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Tan TK, Tan P, Wang K, Hau R. Effect of tranexamic acid on shoulder surgery: an updated meta-analysis of randomized studies. J Shoulder Elbow Surg 2024; 33:e97-e108. [PMID: 37890768 DOI: 10.1016/j.jse.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND The effect of tranexamic acid (TXA) has been proven to be effective in reducing blood loss in lower limb arthroplasty. The aim of this study is to investigate the effect of TXA in shoulder surgery with the updated studies. MATERIALS AND METHODS A systematic review and meta-analysis of all the randomized controlled trials were conducted. We compared the outcomes of patients with and without TXA. The PubMed, MEDLINE, EMBASE, and CENTRAL databases were systematically searched for relevant studies. RESULTS A total of 14 studies, enrolling 1131 patients, were included for qualitative and quantitative analysis. Our results revealed that TXA was associated with a significant reduction in total volume blood loss (mean difference [MD]: -112.97, P = .0006), drain output (MD: -81.90, P < .00001), hemoglobin changes (MD: -0.55, P = .02), shorter operative time (MD: -6.19, P = .01), and lower risk of hematoma formation (odds ratio: -0.20, P = .01). The postoperative visual analog scale pain score was also significantly better in the TXA group (MD: -0.78, P < .00001). No significant difference was detected in length of hospital stay and incidence of thromboembolization. CONCLUSION The usage of TXA in shoulder surgery appeared to be safe and effective in reducing blood loss without any significant complication.
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Affiliation(s)
- Tze Khiang Tan
- Department of Orthopaedic Surgery, Monash Health Dandenong Hospital, Dandenong, VIC, Australia.
| | - Pham Tan
- Radiology Department, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Kemble Wang
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia; Department of Orthopaedic Surgery, Royal Children's Hospital, Melbourne, VIC, Australia; Monash University, Melbourne, VIC, Australia
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia; Department of Surgery, University of Melbourne, Carlton, VIC, Australia
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Tan TK, Gopal Subramaniam A, Hau R. Effects of combined dexamethasone and tranexamic acid in lower limb total arthroplasty: a systematic review and meta-analysis of randomized clinical trials. Eur J Orthop Surg Traumatol 2023; 33:3327-3335. [PMID: 37329454 DOI: 10.1007/s00590-023-03612-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To evaluate the effectiveness of combined Tranexamic acid (TXA) and dexamethasone (DEX) in total hip and knee arthroplasty. METHODS PUBMED, EMBASE, MEDLINE and CENTRAL database were systematically searched for randomized studies that utilized TXA and DEX administration of TXA in THA or TKA. RESULTS A total of three randomized studies enrolling 288 patients were eligible for qualitative and quantitative analysis. DEX + TXA group demonstrated statistical significantly lesser usage of oxycodone (OR: 0.34, p < 0.0001), metoclopramide (OR: 0.21, p < 0.00001), lesser incidence of postoperative nausea and vomiting (OR: 0.27, p < 0.0001), better postoperative range of motion (MD: 2.30, p < 0.00001) and shorter length of hospital stay (MD: 0.31, p = 0.03). Comparable results were seen in total blood loss, transfusion rate and postoperative complications. CONCLUSION In this meta-analysis, the combination of TXA and DEX has positive impacts on the usage of oxycodone and metoclopramide, postoperative range of motion, postoperative nausea and vomiting and reduces the length of hospital stay.
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MESH Headings
- Humans
- Tranexamic Acid/therapeutic use
- Antifibrinolytic Agents/therapeutic use
- Postoperative Nausea and Vomiting/etiology
- Postoperative Nausea and Vomiting/prevention & control
- Metoclopramide/therapeutic use
- Oxycodone
- Blood Loss, Surgical/prevention & control
- Randomized Controlled Trials as Topic
- Arthroplasty, Replacement, Knee/adverse effects
- Arthroplasty, Replacement, Knee/methods
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/methods
- Dexamethasone
- Administration, Intravenous
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Affiliation(s)
- Tze Khiang Tan
- Department of Orthopaedic Surgery, Monash Health Dandenong Hospital, Dandenong, VIC, Australia.
| | | | - Raphael Hau
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
- Department of Surgery, University of Melbourne, Carlton, VIC, Australia
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Rafiudeen R, Barlis P, Hau R, Vasanthakumar S, Ng R, Wu P, Tacey M, Banning A, van Gaal W. Ivabradine in the Prevention, and Reduction in Size, of Perioperative Myocardial Injury in Patients Undergoing Orthopedic Surgery for Acute Fracture. J Am Heart Assoc 2023; 12:e028760. [PMID: 37982213 PMCID: PMC10727297 DOI: 10.1161/jaha.122.028760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 10/02/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND Perioperative myocardial injury is common after major noncardiac surgery and is associated with adverse outcomes. This study investigated the use of ivabradine in patients undergoing urgent surgery for fracture. METHODS AND RESULTS This was a prospective, double-blind, placebo-controlled, randomized clinical trial. Participants were enrolled 1:1 into ivabradine or placebo arm, and study drug was commenced before operation and continued for 7 days or until discharge. High-sensitivity troponin I was measured daily using Abbott Alinity analyzer and assay, and heart rate data were obtained using continuous Holter monitoring. A total of 199 patients underwent acute orthopedic surgery, 98 in the ivabradine group and 101 in the placebo group. The mean age was 78.7 years (range, 77.5-79.9 years), with 68% women. The average heart rate was 5 to 11 beats per minute lower in the ivabradine group compared with the placebo group at all time points (P<0.001 for all). There was no statistically significant difference between the ivabradine and placebo groups in the number of patients who had perioperative myocardial injury: 28.6% versus 31.6% (P=0.71). In patients with perioperative myocardial injury, average peak troponin was 168.8 ng/L (±431.2 ng/L) in the ivabradine group and 2094.5 ng/L (±7201.9 ng/L) in the placebo group (P=0.16). There was no statistically significant difference between groups in 30-day mortality, blood pressure, stroke, or major adverse cardiovascular event. CONCLUSIONS Starting ivabradine preoperatively in elderly patients requiring acute surgery for fracture did not result in a statistically significant difference in the incidence of perioperative myocardial injury. There was no statistically significant difference in morbidity, mortality, or adverse events between treatment groups. REGISTRATION URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12616001634460p.
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Affiliation(s)
- Rifly Rafiudeen
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| | - Peter Barlis
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| | - Raphael Hau
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
- Orthopaedic DepartmentBox Hill HospitalMelbourneVICAustralia
| | | | - Reginald Ng
- Orthopaedic DepartmentBox Hill HospitalMelbourneVICAustralia
| | - Philip Wu
- Orthopaedic DepartmentBox Hill HospitalMelbourneVICAustralia
| | - Mark Tacey
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
| | - Adrian Banning
- Cardiology DepartmentJohn Radcliffe HospitalOxfordUnited Kingdom
| | - William van Gaal
- Cardiology DepartmentThe Northern HospitalMelbourneVICAustralia
- Department of MedicineThe University of MelbourneMelbourneVICAustralia
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Chua N, Onggo JR, Nambiar M, Onggo JD, Wang KK, Pennington R, Hau R. Functional outcomes of reverse total shoulder arthroplasty in Boileau class 1 and class 2 proximal humeral fracture sequelae: A meta-analysis and systematic review. Shoulder Elbow 2023; 15:43-53. [PMID: 37974647 PMCID: PMC10649513 DOI: 10.1177/17585732221088496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/19/2023]
Abstract
Background Reverse total shoulder arthroplasty (RTSA) is an increasingly popular salvage treatment option for proximal humeral fracture (PHF) sequelae. This meta-analysis aimed to conduct a pooled analysis of functional outcomes of RTSA in PHF sequelae, with subgroup analysis comparing between intracapsular (Class 1) and extracapsular (Class 2) PHF sequelae. Methods A multi-database search (PubMed, OVID, EMBASE) was performed according to PRISMA guidelines on 27th July 2020. Data from all published literature meeting inclusion criteria were extracted and analysed. Findings Eleven studies were included, comprising 359 shoulders (167 Class 1 and 192 Class 2). The mean age was 68.2 years, and the mean time between injury and surgery was 49 months, (1-516 months). Constant score and forward flexion improved by 31.8 (95%CI: 30.5-33.1, p < 0.001) and 60o (95%CI: 58o-62o, p < 0.001) respectively between pre-operative and post-operative values for both groups. Constant scores were better in Class 1 patients (MD = 3.60, 95%CI: 1.0-6.2, p < 0.001) pre-operatively and post-operatively (MD = 7.4, 95%CI: 5.8-9.0, p < 0.001). Forward flexion was significantly better in Class 1 patients (MD = 13o, 95%CI: 7o-17o, p < 0.001) pre-operatively, but was slightly better in Class 2 patients post-operatively (MD = 7o, 95%CI: 4o-10o, p < 0.001). Overall complication rate was 16.8%. Conclusion Salvage RTSA is effective for PHF sequelae, with multiple factors contributing to the high complication rate.
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Affiliation(s)
- Nina Chua
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
| | - James R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Kemble K Wang
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
- Department of Orthopaedic Surgery, Royal Children’s Hospital, Victoria, Australia
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Richard Pennington
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, Victoria, Australia
- Epworth Eastern Hospital, Box Hill, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
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Onggo J, Nambiar M, McDougall C, Hau R, Babazadeh S. Comparing outcomes of total hip arthroplasty versus hemiarthroplasty in neck of femur fracture patients: an Australian registry study. Eur J Trauma Emerg Surg 2023; 49:2147-2153. [PMID: 37355483 PMCID: PMC10520181 DOI: 10.1007/s00068-023-02305-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/06/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE To determine discharge outcomes of displaced subcapital NOF patients who were from home, with intact pre-operative cognition, ASA 1 or 2 and independent walkers treated with either THA or hemiarthroplasty. METHODS A retrospective registry study was performed using data from the Australia and New Zealand Hip Fracture Registry (ANZHFR). Institutional ethics approval was obtained prior to commencement. Hip fracture registry records between 1st January 2016 and 31st January 2020 were reviewed. RESULTS A total of 930 patients with complete records were identified and included. There were 602 THA and 328 hemiarthroplasty patients. Using multivariate analysis, pre-operative factors associated with THA include younger age (OR = 0.90 for every year older, p < 0.001), females (p = 0.043), private admissions (OR = 1.62, p = 0.028) and receiving pre-operative geriatric assessment (OR = 1.89, p = 0.002). Delay to theatre due to not being fit for surgery was associated with not receiving THA (OR = 0.21, p < 0.001). THA resulted in a shorter total hospital length of stay (MD = 7.24, p < 0.001), higher likelihood of being discharged home (OR = 1.88, p < 0.001) and lower likelihood of being discharged to a residential aged care facility (OR = 0.32, p = 0.019). CONCLUSION Displaced subcapital NOF patients who were admitted from home, had intact pre-operative cognition, ASA 1 or 2, independent walkers and had THAs, had shorter total hospital length of stay, were more likely to be discharged home directly and less likely to end up in residential aged care facilities compared to those undergoing hemiarthroplasty.
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Affiliation(s)
- James Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Catherine McDougall
- Department of Orthopaedic Surgery, Metro North Hospital and Health Service, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia
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6
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Mather AM, Edwards E, Hau R, Ekegren CL. Primary and Periprosthetic Distal Femur Fractures in Older Adults: No Difference in 12-Month Mortality and Patient-Reported Outcomes. J Orthop Trauma 2023; 37:492-499. [PMID: 37296087 DOI: 10.1097/bot.0000000000002649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To compare fracture incidence, mortality, and patient-reported health outcomes at 6 and 12 months postinjury between primary and periprosthetic distal femur fractures in older adults. METHODS A registry-based cohort study was conducted including all adults 70 years of age or older registered by the Victorian Orthopaedic Trauma Outcomes Registry who experienced a primary or periprosthetic distal femur fracture between 2007 and 2017. Outcomes included mortality and health status (Three-Level European Quality of Life-Five Dimensions Scale [EQ-5D-3L]) collected at 6 and 12 months postinjury. All distal femur fractures were confirmed by radiological review. Multivariable logistic regression was conducted to report associations between fracture type and mortality and health status. RESULTS A final cohort of 292 participants was identified. Overall mortality for the cohort was 29.8%, and no significant differences were found in mortality rate or EQ-5D-3L outcomes between fracture types (ie, primary vs. periprosthetic). A large proportion of participants reported problems across all EQ-5D-3L domains at 6 and 12 months postinjury, with slightly worse outcomes in the primary fracture group. CONCLUSIONS This study reports high mortality and poor 12-month outcomes in an older adult cohort with both periprosthetic and primary distal femur fractures. Given these poor outcomes, fracture prevention and a greater focus on long-term rehabilitation is needed in this cohort. In addition, the involvement of an ortho-geriatrician should be considered as a routine component of care. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Anne M Mather
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Elton Edwards
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
| | - Raphael Hau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, Australia; and
| | - Christina L Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Alfred Health, Melbourne, VIC, Australia
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
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7
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Sidhu VS, Kelly TL, Pratt N, Graves SE, Buchbinder R, Adie S, Cashman K, Ackerman IN, Bastiras D, Brighton R, Burns AWR, Chong BH, Clavisi O, Cripps M, Dekkers M, de Steiger R, Dixon M, Ellis A, Griffith EC, Hale D, Hansen A, Harris A, Hau R, Horsley M, James D, Khorshid O, Kuo L, Lewis PL, Lieu D, Lorimer M, MacDessi SJ, McCombe P, McDougall C, Mulford J, Naylor JM, Page RS, Radovanovic J, Solomon M, Sorial R, Summersell P, Tran P, Walter WL, Webb S, Wilson C, Wysocki D, Harris IA. Effect of Aspirin vs Enoxaparin on 90-Day Mortality in Patients Undergoing Hip or Knee Arthroplasty: A Secondary Analysis of the CRISTAL Cluster Randomized Trial. JAMA Netw Open 2023; 6:e2317838. [PMID: 37294566 PMCID: PMC10257098 DOI: 10.1001/jamanetworkopen.2023.17838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/15/2023] [Indexed: 06/10/2023] Open
Abstract
Importance Ischemic heart disease remains the leading cause of mortality following hip and knee arthroplasty. Due to its antiplatelet and cardioprotective properties, aspirin has been proposed as an agent that could reduce mortality when used as venous thromboembolism (VTE) prophylaxis following these procedures. Objective To compare aspirin with enoxaparin in reducing 90-day mortality for patients undergoing hip or knee arthroplasty procedures. Design, Setting, and Participants This study was a planned secondary analysis of the CRISTAL cluster randomized, crossover, registry-nested trial performed across 31 participating hospitals in Australia between April 20, 2019, and December 18, 2020. The aim of the CRISTAL trial was to determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE following hip or knee arthroplasty. The primary study restricted the analysis to patients undergoing total hip or knee arthroplasty for a diagnosis of osteoarthritis only. This study includes all adult patients (aged ≥18 years) undergoing any hip or knee arthroplasty procedure at participating sites during the course of the trial. Data were analyzed from June 1 to September 6, 2021. Interventions Hospitals were randomized to administer all patients oral aspirin (100 mg daily) or subcutaneous enoxaparin (40 mg daily) for 35 days after hip arthroplasty and 14 days after knee arthroplasty procedures. Main Outcomes and Measures The primary outcome was mortality within 90 days. The between-group difference in mortality was estimated using cluster summary methods. Results A total of 23 458 patients from 31 hospitals were included, with 14 156 patients allocated to aspirin (median [IQR] age, 69 [62-77] years; 7984 [56.4%] female) and 9302 patients allocated to enoxaparin (median [IQR] age, 70 [62-77] years; 5277 [56.7%] female). The mortality rate within 90 days of surgery was 1.67% in the aspirin group and 1.53% in the enoxaparin group (estimated difference, 0.04%; 95% CI, -0.05%-0.42%). For the subgroup of 21 148 patients with a nonfracture diagnosis, the mortality rate was 0.49% in the aspirin group and 0.41% in the enoxaparin group (estimated difference, 0.05%; 95% CI, -0.67% to 0.76%). Conclusions and Relevance In this secondary analysis of a cluster randomized trial comparing aspirin with enoxaparin following hip or knee arthroplasty, there was no significant between-group difference in mortality within 90 days when either drug was used for VTE prophylaxis. Trial Registration http://anzctr.org.au Identifier: ACTRN12618001879257.
