RESUMO
Purpose: The aim of this study was to evaluate the development of the worldwide survival rate of primary total hip arthroplasty (THA). The hypothesis was that survival improved over the last decade in worldwide arthroplasty registers. Methods: THA registers were screened in 2022 and compared between different countries with respect to the number of primary implantations per inhabitant, age, fixation type, and survival rate, and compared to similar data from 2009. The data from these reports were analyzed in terms of number, age distribution, and procedure type of primary THAs. Survival curves and a comparative analysis with respect to the development over time were calculated. Results: We identified nine hip arthroplasty registers that contained sufficient data to be included. A large variation was found in the annual number of primary THA implantations per inhabitant, with more than the factor 4 for all age groups across regions. The procedure type varied strongly as well, e.g. in Sweden, 50% were cemented THAs, whereas in Emilia-Romagna (Italy), 96% of THAs were implanted cementless. We found an improved survival rate of 5%, with 90% of survival after 15 years in the cohorts from 2021 compared to 85% in the cohorts from 2009. Conclusion: The present study revealed a significant improvement in the survival of THA in worldwide arthroplasty registers within different countries and regions over the period of one decade. We believe that it is safe to state that the success of THA is still rising with respect to this main outcome.
RESUMO
BACKGROUND: Outcomes and safety of "mix and match" in total hip arthroplasty (THA) using universal head-neck adapters (UHNA) are a matter of ongoing discussion and concern due to legal affairs. This study aimed at analyzing the "mix and match" use of UHNA and evaluating complication and reoperation rates, possible risk factors, and the implant's survival. METHODS: A total of 306 patients treated with THA (94.1% revisions) using a UHNA at our institution between 2006 and 2022 were identified and included. Diagnoses, comorbidities, implants, and UHNA specifications were retrospectively recorded. Outcomes, complications, and survival analyses were evaluated, taking into account various possible risk factors. RESULTS: There were 19.9% of the 306 included cases (58.5% women; median age 74 years; median follow-up 57 months) that had at least 1 complication. There were 43 patients (14.1%) who had to receive ≥1 rerevision surgery. The most common complication was postoperative recurrent dislocation (n = 27, 8.8%). There was one case of a prosthetic stem-neck fracture that was registered. Statistically significant risk factors for postoperative recurrent dislocations and postoperative aseptic loosening were, respectively, dislocation as an indication for UHNA implantation (P < .001) and oversized neck lengths (≥2XL; P = .004). The overall revision-free survival was 92% after 1 year and 82% at ten years. Statistically significant better survival rates were registered in patients ≥60 years old, who had fewer comorbidities (<2), and normal neck lengths (S to XL). CONCLUSIONS: The results of this study underline the overall safety of UHNA use in THA through "mix and match." Only one case of a stem-neck fracture was identified. The highlighted risk factors for failure must be kept in mind during the decision-making process with patients.
RESUMO
INTRODUCTION: A decade ago, a comprehensive study was conducted to investigate the reasons for revision surgeries and their respective frequencies in cases of total hip arthroplasty (THA) and total knee arthroplasty (TKA) based on a complication-based analysis of joint replacement registries. The aim of the present study was to determine whether the causes and risks of their occurrence have changed over the last ten years and to present an updated analysis. MATERIALS AND METHODS: A systematic review of national arthroplasty registries from seven countries examined the causes and rates of revisions of THA and TKA. The study focused on a descriptive analysis that provided an updated overview without statistical significance values. RESULTS: The most common causes for revisions of THA were aseptic loosening (35.1%), deep infection (18.2%), dislocation/instability (15.9%), and periprosthetic fractures (11.4%). The most common causes for revisions of TKA were deep infection (21.6%), aseptic loosening (18.3%), instability (14.1%), and pain (10.9%). CONCLUSION: The findings of this study revealed significant shifts in the underlying causes of revision surgeries in the last decade. Notably, septic complications emerged as the predominant reason for revision of primary TKA, while they also gained prominence as a cause of failure of THA. Although aseptic loosening remains the primary cause for re-operation of THA, the relative risk has decreased for both THA and TKA.
