Avascular necrosis or rapid destruction of the hip following hip intra-articular corticosteroid injections: a systematic review.

Purpose: This study aimed to systematically review the literature to identify the incidence of avascular necrosis (AVN) following hip intra-articular corticosteroid injections (IACSIs) as well as to elucidate risk factors that may predispose patients to AVN following IACSI.

Methods: The MEDLINE, Embase, PubMed, and Web of Science databases were systematically searched through inception to July 21, 2024, in accordance with the PRISMA statement with data extracted for descriptive analysis. The inclusion criteria were hip IACSI and AVN of the femoral head.

Insurance Type and Withdrawal of Life-Sustaining Therapy in Critically Injured Trauma Patients.

Importance: Withdrawal of life-sustaining therapy (WLST) decisions for critically injured trauma patients are complicated and multifactorial, with potential for patients' insurance status to affect decision-making.

Objectives: To determine if patient insurance type (private insurance, Medicaid, and uninsured) is associated with time to WLST in critically injured adults cared for at US trauma centers.

Design, Setting, And Participants: This retrospective registry-based cohort study included reported data from level I and level II trauma centers in the US that participated in the American College of Surgeons Trauma Quality Improvement Program (TQIP) registry.

Local vancomycin administration in Orthopaedic Surgery - A systematic review of comparative studies.

Background: There is still controversy surrounding the routine use of vancomycin locally in primary orthopaedic surgery procedures. Therefore, the aim of this review is to assess how local vancomycin impacts the rates and microbiology of surgical site infections.

Methods: A systematic electronic search of MEDLINE, EMBASE, and Web of Science was carried out for all comparative studies comparing locally applied vancomycin to control for primary orthopaedic surgery procedures published before August 14, 2022.

Does-dual mobility still offer improved stability in smaller cup sizes? A computer modelling comparison of stability with 22-mm versus 28-mm inner heads in dual-mobility versus single-bearing constructs.

Purpose: Dislocation remains 1 of the leading causes of revision after primary total hip arthroplasty (THA) and there is clear evidence the dual-mobility (DM) is used more frequently to minimise this. But in smaller cups, whether the use of DM with smaller 22-mm heads imparts any increased stability compared to standard bearing is unknown; especially when those smaller cups now allow for large single-bearing (SB) heads.

Methods: 3 primary cup sizes (48 mm, 50 mm, 52 mm) were chosen for modelling.

A Geometric Analysis of Polyethylene Liners Exposed to Acrylic-based Bone Cement.

Background: Acrylic-based bone cement (polymethyl methacrylate [PMMA]) is a material commonly used in orthopaedic surgeries; however, during PMMA polymerization, a highly exothermic reaction occurs. The heat released in polymerization can damage nearby materials including poorly heat-resistant cross-linked polyethylene (XLPE). Both PMMA and XLPE are used in total hip arthroplasty and could interact during femoral stem fixation.

The influence of the COVID-19 pandemic on total hip and knee arthroplasty in Ontario: a population-level analysis.

Background: The effects of the COVID-19 pandemic on elective orthopedic surgery have yet to be reported at the population level in Canada. We sought to detail the effect of the pandemic on patients who underwent total hip arthroplasty (THA) and total knee arthroplasty (TKA), and on surgeons with respect to surgical volume, wait times and health care quality.

Method: We compared patient length of hospital stay, revisions, readmissions and emergency department presentations between pre-pandemic (April 2019 to February 2020) and postpandemic (April 2020 to February 2021) cohorts of patients who underwent inpatient THAs or TKAs.

The association between preoperative COVID-19-positivity and acute postoperative complication risk among patients undergoing orthopedic surgery.

Aims: This study aimed to investigate the risk of postoperative complications in COVID-19-positive patients undergoing common orthopaedic procedures.

Methods: Using the National Surgical Quality Improvement Programme (NSQIP) database, patients who underwent common orthopaedic surgery procedures from 1 January to 31 December 2021 were extracted. Patient preoperative COVID-19 status, demographics, comorbidities, type of surgery, and postoperative complications were analyzed.

The International Initiative to Measure Perceived Risk in Arthroplasty: The Results From a Multinational Survey.

Background: There is an inherent moral imperative to avoid complications from arthroplasty. Doing so at ideal cost is also associated with surgeon reputation, and, increasingly in health care delivery systems that measure and competitively score outcomes, reimbursement to the surgeons and their hospitals. As a result, patients who are perceived to be in higher risk comorbidity groups, such as the obese and diabetics, as well as those challenged by socioeconomic factors may face barriers to access elective arthroplasty.

Association of age, sex and race with prescription of anti-osteoporosis medications following low-energy hip fracture in a retrospective registry cohort.

Background: Initiation of anti-osteoporosis medications after hip fracture lowers the risk of subsequent fragility fractures. Historical biases of targeting secondary fracture prevention towards certain groups may result in treatment disparities. We examined associations of patient age, sex and race with anti-osteoporosis medication prescription following hip fracture.

A desirability of outcome ranking (DOOR) for periprosthetic joint infection - a Delphi analysis.

: Treatment outcomes in studies on prosthetic joint infection are generally assessed using a dichotomous outcome relating to treatment success or failure. These outcome measures neither include patient-centred outcome measures including joint function and quality of life, nor do they account for adverse effects of treatment. A desirability of outcome ranking (DOOR) measure can include these factors and has previously been proposed and validated for other serious infections.