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Affiliation(s)
- Verinder S Sidhu
- School of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Thu-Lan Kelly
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole Pratt
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Rachelle Buchbinder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sam Adie
- School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Kara Cashman
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ilana N Ackerman
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Durga Bastiras
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Roger Brighton
- Orthopaedic Department, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
- Orthopaedic Department, Lakeview Private Hospital, Baulkham Hills, Sydney, New South Wales, Australia
| | - Alexander W R Burns
- Orthopaedic Department, Calvary John James Hospital, Deakin, Australian Capital Territory, New South Wales, Australia
| | - Beng Hock Chong
- Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Hematology, New South Wales Pathology, Kogarah Campus, Sydney, New South Wales, Australia
| | | | - Maggie Cripps
- Musculoskeletal Australia, Melbourne, Victoria, Australia
| | - Mark Dekkers
- Orthopaedic Department, Greenslopes Private Hospital, Greenslopes, Queensland, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dixon
- Orthopaedic Department, Kareena Private Hospital, Sutherland, New South Wales, Australia
| | - Andrew Ellis
- Orthopaedic Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
| | - Elizabeth C Griffith
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Hale
- Orthopaedic Department, Hornsby and Kuringai Hospital, Hornsby, New South Wales, Australia
| | - Amber Hansen
- School of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Mark Horsley
- Orthopaedic Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Dugal James
- Bendigo Healthcare Group, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Omar Khorshid
- Orthopaedic Department, Fremantle Hospital, Fremantle, Perth, Western Australia, Australia
| | - Leonard Kuo
- Orthopaedic Department, Canterbury Hospital, Canterbury, New South Wales, Australia
| | - Peter L Lewis
- Calvary Adelaide Hospital, Adelaide, South Australia, Australia
- Discipline of Medical Specialties, University of Adelaide, Adelaide, South Australia, Australia
| | - David Lieu
- Orthopaedic Department, Fairfield Hospital, Fairfield, New South Wales, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Samuel J MacDessi
- School of Clinical Medicine, UNSW Medicine & Health, St George & Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
- Orthopaedic Department, St George Private Hospital, Kogarah, New South Wales, Australia
| | - Peter McCombe
- Orthopaedic Department, Frankston Hospital, Frankston, Victoria, Australia
| | - Catherine McDougall
- Orthopaedic Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Jonathan Mulford
- Orthopaedic Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Justine Maree Naylor
- School of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Richard S Page
- School of Medicine, St John of God Hospital and Barwon Health, Deakin University, Geelong, Australia
| | - John Radovanovic
- Orthopaedic Department, Mater Hospital, Raymond Terrace, Brisbane, Queensland, Australia
| | - Michael Solomon
- Orthopaedic Department, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Rami Sorial
- Orthopaedic Department, Nepean Hospital, Penrith, New South Wales, Australia
| | - Peter Summersell
- Orthopaedic Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia
| | - Phong Tran
- Orthopaedic Department, Western Health, Melbourne, Victoria, Australia
| | - William L Walter
- Orthopaedic Department, Royal North Shore Hospital, St Leonards, New South Wales, Australia
- Sydney Musculoskeletal Health, University of Sydney, Sydney, New South Wales, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Steve Webb
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- St John of God Health Care, Perth, Western Australia, Australia
| | - Chris Wilson
- Orthopaedic Department, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Department of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Wysocki
- Orthopaedic Department, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Ian A Harris
- School of Clinical Medicine, South Western Sydney Clinical School, Faculty of Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Zheng Z, Stelmach WS, Ma J, Briedis J, Hau R, Tacey M, Atme J, Bourne D, Crabbe J, Fletcher C, Howat P, Layton J, Xue CC. Health professionals' attitudes towards acupuncture/acupressure for post-operative nausea and vomiting: a survey and implications for implementation. Acupunct Med 2023; 41:16-26. [PMID: 35579002 DOI: 10.1177/09645284221085282] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE Level 1 evidence supports the use of acupuncture/acupressure (A/A) to manage post-operative nausea and vomiting (PONV). This study aimed to survey healthcare professionals' attitudes towards A/A, influencing factors and barriers to implementing this effective non-drug intervention into peri-operative care. METHODS A validated, anonymous survey with 43 questions was emailed or distributed as a hard copy at meetings to anaesthetists, midwives, nurses, obstetricians, gynaecologists and surgeons at a public hospital in Australia. Descriptive data were presented. Influencing factors were explored using chi-square analysis. Multinomial logistical regression was used to identify the influences of confounding factors. RESULTS A total of 155 completed surveys were returned, reflecting a response rate of 32%. The majority of participants were female (69%), nurses/midwives (61%) and aged between 20 and 50 years old (76%). Eighty-three percent of respondents considered A/A 'clearly alternative' medicine or 'neither mainstream nor alternative'. Eighty-one percent would encourage patients to use acupressure for PONV if it was offered at the hospital. Previous personal use of A/A was the key factor influencing attitudes and openness to clinical use. The key barriers to implementation were perceived lack of evidence and lack of qualified providers and time. CONCLUSION Hospital-based healthcare professionals strongly supported the evidence-based use of A/A for PONV despite considering the therapy to be non-mainstream and having limited A/A education or history of personal use, providing a positive context for an acupressure implementation study. Significant gaps in training and a desire to learn were identified.
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Affiliation(s)
- Zhen Zheng
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM), RMIT University, Bundoora, VIC, Australia
| | - Wanda S Stelmach
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Jason Ma
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Juris Briedis
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Raphael Hau
- Box Hill Hospital, Eastern Health, Box Hill, VIC, Australia
| | - Mark Tacey
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Jeannette Atme
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Debra Bourne
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Julie Crabbe
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | | | - Paul Howat
- Northern Hospital Epping, Northern Health, Epping, VIC, Australia
| | - Jenny Layton
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM), RMIT University, Bundoora, VIC, Australia
| | - Charlie C Xue
- School of Health and Biomedical Sciences, College of Science, Technology, Engineering and Mathematics (STEM), RMIT University, Bundoora, VIC, Australia
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9
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Taylor NF, Shields N, Thompson AL, O'Halloran PD, Harding KE, Dennett AM, Hau R, Peiris CL. A walking programme for adults living in the community after hip fracture: A feasibility randomized controlled trial. Clin Rehabil 2022; 37:47-59. [PMID: 36163694 DOI: 10.1177/02692155221128721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. DESIGN A randomized controlled trial with embedded qualitative analysis. SETTING Community. PARTICIPANTS Aged at least 60 years and living in the community after hip fracture. INTERVENTIONS In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking. MAIN OUTCOME MEASURES Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy. RESULTS Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2-13). There were no between-group differences in mobility, walking confidence or quality of life. CONCLUSION A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.
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Affiliation(s)
- Nicholas F Taylor
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia
| | - Anne L Thompson
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Paul D O'Halloran
- School of Public Health and Psychology, 2080La Trobe University, Bundoora, Australia
| | - Katherine E Harding
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Amy M Dennett
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Raphael Hau
- Department of Orthopaedics, Eastern Health, Box Hill, Australia
| | - Casey L Peiris
- School of Allied Health, Human Services and Sport, 2080La Trobe University, Bundoora, Australia
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10
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Sidhu VS, Kelly TL, Pratt N, Graves SE, Buchbinder R, Adie S, Cashman K, Ackerman I, Bastiras D, Brighton R, Burns AWR, Chong BH, Clavisi O, Cripps M, Dekkers M, de Steiger R, Dixon M, Ellis A, Griffith EC, Hale D, Hansen A, Harris A, Hau R, Horsley M, James D, Khorshid O, Kuo L, Lewis P, Lieu D, Lorimer M, MacDessi S, McCombe P, McDougall C, Mulford J, Naylor JM, Page RS, Radovanovic J, Solomon M, Sorial R, Summersell P, Tran P, Walter WL, Webb S, Wilson C, Wysocki D, Harris IA. Effect of Aspirin vs Enoxaparin on Symptomatic Venous Thromboembolism in Patients Undergoing Hip or Knee Arthroplasty: The CRISTAL Randomized Trial. JAMA 2022; 328:719-727. [PMID: 35997730 PMCID: PMC9399863 DOI: 10.1001/jama.2022.13416] [Citation(s) in RCA: 56] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
IMPORTANCE There remains a lack of randomized trials investigating aspirin monotherapy for symptomatic venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA) or total knee arthroplasty (TKA). OBJECTIVE To determine whether aspirin was noninferior to enoxaparin in preventing symptomatic VTE after THA or TKA. DESIGN, SETTING, AND PARTICIPANTS Cluster-randomized, crossover, registry-nested trial across 31 hospitals in Australia. Clusters were hospitals performing greater than 250 THA or TKA procedures annually. Patients (aged ≥18 years) undergoing hip or knee arthroplasty procedures were enrolled at each hospital. Patients receiving preoperative anticoagulation or who had a medical contraindication to either study drug were excluded. A total of 9711 eligible patients were enrolled (5675 in the aspirin group and 4036 in the enoxaparin group) between April 20, 2019, and December 18, 2020. Final follow-up occurred on August 14, 2021. INTERVENTIONS Hospitals were randomized to administer aspirin (100 mg/d) or enoxaparin (40 mg/d) for 35 days after THA and for 14 days after TKA. Crossover occurred after the patient enrollment target had been met for the first group. All 31 hospitals were initially randomized and 16 crossed over prior to trial cessation. MAIN OUTCOMES AND MEASURES The primary outcome was symptomatic VTE within 90 days, including pulmonary embolism and deep venous thrombosis (DVT) (above or below the knee). The noninferiority margin was 1%. Six secondary outcomes are reported, including death and major bleeding within 90 days. Analyses were performed by randomization group. RESULTS Enrollment was stopped after an interim analysis determined the stopping rule was met, with 9711 patients (median age, 68 years; 56.8% female) of the prespecified 15 562 enrolled (62%). Of these, 9203 (95%) completed the trial. Within 90 days of surgery, symptomatic VTE occurred in 256 patients, including pulmonary embolism (79 cases), above-knee DVT (18 cases), and below-knee DVT (174 cases). The symptomatic VTE rate in the aspirin group was 3.45% and in the enoxaparin group was 1.82% (estimated difference, 1.97%; 95% CI, 0.54%-3.41%). This failed to meet the criterion for noninferiority for aspirin and was significantly superior for enoxaparin (P = .007). Of 6 secondary outcomes, none were significantly better in the enoxaparin group compared with the aspirin group. CONCLUSIONS AND RELEVANCE Among patients undergoing hip or knee arthroplasty for osteoarthritis, aspirin compared with enoxaparin resulted in a significantly higher rate of symptomatic VTE within 90 days, defined as below- or above-knee DVT or pulmonary embolism. These findings may be informed by a cost-effectiveness analysis. TRIAL REGISTRATION ANZCTR Identifier: ACTRN12618001879257.