RESUMO
BACKGROUND: This study aimed to meta-analyze epidemiological data, revision rates, and incidences of different designs of a single Total Knee Arthroplasty System and compare these factors across different countries. METHODS: A systematic review was conducted on clinical studies and arthroplasty registries of ATTUNE TKA from 1999 to 2020. The main endpoints analyzed were revision rates and epidemiological data. RESULTS: The average age of patients was 67.8 years, with a gender distribution of 60% female and 40% male. The pooled average BMI was 29.4 kg/m2. Eight clinical studies showed a pooled revision rate per 100 observed CY of 0.5 (n = 1343 cases). Cumulative revision rates after 1, 3, and 5 years varied among registries, with the Swiss registry having the highest revision data (after 5 years: 6.3%) and the American registry having the lowest revision data (after 5 years: 1.7%). A comparison of the revision rates of mobile bearing and fixed bearing (41,200 cases) as well as cruciate retaining and posterior stabilized (n = 123,361 cases) showed no significant advantage in the first 5 years after implantation. CONCLUSION: In conclusion, pooled data from 41,200 cases of TKA with a single Total Knee Arthroplasty System in two arthroplasty registries revealed that there was no significant difference in revision rates between the mobile bearing and fixed bearing design within the first 5 years after implantation. In addition, a comparison of the revision rates in n = 123,361 cases showed no significant advantage for cruciate retaining or posterior stabilized in the first 5 years after implantation.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Desenho de Prótese , Sistema de Registros , Reoperação , Humanos , Artroplastia do Joelho/estatística & dados numéricos , Artroplastia do Joelho/métodos , Reoperação/estatística & dados numéricos , Masculino , Feminino , Falha de Prótese , Ensaios Clínicos como Assunto/estatística & dados numéricos , IdosoRESUMO
BACKGROUND: Our purpose was to evaluate whether the time of intervention and the type of meniscus surgery (repair vs. partial meniscectomy) play a role in managing anterior cruciate ligament (ACL) reconstructions with concurrent meniscus pathologies. METHODS: We performed a prospective cohort study which differentiated between early and late ACL reconstructions with a cut-off at 3 months. Patients were re-evaluated after 2 years. RESULTS: Thirty-nine patients received an operation between 2-12 weeks after the injury, and thirty patients received the surgery between 13-28 weeks after trauma. The strongest negative predictive factor of the International Knee Documentation Committee subjective knee form in a hierarchical regression model was older age (ß = -0.49 per year; 95% CI [-0.91; -0.07]; p = 0.022; partial R2 = 0.08)). The strongest positive predictive factor was a higher preoperative Tegner score (ß = 3.6; 95% CI [0.13; 7.1]; p = 0.042; partial R2 = 0.07) and an interaction between meniscus repair surgery and the time of intervention (ß = 27; 95% CI [1.6; 52]; p = 0.037; partial R2 = 0.07), revealing a clinical meaningful difference as to whether meniscus repairs were performed within 12 weeks after trauma or were delayed. There was no difference whether partial meniscectomy was performed early or delayed. CONCLUSIONS: Surgical timing plays a crucial role when surgeons opt for a meniscus repair rather than for a meniscectomy.
RESUMO
Aims: Patients with proximal femoral fractures (PFFs) are often multimorbid, thus unplanned readmissions following surgery are common. We therefore aimed to analyze 30-day and one-year readmission rates, reasons for, and factors associated with, readmission risk in a cohort of patients with surgically treated PFFs across Austria. Methods: Data from 11,270 patients with PFFs, treated surgically (osteosyntheses, n = 6,435; endoprostheses, n = 4,835) at Austrian hospitals within a one-year period (January to December 2021) was retrieved from the Leistungsorientierte Krankenanstaltenfinanzierung (Achievement-Oriented Hospital Financing). The 30-day and one-year readmission rates were reported. Readmission risk for any complication, as well as general medicine-, internal medicine-, and surgery/injury-associated complications, and factors associated with readmissions, were investigated. Results: The 30-day and one-year readmission rates due to any complication were 15% and 47%, respectively. The 30-day readmission rate (p = 0.001) was higher in endoprosthesis than osteosynthesis patients; this was not the case for the one-year readmission rate (p = 0.138). Internal medicine- (n = 2,273 (20%)) and surgery/injury-associated complications (n = 1,612 (14%)) were the most common reason for one-year readmission. Regardless of the surgical procedure, male sex was significantly associated with higher readmission risk due to any, as well as internal medicine-associated, complication. Advanced age was significantly associated with higher readmission risk after osteosynthesis. In both cohorts, treatment at mid-sized hospitals was significantly associated with lower readmission risk due to any complication, while prolonged length of stay was associated with higher one-year readmission risks due to any complication, as well as internal-medicine associated complications. Conclusion: Future health policy decisions in Austria should focus on optimization of perioperative and post-discharge management of this vulnerable patient population.
