliteration and posterior canal wall reconstruction is superior to revision CWD surgery without mastoid obliteration in the management of chronically discharging mastoid cavities. In the obliteration group, a dry ear was achieved in 96.4% as this was 73.9% in the non-obliteration group. We found no differences in audiological outcome and in incidence of complications between the two techniques.

More complications in uncemented compared to cemented hemiarthroplasty for displaced femoral neck fractures: a randomized controlled trial of 201 patients, with one year follow-up.

BACKGROUND: It is unclear whether cemented or uncemented hemiarthroplasty is the best treatment option in elderly patients with displaced femoral neck fractures. Previous randomized trials comparing cemented and uncemented hemiarthroplasty have conflicting results. We conducted a randomized controlled trial to compare cemented and uncemented hemiarthroplasty. METHODS: This multicenter parallel-randomized controlled trial included patients of 70 years and older with a displaced femoral neck fracture (Garden type III or IV). Inclusion was between August 2008 and June 2012. Patients were randomized between a cemented hemiarthroplasty, type Müller Straight Stem or an uncemented hemiarthroplasty, type DB-10. Primary outcomes were complications, operation time, functional outcome (measured by Timed-Up-and-Go (TUG) and Groningen Activity Restriction Scale (GARS)) and mid-thigh pain. Health Related Quality of Life (HRQoL, expressed with the SF-12) was measured as an secondary outcome. Follow up was 1 year. RESULTS: In total 201 patients were included in the study (91 uncemented, 110 cemented hemiarthroplasties) The uncemented group showed more major local complications (intra- and postoperative fractures and dislocations) odds ratio (95% confidence interval) 3.36 (1.40 to 8.11). There was no difference in mean operation time (57.3 vs 55.4 min). There were no differences in functional outcomes (TUG 12.8 (9.4) vs. 13.9 (9.0), GARS 43.2 (19.7) vs. 39.2 (16.5)) and mid-thigh pain (18.6 vs 21.6%). Physical component SF-12 HRQoLwas lower in the uncemented group (30.3 vs. 35.3 p < 0.05 after six weeks, 33.8 vs 38.5 p < 0.05 after 12 weeks). CONCLUSION: A cemented hemiarthroplasty in elderly patients with a displaced femoral neck fracture results in less complications compared to an uncemented hemiarthroplasty. TRIAL REGISTRATION: Netherlands Trial Registry; NTR 1508 , accepted date 27 okt 2008.

Factors influencing length of hospital stay after primary total knee arthroplasty in a fast-track setting.

PURPOSE: The goal of this study was to identify factors prior to surgery that are associated with an increased length of hospital stay after TKA using a fast-track protocol. MATERIALS AND METHODS: In total, 879 consecutive patients who underwent primary TKA were included in this retrospective cohort study. A length of stay greater than or equal to three nights was considered an increased length of hospital stay. Univariable and multivariable generalized linear mixed models were used to identify potential factors associated with increased length of hospital stay. RESULTS: Length of hospital stay was significantly associated with age [OR 1.01 (95 % CI 1.01-1.02); p < 0.001], gender [female vs. male, OR 1.07 (95 % CI 1.00-1.15); p = 0.04], ASA [ASA III/IV vs. ASA I, OR 1.22 (95 % CI 1.06-1.39); p = 0.005], living situation (alone vs. together, OR 1.08 (95 % CI 1.00-1.16); p = 0.04], neurological comorbidities [OR 1.14 (95 % CI 1.06-1.23); p < 0.001], musculoskeletal comorbidities [OR 0.91 (95 % CI 0.85-0.97); p = 0.005], anaesthesia [spinal vs. general, OR 0.86 (95 % CI 0.76-0.97); p = 0.02], and weekday of surgery [Thursday vs. Monday, OR 1.12 (95 % CI 1.02-1.23); p = 0.02]. CONCLUSIONS: Older age, female gender, ASA III/IV, people living alone, the presence of neurological comorbidities, general anaesthesia and surgery on Thursday were associated with an increased length of hospital stay. In clinical practice, the knowledge of factors associated with an increased length of hospital stay can be used to further optimize peri-operative protocols for patients at risk for an increased length of hospital stay after TKA. LEVEL OF EVIDENCE: II.