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Affiliation(s)
| | - Verinder S Sidhu
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Thu-Lan Kelly
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Nicole Pratt
- Clinical and Health Sciences, Quality Use of Medicines Pharmacy Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Stephen E Graves
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia
| | - Sam Adie
- School of Clinical Medicine, UNSW Medicine and Health, St George and Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
| | - Kara Cashman
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Ilana Ackerman
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Victoria, Australia
| | - Durga Bastiras
- Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, South Australia, Australia
| | - Roger Brighton
- Orthopaedic Department, Westmead Private Hospital, Westmead, Sydney, New South Wales, Australia
- Orthopaedic Department, Lakeview Private Hospital, Baulkham Hills, Sydney, New South Wales, Australia
| | - Alexander W R Burns
- Orthopaedic Department, Calvary John James Hospital, Deakin, Canberra, Australian Capital Territory, Australia
| | - Beng Hock Chong
- Department of Medicine, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Hematology, New South Wales Pathology, Kogarah Campus, Sydney, New South Wales, Australia
| | | | - Maggie Cripps
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Mark Dekkers
- Orthopaedic Department, Greenslopes Private Hospital, Greenslopes, Brisbane, Queensland, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Dixon
- Orthopaedic Department, Kareena Private Hospital, Sutherland, Sydney, New South Wales, Australia
| | - Andrew Ellis
- Orthopaedic Department, Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health Flagship Centre of the University of Sydney and Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
| | - Elizabeth C Griffith
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - David Hale
- Orthopaedic Department, Hornsby and Kuringai Hospital, Hornsby, Sydney, New South Wales, Australia
| | - Amber Hansen
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Anthony Harris
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Mark Horsley
- Orthopaedic Department, Royal Prince Alfred Hospital, Camperdown, Sydney, New South Wales, Australia
| | - Dugal James
- Bendigo Healthcare Group, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Omar Khorshid
- Orthopaedic Department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Leonard Kuo
- Orthopaedic Department, Canterbury Hospital, Canterbury, Sydney, New South Wales, Australia
| | - Peter Lewis
- Orthopaedic Department, Calvary Hospital, Adelaide, South Australia, Australia
| | - David Lieu
- Orthopaedic Department, Fairfield Hospital, Fairfield, Sydney, New South Wales, Australia
| | - Michelle Lorimer
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Samuel MacDessi
- School of Clinical Medicine, UNSW Medicine and Health, St George and Sutherland Clinical Campuses, Faculty of Medicine and Health, UNSW Sydney, New South Wales, Australia
- Orthopaedic Department, St George Private Hospital, Kogarah, Sydney, New South Wales, Australia
| | - Peter McCombe
- Orthopaedic Department, Frankston Hospital, Frankston, Melbourne, Victoria, Australia
| | - Catherine McDougall
- Orthopaedic Department, The Prince Charles Hospital, Chermside, Brisbane, Queensland, Australia
| | - Jonathan Mulford
- Orthopaedic Department, Launceston General Hospital, Launceston, Tasmania, Australia
| | - Justine Maree Naylor
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Richard S Page
- School of Medicine, St John of God Hospital and Barwon Health, Deakin University, Geelong, Victoria, Australia
| | - John Radovanovic
- Orthopaedic Department, Mater Hospital, Raymond Terrace, Brisbane, Queensland, Australia
| | - Michael Solomon
- Orthopaedic Department, Prince of Wales Hospital, Randwick, Sydney, New South Wales, Australia
| | - Rami Sorial
- Orthopaedic Department, Nepean Hospital, Nepean, Sydney, New South Wales, Australia
| | - Peter Summersell
- Orthopaedic Department, Coffs Harbour Base Hospital, Coffs Harbour, New South Wales, Australia
| | - Phong Tran
- Orthopaedic Department, Western Health, Melbourne, Victoria, Australia
| | - William L Walter
- Orthopaedic Department, Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
- Sydney Musculoskeletal Health Flagship Centre of the University of Sydney and Royal North Shore Hospital, St Leonard's, Sydney, New South Wales, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney and the Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Steve Webb
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Chris Wilson
- Orthopaedic Department, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, Australia
- Department of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - David Wysocki
- Orthopaedic Department, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Ian A Harris
- School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Sydney, New South Wales, Australia
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
- Institute of Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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11
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Aebischer AS, Hau R, de Steiger RN, Holder C, Wall CJ. Distal femoral arthroplasty for native knee fractures : results from the Australian Orthopaedic Association National Joint Replacement Registry. Bone Joint J 2022; 104-B:894-901. [PMID: 35775178 DOI: 10.1302/0301-620x.104b7.bjj-2021-1136.r3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
AIMS The aim of this study was to investigate the rate of revision for distal femoral arthroplasty (DFA) performed as a primary procedure for native knee fractures using data from the Australian Orthopaedic Association National Joint Arthroplasty Registry (AOANJRR). METHODS Data from the AOANJRR were obtained for DFA performed as primary procedures for native knee fractures from 1 September 1999 to 31 December 2020. Pathological fractures and revision for failed internal fixation were excluded. The five prostheses identified were the Global Modular Arthroplasty System, the Modular Arthroplasty System, the Modular Universal Tumour And Revision System, the Orthopaedic Salvage System, and the Segmental System. Patient demographic data (age, sex, and American Society of Anesthesiologists grade) were obtained, where available. Kaplan-Meier estimates of survival were used to determine the rate of revision, and the reasons for revision and mortality data were examined. RESULTS The AOANJRR identified 153 primary DFAs performed for native knee fractures in 151 patients during the study period, with 63.3% of these (n = 97) performed within the last five years. The median follow-up was 2.1 years (interquartile range 0.8 to 4.4). The patient population was 84.8% female (n = 128), with a mean age of 76.1 years (SD 11.9). The cumulative percent revision rate at three years was 10%. The most common reason for revision was loosening, followed by infection. Patient survival at one year was 87.5%, decreasing to 72.8% at three years postoperatively. CONCLUSION The use of DFA to treat native knee fractures is increasing, with 63.3% of cases performed within the last five years. While long-term data are not available, the results of this study suggest that DFA may be a reasonable option for elderly patients with native knee fractures where fixation is not feasible, or for whom prolonged non-weightbearing may be detrimental. Cite this article: Bone Joint J 2022;104-B(7):894-901.
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Affiliation(s)
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Melbourne, Australia.,Department of Surgery, University of Melbourne, Northern Medical School, Melbourne, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Melbourne, Australia.,Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Carl Holder
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Australia.,School of Medicine Rural Clinical School, University of Queensland, Toowoomba, Australia
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12
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Aebischer AS, Hau R, de Steiger RN, Holder C, Wall CJ. Distal Femoral Replacement for Periprosthetic Fractures After TKA: Australian Orthopaedic Association National Joint Replacement Registry Review. J Arthroplasty 2022; 37:1354-1358. [PMID: 35271977 DOI: 10.1016/j.arth.2022.02.115] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Distal femoral replacement (DFR) is a potential treatment option following periprosthetic fracture (PPF) of a total knee arthroplasty (TKA). However, there is limited literature regarding implant survivorship and complication rates. The aim of this study was to examine patient demographics and trends in usage, implant survivorship and modes of failure, and patient mortality following DFR for PPF captured by a national joint replacement registry. METHODS A retrospective registry review was performed using data from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR). In total, 306 DFR were performed for PPF of a known primary TKA. Eighty-five percent of patients were female, and the mean age was 76.4 years. Kaplan-Meier estimates of implant and patient survivorship were performed. RESULTS The number of DFR performed for PPF has doubled over the past five years. The cumulative percent second revision rate at six years was 12%. The most common indications for revision were infection (37%) and aseptic loosening (33%). Patient survivorship after DFR was 97% and 83% at five and ten years, respectively. CONCLUSION A national registry review has identified the increasing prevalence of DFR for PPF after primary TKA and demonstrated implant survivorship of 88% at midterm follow-up. Surgeons may consider DFR as an acceptable and durable treatment option. LEVEL OF EVIDENCE Level III - Case Series.
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Affiliation(s)
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia; Department of Surgery, University of Melbourne, Northern Medical School, Epping, Victoria, Australia
| | - Richard N de Steiger
- Department of Surgery, Epworth Healthcare, University of Melbourne, Richmond, Australia; Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia
| | - Carl Holder
- MBiostat, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia
| | - Christopher J Wall
- Department of Orthopaedics, Toowoomba Hospital, Toowoomba, Australia; School of Medicine Rural Clinical School, University of Queensland, Toowoomba, Australia
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13
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Dipnall JF, Page R, Du L, Costa M, Lyons RA, Cameron P, de Steiger R, Hau R, Bucknill A, Oppy A, Edwards E, Varma D, Jung MC, Gabbe BJ. Predicting fracture outcomes from clinical registry data using artificial intelligence supplemented models for evidence-informed treatment (PRAISE) study protocol. PLoS One 2021; 16:e0257361. [PMID: 34555069 PMCID: PMC8460020 DOI: 10.1371/journal.pone.0257361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/27/2021] [Indexed: 11/18/2022] Open
Abstract
Background Distal radius (wrist) fractures are the second most common fracture admitted to hospital. The anatomical pattern of these types of injuries is diverse, with variation in clinical management, guidelines for management remain inconclusive, and the uptake of findings from clinical trials into routine practice limited. Robust predictive modelling, which considers both the characteristics of the fracture and patient, provides the best opportunity to reduce variation in care and improve patient outcomes. This type of data is housed in unstructured data sources with no particular format or schema. The “Predicting fracture outcomes from clinical Registry data using Artificial Intelligence (AI) Supplemented models for Evidence-informed treatment (PRAISE)” study aims to use AI methods on unstructured data to describe the fracture characteristics and test if using this information improves identification of key fracture characteristics and prediction of patient-reported outcome measures and clinical outcomes following wrist fractures compared to prediction models based on standard registry data. Methods and design Adult (16+ years) patients presenting to the emergency department, treated in a short stay unit, or admitted to hospital for >24h for management of a wrist fracture in four Victorian hospitals will be included in this study. The study will use routine registry data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), and electronic medical record (EMR) information (e.g. X-rays, surgical reports, radiology reports, images). A multimodal deep learning fracture reasoning system (DLFRS) will be developed that reasons on EMR information. Machine learning prediction models will test the performance with/without output from the DLFRS. Discussion The PRAISE study will establish the use of AI techniques to provide enhanced information about fracture characteristics in people with wrist fractures. Prediction models using AI derived characteristics are expected to provide better prediction of clinical and patient-reported outcomes following distal radius fracture.
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Affiliation(s)
- Joanna F. Dipnall
- Clinical Registries, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Deakin University, Geelong, Victoria, Australia
- * E-mail:
| | - Richard Page
- School of Medicine, Deakin University, St. John of God Hospital, University Hospital Geelong, Geelong, Victoria, Australia
| | - Lan Du
- Department of Data Science & AI, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Matthew Costa
- Oxford Trauma and Emergency Care, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - Ronan A. Lyons
- Clinical Registries, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Health Data Research UK, Swansea University, Swansea, United Kingdom
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
| | - Peter Cameron
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Hospital, Prahran, Victoria, Australia
| | - Richard de Steiger
- Department of Surgery, University of Melbourne, Epworth HealthCare, Epworth, Richmond, Victoria, Australia
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Oppy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Epworth Healthcare, Melbourne, Victoria, Australia
| | - Elton Edwards
- Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Alfred Hospital, Prahran, Victoria, Australia
| | - Dinesh Varma
- Department of Surgery, Monash University, Melbourne, Australia
- National Trauma Research Institute, Melbourne, Australia
- Department of Radiology, Alfred Hospital, Melbourne, Australia
| | - Myong Chol Jung
- Clinical Registries, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Data Science & AI, Faculty of Information Technology, Monash University, Clayton, Victoria, Australia
| | - Belinda J. Gabbe
- Clinical Registries, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- National Centre for Population Health and Wellbeing Research, Swansea University, Swansea, United Kingdom
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14
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Onggo JR, Ang JJM, Onggo JD, de Steiger R, Hau R. Greater risk of all-cause revisions and complications for obese patients in 3 106 381 total knee arthroplasties: a meta-analysis and systematic review. ANZ J Surg 2021; 91:2308-2321. [PMID: 34405518 DOI: 10.1111/ans.17138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Obesity is a major public health issue and has considerable implications on outcomes of total knee arthroplasty (TKA). However, there has been conflicting evidence and conclusions on the effects of obesity on TKA. This meta-analysis compares the outcomes, complications, and peri-operative parameters of TKA in the obese (body mass index [BMI] ≥ 30 kg/m2 ) versus non-obese (BMI < 30 kg/m2 ) population as well as subgroup analysis of morbidly obese (BMI ≥ 40 kg/m2 ) versus non-obese population. METHODS A meta-analysis was conducted with a multi-database search according to PRISMA guidelines on 12 September 2019. Data from all published literature meeting inclusion criteria were extracted and analysed. RESULTS Ninety-one studies were included, consisting of 917 447 obese and 2 188 834 non-obese TKA. Obese patients had higher risk of all-cause revisions (odds ratio [OR] = 1.15, 95% CI: 1.08-1.24, p < 0.0001), all complications (OR = 1.21, 95% CI: 1.06-1.38, p = 0.004), deep infections (OR = 1.47, 95% CI: 1.27-1.69, p < 0.0001), superficial infections (OR = 1.59, 95% CI: 1.32-1.91, p < 0.0001), wound dehiscence (OR = 1.46, 95% CI: 1.24-1.72, p < 0.0001) and readmissions (OR = 1.21, 95% CI: 1.05-1.40, p = 0.009). Subgroup analysis of morbidly obese patients revealed greater risks of all-cause revisions (OR = 1.25, 95% CI: 1.10-1.43, p = 0.0009), deep infections (OR = 1.98, 95% CI: 1.05-3.75, p = 0.04), superficial infections (OR = 2.44, 95% CI: 2.08-2.88, p < 0.0001) and readmissions (OR = 1.33, 95% CI: 1.20-1.47, p < 0.0001). No analysis was performed on patient reported outcome measures due to heterogeneous reporting methods. CONCLUSION Obese and morbidly obese patients have higher risks of revisions and infections post TKA. Surgeons should counsel patients of these risks during the informed consenting process and adopt preventative strategies into clinical practice to reduce risks where possible. In conclusion, obesity is a significant, modifiable risk factor for increased complications following TKA.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - James Jia Ming Ang
- Monash Medical School, Monash University, Melbourne, Victoria, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Richard de Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Epworth Eastern Hospital, Melbourne, Victoria, Australia
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15
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Taylor NF, O'Halloran PD, Watts JJ, Morris R, Peiris CL, Porter J, Prendergast LA, Harding KE, Snowdon DA, Ekegren CL, Hau R, Mudiyanselage SB, Rimayanti MU, Noeske KE, Snowdon M, Kim D, Shields N. Motivational interviewing with community-dwelling older adults after hip fracture (MIHip): protocol for a randomised controlled trial. BMJ Open 2021; 11:e047970. [PMID: 34108169 PMCID: PMC8191622 DOI: 10.1136/bmjopen-2020-047970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Community-dwelling people recovering from hip fracture have the physical capacity to walk in their community but lack the confidence to do so. The primary aim of this trial is to determine whether motivational interviewing increases time spent walking at 12 months in community-dwelling people after hip fracture compared with an attention placebo control group. Secondary aims are to evaluate cost effectiveness, patient and health service outcomes and to complete a process evaluation. METHODS AND ANALYSIS An assessor-blinded parallel group randomised controlled design with embedded health economic evaluation and process evaluation will compare the effects of n=270 participants randomly allocated to an experimental group (motivational interviewing) or a control group (dietary advice). For inclusion, participants are aged ≥65 years, living at home independently within 6 months of discharge from hospital after hip fracture and able to walk independently and communicate with conversational English. Key exclusion criteria are severe depression or anxiety, impaired intellectual functioning and being medically unstable to walk. Participants allocated to the experimental group will receive 10 (8 weekly and 2 booster) telephone-based sessions of motivational interviewing to increase walking over 16 weeks. Participants allocated to the control group will receive an equivalent dose of telephone-based dietary advice. The primary outcome is daily time spent walking over 7 days assessed at weeks 0, 9, 26 and 52. Secondary outcomes include measures of psychological-related function, mobility-related function, community participation, health-related quality of life and falls. Health service utilisation and associated costs will be assessed. Process evaluation will assess the fidelity of the motivational interviewing intervention and explore contextual factors through semistructured interviews. ETHICS AND DISSEMINATION Ethical approval obtained from Eastern Health (E19-002), Peninsula Health (50261/EH-2019), Alfred Health (617/20) and La Trobe University (E19/002/50261). The findings will be disseminated in peer-reviewed journals, conference presentations and public seminars. TRIAL REGISTRATION NUMBER ACTRN12619000936123.