RESUMO
BACKGROUND: The aim of this study was to investigate the frequency and type of injuries during the career of orthopedic and trauma surgeons in Austria. The hypothesis was that the percentage of occupational injuries among orthopedic and trauma surgeons aligns with the incidence reported in the United States, thus indicating the need for a workplace prevention program. METHODS: A web-based survey was created to collect all necessary data and was sent to all orthopedic and trauma surgeons in Austria via e-mail. Relevant parameters included the surgeons' age, work experience, severity of pain, type of injury, and current pain. Descriptive and explorative statistical analysis was performed. RESULTS: A web-based survey was sent to 1122 board-certified orthopedic surgeons and residents in Austria via e-mail. In total, the response rate was 135 (12%). Seventy-two surgeons (54%) had suffered from one or more occupational injuries during their career. We detected a significant raise of occupational injuries related to the work life duration in which operations were performed and the prevalence of injuries. Most injuries of surgeons were reported between 21 and 30 years of their professional life. According to the frequency at different locations, the distribution in descending order was 25% with injuries of the hand, 22% of finger(s), 12% of the foot, 10% of the spine, 2% of the neck, 3% of the head, and 2% of the abdomen. A causality of incapacity to work through injuries at the workplace was given as 4%. Four percent stated a sick leave of at least 3 weeks. In 7% of the facilities, there was no optimization of preventive measures following an occupational injury. We found no correlation of injuries and resident status. CONCLUSION: Orthopedic surgeons in Austria show a high incidence of occupational injuries in line with the findings of colleagues from the United States. The impact on the health system consists of absenteeism in the workplace of highly specialized health service providers as well as the incapacity to work of a high quality, highly trained workforce of at least 4%. With more preventive measures and more attention and care in the rehabilitation phase after such injuries, a positive effect could be achieved. We believe that residents should be specifically trained on how to avoid such injuries.
Assuntos
Traumatismos Ocupacionais , Cirurgiões Ortopédicos , Ortopedia , Cirurgiões , Humanos , Estados Unidos , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/etiologia , Áustria/epidemiologia , DorRESUMO
PURPOSE: The aim was to compare total knee arthroplasty (TKA) between countries with regard to epidemiologic data and surgical technique by the use of worldwide registers and compare findings with a previous report after one decade. METHODS: A systematic search was carried out in November 2022 and compared to previous reports from 2010. We extracted data regarding implanted TKAs, patients' age distribution, procedure types, fixation and revision rates. After identification of 28 national arthroplasty registers, 8of them, namely Australia, Canada, Denmark, England and Wales, New Zealand, Norway, Scotland and Sweden, offered sufficient data and were included in final analysis. RESULTS: A large variation was found in the annual number of implantations per 100,000 inhabitants with a range from 77 to 210.2 (mean 132.8). The fixation type varied strongly as well, e.g. over 95% of totally cemented TKAs in Sweden versus 61.2% cemented fixation in Denmark. Another significant difference was the use of patellar resurfacing in TKA, ranging from 47.3% (Canada) using a patellar button in TKA to less than 5% (Sweden). Within the period of one decade, the mean overall number of annual implantations increased (10%), whilst relative number of revisions decreased, the use of cemented TKA decreased from 87 to 74%, and the use of patella button remained largely inhomogeneous. CONCLUSION: Comparison of arthroplasty registers revealed large differences regarding the annual number of primary TKAs per inhabitant as well as primary TKA procedure types with an increase of annual implantations, decrease of relative number of revisions, and a decrease of the use of cemented systems over the period of one decade.