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Patil VS, Adithya N, Narendra BS, Varun V. A Prospective Case Series - Study of Neck of Femur Fractures in Elderly Patients with Pre-operative Urinary Tract Infection in Rural India. J Orthop Case Rep 2024; 14:208-213. [PMID: 39524286 PMCID: PMC11546023 DOI: 10.13107/jocr.2024.v14.i11.4970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2024] [Revised: 09/06/2024] [Indexed: 11/16/2024] Open
Abstract
Introduction The annual incidence of fractured neck of femur in the elderly continues to rise year after year. Longer lifespan also contributes to the increase in the incidence of fracture neck of femur. Contributing factors include genetic factors, reduced bone mineral density, physical inactivity, aging population, and environmental factors such as diet and vitamin D levels. Urinary tract infections (UTIs) are common in elderly population, especially females with associated risk factors such as diabetes mellitus, obesity, malnutrition, immunosuppression, and malignancies. Case Report A series of 10 cases of either gender above 55 years with fractured neck of femur associated with UTI were included in the study. All patients were clinically assessed for UTI supported with laboratory evidence of urine cultures followed by medical management for control of UTI, before surgery. Patient was operated using cemented modular bipolar prosthesis with antibiotic bone cement for femoral stem implantation only after the infection was under control. Conclusion Diagnosis and control of UTI are of utmost importance before operating patients with fracture neck of femur with hemiarthroplasty.
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Affiliation(s)
- V Sandeep Patil
- Department of Orthopaedic, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, Karnataka, India
| | - N Adithya
- Department of Orthopaedic, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, Karnataka, India
| | - B S Narendra
- Department of Orthopaedic, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, Karnataka, India
| | - V Varun
- Department of Orthopaedic, Sri Madhusudan Sai Institute of Medical Sciences and Research, Chikkaballapur, Karnataka, India
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Baertl S, Renz N, Alt V, Perka C, Kirschbaum S. [Acute postoperative infections after dual head arthroplasty in geriatric patients]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2024; 127:110-116. [PMID: 37853237 DOI: 10.1007/s00113-023-01376-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/20/2023]
Abstract
Acute periprosthetic joint infections (PJI) after dual head arthroplasty represent a major challenge with a 1-year mortality rate up to 50% in the mostly multimorbid geriatric patient collective. Due to the limited possibilities of preoperative patient optimization, infection rates of up to 9% have been reported, which is significantly higher than in elective arthroplasty. A therapeutic gold standard has not yet been established due to the heterogeneous study situation and the lack of prospective randomized studies. The most promising therapeutic option currently appears to be a single-stage stem replacement in combination with implantation of a cup component (conversion to total hip arthroplasty, infection eradication in up to 100%). An approach of débridement, antibiotics, implant retention (DAIR) alone shows significantly poorer success rates (16-82%). Surgical treatment should always be followed by antibiotic treatment with a total duration of 12 weeks. In addition to the established perioperative antibiotic prophylaxis, the use of antibiotic-loaded bone cement seems to be superior to cementless stem fixation in preventing PJI in dual head arthroplasty.
