Archives of orthopaedic and trauma surgery
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Arch Orthop Trauma Surg · Mar 2023
What is the failure rate of constrained liners in complex revision total hip arthroplasty?
Recurrent hip dislocation after multiple revision total hip arthroplasty is a severe complication. Therefore, constrained acetabular liners (CL) have been used during salvage procedures. We report our experience of constrained liners in a re-revision setting with focus on re-dislocation. We also evaluated acetabular and femoral bone loss as potential risk factor. ⋯ We found the use of a constrained liner in a re-revision setting still bears a high risk of re-revision and re-dislocation. Therefore we restrained from using constrained liners in favour of Dual mobility cups. In this study there was no significant higher dislocation rate in the subgroup of periprosthetic infection. Furthermore the rigid design of a constrained liner bears the known risk of structural failure of acetabular reconstruction implants. Severe acetabular or femoral bone defects seem to have an impact on the revision rate, but not on the dislocation rate with regards to the restored offset and center of the hip. Results have to be taken into context such that the study population inherently has a predisposition for poorer outcomes. Indications should be strongly filtered for patients at high risk for recurrent hip joint dislocation including failed DMCs with only limited bone loss and moderate soft tissue defects. Our modification to the existing classification with a high inter and intraobserver reliability will make future studies more comparable regarding revisions and bone stock loss. Still further research using objective and reproducible parameters is needed to better analyze data especially in the background of complex revision hip arthroplasty.
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Arch Orthop Trauma Surg · Mar 2023
Total hip arthroplasty for hip fractures in patients older than 80 years of age: a retrospective matched cohort study.
Increasing age and hip fractures are considered risk factors for post-operative complications in total hip arthroplasty (THA). Consequently, older adults undergoing THA due to hip fracture may have different outcomes and require additional healthcare resources than younger patients. This study aimed to identify the influence of age on discharge disposition and 90-day outcomes of THA performed for hip fractures in patients ≥ 80 years to those aged < 80. ⋯ Level III, Retrospective Cohort Study.
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The regional variation in spine surgery rates has been shown to be large both within and between countries. This variation has been reported to be less in studies from countries with spine registers. The aim of this study was to describe the regional variation in lumbar spine surgery in Finland. ⋯ In Finland, the regional variations in spine surgeries were vast. In a country with a publicly funded healthcare system, this finding was surprising. The recently created national spine register may serve to shed more light on the reasons for this regional variation.
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Arch Orthop Trauma Surg · Mar 2023
Observational StudyEpidemiology of hand injuries that presented to a tertiary care facility in Germany: a study including 435 patients.
Hand injuries compose up to 30% of all injuries in emergency care. However, there is a lack of epidemiological data reflecting patient or accident-related variables, injury types, injured anatomical structures or trauma localization. ⋯ The dorsal aspect of the hand including the 5th metacarpal, the radial wrist and thenar region, as well as the fingertips of Digiti II/III represent anatomic danger zones to injury of the hand. Due to the large variety of potentially injured structures, diagnosis and treatment is not trivial. Specific training is required for all surgical specialties in emergency care, to increase quality of diagnostic work-up and management of hand injuries.
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Arch Orthop Trauma Surg · Mar 2023
Effect of documented and undocumented psychiatric conditions on length of stay and discharge destination after total knee arthroplasty.
Length of stay (LOS) and readmissions are quality metrics linked to physician payments and substantially impact the cost of care. This study aims to evaluate the effect of documented and undocumented psychiatric conditions on LOS, discharge location, and readmission following total knee arthroplasty (TKA). ⋯ Retrospective Cohort Study.