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Humanos , Artroplastia do Joelho/métodos , Falha de Prótese , Reoperação , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND: Our aim was to analyze anesthetic induction time and postoperative pain using spinal anesthesia versus general anesthesia with or without the use of peripheral nerve blocks (PNBs) in total knee arthroplasty. The hypothesis was that spinal anesthesia would be beneficial with respect to induction time and postoperative pain and that PNBs would complement this effect. METHODS: Patients were stratified according to demographics, American Society of Anesthesiologists physical status classification system (ASA), and opioid intake and divided into: (A) general anesthesia without PNB; (B) general anesthesia with PNB; (C) spinal anesthesia without PNB; and (D) spinal anesthesia with PNB. Endpoints were anesthetic induction time, opioid consumption, and pain. Of 559 patients, 348 (62.3%) received general anesthesia (consisting of group A with 46 and group B with 302 patients), and 211 (37.7%) spinal anesthesia (consisting of group C with 117 and group D with 94 patients). RESULTS: We observed significantly lower total opioid intake 48 hours postoperative when applying spinal anesthesia by 2.08 mg (P < .05) of intravenous morphine-equivalent, and a reduction of 7.0 minutes (P < .05) until skin incision. The application of a PNB achieved a reduction of piritramide intake of 3.59 mg (P < .05) 48 hours postoperative and lengthened induction time by 8.5 minutes (P < .05). CONCLUSIONS: Statistically shorter anesthetic induction times without clinical relevance, but lower postoperative opioid dosages with clinical relevance were observed for patients undergoing total knee arthroplasty with spinal anesthesia. The additional application of PNBs led to a lower need for opioids and lower pain levels in the early postoperative phase.
Assuntos
Raquianestesia , Anestésicos , Artroplastia do Joelho , Humanos , Raquianestesia/métodos , Artroplastia do Joelho/efeitos adversos , Analgésicos Opioides/uso terapêutico , Nervos Periféricos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Anestesia Geral/métodos , Anestésicos/uso terapêuticoRESUMO
Restoring sagittal alignment in kinematically aligned (KA) total knee arthroplasty (TKA) is crucial to avoid patellofemoral joint instability or overstuffing and to restore an adequate range of motion. This prospective study compared the accuracy of conventional instrumentation (CI) versus patient-specific instrumentation (PSI) in restoring sagittal alignment of KA TKA measured by the tibial slope and degree of flexion of the femoral component to the sagittal femoral axis. One hundred patients were randomized to receive either CI (n = 50) or PSI (n = 50) for KA TKA. Two observers measured pre- and postoperative X-rays to assess restoration of the tibial slope and sagittal flexion. Inter- and intraclass correlations were calculated, and postoperative tibial and femoral components were compared with preoperative anatomy. In 50 CI patients, 86% (n = 43) had the tibial slope restored exactly, and no deviation more than 1 degree was found. Deviations of 0 to 1 degree were detected in 14% (n = 7). In 50 patients of the PSI group, 56% (n = 28) achieved an exact anatomic tibial slope restoration and 20% (n = 10) showed a deviation more than 2 degrees compared with the preoperative measurement. Deviations ranging between 0 to 1 and 1 to 2 degrees were found in 22% (n = 11) and 2% (n = 1) of cases, respectively. Sagittal alignment of the femoral component showed in both groups no deviation exceeding 1 degree. The restoration of sagittal alignment in KA TKA was statistically significantly differently distributed between CI and PSI (p = < 0.001) without clinical relevance. We found that PSI increased the odds for deviations >2 degrees in tibial slope reconstructions from 0 to 0.20 ([95% confidence interval: 0.09-0.31]; p = 0.001). Both CI and PSI revealed adequate results with respect to restoring sagittal alignment of the tibial and femoral components in KA TKA. The conventional technique requires adequate adjustment of the intramedullary rod to avoid hyperflexion of the femoral component and attention must be paid when restoring the tibial slope using PSI. This is a prospective Level II study.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/métodos , Estudos Prospectivos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Osteoartrite do Joelho/cirurgia , Fenômenos BiomecânicosRESUMO
