Knee Pain and Functional Outcomes after Retrograde Femoral Nailing: A Retrospective Review.

Objectives: To investigate the incidence and severity of knee pain following retrograde intramedullary nailing of femur fractures and to better understand functional outcomes using validated patient-reported outcome measures. Methods: Fifty-three patients with OTA 32 or 33 fractures treated by retrograde nail at a single academic Level 1 trauma center between 2009 and 2020 were retrospectively reviewed. Patients verbally completed the Oxford Knee Score (OKS) and Patient-Reported Outcome Measurement Information System (PROMIS) Short Form 6b, minimum one year postoperatively. Results: Thirty-four (64%) patients reported the presence of pain. Of those reporting pain, 16 (47.1%) reported their pain as mild. Compared to those without pain, patients with knee pain had lower OKS (30.38 +/- 10.65, versus 41.95 +/- 6.87; P <0.001) and higher PROMIS scores (14.65 +/- 6.76 versus 10.95 +/- 7.09; P=0.066). Conclusion: The increasing severity of pain was inversely correlated with functional status as measured by patient-reported measures. At present, the reliability, high union rates, and otherwise low complication rates associated with retrograde femoral nailing justify its continued use. However, knee pain and functional outcomes should remain an integral part of the preoperative discussion with the patient.

Outcomes of hip fracture surgery during the COVID-19 pandemic.

PURPOSE: To investigate if changes to hospital operational models during the COVID-19 pandemic negatively impacted overall time to surgery (TtS) as well as morbidity and mortality rates of hip fractures (HFx). METHODS: 416 patients treated for OTA 31 fractures at a single institution between January 2019 and November 2020 were reviewed. TtS as well as morbidity and mortality rates were obtained from pre-pandemic and pandemic groups. RESULTS: 263 patients were treated pre-pandemic and 153 were treated during the pandemic. There were no significant differences in median TtS, readmission rates (p = 0.134), reoperation rates (p = 0.052), 30-day (p = 0.095) and 90-day (p = 0.22) mortality rates. CONCLUSION: Reallocation of hospital resources in response to the COVID-19 pandemic did not negatively impact surgical timing or complications. TtS for HFx remains a challenge and often requires multidisciplinary care, which is complicated by a pandemic. However, this study demonstrates HFx standard of care can be maintained despite COVID-19 obstacles to treatment efficiency and efficacy.

Consistency of Acetabular Height in Sequential Bilateral Total Hip Arthroplasty.

BACKGROUND: Achieving appropriate leg length after surgery remains a concern for surgeons performing total hip arthroplasty (THA). The focus of surgeons trying to equalize leg length has been primarily on positioning of the femoral implant. This study evaluates the impact of acetabular height on leg length and its impact on femoral component choices during THA. METHODS: We reviewed standing pelvic radiographs of 100 patients who underwent staged bilateral THA by a single surgeon from 2016 to 2019. Leg length discrepancies and acetabular heights were determined from preoperative and postoperative radiographs. The difference between the first and second operative hips was compared at each stage of the procedures. Results were analyzed using paired t-tests. RESULTS: There is a significant increase in mean leg length and acetabular height after both the first and second stages of the procedure. Although there was a small change in average acetabular height for each procedure, height increased or decreased by greater than 5 mm in 44 of 200 cases. Comparing left to right hips after the second surgery disclosed no statistically significant differences in acetabular height or leg length. CONCLUSION: Acetabular height and leg length changes with each stage of the procedure in sequential bilateral THA. In almost 25% of cases, the acetabular height changed by more than 5 mm. This has significant implications and needs to be considered during preoperative planning as well as operative decision-making. To account for these differences, a THA may require intraoperative acetabular assessment and changes in femoral positioning and sizing to achieve the optimal leg length.