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Affiliation(s)
- Nicholas F Taylor
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Paul D O'Halloran
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Jennifer J Watts
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Rebecca Morris
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
- College of Science Health and Engineering, La Trobe University - Bundoora Campus, Melbourne, Victoria, Australia
| | - Casey L Peiris
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), Deakin University School of Exercise and Nutrition Sciences, Geelong, Victoria, Australia
| | - Luke A Prendergast
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
| | - Katherine E Harding
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - David A Snowdon
- Peninsula Clinical School, Central Clinical School, Monash University, Frankston, Victoria, Australia
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, School of Primary and Allied Health Care, Monash University, Clayton, Victoria, Australia
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedics and Surgery, Eastern Health, Box Hill, Victoria, Australia
| | - Shalika B Mudiyanselage
- School of Health & Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Made U Rimayanti
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Kate E Noeske
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Megan Snowdon
- Academic Unit, Peninsula Health, Frankston, Victoria, Australia
| | - Daniel Kim
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Nora Shields
- La Trobe University College of Science Health and Engineering, Bundoora, Victoria, Australia
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16
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Bass C, Ruen A, Hau R, Fischer O, Dorsam S. 106 Maternal recognition of pregnancy (MRP) and mares: Is the epithelial sodium channel (ENaC) involved? J Equine Vet Sci 2021. [DOI: 10.1016/j.jevs.2021.103569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Onggo JR, Nambiar M, Onggo JD, Hau R, Pennington R, Wang KK. Improved functional outcome and tuberosity healing in patients treated with fracture stems than nonfracture stems during shoulder arthroplasty for proximal humeral fracture: a meta-analysis and systematic review. J Shoulder Elbow Surg 2021; 30:695-705. [PMID: 33157239 DOI: 10.1016/j.jse.2020.09.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/15/2020] [Accepted: 09/29/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Proximal humeral fractures are difficult injuries to treat and obtain satisfactory outcomes. For those treated with arthroplasty, humeral fracture stems have been popular due to better ability for reduction and fixation of tuberosities. This study aims to investigate the outcomes of fracture stems in shoulder arthroplasty for proximal humeral fracture and the comparison of outcomes between fracture vs. nonfracture stems. METHODS A meta-analysis was conducted with a multidatabase search (PubMed, OVID, EMBASE, Medline) according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines on May 19, 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed. FINDINGS Eleven studies were included for analysis, including 383 hemiarthroplasties (HA) (294 fracture stems, 89 nonfracture stems) and 358 reverse total shoulder arthroplasties (RTSA) (309 fracture stems, 49 nonfracture stems). At the final follow-up, meta-analysis shows favorable overall ASES score in all fracture stem prosthesis (mean = 74.0, 95% confidence interval [CI]: 69.3-78.7), Constant-Murley score (mean = 67.2, 95% CI: 61.6-72.8), external rotation (mean difference [MD] = 7°, 95% CI: 3°-10°, P < .001), and forward flexion (MD = 17°, 95% CI: 10°-25°, P < .001). Pooled proportion (PP) of greater tuberosity healing (PP = 0.786, 95% CI: 0.686-0.886) was high, whereas all-cause revisions (PP = 0.034, 95% CI: 0.018-0.061) remained low. With the exception of RTSA scapular notching (PP = 0.109, 95% CI: 0.020-0.343), other complication metrics had PP of ≤0.023. In the 4 studies comparing fracture (138 HA, 54 RTSA) vs. nonfracture stems (89 HA, 49 RTSA), fracture stems had statistically significant better American Shoulder and Elbow Surgeons scores (MD = 14.29, 95% CI: 8.18-20.41, P < .001), external rotation (MD = 6°, 95% CI: 2°-9°, P = .003), forward flexion (MD = 16°, 95% CI: 7°-24°, P < .001), and greater tuberosity healing (odds ratio = 2.20, 95% CI: 1.28-3.77, P = .004). There was no statistically significant difference in complications. CONCLUSION Fracture stems showed promising overall clinical outcomes with low complication rates in treating proximal humeral fractures. The use of fracture stems is also associated with greater chance of tuberosity healing compared with nonfracture stems. There is increasing evidence to suggest the superiority of fracture stems over nonfracture stems in clinical outcomes, while maintaining similar complication rates.
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Affiliation(s)
- James R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia.
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Epworth Eastern Hospital, Box Hill, VIC, Australia
| | - Richard Pennington
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Epworth Eastern Hospital, Box Hill, VIC, Australia
| | - Kemble K Wang
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia; Department of Orthopaedic Surgery, Royal Children's Hospital, Parkville, VIC, Australia
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18
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Nair S, Nambiar M, Pope A, Parkes M, De Jong K, Hau R. Intraoperative fluoroscopy alone versus routine post-operative X-rays in identifying return to theatre after fracture fixation. ANZ J Surg 2021; 91:392-397. [PMID: 33538096 DOI: 10.1111/ans.16610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Post-operative imaging aims to assess fracture reduction and fixation with better resolution than intraoperative fluoroscopy (IF). However, this routine practice may increase costs and delay the discharge of patients. The aim of this study is to assess the role of post-operative imaging in identifying patients that require a return to theatre following the use of IF. METHODS A retrospective cohort study was conducted in a single health network comprising of two hospitals over 1 year. All fracture fixations that required IF were included. Patients who had post-operative imaging were identified and complications requiring a return to theatre were obtained. Non-trauma patients and those who did not have IF were excluded. RESULTS A total of 1319 patients had IF. Of these patients, 1131 patients had post-operative radiographs within 7 days of their operation. In total, 12 patients (1.1%) returned to theatre as a result of a finding identified in their post-operative imaging. The calculated number of X-rays required to be taken to identify a complication was 94. The main reasons identified for these cases to require a return to theatre despite having had IF included: (i) insufficient quality/views of IF, (ii) loss of position/new injury occurring in post-operative period and (iii) poor reduction/fixation demonstrated intraoperatively that was missed/accepted. CONCLUSION The use of post-operative radiographs can identify significant complications despite the use of IF in trauma patients. However, further consideration needs to be made regarding the benefits and costs of this practice in evaluating its clinical effectiveness.
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Affiliation(s)
- Sachin Nair
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Mithun Nambiar
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Alun Pope
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Muhajir Parkes
- Department of Radiology, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Kenneth De Jong
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia.,Northwest Clinical School, Northern Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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19
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Onggo JR, Nambiar M, Onggo JD, Phan K, Ambikaipalan A, Babazadeh S, Hau R. Comparable dislocation and revision rates for patients undergoing total hip arthroplasty with subsequent or prior lumbar spinal fusion: a meta-analysis and systematic review. Eur Spine J 2021; 30:63-70. [PMID: 33104880 DOI: 10.1007/s00586-020-06635-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is a known correlation between the procedures of lumbar spinal fusion (LSF), total hip arthroplasty (THA) and the complication of hip dislocation and revision occurring in patients. However there is no consensus as to whether the risk of this complication is higher if THA is performed before or after LSF. This meta-analysis aims to determine the influence of surgical sequence of lumbar spinal fusion and total hip arthroplasty on the rates of hip dislocation and revisions. METHODS A meta-analysis was conducted with a multi-database search (PubMed, OVID, EMBASE, Medline) according to PRISMA guidelines on 27th May 2020. Data from all published literature meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model. FINDINGS A total of 25,558 subsequent LSF and 43,880 prior LSF THA patients were included in this study. There was no statistically significant difference in all-cause revisions (OR = 0.86, 95%CI: 0.48-1.54, p = 0.61), dislocation (OR = 0.82, 95%CI: 0.25-2.72, p = 0.75) or aseptic loosening (OR = 1.14, 95%CI: 0.94-1.38, p = 0.17) when comparing patients receiving LSF subsequent versus prior to THA. CONCLUSION Lumbar spinal fusion remains a risk factor for dislocation and revision of total hip arthroplasties regardless of whether it is performed prior to or after THA. Further preoperative assessment and altered surgical technique may be required in patients having THA who have previously undergone or are likely to undergo LSF in the future. EVIDENCE LEVEL Level II, Meta-analysis of homogeneous studies.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia.
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash University Clayton Campus, Clayton, VIC, 3168, Australia.
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash University Clayton Campus, Clayton, VIC, 3168, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, 11 Jln Tan Tock Seng, Singapore, 308433, Singapore
| | - Kevin Phan
- NeuroSpine Surgery Research Group, 320-346 Barker St, Sydney, NSW, 2031, Australia
| | - Anuruban Ambikaipalan
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
| | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Department of Surgery, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC, 3128, Australia
- Eastern Health Clinical School, Monash University, 5 Arnold Street, Melbourne, VIC, 3128, Australia
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20
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Reimert J, Lockwood KJ, Hau R, Taylor NF. Are hip movement precautions effective in preventing prosthesis dislocation post hip arthroplasty using a posterior surgical approach? A systematic review and meta-analysis. Disabil Rehabil 2020; 44:2560-2566. [PMID: 33190554 DOI: 10.1080/09638288.2020.1845404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To determine if hip movement precautions reduce hip prosthesis dislocation rates post hip arthroplasty using a posterior surgical approach compared to minimal or no movement restrictions. MATERIALS AND METHODS This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered prospectively. CINAHL, MEDLINE and Embase were searched from inception until September 2020 supplemented by citation tracking. Studies were included if patients had a hip arthroplasty using a posterior surgical approach with comparative data on hip movement precautions or minimal to no movement restrictions. Methodological quality was evaluated using the Downs and Black checklist. RESULTS From a yield of 8 studies, meta-analysis of 7 studies and 9599 total hip arthroplasties, there was low quality evidence of no increased risk of dislocation (RR = 0.98, 95%CI 0.58 to 1.67) for patients prescribed minimal or no hip movement restrictions compared with patients prescribed hip movement precautions. There were 121/5440 dislocations (2.2%) in the movement precaution group and 90/4159 dislocations in the minimally restricted group (2.2%). CONCLUSIONS Dislocation rates after total hip arthroplasty are low irrespective of movement precaution allocation. Resources allocated to implementing hip movement precautions may be better directed towards other clinical areas.IMPLICATIONS FOR REHABILITATIONThere was no difference in hip prosthesis dislocation rate between patients who received hip movement precautions compared to patients who received minimal or no restrictions after total hip arthroplasty using a posterior surgical approach.Health professionals involved in prescribing and monitoring adherence to hip movement precautions after total hip arthroplasty may be better allocating their resources to other areas of clinical care.Falls were associated with the greatest number of prosthesis dislocations, accounting for 24% of dislocations; resources may be better allocated towards evidence-based strategies to reduce falls.
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Affiliation(s)
- Jacoba Reimert
- Physiotherapy Department Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Kylee J Lockwood
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Raphael Hau
- Department of Orthopaedics, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- Physiotherapy Department Eastern Health, Allied Health Clinical Research Office, Box Hill, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
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21
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Onggo JR, Onggo JD, De Steiger R, Hau R. Robotic-assisted total knee arthroplasty is comparable to conventional total knee arthroplasty: a meta-analysis and systematic review. Arch Orthop Trauma Surg 2020; 140:1533-1549. [PMID: 32537660 DOI: 10.1007/s00402-020-03512-5] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 10/24/2022]
Abstract
BACKGROUND Total knee arthroplasty (TKA) is a successful procedure in managing end-stage arthritis when non-operative treatments fail. New technologies such as robotic TKA (rTKA) have been developed to improve the accuracy of prosthesis implantation. While short-term cohort studies on rTKA have shown excellent results, the evidence comparing between rTKA and conventional TKA (cTKA) is not yet well established. This meta-analysis aims to compare the efficacy and safety of rTKA versus cTKA in terms of clinical outcomes, radiographic results, complications, peri-operative parameters and costs. METHODS A multi-database search was performed according to PRISMA guidelines. Data from studies comparing between rTKA and cTKA were extracted and analyzed. RESULTS Eighteen studies were included in this review, consisting of 2234 rTKA and 4300 cTKA. Robotic TKA led to a more precise prosthesis implantation with significantly fewer outliers in the mechanical axis (p < 0.001), femoral coronal (p = 0.002) and tibial sagittal (p = 0.01) alignments. Only the Hospital for Special Surgery (HSS) (p < 0.001) score at final follow-up was significantly better in rTKA than cTKA. rTKA also had a lower mean blood loss (p < 0.001) despite a longer mean operation time (p = 0.006). There were no statistically significant difference in terms of other clinical outcome measures, range of motion and complications. CONCLUSION Both rTKA and cTKA are reliable and safe to perform. However, rTKA is capable of achieving superior alignment in several axes, lower mean blood loss and this may lead to marginally better clinical outcomes than cTKA. EVIDENCE LEVEL Level II, Meta-analysis of non-homogeneous studies.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.,Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore, 768828, Singapore
| | - Richard De Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, University of Melbourne, Parkville, Melbourne, VIC, 3010, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.,Epworth Eastern Hospital, 1 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia.,Eastern Health Clinical School, Monash University, Box Hill, Melbourne, Vic, 3128, Australia.,Northern Clinical School, University of Melbourne, Epping, Melbourne, Vic, 3076, Australia
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22
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Taylor NF, Peiris CL, Thompson AL, Prendergast LA, Harding KE, Hau R, Shields N. Association between physical activity and short-term physical function changes after hip fracture: An observational study. Physiother Res Int 2020; 26:e1876. [PMID: 32918389 DOI: 10.1002/pri.1876] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/18/2020] [Accepted: 08/30/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE To investigate whether physical activity levels are predictive of short-term changes in physical function for people discharged to independent living in the community following withdrawal of rehabilitation services after hip fracture; and to describe short-term recovery in physical activity, physical function, walking confidence, health-related quality of life and walking participation. METHODS This prospective cohort study comprised 57 older adults (39 females, mean age 80.4, SD 8.4 years) living independently in the community after hip fracture. Accelerometer-based physical activity, physical function (Functional Independence Measure [FIM], de Morton Mobility Index, Frenchay Activities Index and Participation in outdoor walking), walking confidence and health-related quality of life were measured after discharge from rehabilitation services (baseline) and 12 weeks later. Multiple linear regression analyses determined the ability of physical activity (daily steps), walking self-confidence, health-related quality of life and demographic factors (age, sex and time since fracture) to predict Week 12 physical function using Week 0 physical function as a covariate. RESULTS Participants at baseline averaged 4439 daily steps which did not change 12 weeks later. There were small increases in all measures of physical function and walking confidence, but not health-related quality of life. Increased walking self-confidence was associated with an increase in FIM total, FIM mobility and de Morton Index scores. Physical activity did not predict change in measures of physical function. CONCLUSIONS Walking confidence of adults discharged from rehabilitation services after hip fracture had a greater association with short-term recovery of physical function than level of physical activity. Community-dwelling adults continue to make small short-term improvements in physical function and walking confidence after discharge home and withdrawal of rehabilitation services.