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Affiliation(s)
- Susanne Baertl
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Nora Renz
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Volker Alt
- Klinik und Poliklinik für Unfallchirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Carsten Perka
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
| | - Stephanie Kirschbaum
- Centrum für Muskuloskeletale Chirurgie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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de Haan E, Roukema GR, van Rijckevorsel VAJIM, Kuijper TM, Jong LD. Risk factors for prosthetic joint infections after hemiarthroplasty of the hip following a femoral neck fracture. Injury 2024; 55:111195. [PMID: 38039635 DOI: 10.1016/j.injury.2023.111195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE The primary aim of this study was to identify risk factors and validate earlier reported risk factors for Prosthetic Joint Infection (PJI) after hemiarthroplasty. The secondary aim was to assess peri‑operative clinical outcomes, adverse events and mortality rates in PJI patients after hemiarthroplasty. METHODS A prospective hip fracture database was used to obtain data for this observational cohort study. Patients who underwent hemiarthroplasty between 2011 and 2021 were included. A PJI was diagnosed by the Musculoskeletal Infection Society criteria. Univariable and multivariable analyses were performed to identify factors highly associated with a PJI. RESULTS In total, 2044 patients were analysed of which 72 patients (3.5 %) developed PJI. The multivariable analysis showed that Body Mass Index (BMI) >30 (OR2.84, P = 0.020), operating time of <45 min (OR=2.80, P = 0.002), occurrence of haematoma (OR=6.24, P<0.001), decreasing level of hemoglobin (OR=1.62, P = 0.001) and re-operation for luxation (OR=9.25, P<0.001) were significant independent prognostic risk factors for development of PJI after hemiarthroplasty. Diabetes Mellitus (OR=0.34, P = 0.018) and >20 hemiarthroplasties performed by the surgeon in the previous year (OR=0.33, P = 0.019) were prognostic protective factors. In patients with PJI, 40 % (n = 29) died within one year after surgery, compared with 27 % (n = 538) in patients without PJI (OR=1.80, P = 0.017). CONCLUSION Independent significant prognostic factors highly associated with PJI after hemiarthroplasty were BMI >30, operating time of <45, decreasing level of hemoglobin, occurrence of haematoma and re-operation for luxation. Diabetes Mellitus and >20 hemiarthroplasties performed by the surgeon in the previous year were prognostic protective factors for the development of PJI. PJI was associated with significantly higher 1-year all-cause mortality.
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Affiliation(s)
- Eveline de Haan
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands; Surgery Department, Franciscus Gasthuis en Vlietland, 3045 PM Rotterdam, the Netherlands.
| | - Gert R Roukema
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands
| | | | - T Martijn Kuijper
- Maasstad Academy, Maasstad Hospital, 3079 DZ Rotterdam, the Netherlands
| | - Louis de Jong
- Surgery Department, Maasstad Hospital, 3007 AC Rotterdam, the Netherlands
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Xu Z, Zhang K, Cheng K, Sun G, Zhang Y, Jia J. A meta-analysis comparing the effects of cemented and uncemented prostheses on wound infection and pain in patients with femoral neck fractures. Int Wound J 2023; 20:4122-4129. [PMID: 37555547 PMCID: PMC10681411 DOI: 10.1111/iwj.14306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 08/10/2023] Open
Abstract
To providing evidence-based recommendations for surgery in patients with femoral neck fractures, a meta-analysis was conducted to comprehensively evaluate the effects of cemented and uncemented prostheses on postoperative surgical site wound infection and pain in these patients. Relevant studies on the use of cemented prostheses in femoral neck fractures were retrieved from PubMed, EMBASE, Cochrane Library, Ovid, CNKI, and Wanfang databases from the time of their establishment until March 2023. Two authors independently screened and extracted data from the included and excluded literature according to predetermined criteria. Review Manager 5.4 software was used to perform meta-analyses on the collected data. A total of 27 articles comprising 34 210 patients (24 646 cases in the cemented group and 9564 cases in the uncemented group) were included in the final analysis. The results of the meta-analysis showed that, compared with the uncemented group, cemented prostheses significantly reduced the incidence of surgical site wound infections (odds ratio [OR]: 0.75, 95% confidence interval [CI]: 0.64-0.88, p < 0.001) and relieved surgical site wound pain (standardised mean difference: -0.76, 95% CI: -1.12-0.40, p < 0.001), but did not reduce the incidence of pressure ulcers after surgery (OR: 0.50, 95% CI: 0.20-1.26, p = 0.140). Therefore, existing evidence suggests that the use of cemented prostheses in femoral neck fracture surgery can significantly reduce the incidence of surgical site wound infections and relieve surgical site wound pain, which is worthy of clinical recommendation.
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Affiliation(s)
- Ze Xu
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Ke Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Kai Cheng
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Guangwei Sun
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Yaning Zhang
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
| | - Jian Jia
- Department of OsteologyLinfen People's Hospital of Shanxi Medical UniversityLinfenChina
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Domingue G, Warren D, Koval KJ, Riehl JT. Complications of Hip Hemiarthroplasty. Orthopedics 2023; 46:e199-e209. [PMID: 36719411 DOI: 10.3928/01477447-20230125-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hip hemiarthroplasty is a commonly performed orthopedic surgery, used to treat proximal femur fractures in the elderly population. Although hip hemiarthroplasty is frequently successful in addressing these injuries, complications can occur. Commonly seen complications include dislocation, periprosthetic fracture, acetabular erosion, and leg-length inequality. Less frequently seen complications include neurovascular injury and capsular interposition. This article presents a comprehensive review of the complications associated with the management of hip hemiarthroplasty. [Orthopedics. 2023;46(4):e199-e209.].
