The American journal of orthopedics
-
We conducted this study to determine the effect of reinfusion drains on the difference in hemoglobin (Hb) levels before and after total knee arthroplasty. Of the 158 patients who underwent total knee arthroplasty on one side, 74 had autologous blood transfusion through reinfusion drains (group 1); the other 84 did not have autologous blood transfusion, but ordinary suction drains were used to drain the wound during the immediate postoperative period (group 2). Mean preoperative Hb levels were 13.6 g/dL for group 1 (SD, 1.4 g/dL; range, 10.4-18.1 g/dL) and 13.6 g/dL for group 2 (SD, 1.3 g/dL; range, 10.0-16.7 g/dL). ⋯ The reinfusion drain cost pound 36.43 ( approximately US$58.87) more than the suction drain. Autologous blood from reinfusion drains did not significantly improve postoperative Hb levels. Further use of reinfusion drain is not cost-beneficial.
-
Acute or chronic infection in the presence of nonunited fracture or chronic nonunion often necessitates staged surgical treatment. Treatment typically involves removal of hardware, débridement of infected tissue, use of local antibiotic delivery, and a long-term course of intravenous antibiotics. ⋯ In this report we describe a simple method for fashioning an antibiotic cement-coated interlocking intramedullary nail to treat an infected tibia fracture. This technique capitalizes on local delivery of antibiotics through use of antibiotic cement with the added benefit of improving fracture stability and fixation with an interlocking nail to achieve bony union.
-
We assessed the differential complications and mortality rates of teaching versus nonteaching hospitals in July against other month-to-month differences in a cohort of 324,988 elderly patients hospitalized for a femoral neck or intertrochanteric fracture (data taken from the 1998-2003 National Inpatient Sample). Demographics were similar between teaching and nonteaching hospitals and across admission months. The overall mortality rate was 3.64% and was slightly higher in teaching hospitals compared with nonteaching hospitals (3.69% vs. 3.61%, relative risk [RR] = 1.0062, 95% CI 0.99-1.02). ⋯ Intraoperative complications and length of stay were statistically significantly greater in teaching hospitals but did not demonstrate a "July effect." Teaching hospitals had lower perioperative complication rates. Elderly hip fracture patients treated at teaching hospitals had 12% greater relative risk of mortality in July/August (ie, experience a "July effect") compared with nonteaching hospitals during that time period (1998-2003). Although various methods exist for exploring the "July effect," it is critical to take into account inherent month-to-month variation in outcomes and to use nonteaching hospitals as a control group.
-
The continually increasing number of total hip arthroplasties (THAs) being performed, in conjunction with the rapid growth in new surgical techniques and implants related to THA, warrants ongoing and objective monitoring of results. National joint replacement registries have become powerful surveillance systems for monitoring contemporary THAs and improving outcomes. Despite the compelling evidence of their benefits, such a registry has yet to be established in the United States. In this article, we provide a rationale for implementing a national joint replacement registry in the United States.