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Affiliation(s)
- Nicholas F Taylor
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Casey L Peiris
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Anne L Thompson
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Luke A Prendergast
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
| | - Katherine E Harding
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedics, Eastern Health, Box Hill, Victoria, Australia
| | - Nora Shields
- College of Health Science and Engineering, La Trobe University, Bundoora, Victoria, Australia
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23
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Yee ML, Hau R, Taylor A, Guerra M, Guerra P, Darzins P, Gilfillan C. Sarcopenia in women with hip fracture: A comparison of hormonal biomarkers and their relationship to skeletal muscle mass and function. Osteoporos Sarcopenia 2020; 6:139-145. [PMID: 33102808 PMCID: PMC7573494 DOI: 10.1016/j.afos.2020.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/13/2020] [Accepted: 06/21/2020] [Indexed: 12/22/2022] Open
Abstract
Objectives Sarcopenia is a decline in skeletal muscle mass and function. It is associated with adverse outcomes and increased mortality. Sarcopenia is also reported to be prevalent in the hip fracture population. Our aims in this study are to compare the hormonal profile in women with hip fracture to controls, and to assess the relationship between hormonal biomarkers to skeletal muscle mass and function in these women. Methods A cross sectional study was performed enrolling women above age 60 years old with hip fracture as a study group. For comparison healthy women from the community were recruited. Peripheral blood samples were obtained for analysis of hormonal profiles. Measures of skeletal muscle mass and function by muscle area on computed tomography, dual energy X-ray absorptiometry, bioelectrical impedance analysis, and grip strength was performed. Results A high proportion of sarcopenic individuals were detected in the hip fracture group (60%). Women with hip fracture compared to controls were older (P = 0.073), had lower serum albumin levels (P < 0.001), serum insulin-like growth factor-1 (IGF-1) (P < 0.001), insulin-like growth factor binding protein -3 (IGFBP-3) (P < 0.001), free testosterone levels (P = 0.001), and impaired beta cell function by homeostasis model assessment (HOMA beta) (P = 0.038). Conclusions There is a high proportion of sarcopenic individuals in the hip fracture group. Lowered serum levels of IGF-1 and IGFBP-3, HOMA beta cell function, and free testosterone levels were detected in this group and may serve as potential biomarkers of sarcopenia.
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Affiliation(s)
- Ming Li Yee
- Eastern Health Clinical School, Monash University, Victoria, Australia.,Department of Endocrinology, Eastern Health, Victoria, Australia
| | - Raphael Hau
- Eastern Health Clinical School, Monash University, Victoria, Australia.,Department of Orthopaedic Surgery, Eastern Health, Victoria, Australia
| | - Alison Taylor
- Department of Orthopaedic Surgery, Eastern Health, Victoria, Australia
| | - Mark Guerra
- Department of Physiotherapy, Eastern Health, Victoria, Australia
| | - Peter Guerra
- Department of Physiotherapy, Eastern Health, Victoria, Australia
| | - Peteris Darzins
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - Christopher Gilfillan
- Eastern Health Clinical School, Monash University, Victoria, Australia.,Department of Endocrinology, Eastern Health, Victoria, Australia
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Lawson A, Naylor J, Buchbinder R, Ivers R, Balogh Z, Smith P, Mittal R, Xuan W, Howard K, Vafa A, Yates P, Rieger B, Smith G, Elkinson I, Kim W, Sungaran J, Latendresse K, Wong J, Viswanathan S, Landale K, Drobetz H, Tran P, Page R, Hau R, Mulford J, Incoll I, Kale M, Schick B, Higgs A, Oppy A, Perriman D, Harris I. A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE): a statistical analyses plan. Trials 2020; 21:651. [PMID: 32669121 PMCID: PMC7364640 DOI: 10.1186/s13063-020-4228-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/03/2020] [Indexed: 01/21/2023] Open
Abstract
Background We are performing a combined randomised and observational study comparing internal fixation to non-surgical management for common wrist fractures in older patients. This paper describes the statistical analysis plan. Methods/design A Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly (CROSSFIRE) is a randomised controlled trial comparing two types of usual care for treating wrist fractures in older patients, surgical fixation using volar locking plates and non-surgical treatment using closed reduction and plaster immobilisation. The primary aim of this comparative-effectiveness study is to determine whether surgery is superior to non-surgical treatment with respect to patient-reported wrist function at 12 months post treatment. The secondary outcomes include radiographic outcomes, complication rates and patient-reported outcomes including quality of life, pain, treatment success and cosmesis. Primary analysis will use a two-sample t test and an intention-to-treat analysis using the randomised arm of the study. Statistical analyses will be two-tailed and significance will be determined by p < 0.05. Sensitivity analyses will be conducted to assess for differences in intention-to-treat, per-protocol and as-treated analyses. Sensitivity analyses will also be conducted to assess selection bias by evaluating differences in participants between the randomised and observational study arms, and for bias relating to any missing data. An economic analysis will be conducted separately if surgery is shown to provide superior outcomes to a level of clinical significance. Discussion This statistical analysis plan describes the analysis of the CROSSFIRE study which aims to provide evidence to aid clinical decision-making in the treatment of distal radius fractures in older patients. Trial registration CROSSFIRE was approved by The Hunter New England Human Research Ethics Committee (HNEHREC Reference No: 16/02/17/3.04). Registered on 22 July 2016 with The Australian and New Zealand Clinical Trials Registry (ANZCTR Number; ACTRN12616000969460). This manuscript is based on v.11 of the statistical analysis plan. A copy of v.11, signed by the chief investigator and the senior statistician is kept at the administering institution.
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Affiliation(s)
- Andrew Lawson
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia. .,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.
| | - Justine Naylor
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Monash University, Melbourne, VIC, Australia.,Cabrini Institute, Melbourne, VIC, Australia
| | - Rebecca Ivers
- School of Public Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
| | | | - Paul Smith
- Canberra Hospital, Canberra, ACT, Australia
| | - Rajat Mittal
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Kirsten Howard
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Arezoo Vafa
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Piers Yates
- Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, NSW, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | - Kim Latendresse
- Nambour Hospital and Sunshine Coast University Hospital, Nambour, QLD, Australia
| | - James Wong
- Westmead Hospital, Sydney, NSW, Australia
| | | | | | | | - Phong Tran
- Western Health, Melbourne, VIC, Australia
| | - Richard Page
- University Hospital Geelong, Barwon Health, Geelong, NSW, Australia.,School of Medicine, Deakin University, Geelong, VIC, Australia
| | | | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | - Michael Kale
- Gosford and Wyong Hospitals, Gosford, NSW, Australia
| | | | | | - Andrew Oppy
- Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Ian Harris
- Whitlam Orthopaedic Research Centre, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.,South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia.,Liverpool Hospital, Sydney, NSW, Australia
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25
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Onggo JR, Onggo JD, Hau R. Comparable outcomes in mini-midvastus versus mini-medial parapatellar approach in total knee arthroplasty: a meta-analysis and systematic review. ANZ J Surg 2020; 90:840-845. [PMID: 32062865 DOI: 10.1111/ans.15719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/04/2020] [Accepted: 01/08/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) techniques in total knee arthroplasties (TKA) have gained popularity over conventional techniques due to benefits of hastened recovery and reduced complications. There are a variety of MIS techniques available and two most common techniques currently employed are the mini-midvastus (mMV) and mini-medial parapatellar (mMPP) approaches. This meta-analysis aims to compare the clinical outcomes and peri-operative parameters between mMV and mMPP in TKA in order to determine the presence of a superior technique. METHODS A multi-database search was performed according to PRISMA guidelines. Data from studies comparing clinical outcomes and peri-operative parameters between mMV and mMPP approaches in TKA were extracted and analysed. RESULTS A total of five randomized controlled trials were included for analysis, consisting of 190 mMV and 189 mMPP knees. Clinically unimportant differences were noted in blood loss and surgical time between the groups (5 mL less blood loss and 7 min less surgical time in mMV, P < 0.001). There was no statistically significant difference between both groups for Knee Society Score at 1 and 2 years, range of motion at 1 and 2 years, incision length or incidence of lateral retinacular release (all non-significant, P > 0.05). CONCLUSION The mMV and mMPP MIS TKA approaches have equivalent clinical outcomes. Despite a statistically significant longer operative time and higher mean blood loss in mMV than mMPP approach, clinically significant difference was not demonstrated. Both mMV and mMPP MIS techniques are reliable and safe to perform in TKA.
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Affiliation(s)
- James R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Jason D Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Flinders Medical School, Flinders University, Adelaide, South Australia, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Northern Hospital, Melbourne, Victoria, Australia.,Department of Orthopaedic Surgery, Epworth Eastern Hospital, Melbourne, Victoria, Australia
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26
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Kimmel LA, Simpson PM, Holland AE, Edwards ER, Cameron PA, de Steiger RS, Page RS, Hau R, Bucknill A, Kasza J, Gabbe BJ. Discharge destination and patient-reported outcomes after inpatient treatment for isolated lower limb fractures. Med J Aust 2020; 212:263-270. [PMID: 32017129 DOI: 10.5694/mja2.50485] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/30/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To examine the association between discharge destination (home or inpatient rehabilitation) for adult patients treated in hospital for isolated lower limb fractures and patient-reported outcomes. DESIGN Review of prospectively collected Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) data. SETTING, PARTICIPANTS Adults (18-64 years old) treated for isolated lower limb fractures at four Melbourne trauma hospitals that contribute data to the VOTOR, 1 March 2007 - 31 March 2016. MAIN OUTCOME MEASURES Return to work and functional recovery (assessed with the extended Glasgow Outcomes Scale, GOS-E); propensity score analysis of association between discharge destination and outcome. RESULTS Of 7961 eligible patients, 1432 (18%) were discharged to inpatient rehabilitation, and 6775 (85%) were followed up 12 months after their injuries. After propensity score adjustment, the odds of better functional recovery were 56% lower for patients discharged to inpatient rehabilitation than for those discharged directly home (odds ratio, 0.44; 95% CI, 0.37-0.51); for the 5057 people working before their accident, the odds of return to work were reduced by 66% (odds ratio, 0.34; 95% CI, 0.26-0.46). Propensity score analysis improved matching of the discharge destination groups, but imbalances in funding source remained for both outcome analyses, and for also for site and cause of injury in the GOS-E analysis (standardised differences, 10-16%). CONCLUSIONS Discharge to inpatient rehabilitation after treatment for isolated lower limb fractures was associated with poorer outcomes than discharge home. Factors that remained unbalanced after propensity score analysis could be assessed in controlled trials.
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Affiliation(s)
- Lara A Kimmel
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | | | - Anne E Holland
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC.,La Trobe University, Melbourne, VIC
| | - Elton R Edwards
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | | | - Richard S Page
- Barwon Health, Geelong, VIC.,St John of God Hospital, Geelong, VIC.,Deakin University, Geelong, VIC
| | | | - Andrew Bucknill
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | | | - Belinda J Gabbe
- Monash University, Melbourne, VIC.,Health Data Research UK, Swansea University Medical School, Swansea University, United Kingdom
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27
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Onggo JR, Nambiar M, Phan K, Hickey B, Ambikaipalan A, Hau R, Bedi H. Suture button versus syndesmosis screw constructs for acute ankle diastasis injuries: A meta-analysis and systematic review of randomised controlled trials. Foot Ankle Surg 2020; 26:54-60. [PMID: 30503612 DOI: 10.1016/j.fas.2018.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/04/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ankle syndesmotic injuries can be surgically managed with syndesmosis screws (SS) or suture button (SB) fixation. We performed a meta-analysis of randomized controlled trials (RCTs) aiming to compare the clinical and complication profiles of both modalities. METHODS A multi-database search up to 4th of March 2018 was performed according to PRISMA guidelines. All RCTs comparing both techniques and published in English were included. RESULTS Five RCTs with a total of 280 patients (140 SB, 140 SS) were included for analysis. SB had a statistically significant higher AOFAS score at 1 year (mean difference=5.46, 95% CI=0.40-10.51, p=0.03) and lower implant failure rate (OR=0.03, 95% CI=0.01-0.15, p<0.001). Infection and wound issues were marginally higher with SB (OR=1.4, 95% CI=0.4-4.85, p=0.60). No other parameters showed statistically significant difference. CONCLUSIONS Both constructs yielded similar clinical outcomes. The 1 year AOFAS score was higher in SB but clinical significance is unlikely. SB had significantly fewer implant failures. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Department of Surgery, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Kevin Phan
- The Prince of Wales Clinical School, The University of New South Wales, Sydney, New South Wales, Australia; NeuroSpine Surgery Research Group, The Prince of Wales Private Hospital, Sydney, New South Wales, Australia.
| | - Benjamin Hickey
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
| | | | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Monash University, Epidemiology and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Harvinder Bedi
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia.
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Onggo JR, Onggo JD, de Steiger R, Hau R. Greater risks of complications, infections, and revisions in the obese versus non-obese total hip arthroplasty population of 2,190,824 patients: a meta-analysis and systematic review. Osteoarthritis Cartilage 2020; 28:31-44. [PMID: 31705995 DOI: 10.1016/j.joca.2019.10.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/03/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Obesity is an epidemic, especially in developed countries. This affects the general health of these patients, especially when they are having a major surgical procedure such as total hip arthroplasty (THA). Several articles have described the effects of obesity on THA with varying conclusions. This meta-analysis aims to compare the outcomes, complications, and peri-operative parameters of THA in the obese (BMI≥30 kg/m2) vs non-obese (BMI<30 kg/m2) population as well as a subgroup analysis of morbidly obese (BMI≥40 kg/m2) vs non-obese population. METHODS A multi-database search was performed according to PRISMA guidelines. Data from studies assessing the outcomes and complications of THA in the obese and non-obese population were extracted and analyzed. RESULTS Sixty-seven studies were included in this meta-analysis, consisting of 581,012 obese and 1,609,812 non-obese patients. Meta-analysis could not be performed on patient reported outcome measures due to heterogeneous reporting methods. Obese patients had a higher risk of all complications (OR = 1.53, 95%CI: 1.30-1.80, P < 0.001), deep infections (OR = 2.71, 95%CI: 2.08-3.53, P < 0.001), superficial infections (OR = 1.99, 95%CI: 1.55-2.55, P < 0.001), dislocations (OR = 1.72, 95%CI: 1.66-1.79, P < 0.001), reoperations (OR = 1.61, 95%CI: 1.40-1.85, P < 0.001), revisions (OR = 1.44, 95%CI: 1.32-1.57, P < 0.001), and readmissions (OR = 1.37, 95%CI: 1.15-1.63, P < 0.001). When sub-group analysis of morbidly obese (BMI≥40 kg/m2) patients was performed, the risks of all these parameters were even greater. CONCLUSION Obese and morbidly obese patients are at higher risks of complications post THA than non-obese patients. Surgeons should be aware of these risks in order to counsel patients and adopt prophylactic strategies to reduce these risks where applicable.
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Affiliation(s)
- J R Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia.
| | - J D Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia.
| | - R de Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, Parkville, VIC 3010, Melbourne, Australia.
| | - R Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia; Department of Orthopaedic Surgery, Epworth Eastern Hospital, 1 Arnold Street, Box Hill, VIC 3128, Melbourne, Australia.
