Background:The use of computer navigation has been shown to produce more accurate cup positioning when compared with non-navigated total hip arthroplasty (THA), but so far there is only limited evidence to show its effect on clinical outcomes. The present study analyzed data from the Australian Orthopaedic Association National Joint Replacement Registry to assess the impact of computer navigation on the rates of all-cause revision and revision for dislocation following THA.Methods:Data for all non-navigated and navigated primary THAs performed for osteoarthritis in Australia from January 1, 2009, to December 31, 2019, were examined to assess the rate of revision. We analyzed the effects of navigation on rate, reason, and type of revision. Hazard ratios (HRs) from Cox proportional hazard models, adjusted for age, sex, and head size, were utilized. Because of known prosthesis-specific differences in outcomes, we performed a further analysis of the 5 acetabular and femoral component combinations most commonly used with navigation.Results:Computer navigation was utilized in 6,912 primary THAs for osteoarthritis, with the use of navigation increasing from 1.9% in 2009 to 4.4% of all primary THAs performed in 2019. There was no difference in the rate of all-cause revision between navigated and non-navigated THAs looking at the entire group. There was a lower rate of revision for dislocation in the navigation THA cohort. The cumulative percent revision for dislocation at 10 years was 0.4% (95% confidence interval [CI], 0.2% to 0.6%) for navigated compared with 0.8% (95% CI, 0.8% to 0.9%) for non-navigated THAs (HR adjusted for age, sex, and head size, 0.46; 95% CI, 0.29 to 0.74; p = 0.002). In the 5 component combinations most commonly used with navigation, the rate of all-cause revision was significantly lower when these components were navigated compared with non-navigated. The cumulative percent revision at 10 years for these 5 prostheses combined was 2.4% (95% CI, 1.6% to 3.4%) for navigated compared with 4.2% (95% CI, 4.0% to 4.5%) for non-navigated THAs (HR, 0.64; 95% CI, 0.48 to 0.86; p = 0.003).Conclusions:This study showed that the use of computer navigation was associated with a reduced rate of revision for dislocation following THA. Furthermore, in the component combinations most commonly used with navigation there was also a reduction in the rate of all-cause revision.Level of Evidence:Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Aim This study aims to estimate the risk of acquiring medical complication or death from COVID-19 infection in patients who were admitted for orthopaedic trauma surgery during the peak and plateau of pandemic. Unlike other recently published studies, where patient-cohort included a more morbid group and cancer surgeries, we report on a group of patients who had limb surgery and were more akin to elective orthopaedic surgery. Methods The study included 214 patients who underwent orthopaedic trauma surgeries in the hospital between 12th March and 12th May-2020 when the pandemic was on the rise in the United Kingdom. Data was collected on demographic profile including comorbidities, ASA grade, COVID-19 testing, type of procedures and any readmissions, complications or mortality due to COVID-19. Results There were 7.9% readmissions and 52.9% of it was for respiratory complications. Only one patient had positive COVID-19 test during readmission. 30-day mortality for trauma surgeries was 0% if hip fractures were excluded and 2.8% in all patients. All the mortalities were for proximal femur fracture surgeries and between ASA Grade 3 and 4 or in patients above the age of 70 years. Conclusion This study suggests that presence of COVID-19 virus in the community and hospital did not adversely affect the outcome of orthopaedic trauma surgeries or lead to excess mortality or readmissions in patients undergoing limb trauma surgery. The findings also support resumption of elective orthopaedic surgeries with appropriate risk stratification, patient optimization and with adequate infrastructural support amidst the recovery phase of the pandemic.
PurposeLately there is an increasing tendency of using Patient Reported Outcome Measures (PROMs) as a final indicator of the outcome of many surgical treatments in orthopaedics and in other medical specialties. Currently there are many outcome scores in orthopaedics and most of them are site specific. In the contrary there is a lack of trauma specific outcome scores.MethodsWe have designed a new PROM especially for orthopaedic trauma patients, in order to measure in what extent the patients manage to return to their pre-injury state. This score uses as baseline the pre-injury status of the patient and has the aim to determine the percentage of rehabilitation after treatment for any injury.ResultsA total of 60 Chertsey Outcome Score for Trauma (COST) questionnaires were gathered in our outpatients department. The participants were 57% male (aged 46.81 years ± 18.5 years) and the questionnaires collected at mean 10 months post-injury. A Cronbach's Alpha value of 0.89 was identified for the whole construct. The three dimensions of the scale had good internal consistency as well (Cronbach's Alpha test values 0.74, 0.84 and 0.81 for symptoms, function and mental status respectively). Strong/moderate correlation (Spearman's Rho test 0.43–0.65) was observed between the respective physical/mental dimensions of the COST and SF-12v2 questionnaires.ConclusionThere is a need among the orthopaedic trauma society for a specific PROM of trauma. COST is a useful and easy to use tool for every trauma surgeon.
Treatment of scapholunate dissociation (SLD) depends on the degree of injury. We present our technique of extensor carpi radialis longus (ECRL) tenodesis for Geissler grade 2 SLD and our preliminary results. After arthroscopic confirmation of Geissler grade 2 SLD, we use a single incision and a polyetheretherketone (PEEK) anchor, attaching half of the ECRL tendon to the scaphoid. Preliminary results include improvements in QDASH, QDASH (work) and QDASH (sports/music), a median satisfaction level of 4/5 (satisfied), and a low complication rate. Our method is a safe, reproducible, and effective treatment of symptomatic Geissler grade 2 SLD that has failed nonoperative management, with technical advantages over alternative methods in the literature.
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