Is single-anaesthetic bilateral primary total hip replacement still safe? A 16-year cohort study from the New Zealand Joint Registry.

Background: The surgical management options for bilateral hip osteoarthritis comprise staged or single-anaesthetic bilateral total hip replacements (THRs). The key issue of contention in performing the latter remains safety. We compared unilateral, staged bilateral and single-anaesthetic bilateral THR with the hypothesis that there would be no difference between these three practices using mortality risk, functional outcome and revision rate as the primary outcome measures.

Long-Term Survival of Total Hip Arthroplasty Using Implants From Different Manufacturers.

Background: Total hip arthroplasty (THA) can be performed using either femoral and acetabular components provided by the same manufacturer (matched components) or components from different manufacturers (unmatched components). We hypothesized that there would be no difference in outcomes following the use of unmatched compared to matched components.

Methods: Data from a nationwide joint registry, the New Zealand Joint Registry (NZJR), were analyzed to assess long-term outcomes of using unmatched implants in THA.

Rates of Joint Replacement Surgery in New Zealand, 1999-2015: A Comparison of Rheumatoid Arthritis and Osteoarthritis.

Objective: To determine rates of joint replacement for people with rheumatoid arthritis (RA) and osteoarthritis (OA) and to examine the characteristics of those receiving elbow replacements.

Methods: Data were extracted from the New Zealand Joint Registry from 1999 to 2015 and annual rates calculated.

Results: Rates of joint replacement increased over time for OA but not RA.

A Comparative Outcome Study of Hamstring Versus Tibialis Anterior and Synthetic Grafts for Deltoid to Triceps Transfers.

Purpose: To assess elbow extension strength and complications after deltoid-triceps transfers using hamstring tendon graft compared with tibialis anterior and synthetic tendon grafts.

Methods: A retrospective review of deltoid-triceps transfers in patients with tetraplegia performed between 1983 and 2014.

Results: Seventy-five people (136 arms) had surgery performed, with the majority undergoing simultaneous bilateral surgery (n = 61; 81%).

Rehabilitation after total joint replacement: a scoping study.

Purpose: The evidence supporting rehabilitation after joint replacement, while vast, is of variable quality making it difficult for clinicians to apply the best evidence to their practice. We aimed to map key issues for rehabilitation following joint replacement, highlighting potential avenues for new research.

Materials And Methods: We conducted a scoping study including research published between January 2013 and December 2016, evaluating effectiveness of rehabilitation following hip and knee total joint replacement.

Tendon Transfer Surgery for People With Tetraplegia: An Overview.

After cervical spinal cord injury, the loss of upper limb function is common. This affects an individual's ability to perform activities of daily living and participate in previous life roles. There are surgical procedures that can restore some of the upper limb function lost after cervical spinal cord injury.

Survival outcomes of cemented compared to uncemented stems in primary total hip replacement.

Total hip replacement (THR) is a successful and reliable operation for both relieving pain and improving function in patients who are disabled with end stage arthritis. The ageing population is predicted to significantly increase the requirement for THR in patients who have a higher functional demand than those of the past. Uncemented THR was introduced to improve the long term results and in particular the results in younger, higher functioning patients.

Current trends and projections in the utilisation rates of hip and knee replacement in New Zealand from 2001 to 2026.

Aim: This study aimed to estimate the demand for total hip (THR) and knee replacements (TKR) by 2026 within New Zealand (NZ) and show how demographic factors are likely to influence this projection.

Method: Yearly population data from the NZ Census was compared to the NZ Joint Register from 2001-2011 and ethnic and gender specific data was organised into 5 year age groups from 35 years to calculate the incidence for each age group. Poisson regression analysis was used to project the incidence for 2026 and to evaluate the independent associations between age, gender and ethnicity.

The effects of aging on upper limb tendon transfers in patients with tetraplegia.

Purpose: To evaluate the effects of aging on hand function among patients with tetraplegia who had forearm tendon transfer surgery between 1982 and 1990.

Methods: The study used a longitudinal cohort design that compared hand function outcomes in 2012 with those obtained 11 years earlier. A digital analyzer was used to measure key pinch and grip strength, and results were compared with those obtained in 2001 to determine changes in strength over time.

Does orthopedic training compromise the outcome in total hip arthroplasty?

Background: This study compares the outcomes of total hip arthroplasty surgery performed by a consultant with those performed by supervised and unsupervised orthopedic trainees.

Methods: We reviewed 6 years of patient data from the New Zealand Joint Registry in patients undergoing total hip arthroplasty comparing the outcome measures of revision surgery and Oxford hip score at 6 months with the experience of the primary surgeon.

Results: Over the study period 35,415 patients underwent elective total hip arthroplasty; 30,344 performed by a consultant, 2982 by a supervised trainee and 1067 by an unsupervised trainee.

Osteotomy and unicompartmental knee arthroplasty converted to total knee arthroplasty: data from the New Zealand Joint Registry.

We reviewed the revision rate and functional outcome of all patients who had a total knee arthroplasty (TKA) after an osteotomy or unicompartmental knee arthroplasty (UKA) on the New Zealand Joint Registry. We used these data to compare the results with primary TKA scores, including comparison of age-matched subgroups. There were 711 patients who had undergone TKA as salvage for a failed osteotomy with a revision rate of 1.