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29
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Onggo JR, Nambiar M, Onggo JD, Phan K, Ambikaipalan A, Babazadeh S, Hau R. Clinical outcomes and complication profile of total hip arthroplasty after lumbar spine fusion: a meta-analysis and systematic review. Eur Spine J 2019; 29:282-294. [PMID: 31676947 DOI: 10.1007/s00586-019-06201-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/20/2019] [Accepted: 10/24/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Hip and spine pathology can alter the biomechanics of spino-pelvic mobility. Lumbar spine fusions can reduce the mobility of the lumbar spine and therefore result in compensatory femoral motion, contributing towards dislocations of THA. PURPOSE This meta-analysis aims to determine the effect of pre-existing spine fusions on THA outcomes, and complication profile including hip dislocations, all-cause revisions and all complications. METHODS A multi-database search was performed according to PRISMA guidelines. All studies that compared patients who underwent THA with and without prior SF were included in the analysis. RESULTS Ten studies were included in this review, consisting of 28,396 SF THA patients and 1,550,291 non-SF THA patients. There were statistically significant higher rates of hip dislocation (OR 2.20, 95% CI 1.71-2.85, p < 0.001), all-cause revision (OR 3.43, 95% CI 1.96-6.00, p < 0.001) and all complications (OR 2.83, 95% CI 1.28-6.24, p = 0.01) in SF than in non-SF THA patients. When registry data were excluded, these rates were approximately doubled. Subgroup analysis of revisions for dislocations was not statistically significant (OR 5.28, 95% CI 0.76-36.87, p = 0.09). While no meta-analysis was performed on clinical outcomes due to heterogeneous parameter reporting, individual studies reported significantly poorer outcomes in SF patients than in non-SF patients. CONCLUSION THA patients with SF are at higher risks of hip dislocations, all-cause revisions and all complications, which may adversely affect patient-reported outcomes. Surgeons should be aware of these risks and appropriately plan to account for altered spino-pelvic biomechanics, in order to reduce the risks of hip dislocations and other complications. LEVEL OF EVIDENCE II (Meta-analysis of non-homogeneous studies). These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
| | - Mithun Nambiar
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Kevin Phan
- NeuroSpine Research Group, Sydney, NSW, Australia
| | | | - Sina Babazadeh
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,Department of Orthopaedic Surgery, St Vincent's Hospital, East Melbourne, VIC, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Box Hill, VIC, Australia.,Epworth Eastern Hospital, Box Hill, VIC, Australia
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30
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Onggo JR, Onggo JD, De Steiger R, Hau R. The Efficacy and Safety of Inpatient Rehabilitation Compared With Home Discharge After Hip or Knee Arthroplasty: A Meta-Analysis and Systematic Review. J Arthroplasty 2019; 34:1823-1830. [PMID: 31053467 DOI: 10.1016/j.arth.2019.04.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 03/21/2019] [Accepted: 04/01/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Total hip and knee arthroplasties (THKAs) are successful procedures in managing end-stage arthritis when nonoperative treatments fail. The immediate postoperative period is an important time for the body to recuperate and rehabilitate. Studies have shown that early intensive rehabilitation can enhance recovery. Rehabilitation can be provided as inpatient rehabilitation (IR) or discharge with home rehabilitation. These options have been studied, but literature on the efficacy and safety of IR compared to home discharge is scarce, and evidence is not well established. This meta-analysis aims to compare the efficacy and safety of IR to home discharge with rehabilitation after THKA. METHODS A multidatabase search was performed according to PRISMA guidelines. Data from studies assessing the efficacy and safety of IR and home as discharge destinations after THKA were extracted and analyzed. RESULTS Fifteen studies were included, consisting of 37,411 IR patients and 172,219 home discharge patients. These studies had heterogeneous reporting methods, with some conflicting results. There was no clinically significant difference in clinical outcomes between the groups. Readmission was nearly 5 times (odds ratio = 4.87, 95% confidence interval = 3.24-7.33, P < .001) and periprosthetic complications nearly 3 times (odds ratio = 2.82, 95% confidence interval: 1.54-5.24, P < .001) higher in IR patients than those discharged home after THKA. CONCLUSION Although IR is associated with higher risks of complications and readmissions, this may be because of patient selection bias in the clinical setting. Following THKA, it is safe to discharge patients to home with rehabilitation whenever possible. EVIDENCE LEVEL Level II, Meta-analysis of heterogeneous studies.
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Affiliation(s)
- James Randolph Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Jason Derry Onggo
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Richard De Steiger
- Department of Surgery Epworth Healthcare, University of Melbourne, Melbourne, Victoria, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria, Australia; Department of Orthopaedic Surgery, Northern Hospital, Melbourne, Victoria, Australia
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31
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Snowdon DA, Leggat SG, Harding KE, Scroggie G, Hau R, Darzins P, Taylor NF. Direct supervision of physiotherapists improves compliance with clinical practice guidelines for patients with hip fracture: a controlled before-and-after study. Disabil Rehabil 2019; 42:3825-3832. [PMID: 31079500 DOI: 10.1080/09638288.2019.1610805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: To determine if the addition of direct supervision to usual clinical supervision practice of physiotherapists can improve compliance with clinical practice guidelines and post-surgical outcomes for inpatients with hip fracture.Methods: A controlled before-and-after study was conducted on two acute orthopedic wards. Junior and mid-level physiotherapists on one ward were provided with direct supervision during their post-operative management of patients with hip fracture. Physiotherapists on the comparison ward received usual reflective supervision. The primary outcome was patient compliance with the hip fracture guideline to mobilize on the day following surgery. Secondary patient outcomes included physical function on the fifth post-operative day.Results: Data were collected from 290 patients with acute hip fracture. Patients at the direct supervision site were more likely to mobilize on the day after surgery [OR 3.14, 95% confidence interval (CI) 1.41-7.01; p = 0.005] and by the second post-operative day (OR 4.62, 95% CI 2.31-9.23; p < 0.001) compared to patients at the comparison site. Patients walked further on the fifth post-operative day (p < 0.001) with less assistance from therapists (p = 0.044).Conclusions: The addition of direct supervision improved physiotherapists' compliance with hip fracture guidelines and walking endurance and independence in hospitalized patients with hip fracture.Implications for rehabilitationThe addition of a direct supervision model, where physiotherapists are directly observed in their management of patients with hip fracture, to usual practice supervision improved early mobilization of patients with hip fractureDirect supervision appears to be an effective guideline implementation strategy that can improve care and outcomes for hospitalized patients with hip fracture.
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Affiliation(s)
- David A Snowdon
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Sandra G Leggat
- School of Public Health, La Trobe University, Melbourne, Australia
| | - Katherine E Harding
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Grant Scroggie
- Allied Health Department, Eastern Health, Box Hill, Australia
| | - Raphael Hau
- Department of Orthopaedic Surgery, Eastern Health, Box Hill, Australia
| | - Peteris Darzins
- Department of Continuing Care, Eastern Health, Box Hill, Australia
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University, Melbourne, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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32
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Hau R, Hammeschlag J, Law C, Wang KK. Optimal position of lipped acetabular liners to improve stability in total hip arthroplasty-an intraoperative in vivo study. J Orthop Surg Res 2018; 13:289. [PMID: 30453985 PMCID: PMC6245846 DOI: 10.1186/s13018-018-1000-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 11/08/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipped or elevated acetabular liners are frequently used in total hip arthroplasty to improve stability. However, the optimal position of the lip is not known. The purpose of this study was to determine the optimal position of lipped acetabular liners in total hip arthroplasty performed with a posterior approach. METHODS In 14 hips, lipped trial liners were placed intraoperatively in various positions around the posterior clock-face of the implanted acetabular shell component. For each liner position, stability of the hip was tested at maximal hip flexion with gradually increasing internal rotation until subluxation occurred, at which point the position of the hip was measured using smartphone accelerometer-based goniometers. Smartphone goniometers were first validated against a computer-assisted navigation system. Post-operative radiographs were analyzed for cup inclination angle, cup anteversion angle, and femoral offset. RESULTS Mean cup inclination angle in our series was 31° ± 6°. The most common liner position that imparted the greatest stability to posterior subluxation was posteriorly and inferiorly (4 o'clock position for left hip, or 8 o'clock position for right hip). The range for most stable liner position for different patients varied from postero-superior (11 o'clock/1 o'clock position) to directly inferior (6 o'clock position). Comparing a non-lipped liner to a lipped liner placed in the optimal position, the average difference in internal rotation gained before dislocation was 23°. There was no association between cup inclination or anteversion angle with liner position of greatest stability. CONCLUSION In hip replacements performed through a posterior approach and with mean cup inclination angle of 31° ± 6°, placing the lip of the elevated liner in the postero-inferior quadrant may impart more stability than in the postero-superior quadrant.
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Affiliation(s)
- Raphael Hau
- Department of Orthopaedic Surgery, Box Hill Hospital, Eastern Health, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.,Department of Orthopaedic Surgery, Northern Health, Melbourne, 185 Cooper St, Epping, Melbourne, VIC, 3076, Australia.,Monash University, Melbourne, Wellington Road, Clayton, Melbourne, VIC, 3800, Australia.,Epworth Eastern Hospital, Melbourne, 1 Arnold St, Box Hill, Melbourne, VIC, 3128, Australia
| | - Joshua Hammeschlag
- Department of Orthopaedic Surgery, Northern Health, Melbourne, 185 Cooper St, Epping, Melbourne, VIC, 3076, Australia
| | - Christopher Law
- Department of Orthopaedic Surgery, Box Hill Hospital, Eastern Health, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.,Department of Orthopaedic Surgery, Northern Health, Melbourne, 185 Cooper St, Epping, Melbourne, VIC, 3076, Australia
| | - Kemble K Wang
- Department of Orthopaedic Surgery, Box Hill Hospital, Eastern Health, 8 Arnold Street, Box Hill, Melbourne, VIC, 3128, Australia.
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Harms A, Heredia-Rizo AM, Moseley GL, Hau R, Stanton TR. A feasibility study of brain-targeted treatment for people with painful knee osteoarthritis in tertiary care. Physiother Theory Pract 2018; 36:142-156. [PMID: 29889597 DOI: 10.1080/09593985.2018.1482391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To assess the feasibility and clinical impact of brain-targeted treatment (BT; aiming to target sensorimotor processing) in knee osteoarthritis patients attending tertiary care. Methods: Randomized replicated case series. The study involved three phases, each of 2 weeks duration: (1) no-treatment phase; (2) BT phase (left/right judgments and touch discrimination training); and (3) usual care (education, strengthening, and stretching training). Primary outcomes were: timely recruitment; number of participants completing the interventions; treatment compliance and barriers; follow-up rates; and treatment impact on pain and function. Fear-avoidance beliefs and clinical measures of cortical body representation (tactile acuity and left/right judgment performance) were secondary outcomes. Results: A total of 5% (19/355) of all assessed patients were eligible to participate and of these, 58% (11/19) agreed to participate. Ten patients completed the study, and 9 were successfully followed up, with treatment compliance varying between interventions. Compliance was poor for the touch discrimination component of BT. No significant effects were observed for pain relief or knee function after any treatment. A positive impact of treatment was found for fear-avoidance beliefs (usual care vs. washout, p = 0.007; BT vs. washout, p = 0.029) and left/right judgment accuracy (usual care vs. washout; p = 0.006). Conclusions: Clear barriers were identified to implementing BT in tertiary care for knee osteoarthritis. Access to all available services (especially the use of interpreters), and treatment options that do not require additional assistance to perform (e.g., touch discrimination training) represent the main lessons learned.
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Affiliation(s)
- Anton Harms
- Department of Physiotherapy, Northern Hospital, Epping, Victoria, Australia
| | - Alberto M Heredia-Rizo
- Physiotherapy Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, Sevilla, Spain.,School of Health Sciences, University of South Australia, Adelaide, South Australia
| | - G Lorimer Moseley
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
| | - Raphael Hau
- Northern Clinical School of Melbourne Medical School, Northern Hospital, Epping, Victoria, Australia
| | - Tasha R Stanton
- School of Health Sciences, University of South Australia, Adelaide, South Australia.,Neuroscience Research Australia, Randwick, New South Wales, Australia
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Darcy G, Edwards E, Hau R. Epidemiology and outcomes of traumatic knee dislocations: Isolated vs multi-trauma injuries. Injury 2018; 49:1183-1187. [PMID: 29576239 DOI: 10.1016/j.injury.2018.02.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE Traumatic dislocation of the knee (TKD) is a rare injury, accounting for approximately 0.02% of orthopaedic injuries. They are a challenging entity for orthopaedic surgeons to manage, and can have devastating consequences. The aim of this study was to describe the epidemiology of traumatic knee dislocations (TKD'S) and contrast the incidence of neurovascular injury between isolated and multi-trauma dislocations as well as key patient reported outcomes achieved between these groups. MATERIAL AND METHODS Patients who had a traumatic disruption of the tibiofemoral articulation between March 1 2007 and February 31, 2015 were identified from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR). Data was cross-checked with medical records and radiological reports to confirm true multi-ligamentous dislocation. VOTOR collects information pertaining to orthopaedic injuries, treatment, complications and outcomes from four adult hospitals in Victoria, Australia, including the major trauma centers. Patient-reported outcomes are collected by VOTOR at 12 months post-injury including the EQ-5D-3L (EQ-5D) and Glasgow Extended Outcome Scores (GOS-E) and return to work status. Patient reported functional and quality of life outcomes at 12 months after injury were analysed. RESULTS A cohort of 88 patients were identified that fit the inclusion criteria for the study, and at 12 months post-injury there was data available for 80 patients (90.9%). There were 38 (42.9%) patients who experienced an isolated traumatic knee dislocation and 52 (57.1%) who experienced a traumatic knee dislocation in association with another injury. Of the 88 patients identified as eligible for the study, two had bilateral knee dislocations, hence there were 90 multi-ligamentous knee injuries. Those who were injured at a higher velocity were more likely to have additional injuries. Dislocations that occurred at a lower velocity were shown to have better overall outcomes, as did dislocations that occurred in isolation. CONCLUSIONS Traumatic knee dislocations that occur in isolation typically result in better outcomes than those that occur with associated injuries. TKD's are a rare but severe injury that requires further research in order for functional outcomes to be optimized.
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Affiliation(s)
- Genevieve Darcy
- Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), Monash University, Department of Epidemiology and Preventative Medicine, Melbourne, Australia.
| | - Elton Edwards
- Department of Orthopaedics, Alfred Health, Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), Monash University, Department of Epidemiology and Preventative Medicine, Melbourne, Australia.
| | - Raphael Hau
- Department of Orthopaedics, Northern Health, Victorian Orthopaedic Trauma Outcomes Registry (VOTOR), Monash University, Department of Epidemiology and Preventative Medicine, Melbourne, Australia.
