Predictors of mortality in periprosthetic fractures of the hip: Results from the national PPF study.

Introduction: Periprosthetic fractures (PPFs) around the hip joint are increasing in prevalence. In this collaborative study, we aimed to investigate the impact of patient demographics, fracture characteristics, and modes of management on in-hospital mortality of PPFs involving the hip.

Methods: Using a multi-centre cohort study design, we retrospectively identified adults presenting with a PPF around the hip over a 10-year period.

Haemorrhagic Pseudotumour Following Metal-on-Metal Hip Replacement.

We present a unique report of a spontaneous haemorrhage into a pseudotumour five years following revision surgery for failed metal-on-metal hip arthroplasty. The patient sustained no trauma, was not taking anticoagulants and had no bleeding disorder. Rapid progression in the size of the pseudotumour caused significant symptoms and functional impairment.

Resuming hip and knee arthroplasty after COVID-19: ethical implications for wellbeing, safety and the economy.

Reinstating elective hip and knee arthroplasty services presents significant challenges. We need to be honest about the scale of the obstacles ahead and realise that the health challenges and economic consequences of the COVID-19 pandemic are potentially devastating.We must also prepare to make difficult ethical decisions about restarting elective hip and knee arthroplasty.

How to prepare and manage a systematic review and meta-analysis of clinical studies.

Use the PICO framework to formulate a specific clinical question.Formulate a search strategy.Prospectively register the review protocol.

Use of work-based assessments in postgraduate medical education.

Work-based assessments are ubiquitous in postgraduate medical training in the UK. This article discusses the variety of these assessments and explores barriers to their use and solutions for improving the educational value of these tools for adult learners. The focus should be on feedback and learning rather than assessment, and this may promote discussion of more challenging scenarios where the opportunity for learning is greater.

Trochanteric spurs and surface irregularities on plain radiography are not predictive of greater trochanteric pain syndrome.

Purpose: Surface irregularities of the greater trochanter have been described as a potential radiographic sign of greater trochanteric pain syndrome (GTPS). We report a diagnostic accuracy study to evaluate the clinical usefulness of trochanteric surface irregularities on plain radiographs in the diagnosis of GTPS.

Methods: We retrospectively identified the anteroposterior pelvic radiographs of a consecutive group of 38 patients (representing a 27.

Higher 30-day mortality associated with the use of intramedullary nails compared with sliding hip screws for the treatment of trochanteric hip fractures: a prospective national registry study.

Aims: The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality.

Patients And Methods: Data on 82 990 patients from the National Hip Fracture Database were analyzed using generalized linear models with incremental case-mix adjustment for patient, non-surgical and surgical characteristics, and socioeconomic factors.

Results: The use of short and long intramedullary nails was associated with an increase in 30-day mortality (adjusted odds ratio (OR) 1.

Mortality After Total Knee Arthroplasty: A Systematic Review of Incidence, Temporal Trends, and Risk Factors.

Background: The capacity for total knee arthroplasty to improve pain, quality of life, and functional outcomes is widely recognized. Postoperative mortality is rare but of paramount importance, and needs to be accurately quantified and conveyed to patients in order to support decision-making prior to surgery. The purpose of this study was to determine a contemporary estimate of the risk of mortality following total knee arthroplasty, including the identification of temporal trends, common causes, and modifiable and nonmodifiable risk factors.

Medial subvastus the medial parapatellar approach for total knee replacement: A systematic review and meta-analysis of randomized controlled trials.

Twenty randomized controlled trials comprising 1893 primary total knee replacements were included in this review.The subvastus approach conferred superior results for mean difference (MD) in time to regain an active straight leg raise (1.7 days, 95% confidence interval [CI] 1.

Surgery for greater trochanteric pain syndrome after total hip replacement confers a poor outcome.

Purpose: Surgery for greater trochanteric pain syndrome (GTPS) may be indicated for cases refractory to conservative measures. We aim to evaluate patient reported outcomes and adverse events following surgery.

Methods: Postal questionnaires were used to evaluate a consecutive series of 61 bursectomy and gluteal fascia transposition (GFT) procedures.

A comparison of the omega and posterior approaches on patient reported function and radiological outcomes following total hip replacement.

Background: The omega approach represents a modification of the lateral approach to the hip for joint replacement. It was developed to reduce the potential for gluteus muscle dysfunction and thereby improve functional outcome following hip replacement.

Methods: A cohort of 415 consecutive hip replacements receiving the same type of cemented femoral component were followed up at a mean of three years postoperatively and invited to complete functional outcome and satisfaction scores.

Recall and patient perceptions of hip precautions 6 weeks after total hip arthroplasty.

Background and purpose - There is a lack of evidence to support the role of hip precautions in preventing dislocation following total hip arthroplasty (THA). We report an exploratory study which assesses recall, adherence, and the impact of precautions on activities of daily living in the first 6 weeks postoperatively. Patients and methods - We designed a new questionnaire based on the education patients receive and refined by professionals within our multidisciplinary team.

The association between the day of the week of milestones in the care pathway of patients with hip fracture and 30-day mortality: findings from a prospective national registry - The National Hip Fracture Database of England and Wales.

Background: Recent publications indicate increased mortality in patients admitted to hospital at the weekend, but these findings may be subject to inadequate adjustment for case-mix and the complexities of resource provision. Hip fractures generally occur in a frail comorbid population with a consistent diagnosis precipitating admission as an emergency. We therefore aimed to examine the association between the day of the week of milestones in the care pathway and 30-day mortality in this population.

Improving theatre turnaround time.

The NHS Institute for Innovation and Improvement has determined that a £7 million saving can be achieved per trust by improving theatre efficiency. The aim of this quality improvement project was to improve orthopaedic theatre turnaround without compromising the patient safety. We process mapped all the stages from application of dressing to knife to skin on the next patient in order to identify potential areas for improvement.

A systematic review and meta-analysis of complications following the posterior and lateral surgical approaches to total hip arthroplasty.

Introduction: Total hip arthroplasty is one of the most commonly performed orthopaedic procedures. Despite this, medical evidence to inform the choice of surgical approach is lacking. Currently in the UK, the two most frequently performed approaches to the hip are the posterior and the direct lateral.

A radiographic comparison of femoral offset after cemented and cementless total hip arthroplasty.

Restoring femoral offset during total hip arthroplasty is important. Femoral offset and leg lengths are inextricably linked by the caput-collum-diaphysis (CCD) angle of the implant being used. We investigate the restoration of offset and leg lengths using the radiographs of a consecutive series of patients following implantation with either a high CCD angled cementless, or an anatomical CCD angled cemented femoral component.

Stem compatibility for cement-in-cement femoral revision: an in vitro study.

Cement-in-cement femoral component revision is a useful and commonly practised technique. Onerous and hazardous re-shaping of the original cement mantle is required if the new stem does not seat easily. Furthermore, without removing the entirety of the original cement mantle, the freedom to alter anteversion or leg length is difficult to predict preoperatively.

A systematic review and meta-analysis of the standard versus mini-incision posterior approach to total hip arthroplasty.

The mini-incision posterior approach may appeal to surgeons comfortable with the standard posterior approach to the hip. We present the first systematic review and meta-analysis of these two approaches. Twelve randomised controlled trials and four non-randomised trials comprising of 1498 total hip arthroplasties were included.

Mortality after total hip replacement surgery: A systematic review.

Total hip replacement causes a short-term increase in the risk of mortality. It is important to quantify this and to identify modifiable risk factors so that the risk of post-operative mortality can be minimised. We performed a systematic review and critical evaluation of the current literature on the topic.