The relationship between the American Society Of Anesthesiologists physical rating and outcome following total hip and knee arthroplasty: an analysis of theNew Zealand Joint Registry.

Background: The purpose of this study was to review the results of the first four years of use of the American Society of Anesthesiologists (ASA) physical status rating system in the New Zealand Joint Registry. Our hypothesis was that patients with a higher ASA score would have an increased mortality rate, an increased early revision arthroplasty rate, and poorer clinical outcomes at six months after total hip or knee arthroplasty.

Methods: We prospectively evaluated the preoperative ASA classes for all patients in the registry who underwent primary total hip or knee arthroplasty from 2005 to 2008 with regard to the six-month mortality rate and the Oxford Hip and Knee Scores at six months.

Use of patient-reported outcomes in the context of different levels of data.

There is increasing interest in measuring patient-reported outcomes as part of routine medical practice, particularly in fields like total joint replacement surgery, where pain relief, satisfaction, function, and health-related quality of life, as perceived by the patient, are primary outcomes. We review some well-known outcome instruments, measurement issues, and early experiences with large-scale collection of patient-reported outcome measures in joint registries. The patient-reported outcome measures are reviewed in the context of multidimensional outcome assessment that includes the traditional clinical outcome parameters as well as disease-specific and general patient-reported outcome measures.

A multinational assessment of metal-on-metal bearings in hip replacement.

There is emerging evidence that many metal-on-metal (MoM) bearings, when used with large femoral heads in conventional hip replacement and some resurfacing prostheses, are associated with increased rates of revision arthroplasty. Registries are the main sources of data on MoM prostheses. At the recent International Consortium of Orthopaedic Registries (ICOR) meeting, data were presented from the Australian, England and Wales, and New Zealand registries.

Bilateral total joint arthroplasty: the early results from the New Zealand National Joint Registry.

This study evaluated the mortality rate, major complications, and early outcomes of single anesthetic bilateral total hip and knee arthroplasty compared with unilateral and staged procedures. A total of 37,828 total hip and knee arthroplasties were evaluated with 6-month Oxford 12 scores. Major complications and mortality rates were recorded.

Measurement issues related to upper limb interventions in persons who have tetraplegia.

Measurement of upper limb function in persons with tetraplegia poses significant issues for clinicians and researchers. It is crucial that measures detect the small but significant improvements in hand function that may or may not occur as a result of our interventions. Before determining how we measure changes from upper limb interventions, we must establish what outcomes are of greatest interest, and for whom.

A New Zealand national joint registry review of 202 total ankle replacements followed for up to 6 years.

Background And Purpose: There have been few reports of large series of ankle replacements. The aim of this study was to document and evaluate the early results of a nationwide series of total ankle replacements (TARs) performed using second- and third-generation implants.

Methods: Records of total ankle replacements performed between February 2000 and November 2005 were retrieved from the New Zealand National Joint Registry and retrospectively reviewed at a mean of 28 months after the primary procedure.

Shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures.

Aims: To evaluate the effect of shared care between geriatricians and orthopaedic surgeons as a model of care for older patients with hip fractures.

Methods: All patients over the age of 65 years are under the shared care of an orthopaedic surgeon and geriatrician (the Ortho-Medicine Service) when they are admitted to the Orthopaedic Service, Christchurch Hospital, New Zealand. This retrospective case records audit includes all patients over the age of 65 years with hip fracture admitted to this service over a 6-month period from December 2002 to June 2003.

Cost analysis of traditional follow-up protocol versus MRI for radiographically occult scaphoid fractures: a pilot study for the Accident Compensation Corporation.

Assessment of the cost-effectiveness of early magnetic resonance imaging (MRI) for suspected radiographically occult scaphoid fractures. Methods Compare costs of patients presenting acutely with suspected scaphoid injuries (managed either with traditional follow-up radiographs and plasters) versus early MRI to exclude a fracture. Results The average medical cost for the control group was NZ470 dollars versus NZ533 dollars in the MRI group.

Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints.

Background: Streptococci cause up to 20% of prosthetic joint infections but this has received little attention in the published literature.

Methods: We reviewed retrospectively our experience with treatment of streptococcal prosthetic joint infections. Patients were followed up for up to 15 years after discontinuation of antimicrobial therapy and up to 8.

Upper limb surgery for tetraplegia: a 10-year re-review of hand function.

Purpose: To perform a 10-year re-review of hand function outcome for 24 tetraplegic persons who had received bilateral tendon transfers and tenodeses.

Methods: The Lamb and Chan questionnaire with additional questions, the Quadriplegic Index of Function (QIF), the Swanson sphygmomanometer technique for hook grip, the Preston Pinch Meter (PP) for key pinch, and a digital analyzer (DA) for both hook and key pinch were the test instruments used. The QIF and DA had not been used previously.

Analysis of posterior deltoid function one year after surgical restoration of elbow extension.

Purpose: The purpose of this study was to measure the extent and timing of elbow extension torque recovery after posterior deltoid-to-triceps tendon transfer.

Methods: Elbow extension moment was measured in 40 limbs from 23 patients who underwent surgical restoration using the posterior deltoid-to-triceps tendon transfer at times ranging from 8 weeks to 1 year after surgery. For comparison purposes, elbow extension moment also was measured in healthy controls and persons with C7 spinal cord injuries.