This study demonstrates a superior outcome for cases of osteonecrosis with uncemented hip resurfacings compared to cases employing hybrid devices.
Background: Distal radioulnar joint (DRUJ) instability and arthritis are often painful and functionally limiting pathologies. Two common salvage procedures for DRUJ dysfunction are the Darrach and Sauvé-Kapandji (S-K) procedures. This study aims to provide an analysis of national Darrach and S-K procedure utilization rates and patient demographics. Methods: A national ambulatory surgery database, the 2018 Nationwide Ambulatory Surgery Sample, was filtered for Darrach and S-K procedure encounters. Data related to patient demographics and medical history, indications for DRUJ salvage, and concurrent hand/wrist procedures were collected. Results: Database analysis revealed 1044 Darrach and 223 S-K procedure encounters. Patients undergoing Darrach procedures were older (60 vs 57, P = .002) and more likely to be women (66.1% vs 54.6%, P < .05). Patients aged <35 years underwent S-K procedures at greater rates compared with Darrach (13.9% vs 8.6%, P < .05). Primary osteoarthritis proved to be the most common indication for DRUJ salvage (64.8%) compared with rheumatoid arthritis (23.2%) and post-traumatic osteoarthritis (12.0%). Darrach and S-K procedures were accompanied by a secondary procedure at rates of 64% and 41%, respectively. The most common secondary procedures were tendon transfer, implant removal, neuroplasty, nerve resections, and wrist arthroscopy. Conclusions: Patient age and sex are associated with DRUJ salvage procedure selection. Sauvé-Kapandji procedures are used in higher rates in male and younger patient populations. Furthermore, primary osteoarthritis and rheumatoid arthritis are the main underlying pathologies for Darrach and S-K procedures.
Introduction:The purpose of this study was to determine whether total ankle arthroplasty (TAA) and ankle/hindfoot fusion patients receiving tranexamic acid (TXA) exhibit fewer wound complications.Methods:A retrospective review was conducted of 212 patients (217 feet) undergoing TAA (n = 72), ankle (n = 36), tibiotalocalcaneal (n = 20), pantalar (n = 1), or hindfoot fusion (ie, subtalar = 47, double = 33, and triple = 8) between 2015 and 2020 by a fellowship-trained foot and ankle surgeon at an academic medical center. Demographics, medical history, complications, and union status were compared between TXA (n = 101) and non-TXA (n = 116) cohorts. The mean follow-up was 1.24 years (range, 0.25 to 4.68).Results:The TXA group had significantly less postoperative infections (5.9% versus 15.5%, P = 0.025). Within a subgroup analysis of ankle/hindfoot fusions, the TXA group exhibited significantly more Charcot neuroarthropathy (20.7% versus 5.7%, P = 0.006) and shorter follow-up duration (0.96 versus 1.30 years, P = 0.030); however, TXA was associated with shorter time to fusion (146 versus 202 days, P = 0.049) and fewer revision surgeries (8.6% versus 21.8%, P = 0.036). Subgroup analysis excluding feet with Charcot also demonstrated less postoperative infections (4.5% versus 14.4%, P = 0.020). Subgroup analysis of TAAs showed fewer cases of superficial infections (2.3% versus 27.6%, P = 0.002) and delayed wound healing (25.6% versus 48.3%, P = 0.047) in the TXA cohort.Discussion:TXA use in ankle/hindfoot surgery was correlated with a reduction in superficial infections and radiographic time to union. The use of TXA in TAA correlated with fewer superficial infections and cases of delayed wound healing. Thus, in addition to other areas of orthopaedics, TXA seems to be beneficial in hindfoot and ankle surgery.Data availability and trial registration numbers:All data were obtained from our institution's medical records. This study is not associated with a clinical trial.
Category: Ankle Arthritis; Other Introduction/Purpose: High-dose opioid prescriptions in osteoarthritis (OA) increase the risk of overdose and chronic opioid dependence, which is associated with worse perioperative outcomes in total joint arthroplasty (TJA). The purpose of this study was to determine the (1) incidence and (2) identify independent risk factors for receiving high-dose initial opioid prescriptions in OA patients. Methods: A retrospective chart review was performed to evaluate initial outpatient opioid prescriptions for OA in opioid-naïve adult patients at a single academic institution between 2013 and 2020. Patients with prior surgery or opioid prescriptions were excluded. Patient demographic data, medical comorbidities, Charlson Comorbidity Index (CCI) scores, and prescription metadata were recorded. High-dose prescriptions were defined as daily oral morphine equivalents (OME/d) >=50. Univariate analysis and multivariate logistic regression were used to identify independent predictors for high-risk opioid prescriptions. Results: A total of 1,527 patients were identified with an initial opioid prescription for OA, with 21.5% of patients receiving high- dose prescriptions. The majority of high-dose prescriptions (>=50 OME/d) were given oxycodone (56.1%), while low-dose prescriptions (<50 OME/d) were more commonly prescribed hydrocodone-acetaminophen (34.2%) and tramadol (32.5%). Using multivariate logistic regression, patient factors that are independently associated with high-dose prescriptions include decreased age, decreased BMI, white race, and non-orthopaedic encounters. Comorbid factors that were independently predictive of high- dose prescriptions include hip OA, higher CCI scores, and depression. (Table 1) Conclusion: Independent predictors for high-dose initial opioid prescriptions in OA include younger age, decreased BMI, white race, non-orthopaedic encounters, hip OA, higher CCI scores, and depression.
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