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Bureau A, Bourget-Murray J, Azad MA, Abdelbary H, Grammatopoulos G, Garceau SP. Management of Periprosthetic Joint Infections After Hemiarthroplasty of the Hip: A Critical Analysis Review. JBJS Rev 2022; 10:01874474-202209000-00006. [PMID: 36155552 DOI: 10.2106/jbjs.rvw.22.00020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
➢ Periprosthetic joint infection (PJI) following hip hemiarthroplasty (HA) is a devastating complication, incurring immense health-care costs associated with its treatment and placing considerable burden on patients and their families. These patients often require multiple surgical procedures, extended hospitalization, and prolonged antimicrobial therapy. ➢ Notable risk factors include older age, higher American Society of Anesthesiologists (ASA) score, inadequate antibiotic prophylaxis, non-antibiotic-loaded cementation of the femoral implant, longer duration of the surgical procedure, and postoperative drainage and hematoma. ➢ Although the most frequent infecting organisms are gram-positive cocci such as Staphylococcus aureus, there is a higher proportion of patients with gram-negative and polymicrobial infections after hip HA compared with patients who underwent total hip arthroplasty. ➢ Several surgical strategies exist. Regardless of the preferred surgical treatment, successful management of these infections requires a comprehensive surgical debridement focused on eradicating the biofilm followed by appropriate antibiotic therapy. ➢ A multidisciplinary approach led by surgeons familiar with PJI treatment and infectious disease specialists is recommended for all cases of PJI after hip HA to increase the likelihood of treatment success.
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Affiliation(s)
- Antoine Bureau
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Marisa A Azad
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Hesham Abdelbary
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Simon P Garceau
- Division of Orthopaedic Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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Accuracy and agreement of national spine register data for 474 patients compared to corresponding electronic patient records. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:801-811. [PMID: 34989877 DOI: 10.1007/s00586-021-07093-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/12/2021] [Accepted: 12/18/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Data quality is essential for all types of research, including health registers. However, data quality is rarely reported. We aimed to assess the accuracy of data in a national spine register (NORspine) and its agreement with corresponding data in electronic patient records (EPR). METHODS We compared data in NORspine registry against data in (EPR) for 474 patients operated for spinal stenosis in 2015 and 2016 at four public hospitals, using EPR as the gold standard. We assessed accuracy using the proportion correctly classified (PCC) and sensitivity. Agreement was quantified using Kappa statistics or interaclass correlation coefficient (ICC). RESULTS The mean age (SD) was 66 (11) years, and 54% were females. Compared to EPR, surgeon-reported perioperative complications displayed weak agreement (kappa (95% CI) = 0.51 (0.33-0.69)), PCC of 96%, and a sensitivity (95% CI) of 40% (23-58%). ASA classification had a moderate agreement (kappa (95%CI) = 0.73 (0.66-0.80)). Comorbidities were underreported in NORspine. Perioperative details had strong to excellent agreements (kappa (95% CI) ranging from 0.76 ( 0.68-0.84) to 0.98 (0.95-1.00)), PCCs between 93% and 99% and sensitivities (95% CI) between 92% (0.84-1.00%) and 99% (0.98-1.00%). Patient-reported variables (height, weight, smoking) had excellent agreements (kappa (95% CI) between 0.93 (0.89-0.97) and 0.99 (0.98-0.99)). CONCLUSION Compared to electronic patient records, NORspine displayed weak agreement for perioperative complications, moderate agreement for ASA classification, strong agreement for perioperative details, and excellent agreement for height, weight, and smoking. NORspine underreported perioperative complications and comorbidities when compared to EPRs. Patient-recorded data were more accurate and should be preferred when available.
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