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Kimmel LA, Holland AE, Hart MJ, Edwards ER, Page RS, Hau R, Bucknill A, Gabbe BJ. Discharge from the acute hospital: trauma patients' perceptions of care. AUST HEALTH REV 2018; 40:625-632. [PMID: 26910554 DOI: 10.1071/ah15148] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 01/12/2016] [Indexed: 11/23/2022]
Abstract
Objective The involvement of orthopaedic trauma patients in the decision-making regarding discharge destination from the acute hospital and their perceptions of the care following discharge are poorly understood. The aim of the present study was to investigate orthopaedic trauma patient experiences of discharge from the acute hospital and transition back into the community. Methods The present qualitative study performed in-depth interviews, between October 2012 and November 2013, with patients aged 18-64 years with lower limb trauma. Thematic analysis was used to derive important themes. Results Ninety-four patients were interviewed, including 35 discharged to in-patient rehabilitation. Key themes that emerged include variable involvement in decision-making regarding discharge, lack of information and follow-up care on discharge and varying opinions regarding in-patient rehabilitation. Readiness for discharge from in-patient rehabilitation also differed widely among patients, with patients often reporting being ready for discharge before the planned discharge date and feeling frustration at the need to stay in in-patient care. There was also a difference in patients' perception of the factors leading to recovery, with patients discharged to rehabilitation more commonly reporting external factors, such as rehabilitation providers and physiotherapy. Conclusion The insights provided by the participants in the present study will help us improve our discharge practice, especially the need to address the concerns of inadequate information provision regarding discharge and the role of in-patient rehabilitation. What is known about the topic? There is no current literature describing trauma patient involvement in decision-making regarding discharge from the acute hospital and the perception of how this decision (and destination choice; e.g. home or in-patient rehabilitation) affects their outcome. What does this paper add? The present large qualitative study provides information on patients' opinion of discharge from the acute hospital following trauma and how this could be improved from their perception. Patients are especially concerned with the lack of information provided to them on discharge, their lack of involvement and understanding of the choices made with regard to their discharge and describe concerns regarding their follow-up care. There is also a feeling from the patients that they are ready to leave rehabilitation before their actual planned discharge date, a concept that needs further investigation. What are the implications for practitioners? The patient insights gained by the present study will lead to a change in discharge practice, including increased involvement of the patient in the decision-making in terms of discharge from both the acute and rehabilitation hospitals and a raised awareness of the need to provide written information and follow-up telephone calls to patients following discharge. Further research into many aspects of patient discharge from the acute hospital should be considered, including the use of rehabilitation prediction tools to ensure patient involvement in decision-making and a discharge and/or follow-up coordinator to ensure patients are aware of how to access information after discharge.
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Affiliation(s)
- Lara A Kimmel
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
| | - Anne E Holland
- The Alfred, Commercial Road, Melbourne, Vic. 3004, Australia. Email
| | - Melissa J Hart
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
| | - Richard S Page
- Barwon Health and St John of God, Geelong, Vic. 3220, Australia
| | - Raphael Hau
- Northern Hospital, 185 Cooper Street, Epping,Melbourne, Vic. 3076, Australia. Email
| | - Andrew Bucknill
- Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia. Email
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.
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Kimmel LA, Holland AE, Lannin N, Edwards ER, Page RS, Bucknill A, Hau R, Gabbe BJ. Clinicians' perceptions of decision making regarding discharge from public hospitals to in-patient rehabilitation following trauma. AUST HEALTH REV 2017; 41:192-200. [PMID: 27144728 DOI: 10.1071/ah16031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/23/2016] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present study was to investigate the perceptions of consultant surgeons, allied health clinicians and rehabilitation consultants regarding discharge destination decision making from the acute hospital following trauma. Methods A qualitative study was performed using individual in-depth interviews of clinicians in Victoria (Australia) between April 2013 and September 2014. Thematic analysis was used to derive important themes. Case studies provided quantitative information to enhance the information gained via interviews. Results Thirteen rehabilitation consultants, eight consultant surgeons and 13 allied health clinicians were interviewed. Key themes that emerged included the importance of financial considerations as drivers of decision making and the perceived lack of involvement of medical staff in decisions regarding discharge destination following trauma. Other themes included the lack of consistency of factors thought to be important drivers of discharge and the difficulty in acting on trauma patients' requests in terms of discharge destination. Importantly, as the complexity of the patient increases in terms of acquired brain injury, the options for rehabilitation become scarcer. Conclusions The information gained in the present study highlights the large variation in discharge practises between and within clinical groups. Further consultation with stakeholders involved in the care of trauma patients, as well as government bodies involved in hospital funding, is needed to derive a more consistent approach to discharge destination decision making. What is known about the topic? Little is known about the drivers for referral to, or acceptance at, in-patient rehabilitation following acute hospital care for traumatic injury in Victoria, Australia, including who makes these decisions of behalf of patients and how these decisions are made. What does this paper add? This paper provides information regarding the perceptions of acute hospital consultant surgeons and allied health, as well as rehabilitation clinicians, in terms of discharge destination decision making from the acute hospital following trauma. The use of case studies further highlights differences between, and within, these specialities with regard to this decision making. This research also highlights the importance of financial considerations as drivers of decision making, and the lack of consistency of the factors thought to be important drivers of discharge between these different clinical groupings. What are the implications for practitioners? This research shows that financial factors are significant drivers of discharge destination decision making for trauma patients. The present study highlights opportunities to engage with stakeholders (acute care, rehabilitation, administration, government and patients) to develop more consistent discharge processes that optimise the use of rehabilitation resources for those patients who could benefit from in-patient rehabilitation.
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Affiliation(s)
- Lara A Kimmel
- Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia.
| | - Anne E Holland
- School of Allied Health, La Trobe University, Vic. 3086, Australia.
| | - Natasha Lannin
- School of Allied Health, La Trobe University, Vic. 3086, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia.
| | - Richard S Page
- Department of Orthopaedics, Barwon Health and St John of God, Geelong, Vic. 3220, Australia. Email
| | - Andrew Bucknill
- Department of Orthopaedics, Royal Melbourne Hospital, Melbourne, Vic. 3050, Australia. Email
| | - Raphael Hau
- Department of Orthopaedics, Northern Hospital, Epping, Vic. 3076, Australia. Email
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Vic. 3004, Australia.
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Ekegren CL, Hart MJ, Cameron PA, Edwards ER, Oppy A, de Steiger R, Page R, Liew S, Hau R, Bucknill A, Gabbe BJ. Do non-steroidal anti-inflammatory drugs impair fracture healing? A survey of Australian orthopaedic surgeons. J Pharm Pract Res 2017. [DOI: 10.1002/jppr.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Christina L. Ekegren
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - Melissa J. Hart
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Orthopaedics; Royal Melbourne Hospital; Melbourne Australia
| | - Peter A. Cameron
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Emergency and Trauma Centre; The Alfred Hospital; Melbourne Australia
| | - Elton R. Edwards
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Australia
| | - Andrew Oppy
- Department of Orthopaedic Surgery; Royal Melbourne Hospital; Melbourne; Australia
| | - Richard de Steiger
- Epworth Health; Melbourne Australia
- Department of Surgery; University of Melbourne; Melbourne Australia
| | - Richard Page
- Department of Orthopaedics; University Hospital Geelong; Geelong Australia
- School of Medicine; Deakin University; Geelong Australia
| | - Susan Liew
- Department of Orthopaedic Surgery; The Alfred Hospital; Melbourne Australia
- Department of Surgery; Monash University; Melbourne Australia
| | - Raphael Hau
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
- Department of Orthopaedic Surgery; Northern Hospital; Epping Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery; Royal Melbourne Hospital; Melbourne; Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
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Beck B, Ekegren CL, Cameron P, Edwards ER, Bucknill A, Judson R, Page R, Hau R, Stevenson M, Gabbe BJ. Predictors of recovery in cyclists hospitalised for orthopaedic trauma following an on-road crash. Accid Anal Prev 2017; 106:341-347. [PMID: 28710974 DOI: 10.1016/j.aap.2017.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 05/26/2017] [Accepted: 06/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND As cycling-related injury rates are on the rise, there is a need to understand the long term outcomes of these patients in order to quantify the burden of injury and to inform injury prevention strategies. This study aimed to investigate predictors of return to work and functional recovery in a cohort of cyclists hospitalised for orthopaedic trauma from crashes occurring on-road. METHODS A retrospective analysis of data from the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) was conducted for patients who were hospitalised for orthopaedic trauma following a cycling crash that occurred on-road between July 2007 and June 2015. RESULTS There were 1787 injured cyclists admitted at the participating hospitals. Most cyclists were male (79%), resided in major cities (89%) and were in the highest socioeconomic quintile (52%). The majority of crashes were either non-collisions (41%) or collisions with a motor vehicle (35%). A smaller proportion of cyclists who collided with motor vehicles had returned to work and had returned to pre-injury functional levels at 12 months post-injury, when compared to collisions with other impact counterparts and non-collisions. Mixed effects logistic regression models revealed that compensable patients demonstrated lower odds of complete functional recovery and return to work when compared with non-compensable patients. CONCLUSION Cyclists who collided with motor vehicles had worse outcomes compared to crashes with other impact counterparts and non-collision events. These findings provide support for reducing the potential for interaction between cyclists and motor vehicles.
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Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.
| | - Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Victoria, Australia
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Orthopaedic Surgery, The Alfred, Melbourne, Victoria, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Rodney Judson
- Department of Surgery, The University of Melbourne, Victoria, Australia; General Surgery, The Royal Melbourne Hospital, Victoria, Australia
| | - Richard Page
- Barwon Centre of Orthopaedic Research and Education (B-CORE), University Hospital Geelong, Victoria, Australia; School of Medicine, Deakin University, Victoria, Australia
| | - Raphael Hau
- Melbourne Medical School, Northern Hospital, Victoria, Australia
| | - Mark Stevenson
- Melbourne School of Design/Melbourne School of Population and Global Health, The University of Melbourne, Victoria, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Farr Institute, Swansea University Medical School, Swansea University, UK
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Harris IA, Naylor JM, Lawson A, Buchbinder R, Ivers R, Balogh Z, Smith P, Mittal R, Xuan W, Howard K, Vafa A, Yates P, Rieger B, Smith G, Elkinson I, Kim W, Chehade M, Sungaran J, Latendresse K, Wong J, Viswanathan S, Richardson M, Shrestha K, Drobetz H, Tran P, Loveridge J, Page R, Hau R, Bingham R, Mulford J, Incoll I. A combined randomised and observational study of surgery for fractures in the distal radius in the elderly (CROSSFIRE)-a study protocol. BMJ Open 2017. [PMID: 28645976 PMCID: PMC5541521 DOI: 10.1136/bmjopen-2017-016100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
UNLABELLED Fractures of the distal radius are common and occur in all age groups. The incidence is high in older populations due to osteoporosis and increased falls risk. Considerable practice variation exists in the management of distal radius fractures in older patients ranging from closed reduction with cast immobilisation to open reduction with plate fixation. Plating is currently the most common surgical treatment. While there is evidence showing no significant advantage for some forms of surgical fixation over conservative treatment, and no difference between different surgical techniques, there is a lack of evidence comparing two of the most common treatments used: closed reduction and casting versus plating. Surgical management involves significant costs and risks compared with conservative management. High-level evidence is required to address practice variation, justify costs and to provide the best clinical outcomes for patients. METHODS AND ANALYSIS This pragmatic, multicentre randomised comparative effectiveness trial aims to determine whether plating leads to better pain and function and is more cost-effective than closed reduction and casting of displaced distal radius fractures in adults aged 60 years and older. The trial will compare the two techniques but will also follow consenting patients who are unwilling to be randomised in a separate, observational cohort. Inclusion of non-randomised patients addresses selection bias, provides practice and outcome insights about standard care, and improves the generalisability of the results from the randomised trial. ETHICS AND DISSEMINATION CROSSFIRE(Combined Randomised and Observational Study of Surgery for Fractures In the distal Radius in the Elderly) was reviewed and approved by The Hunter New England HREC (HNEHREC Reference No: 16/02/17/3.04). The results of the trial will be published in a peer-reviewed journal and will be disseminated via various forms of media. Results will be incorporated in clinical recommendations and practice guidelines produced by professional bodies. REGISTRATION CROSSFIRE has been registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR: ACTRN12616000969460).
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Affiliation(s)
- Ian, A Harris
- Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Justine, M Naylor
- Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Andrew Lawson
- Ingham Institute for Applied Medical Research, Whitlam Orthopaedic Research Centre, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Rachelle Buchbinder
- Monash University, Melbourne, Australia
- Cabrini Institute, Melbourne, Australia
| | - Rebecca Ivers
- The George Institute, Sydney, Australia
- University of Sydney, Sydney, Australia
| | | | | | - Rajat Mittal
- University of New South Wales, Sydney, Australia
| | - Wei Xuan
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | - Arezoo Vafa
- Ingham Institute for Applied Medical Research, Sydney, Australia
| | | | | | - Geoff Smith
- St George and Sutherland Hospitals, Sydney, Australia
| | | | - Woosung Kim
- Wellington Hospital, Wellington, New Zealand
| | | | | | - Kim Latendresse
- Nambour Hospital and Sunshine Coast University Hospital, Nambour, Australia
| | | | | | | | | | | | | | | | - Richard Page
- University Hospital Geelong/Barwon Health, Geelong, Australia
| | | | | | | | - Ian Incoll
- Gosford and Wyong Hospitals, Gosford, Australia
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Peiris C, Shields N, Kingsley M, Yeung J, Hau R, Taylor N. Maximum Tolerated Dose of Walking for Community-Dwelling People Recovering From Hip Fracture: A Dose-Response Trial. Arch Phys Med Rehabil 2017; 98:2533-2539. [PMID: 28465223 DOI: 10.1016/j.apmr.2017.03.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/29/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine how much moderate-intensity physical activity, in the form of walking, could be prescribed for people living in the community after hip fracture in terms of safety, tolerability, and feasibility. DESIGN Phase I dose-response design. SETTING Public community rehabilitation centers. PARTICIPANTS Community-dwelling adults (N=21; 16 women; mean age, 75±9y) who were cognitively alert, attending community rehabilitation after hip fracture (mean days postfracture, 110±47d), able to walk with or without a gait aid, and for whom it was safe to participate in physical activity. INTERVENTIONS Individually supervised doses of moderate-intensity walking completed in 1 week in addition to their usual levels of physical activity. Three participants were required to complete a dose of walking before dose escalation for the next cohort of 3 participants. Dose escalation ceased when >1 participant in a cohort had an adverse event or was unable to tolerate the dose or if the maximum dose of 150min/wk was achieved. MAIN OUTCOME MEASURES Maximum tolerated dose of walking per week (in minutes), adverse events, mobility, and walking confidence. RESULTS The maximum tolerated dose of walking for adults after hip fracture before significant discomfort was experienced (eg, breathlessness, pain, and fatigue) by any participant was 100min/wk. No adverse events occurred, but participants began to be unable to tolerate higher doses beyond 100min/wk. CONCLUSIONS This provides preliminary evidence that community-dwelling older adults recovering from hip fracture can complete a sufficient amount of moderate-intensity physical activity to maintain and improve their health.
