Functional outcome of direct anterior versus posterior approach in total hip arthroplasty: a propensity-matched Asian study.

INTRODUCTION: The direct anterior approach (DAA) to total hip arthroplasty (THA) is a surgical approach that minimises soft tissue trauma, resulting in faster rehabilitation when compared to a posterior approach (PA). This study aimed to evaluate the difference between the two groups in an Asian cohort using propensity score matching. METHODS: A retrospective review of prospectively collected registry data of 794 primary THAs was performed. The effects on patients with DAA THA versus patients with PA THA were investigated. Propensity scores were generated using logistic regression to adjust for confounding variables of age, gender, body mass index and diagnosis. Data analysis was performed, and statistical significance was defined as a P value < 0.05. RESULTS: The average length of stay (LOS) for the PA group and DAA group was 5.4 days and 2.9 days, respectively (P < 0.001). One (1.9%) patient from the PA group suffered a posterior dislocation 6 months after surgery and subsequently underwent revision surgery 2 years later. No dislocations were detected in the DAA group. The DAA group had better functional outcome, satisfaction and expectation scores at 6 months and 2 years. CONCLUSION: In this study, patients who underwent DAA THA had better functional outcome at 2 years and almost 2 days shorter overall LOS than those who underwent PA THA. Therefore, the DAA to THA is a novel technique that has shown improved functional outcomes, with fewer complications compared to PA THA.

Adductor Canal Block Does not Confer Better Immediate Postoperative Pain Relief after Total Knee Arthroplasty.

The adductor canal block (ACB) is a useful adjunct to control postoperative pain in total knee arthroplasty (TKA). The aim of our study was to compare postoperative day 1 (POD1) pain scores, ambulation distance, range of motion, active straight leg raise (SLR), and length of stay (LOS) in TKA patients receiving no ACB (NACB), ACB by surgeon (ACBS), or ACB by anesthetist (ACBA). After obtaining institutional ethics approval, a retrospective review of 135 patients who underwent TKA between September 2020 and March 2021 was performed. All patients underwent TKA by the same surgeon and received the same standardized postoperative rehabilitation. Operating theater time was shortest in the NACB group with 129.3 ± 23.1 minutes compared with 152.4 ± 31.6 minutes in ACBA and 139.2 ± 29.4 minutes in ABCS (p = 0.001). For the POD1 pain score after therapy, the NACB group scored 4.9 ± 3.1 compared with 3.5 ± 2.2 and 3.9 ± 1.8 scored by the ACBA and ACBS groups, respectively (p = 0.302). The mean POD1 ambulation distance was 21.1 ± 15.2 m in the NACB group compared with 15.4 ± 1.3 and 17.8 ± 13.2 m in the ACBA and ACBS groups (all p > 0.05), respectively. There were no significant differences in the median LOS between three groups or ability to perform active SLR (all p > 0.05). Our study found no significant differences when comparing ACBS and ACBA by POD1 pain score, ambulation distance, range of motion, and LOS. We recommend against the use of ACB and instead recommend surgeons to perform an adequate periarticular cocktail injection.

Septuagenarians aged 75 years and older do benefit from arthroscopic rotator cuff repair: a propensity matched-pair analysis.

BACKGROUND: Numerous studies show that patients who failed conservative management, benefit from open, mini open and arthroscopic rotator cuff repair (ARCR). However, there is a paucity of literature addressing ARCR and outcomes in patients older than the age of 75 years. The purpose of our study was to compare the outcomes of ARCR in patients older than 75 years and younger than 75 years of age. METHODS: Between January 2010 and December 2016, 397 patients underwent unilateral ARCR; of which, 23 patients were 75 years of age and older. Outcome measures recorded include the Constant Shoulder Score (CSS), University of California, Los Angeles Shoulder Score (UCLASS), Oxford Shoulder Score (OSS), and visual analog scale (VAS) for pain assessment. RESULTS: There were no statistically significant differences in VAS, CSS, and UCLASS between the two groups at all time points of follow-up (all P > .05). At 2 years after surgery, the OSS was 2 ± 5 points better in the <75 group (P = .012). However, the improvement in OSS was comparable between both groups. The improvement in VAS, CSS, and UCLASS at 2 years after surgery compared with baseline was also similar between the two groups (all P < .05). CONCLUSIONS: The improvement in VAS, CSS, and UCLASS was similar in both groups of patients. We conclude that septuagenarians with symptomatic cuff tears, who have failed conservative management, experience significant improvement in pain, and function after surgery and should not be excluded from the benefits of ARCR.