The objective of this prospective study was to assess the precision of restoring the anatomical tibial obliquity, as measured by the medial proximal tibial angle (MPTA) on conventional X-rays, in relation to the surgical technique employed. Specifically, the study aimed to compare the accuracy of tibial obliquity restoration between kinematic alignment (KA) and conventional mechanical alignment (MA) in total knee arthroplasty (TKA). Two-hundred-and-sixty patients underwent either mechanically aligned TKA (n = 139) or kinematically aligned TKA (n = 121) using conventional instrumentation (CI). Pre- and postoperative X-rays were measured twice by two observers, with a 2-week interval. Inter- and intraclass correlations were calculated, and postoperative tibial obliquity was compared to the preoperative anatomy. In the group of 139 patients with mechanically aligned TKA, no cases with an MPTA deviation greater than 1 degree from 90 degrees were observed. Sixteen percent of the cases (n = 22) had a deviation of 0 to 1 degree. The remaining 84% of the cases (n = 117) had their MPTA of 90 degrees achieved. In the group of 121 patients with kinematically aligned TKA, no cases had a deviation greater than 1 degree compared with the preoperative MPTA. Thirty-one percent of the cases (n = 37) had a deviation of 0 to 1 degree with respect to preoperative MPTA. The remaining 69% of the cases (n = 84) had their tibial obliquity restored. Mechanically aligned TKA revealed statistically significant smaller deviations of accuracy compared to kinematically aligned TKA (p = 0.005). The inter- and intraclass correlations indicated substantial agreement of all measurements (intraclass correlation coefficient [ICC] < 0.90). Both mechanically aligned and kinematically aligned TKA demonstrated satisfactory outcomes in terms of restoring tibial obliquity or a neutral MPTA of 90 degrees using CI. However, MA showed superior results regarding precision compared to KA. When starting with kinematical alignment using CI, the surgeons should be aware that the learning curve according to accuracy differs to MA. It was a Prospective Level II study.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Estudos Prospectivos , Radiografia , Fenômenos Biomecânicos , Osteoartrite do Joelho/cirurgiaRESUMO
INTRODUCTION: To ensure a high-quality standard, it is important to frequently evaluate different prostheses models to avoid prostheses with high failure rates. Thus, the aim of the study was to evaluate the long-term outcome of the uncemented titanium-coated total knee arthroplasty (TKA) system (Advanced Coated System (ACS) III, Implantcast, GERMANY). We hypothesized that the ACS III would have a similar performance as other cemented TKA systems. MATERIALS AND METHODS: A total of 540 ACS III mobile-bearing knee joint prostheses were implanted in 495 patients. The visual analogue scale (VAS) score, Tegner activity score (TAS), knee society score (KSS), Western Ontario and McMaster (WOMAC) score, and the Short Form 12 (SF-12) score for the evaluation of quality of life (QoL) were taken after at least 9 years of follow-up. In addition, we measured range of motion (ROM) and assessed potential sex differences. In addition, the survival analysis was calculated at a median follow-up of 16.7 years. RESULTS: At the final follow-up, 142 patients had died, and 38 had been lost to follow-up. The rate of revision-free implant survival at 16.7 years was 90.0% (95% CI 87.1-92.2%) and the rate of infection-free survival was 97.0% (IQR 95.2-98.2%). The reasons for revision surgery were aseptic loosening (32.9%), followed by infection (27.1%), inlay exchange (15.9%), and periprosthetic fractures (5.7%). At the clinical follow-up visit, the mean VAS score was 1.9 ± 1.9, the median TAS was 3 (IQR 2-4), and the mean KSS for pain and function were 83.5 ± 15.3 and 67.5 ± 25.2, respectively. The mean WOMAC score was 81.1 ± 14.9, and the median SF-12 scores for physical and mental health were 36.9 (IQR 29.8-45.1) and 55.8 (IQR 46.2-61.0), respectively. The mean knee flexion was 102.0° ± 15.4°. Male patients had better clinical outcome scores than female patients [SF-12 mental health score, p = 0.037; SF-12 physical health score, p = 0.032; KSS pain score (p < 0.001), and KSS functional score (p < 0.001)]. CONCLUSION: The ACS III TKA system is a suitable option for the treatment of end-stage osteoarthritis of the knee joint because of its adequate long-term survival. Our findings are in line with published data on similar TKA systems that have shown favourable clinical scores in males. LEVEL OF EVIDENCE: Level III-Retrospective cohort study.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Masculino , Feminino , Qualidade de Vida , Titânio , Estudos Retrospectivos , Articulação do Joelho/cirurgia , Dor/cirurgia , Resultado do Tratamento , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento ArticularRESUMO
