Acta chirurgiae orthopaedicae et traumatologiae Cechoslovaca
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Patient Satisfaction after Total Knee Arthroplasty. Analysis of Pre-Operative and Peri-Operative Parameters Influencing Results in 826 Patients].
PURPOSE OF THE STUDY The aim of the study was, first, to assess satisfaction of our patients after primary total knee arthroplasty (TKA) at various intervals of follow-up. Second, a list of pre- and peri-operative factors with potential effects on patient satisfaction was analysed. The third objective was to identify conditions under which a result of replacement could be considered definite with a little probability of further unexpected development. A more detailed knowledge of unsatisfied patients may provide valuable information for use in pre-operative evaluation, indication for surgery, as well as in the surgery itself. MATERIAL AND METHODS This prospective study consisted of 826 patients who underwent primary TKA between September 2010 and March 2015 and had at least one complete post-operative examination. Our group included 296 men and 530 women. The average age at primary TKA was 68.9 (45-87). Primary osteoarthritis was the most frequent indication to surgery (82.6 %). The followup period ranged from 1 month to 3 years. On each follow-up examination, every patient received an original questionnaire with 24 questions concerning the course of their post-operative period (between the discharge from hospital and the planned follow-up). The patients assessed the degree of satisfaction with surgery outcomes on a scale ranging from "fully satisfied" to "dissatisfied" and expressed their overall satisfaction in percents. RESULTS At the final follow-up, 6.5% of the patients were not satisfied with the outcome. The patients' overall satisfaction was 90.2 % (i.e., responses to the question of how you were satisfied with surgery). Significantly more satisfied patients were among those with primary osteoarthritis. Their satisfaction was related to the level of the UCLA activity rating, feelings of uncertainty when walking and to the functional ability component of the KSS system. On the other hand, more dissatisfied patients were found among those with several previous operations, a higher ASA score or a higher number of risk factors (Charlson comorbidity score etc.). The duration of pre-operative complaints had no relation to post-operative satisfaction. Similarly, there was no relation between VAS-evaluated pain intensity before TKA and patient satisfaction after arthroplasty. Obesity and satisfaction were not inter-related either. DISCUSSION Assessment of satisfaction is one of the Patient Reported Outcome Measures (PROMs) used by patients to evaluate the effect of a therapeutic method. These instruments aid in assessing the degree to which the method has met the needs and expectations of patients. It is relevant to emphasise that subjective factors, such as expectation or satisfaction, do not depend on the therapeutic procedure only. Recent reports have shown that, in 10% to 30% of the patients, the TKA outcome has not met their expectations. More detailed studies draw attention to the fact that there are more dissatisfied patients after TKA than those after THA. When satisfaction with pain relief is considered, the number of dissatisfied patients is even lower (72%-86%). CONCLUSIONS An analysis of the patients' responses shows that the rate of satisfaction is high shortly after surgery but declines gradually thereafter. The overall satisfaction is stable about 12 months after the surgery. The number of dissatisfied patients or those reporting pain after TKA in our study is in agreement with the results reported in relevant literature. The associations found here will be used in preparing a tool for clinical outcome prediction. ⋯ total knee arthroplasty, outcome evaluation, patient-reported outcome measures, satisfaction, dissatisfaction, pain after total knee arthroplasty, function after total knee arthroplasty.
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Treatment for Periprosthetic Femoral Fractures after Total Hip Arthroplasty].
PURPOSE OF THE STUDY To give a description of the patient group, risk factors, classification, therapeutic procedures and treatment outcomes in periprosthetic femoral fractures after total hip arthroplasty treated in the Trauma Hospital in Brno. MATERIAL AND METHODS This retrospective study comprised of 51 patients treated for a periprosthetic femoral fracture between 2003 and 2013. This included 19 (37%) intra-operative and 32 (63%) post-operative fractures. ⋯ Osteosynthesis as a single procedure is indicated only if the femoral component is stable and well fixed. When the stem in B2 and B3 fractures is loose, revision surgery with stem replacement is necessary. Key words: periprosthetic fracture, total hip atrhroplasty, Vancouver classification.
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Acta Chir Orthop Traumatol Cech · Jan 2016
Medial Spike and Obesity Associate with Open Reduction in Type III Supracondylar Humeral Fracture.
PURPOSE OF THE STUDY Although supracondylar humeral fractures represent a major part of the pediatric fractures, no classification system or radiological characteristics describes which supracondylar fractures require open reduction. We aim to evaluate the factors that lead us to perform open reduction during operation. MATERIAL AND METHODS We retrospectively evaluated 57 patients who underwent operation for type III supracondylar fracture, and divided them into two groups; those with open reduction and internal fixation, and those with closed reduction and percutaneous fixation. The two groups were compared based on age, gender, BMI by age, medial spike angle of the fracture, medial spike-skin distance and rotation angle between the fractured fragments. RESULTS Of all patients, 46 (81.71%) underwent closed reduction and percutaneous fixation (CRPF) and 11 (19.29%) were treated with open reduction and internal fixation (ORIF). BMI by age was remarkably higher in the ORIF group (p = 0.00). And medial spike angle was smaller in the ORIF group (p = 0.014). DISCUSSION Closed reduction and percutanous fixation is the main treatment of supracondylar humeral fractuers. Open reduction in supracondylar humeral fractures could be associate with complications and cosmetic lesions. Many studies indicates that obesity is high risk factor for complex fractures as well as preoperative and postoperative complications. A prominant medial spike could associate with muscle entrapment, and obliquity of the fracture line. It could be also an indirect finding of instablity of the fracture. CONCLUSION We suggest that a smaller medial spike angle and a higher BMI in children with Type III supracondylar humeral fractures may require open reduction, and it is unreasonable to avoid open reduction in cases where closed reduction is not achieved. ⋯ supracondylar humerus, open reduction, obesity, medial spike angle.
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Acta Chir Orthop Traumatol Cech · Jan 2016
[Intra-Articular Application of Tranexamic Acid Significantly Reduces Blood Loss and Transfusion Requirement in Primary Total Knee Arthroplasty].
PURPOSE OF THE STUDY The aim of this prospective study was to investigate the effect of topical application of tranexamic acid (TXA, Exacyl) on the amount of post-operative blood loss, and blood transfusion requirement in patients undergoing primary total knee arthroplasty (TKA). Attention was paid to early complications potentially associated with TXA administration, such as haematoma, wound exudate, or knee swelling. In addition, the economic benefit of TXA treatment was also taken into account. ⋯ The economic benefit is also worth considering. In agreement with the recent literature, it is suggested to add topical TXA application to the recommended procedures for TKA surgery. Key words: tranexamic acid, Exacyl, topical application, intra-articular application, blood loss, hidden blood loss, total knee arthroplasty, complications.
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Acta Chir Orthop Traumatol Cech · Jan 2016
Comparative Study[Anterior Superior and Anterior Interior Iliac Spine Fractures. Comparison of the Results of Conservative and Surgical Treatment].
Avulsion fractures of the anterior superior iliac spine (ASIS) and anterior inferior iliac spine (AIIS) are rare injuries to the skeleton in children. They are most frequent in adolescent athletes, such as sprinters and long-distance runners, and football players. The authors present a group of patients treated at their department and compare the results of procedures used to manage different pelvic avulsion fractures. ⋯ Indications for surgical treatment are based on the degree of fragment displacement and the patient's demands for sports activities. Although long-term outcomes of both operative and conservative procedures are comparable, the patients treated surgically show faster recovery and need a shorter time of immobilisation. However, removal of osteosynthesis material may be associated with some risk of complications.