Results of Hallux Valgus Surgery in Diabetic Patients With Good Glycemic Control.

BACKGROUND: Literature is sparse on whether diabetes affects outcomes of hallux valgus surgery. With the rising global prevalence of diabetes and diabetes being an independent predictor of poorer outcomes, particularly in foot and ankle surgery, we aimed to investigate the impact of diabetes on the outcomes of hallux valgus surgery. METHODS: We conducted a retrospective comparative cohort study of prospectively collected registry data of 951 feet in 721 patients who underwent surgery for symptomatic hallux valgus between 2007 and 2015 at our institution. All patients with diabetes were identified and matched with patients without diabetes for age, sex, and body mass index in a 1:2 ratio to construct the matched cohorts for analysis. Glycemic control in the diabetic cohort was assessed using preoperative HbA1c. The primary outcome measure was complication rates. Secondary outcomes were (1) deformity correction using the hallux valgus and intermetatarsal angles; (2) patient-reported outcomes using visual analog scale (VAS) for pain, Short Form-36 (SF-36) Physical and Mental Health subscales, and American Orthopaedic Foot & Ankle Society (AOFAS) scores; (3) patient satisfaction; and (4) reoperation rates up to 2 years postoperatively. Forty diabetic patients were identified and matched to 80 nondiabetic patients. Although matching was only performed for age, sex, and body mass index, the diabetic and the nondiabetic cohorts were also similar in hallux valgus severity, preoperative scores, and types of procedures performed. RESULTS: The mean preoperative HbA1c in our diabetic cohort was 7.1%. Both the diabetic and nondiabetic cohorts showed excellent AOFAS and VAS scores with no differences in degree of deformity correction, complication profiles, reoperation rates, outcome scores, and satisfaction at both 6 months and 2 years postoperatively. CONCLUSION: We believe stringent patient selection was key to reduced complication rates and good outcomes in diabetic patients. Well-selected diabetic patients remain suitable candidates for hallux valgus surgery. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Computed tomography-based diagnosis of occult fragility hip fractures offer shorter waiting times with no inadvertent missed diagnosis.

PURPOSE: Surgical delay due to the wait for advanced cross-sectional imaging in occult fragility hip fracture management is not well studied. Our study aims to investigate computed tomography (CT) as an alternative to the gold standard magnetic resonance imaging (MRI) in occult hip fracture workup to decrease surgical delay. METHODS: We conducted a retrospective review of all CTs and MRIs performed between 2015 and 2017 for patients with clinically suspected fragility hip fractures and negative plain radiographs to investigate surgical delay resulting from the wait for advanced imaging and representations due to missed fractures. RESULTS: A total of 243 scans (42 CTs and 201 MRIs) were performed for occult hip fracture workup over the study timeframe, of which 49 patients (20%) had occult hip fractures [CT: 6 (14%), MRI: 43 (21%), p = 0.296)]. There were no readmissions for fracture in the 12 months following a negative scan. The CT group had shorter waiting times (CT: 29 ± 24 h, MRI: 44 ± 32 h, p = 0.004) without significantly reducing surgical delay (CT: 82 ± 36 h, MRI: 128 ± 58 h, p = 0.196). The MRI group had a higher number of patients with a cancer history (p = 0.036), reflective of the practice for workup of possible metastases as a secondary intention. CONCLUSION: Advanced cross-sectional imaging wait times in occult hip fracture workup contribute significantly to surgical delay. Modern CT techniques are not inferior to MRI in detecting occult fractures and may be a suitable alternative in the absence of a cancer history if MRI cannot be obtained in a timely fashion or is contraindicated. Clinicians should utilize the more readily available imaging modality to reduce surgical delay.