This study aimed to analyse and compare the vancomycin elution kinetics of four biodegradable, osteoconductive antibiotic carriers used in clinical practice within a 42-day in vitro setting. Carriers A and D already contained vancomycin (1.1 g and 0.247 g), whereas carriers B and C were mixed with vancomycin according to the manufacturer's recommendations (B: 0.83 g and C: 0.305 g). At nine time points, 50% (4.5 mL) of the elution sample was removed and substituted with the same amount of PBS. Probes were analysed with a kinetic microparticle immunoassay. Time-dependent changes in vancomycin concentrations for each carrier and differences between carriers were analysed. Mean initial antibiotic levels were highest for carrier A (37.5 mg/mL) and lowest for carrier B (5.4 mg/mL). We observed time-dependent, strongly negative linear elution kinetics for carriers A (-0.835; p < 0.001), C (-0.793; p < 0.001), and D (-0.853; p < 0.001). Vancomycin concentrations increased from 48 h to 7 d and dropped thereafter in carriers C and D whilst constantly decreasing at any time point for carrier A. Carrier B showed a shallower decrease. Mean antibiotics levels at 42 d were 1.5 mg/mL, 2.6 mg/mL, 0.1 mg/mL, and 0.1 mg/mL for carriers A, B, C, and D. Differences in mean initial and final vancomycin concentrations for carrier A were significantly larger in comparison to C (p = 0.040). A carrier consisting of allogenic bone chips showed the highest vancomycin-to-carrier ratio and the largest elution over the study period. Whilst vancomycin concentrations were still measurable at 42 days for all carriers, carrier A provided a higher drug-to-carrier ratio and a more consistent antibiotic-releasing profile.
RESUMO
BACKGROUND: This study aimed to evaluate ChatGPT's performance on questions about periprosthetic joint infections (PJI) of the hip and knee. METHODS: Twenty-seven questions from the 2018 International Consensus Meeting on Musculoskeletal Infection were selected for response generation. The free-text responses were evaluated by three orthopedic surgeons using a five-point Likert scale. Inter-rater reliability (IRR) was assessed via Fleiss' kappa (FK). RESULTS: Overall, near-perfect IRR was found for disagreement on the presence of factual errors (FK: 0.880, 95% CI [0.724, 1.035], p < 0.001) and agreement on information completeness (FK: 0.848, 95% CI [0.699, 0.996], p < 0.001). Substantial IRR was observed for disagreement on misleading information (FK: 0.743, 95% CI [0.601, 0.886], p < 0.001) and agreement on suitability for patients (FK: 0.627, 95% CI [0.478, 0.776], p < 0.001). Moderate IRR was observed for agreement on "up-to-dateness" (FK: 0.584, 95% CI [0.434, 0.734], p < 0.001) and suitability for orthopedic surgeons (FK: 0.505, 95% CI [0.383, 0.628], p < 0.001). Question- and subtopic-specific analysis revealed diverse IRR levels ranging from near-perfect to poor. CONCLUSIONS: ChatGPT's free-text responses to complex orthopedic questions were predominantly reliable and useful for orthopedic surgeons and patients. Given variations in performance by question and subtopic, consulting additional sources and exercising careful interpretation should be emphasized for reliable medical decision-making.
RESUMO
This study assessed the quality of life (QOL) and the functional outcome in daily living in patients with a chronic, treatment-resistant periprosthetic joint infection (PJI) or osteomyelitis, living with a natural or iatrogenic sinus tract. METHODS: A follow-up examination in three national reference centers for septic bone and joint surgery was performed utilizing the Hospital Anxiety and Depression Scale (HADS-D/A), the Visual Analogue Scale (VAS), and the Short Form-36 (SF-36) score, including patients with a chronic sinus tract due to treatment-resistant PJI or osteomyelitis. RESULTS: In total, 48 patients were included, with a mean follow-up time of 43.1 ± 23.9 months. The mean SF-36 Mental Component Summary (MCS) was 50.2 (±12.3) and the Physical Component Summary (PCS) was 33.9 (±11.3). The mean HADS-D was 6.6 (±4.4) and HADS-A was 6.2 (±4.6), and the VAS was 3.4 (±2.6). The SF-36 MCS showed no significant differences between the study group and the standard population (47.0, p = 0.10), as well as the HADS-A. The PCS in the study population was significantly worse (50.0, p < 0.001), as was the HADS-D. CONCLUSIONS: A sinus tract represents a treatment option in selected cases with an acceptable QOL. The treatment should be considered for multimorbid patients with a high perioperative risk or if the bone or soft tissue quality prevents surgery.