Licensed and Liable. Insurance, Road Regulations, and Driving After Hip and Knee Arthroplasty Surgery.

Background: There is a reliance on surgeons to provide advice to patients regarding safe return to driving following hip or knee arthroplasty. Concerns arise that misinformation may place the surgeon in a position of potential legal implication. The purpose of this article is to inform surgeons of their role in accordance with advice from insurance companies and transport regulatory bodies.

Revision Total Hip Arthroplasty in Solid Organ Transplant Patients: A Propensity Score-Matched Cohort Study for Aseptic and Infected Revisions.

Background: Previous studies have demonstrated that solid organ transplant (SOT) patients undergoing primary total hip arthroplasty (THA) are at an increased risk of postoperative complications. The purpose of this study is to use a large, national database to investigate revision THA (rTHA) outcomes in SOT patients.

Methods: Nationwide Readmissions Database (NRD) from 2010-2018 was used, and ICD-9 and ICD-10 codes were used to identify all patients who underwent rTHA, including those with history of SOT.

Cost-effectiveness of dual-mobility components in patients with displaced femoral neck fractures.

Aims: Total hip arthroplasty (THA) with dual-mobility components (DM-THA) has been shown to decrease the risk of dislocation in the setting of a displaced neck of femur fracture compared to conventional single-bearing THA (SB-THA). This study assesses if the clinical benefit of a reduced dislocation rate can justify the incremental cost increase of DM-THA compared to SB-THA.

Methods: Costs and benefits were established for patients aged 75 to 79 years over a five-year time period in the base case from the Canadian Health Payer's perspective.

A Comparison of Acute Complications and Mortality Between Geriatric Knee and Hip Fractures: A Matched Cohort Study.

Introduction: To compare acute complication and mortality rates for operatively treated, closed, isolated, low-energy geriatric knee fractures (distal femur [DFF] or tibial plateau [TPF]) with hip fractures (HFs).

Methods: This is a retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program. We identified all patients ≥ 70 years from 2011 to 2016 who underwent surgery for DFF, TPF, or HF.

Treatment of Geriatric Acetabular Fractures-A Concise Review of the Literature.

Optimal management of acetabular fractures (AF) in the elderly has not been defined clearly. The incidence of such fractures is rising in the aging population. Advancements in implant technology have improved the longevity of combined or staggered total hip arthroplasty procedures for this patient population, thus allowing earlier weight bearing and continued functional independence.

Use of an Intramedullary Nail to Guide Distal Femoral Resection in Primary Total Knee Arthroplasty: A Case Report.

Case: A 67-year-old female patient presented for total knee arthroplasty (TKA) 4 years after receiving an antegrade femoral nail for bisphosphonate-induced femur fracture. She underwent a single-stage procedure with retention of femoral hardware. The femoral nail was used as a surrogate guide to reference the anatomical axis of the femur to position the distal femoral cutting block with good results.

Converting hip and knee arthroplasty cases to same-day surgery due to COVID-19.

Aims: In 2020, the COVID-19 pandemic meant that proceeding with elective surgery was restricted to minimize exposure on wards. In order to maintain throughput of elective cases, our hospital (St Michaels Hospital, Toronto, Canada) was forced to convert as many cases as possible to same-day procedures rather than overnight admission. In this retrospective analysis, we review the cases performed as same-day arthroplasty surgeries compared to the same period in the previous 12 months.

The association of preoperative blood markers with postoperative readmissions following arthroplasty.

Aims: While preoperative bloodwork is routinely ordered, its value in determining which patients are at risk of postoperative readmission following total knee arthroplasty (TKA) and total hip arthroplasty (THA) is unclear. The objective of this study was to determine which routinely ordered preoperative blood markers have the strongest association with acute hospital readmission for patients undergoing elective TKA and THA.

Methods: Two population-based retrospective cohorts were assembled for all adult primary elective TKA (n = 137,969) and THA (n = 78,532) patients between 2011 to 2018 across 678 North American hospitals using the American College of Surgeons National Quality Improvement Programme (ACS-NSQIP) registry.

Analysis of the Digital Footprint of Orthopaedic Surgeons.

Introduction: Patients increasingly rely on Google search to guide their choice of healthcare providers. Despite this trend, there is limited literature systematically characterizing the online presence of orthopaedic surgeons. The goal of this study was to identify the information patients see after queries of Google search when selecting orthopaedic surgeon providers.

Risk of Total Hip Arthroplasty After Acetabular Fracture Fixation: The Importance of Age.

Background: Geriatric patients are the most rapidly growing cohort of patients sustaining acetabular fractures (AFs). The purpose of this study was to examine the risk of a secondary total hip arthroplasty (THA) in older patients (>60 year old) with a prior AF open reduction internal fixation (ORIF) compared with younger patients (<60 year old) with an AF ORIF on a large population level.

Methods: Using administrative health care data from 1996 to 2010 inclusive of all 202 hospitals in Ontario, Canada, all adult patients with an AF ORIF and a minimum of two year follow-up were identified and included.

Outcomes of Total Hip Arthroplasty in Patients With Acetabular Protrusio.

Background: Acetabular protrusio (AP) is associated with distorted anatomic landmarks and insufficient bone stock that increases complexity of total hip arthroplasty (THA). This study used a large national database to compare outcomes after THA in patients with and without AP.

Methods: The Nationwide Readmissions Database was used to identify patients with and without AP who underwent THA from 2010 to 2014.