Should hip fractures be operated upon only by specialist hip unit surgeons in order to lower rates of surgical site infection?

PURPOSE: The purpose of this study was to compare outcomes of hip fractures treated by orthopaedic surgeons, performed by specialist vs. non-specialist surgeons. The rate of surgical site infection (SSI) obtained is taken as the main variable. METHODS: This was a prospective controlled cohort study of 814 patients presenting with hip fractures, operated on by a group of orthopaedic surgeons within the same hospital department. Patients were classified according to whether the surgeons belonged to a specialist hip unit (group A = 212 cases) or not (group B = 602 cases). RESULTS: Multivariate logistic regression showed that there was no relation between gender, SSI, Charlson's index, preoperative period, surgical technique or study groups (A or B). Only age was a determinant factor (rank-sum test p = 0.03; OR 95% CI = 1.07, p = 0.005). CONCLUSIONS: Since there were no differences in the SSI outcome between surgeons working in a specialist hip unit and the general orthopaedic surgeons, delaying operative treatment for hip fractures to enable treatment in such a unit or creating a new unit of this type is not necessary. In this respect, the only significant variable is the patient's age.

Osteoprogenitor cell adhesiveness to a titanium mesh. A clinically relevant hypothesis for revision surgery in hip replacement.

Bone defects are a major problem in primary and, even worse, revision surgery of the hip. Impacted allograft contained by a metallic mesh has been used for bone reconstruction. However, since allograft has been claimed to reabsorb, and to provoke immunogenic responses with potential viral infection and loosening because of allograft and mesh interface, new bone substitutes are being searched for. In this study we have cultured committed osteoprogenitor cells within a titanium mesh. The cells not only multiplied very easily, but also adhered to the mesh surface. We believe this phenomenon may have great clinical relevance for cell therapy as an alternative to allograft for the treatment of bone defects in acetabular or femoral reconstruction in revision surgery of the hip.