RESUMO
PURPOSE: Indication for surgical decompression in metastatic spinal cord compression (MSCC) is often based on prognostic scores such as the modified Bauer score (mBs), with favorable prognosis suggestive of surgery and poor prognosis of non-surgical management. This study aimed to clarify if (1) surgery may directly affect overall survival (OS) aside from short-term neurologic outcome, (2) explore whether selected patient subgroups with poor mBs might still benefit from surgery, and (3) gauge putative adverse effects of surgery on short-term oncologic outcomes. METHODS: Single-center propensity score analyses with inverse-probability-of-treatment-weights (IPTW) of OS and short-term neurologic outcomes in MSCC patients treated with or without surgery between 2007 and 2020. RESULTS: Among 398 patients with MSCC, 194 (49%) underwent surgery. During a median follow-up of 5.8 years, 355 patients (89%) died. MBs was the most important predictor for spine surgery (p < 0.0001) and the strongest predictor of favorable OS (p < 0.0001). Surgery was associated with improved OS after accounting for selection bias with the IPTW method (p = 0.021) and emerged as the strongest determinant of short-term neurological improvement (p < 0.0001). Exploratory analyses delineated a subgroup of patients with an mBs of 1 point who still benefited from surgery, and surgery did not result in a higher risk of short-term oncologic disease progression. CONCLUSION: This propensity score analysis corroborates the concept that spine surgery for MSCC associates with more favorable neurological and OS outcomes. Selected patients with poor prognosis might also benefit from surgery, suggesting that even those with low mBs may be considered for this intervention.
Assuntos
Compressão da Medula Espinal , Neoplasias da Coluna Vertebral , Humanos , Compressão da Medula Espinal/etiologia , Compressão da Medula Espinal/cirurgia , Pontuação de Propensão , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/cirurgia , Neoplasias da Coluna Vertebral/secundário , PrognósticoRESUMO
INTRODUCTION: In total knee arthroplasty (TKA), tibial obliquity-restoration using kinematic alignment (KA) poses a major difference to conventional mechanical alignment. This study aimed at analysing the accuracy of conventional instrumentation (CI) versus patient-specific instrumentation (PSI) to restore anatomic tibial obliquity measured by the medial proximal tibial angle (MPTA) on conventional X-rays. MATERIALS AND METHODS: One-hundred patients were randomized to receive CI (n = 50) or PSI (n = 50) for TKA. Further 100 patients received CI without randomisation, resulting in 200 patients in total (127 women, mean age: 70.7 (range: 48-90 years). Pre- and postoperative X-rays were measured twice by two observers with a 2-week break in-between. Inter- and intraclass correlations were calculated and postoperative tibial obliquity compared to preoperative anatomy. RESULTS: In 150 patients with CI, no case with tibial obliquity-deviation greater than 2° was found, whilst 21.3% (n = 32) and 0.7% (n = 1) of cases and had a deviation of 0°-1°, and 1°-2°, respectively. In the remaining 78.0% (n = 117), tibial obliquity was restored. In 50 patients with PSI, no single case with a deviation greater than 1° was found. Sixty percent (n = 30) had a deviation of 0°-1°. In the remaining 40.0% (n = 20), no deviation from preoperative measurements was found. Consequently, CI resulted in a significantly smaller change in tibial obliquity from preoperative to postoperative than PSI (p < 0.001). Inter- and intra-class correlations showed a substantial agreement (any ICC > 0.90). CONCLUSION: Both conventional and patient-specific instrumentation revealed adequate results with respect to restoring tibial obliquity in kinematically aligned TKA, with conventional instrumentation achieving superior results.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Feminino , Idoso , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgia , Radiografia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgiaRESUMO
