Total Hip Arthroplasty in Chile Is Characterized By Low Utilization Rates and Disparity in Access.

Disparity in access to total hip arthroplasty (THA) is an internationally recognized phenomenon influenced by social and geographical factors. The Organisation for Economic Co-operation and Development (OECD) employs the utilization rates of THA to evaluate and compare healthcare utilization by its 37 country members, including Chile. : We sought to describe THA utilization rates in the elderly Chilean population and to compare it with data from other OECD countries.

An international consensus based on the Delphi method to define failure of medical treatment in pyogenic spinal infections.

Background Context: Pyogenic spinal infections (PSIs) are severe conditions with high morbidity and mortality. If medical treatment fails, patients may require surgery, but there is no consensus regarding the definition of medical treatment failure.

Purpose: To determine criteria for defining failure of medical treatment in PSI through an international consensus of experts.

Predicting Prolonged Hospital Stays in Elderly Patients With Hip Fractures Managed During the COVID-19 Pandemic in Chile: An Artificial Neural Networks Study.

Prolonged length of stay (LOS) after a hip fracture is associated with increased mortality. We sought to create a model to predict prolonged LOS in elderly Chilean patients with hip fractures managed during the COVID-19 pandemic. Employing an official database, we created an artificial neural network (ANN), a computational model corresponding to a subset of machine learning, to predict prolonged LOS (≥14 days) among 2686 hip fracture patients managed in 43 Chilean public hospitals during 2020.

Periprosthetic Infections: Five Steps to Keep Moving Forward in 2021.

The 2010 to 2020 decade produced remarkable advances in the understanding of periprosthetic joint infections (PJI). However, the challenges that surgeons and clinical researchers will face in the coming decade are many. Among the tactics that should comprise the strategy to keep moving forward are: (1) The incorporation of value-based healthcare concepts in PJI diagnosis.

Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons.

Background: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons.

Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons.

Preparation for the next COVID-19 wave: The European Hip Society and European Knee Associates recommendations.

Purpose: To plan for the continuance of elective hip and knee arthroplasty during a resurgence or new wave of COVID-19 infections.

Method: A systematic review was conducted using the terms "COVID-19" or "SARS-Cov-2" and "second wave". No relevant citations were found to inform on recommendations the plan.

Hip fractures in the elderly Chilean population: a projection for 2030.

Unlabelled: Using national databases, we projected the magnitude of hip fractures among the elderly Chilean population by 2030. Hip fractures will increase by 27.5% from 2018 to 9862 cases (95% CI = 8760 to 10,965).

Diagnosis of Periprosthetic Joint Infection: The Role of Nuclear Medicine May Be Overestimated.

Although the International Consensus Meeting on Periprosthetic Joint Infection's definition of periprosthetic joint infection (PJI) does not include nuclear imaging as part of the diagnostic criteria, many contemporary nuclear imaging studies are reporting exceptional results in PJI diagnosis. We conducted a systematic review of studies published from 2004 to 2012 reporting the accuracy of nuclear imaging for diagnosis of PJI, utilizing a specially designed tool (QUADAS-2) for critical appraisal and investigation of bias. Our results revealed high risk of bias as well as high levels of concern regarding the clinical applicability of these tests in a majority of the studies.

Hip arthroscopy and osteoarthritis: Where are the limits and indications?

The use of hip arthroscopy, as a surgical technique, has increased significantly over the past ten years. The procedure has shown good and excellent results in symptom relief and function improvement for patients with femoro-acetabular impingement (FAI) and concurrent chondro-labral lesions. It is also a reliable method to correct the characteristic pathomorphologic alteration of FAI.

Does the nature of chondrolabral injury affect the results of open surgery for femoroacetabular impingement?

Background: The degree to which patient characteristics, clinical outcomes, and the nature, severity, and corresponding treatment of chondrolabral injury in femoroacetabular impingement (FAI) is associated with failure after surgery is incompletely understood.

Questions/purposes: (1) Are patient factors associated with failure (age, sex, body mass index, and preoperative modified Harris hip score [mHHS]) in the open surgical treatment of FAI? (2) Is the nature of chondrolabral injury associated with failure? (3) Are any specific chondrolabral injury treatment methods superior?

Methods: Between 2000 and 2008, 172 open surgical procedures in 167 patients were performed for the treatment of FAI by two surgeons at two separate academic medical centers. Ultimately, 142 patients were included in this retrospective study.

"Warning signs" of primary immunodeficiency among patients with periprosthetic joint infection.

Purpose: The use of ten clinical "warning signs" has been suggested as a screening tool to identify patients that may have primary immunodeficiency (PID) conditions in adulthood. This study aimed to evaluate the presence of these "warning signs" among a cohort of patients with periprosthetic joint infections (PJI), in order to detect those cases that may have had a PID contributing to development of infection.

Methods: A descriptive study using our institutional PJI database was conducted.

Direct anterior approach for total hip arthroplasty: indications, technique, and results.

The direct anterior approach (DAA) to the hip was initially described in the 19th century and has been used sporadically for total hip arthroplasty (THA). In the past decade, enthusiasm for the approach has been renewed because of increased demand for minimally invasive techniques. New surgical instruments and tables designed specifically for use with the DAA for THA have made the approach more accessible to surgeons.

Diagnosis of periprosthetic joint infection in Medicare patients: multicriteria decision analysis.

Background: In the setting of finite healthcare resources, developing cost-efficient strategies for periprosthetic joint infection (PJI) diagnosis is paramount. The current levels of knowledge allow for PJI diagnostic recommendations based on scientific evidence but do not consider the benefits, opportunities, costs, and risks of the different diagnostic alternatives.

Questions/purposes: We determined the best diagnostic strategy for knee and hip PJI in the ambulatory setting for Medicare patients, utilizing benefits, opportunities, costs, and risks evaluation through multicriteria decision analysis (MCDA).

Extensor mechanism reconstruction with achilles tendon allograft in TKA: results of an abbreviate rehabilitation protocol.

Various treatment alternatives address extensor mechanism failure after total knee arthroplasty. We present the results of a protocol utilizing Achilles tendon allograft followed by an abbreviated immobilization program to treat extensor mechanism disruptions after TKA in 29 knees (27 patients). Failed reconstruction was defined as mechanical allograft failure requiring re-intervention, extension lag >30°, recurrent falls, regression to a lower ambulatory status, and revision due to infection.

Periprosthetic knee infection: ten strategies that work.

Periprosthetic joint infection (PJI) is one of the most serious complications following total knee arthroplasty (TKA). The demand for TKA is rapidly increasing, resulting in a subsequent increase in infections involving knee prosthesis. Despite the existence of common management practices, the best approach for several aspects in the management of periprosthetic knee infection remains controversial.

Prevention of venous thromboembolic events following femoroacetabular osteoplasty: aspirin is enough for most.

Background: As hip-preservation surgery is performed in a particularly young and active group of patients, the knowledge accrued in the fields of hip arthroplasty and hip fracture care regarding postoperative thromboprophylaxis cannot be extrapolated to this patient population. Recommendations based on the evidence for each particular surgical procedure and population is desirable. For these reasons, the purpose of our study is to describe the rate of clinically relevant venous thromboembolism (VTE) and anticoagulation-related complications observed in patients undergoing hip-preservation surgery through mini-open femoracetabular osteoplasty (FAO) with a formal postoperative thromboprophylaxis protocol of aspirin dosing.