Data on reconstruction of the femoral anteversion (FA) and the center of rotation after total hip arthroplasty (THA) are rare. We aimed to answer whether a short-stem fixation enables improved anatomical reconstruction of the FA compared to a straight-stem. METHODS: One hundred and thirty patients who underwent short- (n = 89, group A, prospective) or straight-stem THA (n = 41, group B, retrospective) were included. CT scans of the hip, knee, and ankle were performed pre- and postoperatively in group A and in group B during the last follow-up. Femoral torsion was determined using three-dimensional models. RESULTS: The mean preoperative FA was 22.4° ± 11.0°, and the mean postoperative FA was 23.4° ± 10.1°. The relative difference was -0.8° ± 8°, and the absolute difference was 6.4° ± 4.9°. Gender analysis revealed significant differences in preoperative FA between female (f) and male (m) patients (28.1° ± 11.2° (f) vs. 18.4° ± 8.3° (m); p > 0.001) as well as in postoperative FA (26.7° ± 23.5° (f) vs. 21.0° ± 9.7° (m); p < 0.007) in group A. Postoperative FA was higher in group A (mean 6.8°; 23.9° ± 10.1° (f) vs. 16.6° ± 8.6° (m); p < 0.001). CONCLUSIONS: The study's findings suggest that short-stem THA leads to improved anatomical FA reconstruction; however, a substantial postoperative gender-related FA difference was detectable, which may warrant consideration by surgeons when determining the final stem anteversion. It should be noted that the impact of the postoperative gender-related FA difference on clinical outcomes is not entirely clear, and further research is warranted to elucidate this relationship.
RESUMO
BACKGROUND: Total hip arthroplasty (THA) is known to be the most successful orthopaedic surgery of the last century, but it is still struggling with controversies concerning one-stage bilateral THA. The current study aimed to compare the clinical outcome of patients with unilateral or simultaneous bilateral THA by using short-stem and straight-stem designs and focusing on operation time, blood loss, and length of hospital stay (LOS). MATERIAL AND METHODS: Between 2006 and 2018, 92 patients were enrolled in this study. Forty-six patients underwent a bilateral THA in one session, and forty-six matched patients underwent a unilateral THA. In each of the two groups (unilateral vs. bilateral), 23 patients received either a straight (unilateral: 10 females, 13 males, mean age 63; bilateral: 12 females, 11 males, mean age 53 years) or short stem (unilateral: 11 females, 12 males, mean age 60 years; bilateral: 12 females, 11 males, 53 mean age 62 years). The blood count was checked preoperatively as well as one and three days after surgery. Furthermore, the operation time and LOS were investigated. RESULTS: Compared to THA with straight-stems, short-stem THA showed significantly less blood loss; there was no difference in the LOS of both groups. A significantly shorter operative time was only observed in the bilateral THA. CONCLUSION: The current study showed that simultaneous bilateral THA appears to be safe and reliable in patients without multiple comorbidities. In addition, short-stem THA appears to be beneficial in terms of clinical performance and outcome, and it appears to be superior to straight-stem THA, regardless of whether the patient underwent unilateral or simultaneous bilateral THA.
RESUMO
INTRODUCTION: Smoking has been associated with numerous adverse outcomes following surgical procedures. The purpose of this study was to investigate, whether smoking status at time of surgery influences the outcome of primary TKA. MATERIALS AND METHODS: Six hundred and eighty-one patients who underwent primary TKA between 2003 and 2006 were included in the study. Smoking status was defined as current, former, and never smoker. Complications leading to revisions were assessed until 17 years of follow-up. Functional outcome was evaluated using clinical scores: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, Short Form-12 Physical and Mental Component Summaries (SF-12PCS/MCS), and Knee Society Function and Knee Score (KSFS and KSKS). RESULTS: At a mean follow-up of 95 months (± 47 months), 124 complications led to revision surgery. Soft-tissue complications (OR, 2.35 [95% CI 1.08-5.11]; p = 0.032), hematoma formation (OR, 5.37 [95% CI 1.01-28.49]; p = 0.048), and restricted movement (OR, 3.51 [95% CI 1.25-9.84]; p = 0.017) were more likely to occur in current smokers than never smokers. Current smokers were more likely to score higher at KSFS (p < 0.001) and SF-12PCS (p = 0.0197) compared to never smokers. For overall revision, differences were noted. CONCLUSION: Current smoking increases risk of soft-tissue complications and revision after primary TKA, especially due to hematoma and restricted movement. Smoking cessation programs could reduce the risk of revision surgery.