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Affiliation(s)
- Casey Peiris
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia; Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia.
| | - Nora Shields
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia; Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia
| | - Michael Kingsley
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Jack Yeung
- Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia
| | - Raphael Hau
- Northern Health, Northern Centre for Health Education and Research, Epping, Victoria, Australia; Northern Clinical School, University of Melbourne, Epping, Victoria, Australia
| | - Nicholas Taylor
- Department of Rehabilitation, Nutrition and Sport, Allied Health, Physiotherapy, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia; Eastern Health, Eastern Health Clinical Research Office, Box Hill, Victoria, Australia
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Bonato LJ, Edwards ER, Gosling CM, Hau R, Hofstee DJ, Shuen A, Gabbe BJ. Patient reported health related quality of life early outcomes at 12 months after surgically managed tibial plafond fracture. Injury 2017; 48:946-953. [PMID: 28233519 DOI: 10.1016/j.injury.2016.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 10/23/2016] [Accepted: 11/16/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Tibial plafond fractures represent a small but complex subset of fractures of the lower limb. The aim of this study was to describe the health related quality of life, pain and return to work outcomes 12 months following surgically managed tibial plafond fracture. METHODS The Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) database was used to identify patients with tibial plafond fractures. All patients captured by VOTOR with a tibial plafond fracture between September 2003 and July 2009, were identified consecutively and comprised the initial cohort. The radiographs of all identified patients were classified using the AO/OTA fracture classification. A review of the included patient's medical records was performed. Data were collected on the injury event, management and complications. Outcomes at 12 months were prospectively collected by telephone interview and included return to work, a numerical rating scale for assessment of pain and the Short Form 12 (SF-12). RESULTS There were 98 unilateral tibial plafond fractures; 91 fractures were managed operatively, 4 non-operatively and 3 underwent amputation. The 91 operatively managed patients were the focus of this study. A two-stage management approach, involving temporary external fixation, followed by definitive open reduction and internal fixation, was the most common operative treatment. The follow-up rate at 12 months was 70%. 57% had returned to work by 12 months post-injury, the median (IQR) pain score was 2 (0-5) and 27% reported moderate to severe persistent pain. Mean PCS-12 scores were significantly lower than Australian norms (p=0.99), 38.2 for males and 37.5 for females. CONCLUSIONS The presence of persistent pain, loss of physical health and a low return to work rate highlights the profound impact of tibial plafond fractures on patients' lives. Although this study looked at the early 12 month results, it is expected these outcomes will continue to improve over time. Further studies, with larger patient numbers, must focus on how to improve not only the operative management of these fractures, but also patient's mental and overall physical health in the long term. Improved management techniques and early identification of injury patterns known to perform poorly may help long-term outcomes.
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Affiliation(s)
- Luke J Bonato
- Monash University MBBS Program, Monash University, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia; Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Australia
| | | | - Raphael Hau
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedics, The Northern Hospital, Melbourne, Australia
| | - Dirk Jan Hofstee
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedics, Medical Centre Alkmaar, The Netherlands
| | | | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Ekegren CL, Edwards ER, Oppy A, Liew S, Page R, de Steiger R, Cameron PA, Bucknill A, Hau R, Gabbe BJ. Twelve-month work-related outcomes following hip fracture in patients under 65 years of age. Injury 2017; 48:701-707. [PMID: 28118983 DOI: 10.1016/j.injury.2017.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 01/14/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Recent research has highlighted the need for improved outcome reporting in younger hip fracture patients. For this population, return to work (RTW) is a particularly important measure against which to evaluate treatment outcomes. However, to date, only two small studies have reported RTW outcomes in young hip fracture patients and neither investigated factors predictive of RTW. The aims of this study were to report return to work (RTW) status and predictors of RTW 12 months after hip fracture in patients <65 years. METHODS Two hundred and ninety-one adults aged <65 years, admitted with hip fractures between July 2009 and June 2013 and registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) were included in this prospective cohort study. Twelve-month return to work status was collected through structured telephone interviews conducted by trained interviewers. Multivariate logistic regression was used to identify demographic and injury variables that were important predictors of 12-month work status. RESULTS Sixty-five per-cent of patients had returned to work 12 months after hip fracture (62% of whom had an isolated hip fracture and 38% of whom had additional injuries). Relative to patients aged 16-24 years, odds of RTW was reduced by 78%-89% for each 10-year increase in age (p=0.02). Relative to patients employed as managers/administrators/professionals, odds of RTW were 68% to 95% lower for all other workers (p<0.001). For those reporting a pre-injury disability, odds of RTW were 79% lower compared to those without disability (p=0.004) and 69% lower for patients with multiple injuries compared to isolated hip fracture patients (p=0.002). Finally, patients compensated by a work or transport insurer had a 67% lower odds of RTW relative to patients who were not compensated (p=0.02). CONCLUSIONS Approximately one third of patients <65years had not returned to work 12 months after hip fracture. Patients who are older, have multiple injuries or pre-existing disabilities or who work in more physical occupations may need more assistance to RTW following hip fracture. The compensation system should be examined to determine why compensated patients may be at risk of poor RTW outcomes.
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Affiliation(s)
- Christina L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Elton R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia
| | - Andrew Oppy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital,Parkville, Australia
| | - Susan Liew
- Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia; Department of Surgery, Monash University, Melbourne, Australia
| | - Richard Page
- Department of Orthopaedics, University Hospital Geelong, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - Richard de Steiger
- Epworth Hospital, Richmond, Australia; University of Melbourne,Parkville, Australia
| | - Peter A Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Emergency and Trauma Centre, Alfred Hospital, Melbourne, Australia
| | - Andrew Bucknill
- Department of Orthopaedic Surgery, Royal Melbourne Hospital,Parkville, Australia
| | - Raphael Hau
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedic Surgery, Northern Hospital, Epping, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Bruder AM, McClelland JA, Shields N, Dodd KJ, Hau R, van de Water ATM, Taylor NF. Validity and reliability of an activity monitor to quantify arm movements and activity in adults following distal radius fracture. Disabil Rehabil 2017. [PMID: 28637143 DOI: 10.1080/09638288.2017.1288764] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To examine the validity and reliability of an activity monitor to estimate upper limb activity. METHODS Thirty-two adults after distal radial fracture were recruited. 15 adults performed five upper limb activities during two testing sessions, one week apart to investigate criterion validity against the criterion reference of three-dimensional motion analysis, convergent validity, and test-retest reliability. 17 adults in two therapy groups wore monitors for three consecutive days at baseline and six weeks post-intervention. Hypothesis testing (noninferiority) assessed comparison of group differences. RESULTS There were large, significant positive correlations between monitor counts and motion analysis for affected/unaffected wrists during the grocery shelving [r = 0.82, r = 0.73, respectively] and floor sweeping activities [r = 0.54, r = 0.59, respectively]. Large confidence intervals relative to means suggests the monitor could not accurately predict motion analysis distance or acceleration. Relative reliability was excellent in affected/unaffected wrists for crank ergometer [ICC(2,1) = 0.91, ICC(2,1) = 0.88, respectively], grocery shelving [ICC(2,1) = 0.83, ICC(2,1) = 0.89, respectively], and table dusting activities [ICC(2,1) = 0.77, ICC(2,1) = 0.83, respectively]. Correlations and reliability for typing were poor; hypothesis testing of group equivalence was not confirmed. CONCLUSIONS There is preliminary evidence that an activity monitor is a valid and reliable tool to measure gross arm activity after distal radial fracture. Implications for Rehabilitation Distal radius fractures are one of the most common upper limb fractures that cause activity limitations and participation restrictions. After a distal radius fracture patients are often referred to therapy (physiotherapy, occupational therapy, hand therapy) for rehabilitation to return to pre-injury function and activity levels. Activity monitors may be a valid and reliable measurement tool that therapists can use with their patients to quantify gross arm activity to enable monitoring of injury recovery and rehabilitation adherence. Activity monitors may not be sufficiently reliable and valid to monitor fine movements of the wrist and hand after distal radius fracture.
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Affiliation(s)
- Andrea M Bruder
- a School of Allied Health, La Trobe University , Melbourne , Australia
| | | | - Nora Shields
- a School of Allied Health, La Trobe University , Melbourne , Australia.,b Department of Allied Health , Northern Health , Melbourne , Australia
| | - Karen J Dodd
- c College of Science, Health and Engineering, La Trobe University , Melbourne , Australia
| | - Raphael Hau
- d Northern Clinical School, Melbourne Medical School , Melbourne , Australia
| | - Alexander T M van de Water
- a School of Allied Health, La Trobe University , Melbourne , Australia.,e Physiotherapy Department , Saxion University of Applied Science , Enschede , Netherlands
| | - Nicholas F Taylor
- a School of Allied Health, La Trobe University , Melbourne , Australia.,f Allied Health Clinical Research Office, Eastern Health , Melbourne , Australia
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Tjoakarfa C, David V, Ko A, Hau R. Reflective Blankets Are as Effective as Forced Air Warmers in Maintaining Patient Normothermia During Hip and Knee Arthroplasty Surgery. J Arthroplasty 2017; 32:624-627. [PMID: 27546475 DOI: 10.1016/j.arth.2016.07.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/18/2016] [Accepted: 07/07/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The use of forced air warming devices in the operating room has been shown to cause disruption of laminar airflow and a potential for increase in surgical site contamination. In contrast, conductive warming devices such as reflective blankets do not disrupt airflow and therefore have no potential for this increase in surgical site infection. However, some studies have shown them to be inferior to forced air warming devices in maintaining normothermia. We tested the hypothesis that the use of reflective blankets is as effective as forced air warming devices in maintaining intraoperative normothermia after adequate prewarming. METHODS We performed a randomized, controlled trial of 50 patients undergoing hip or knee arthroplasty using a protocol of prewarming followed by application of either forced air warming device or a reflective blanket and recording the patients sublingual temperature at a 15-minute interval till arrival in the post-anesthesia care unit. RESULTS There was no significant difference in the sublingual temperatures in the 2 groups at any time point. CONCLUSION Our study shows that after a period of adequate prewarming, the use of reflective blankets is as effective as the use of forced air warming devices in maintaining normothermia in patients undergoing hip or knee arthroplasty.
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Affiliation(s)
- Clarissa Tjoakarfa
- Department of Orthopaedics, The Northern Hospital, Epping, VIC, Australia
| | - Vikram David
- Department of Orthopaedics, The Northern Hospital, Epping, VIC, Australia
| | - Atlas Ko
- Department of Anesthesia, The Northern Hospital, Epping, VIC, Australia
| | - Raphael Hau
- Department of Orthopaedics, The Northern Hospital, Epping, VIC, Australia
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Fox G, Gabbe BJ, Richardson M, Oppy A, Page R, Edwards ER, Hau R, Ekegren CL. Twelve-month outcomes following surgical repair of the Achilles tendon. Injury 2016; 47:2370-2374. [PMID: 27424531 DOI: 10.1016/j.injury.2016.07.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/27/2016] [Accepted: 07/07/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Incidence of Achilles tendon rupture (ATR) has increased over recent years, and debate regarding optimal management has been widely documented. Most papers have focused on surgical success, complications and short term region-specific outcomes. Inconsistent use of standardised outcome measures following surgical ATR repair has made it difficult to evaluate the impact of ATR on a patient's health status post-surgery, and to compare this to other injury types. This study aimed to report the frequency of surgical repairs of the Achilles tendon over a five-year period within an orthopaedic trauma registry, and to investigate return to work (RTW) status, health status and functional outcomes at 12 months post-surgical repair of the Achilles tendon. METHODS Two hundred and four adults registered by the Victorian Orthopaedic Trauma Outcomes Registry (VOTOR) who underwent surgical repair of the Achilles tendon between July 2009 and June 2014 were included in this prospective cohort study. The Extended Glasgow Outcome Scale (GOS-E), 3-level European Quality of Life 5 Dimension measure (EQ-5D-3L), and RTW status 12 months following surgical ATR repair were collected through structured telephone interviews conducted by trained interviewers. RESULTS At 12 months, 92% of patients were successfully followed up. Of those working prior to injury, 95% had returned to work. 42% of patients reported a full recovery on the GOS-E scale. The prevalence of problems on the EQ-5D-3L at 12 months was 0.5% for self-care, 11% for anxiety, 13% for mobility, 16% for activity, and 22% for pain. 16% of patients reported problems with more than one domain. The number of surgical repairs of the Achilles tendon within the VOTOR registry decreased by 68% over the five-year study period. CONCLUSIONS Overall, patients recover well following surgical repair of the Achilles tendon. However, in this study, deficits in function persisted for over half of patients at 12 months post-injury. The decreased incidence of surgical Achilles tendon repair may reflect a change in practice at VOTOR hospitals whereby surgery may be becoming less favoured for initial ATR management.
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Affiliation(s)
- G Fox
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - B J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - A Oppy
- Department of Orthopaedic Surgery, Royal Melbourne Hospital, Parkville, Australia
| | - R Page
- Department of Orthopaedics, University Hospital Geelong, Geelong, Australia; School of Medicine, Deakin University, Geelong, Australia
| | - E R Edwards
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Department of Orthopaedic Surgery, Alfred Hospital, Melbourne, Australia
| | - R Hau
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Northern Hospital, Epping, Australia
| | - C L Ekegren
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF. A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial. J Physiother 2016; 62:145-52. [PMID: 27323934 DOI: 10.1016/j.jphys.2016.05.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 03/02/2016] [Accepted: 05/19/2016] [Indexed: 11/26/2022] Open
Abstract
QUESTION Does a program of exercise and structured advice implemented during the rehabilitation phase following a distal radial fracture achieve better recovery of upper limb activity than structured advice alone? DESIGN A phase I/II, multi-centre, randomised, controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. PARTICIPANTS Thirty-three adults (25 female, mean age 54 years) following distal radial fracture managed in a cast. INTERVENTION The experimental intervention was a 6-week program of progressive exercise and structured advice implemented over three consultations by a physiotherapist. The control intervention was a program of structured advice only, delivered by a physiotherapist over three consultations. OUTCOME MEASURES The primary outcome was upper limb activity limitations, assessed by the Patient-Rated Wrist Evaluation and the shortened version of the Disabilities of the Arm, Shoulder and Hand outcome measure (QuickDASH). The secondary outcomes were wrist range of movement, grip strength and pain. All measures were completed at baseline (week 0), after the intervention (week 7) and at 6 months (week 24). RESULTS There were no significant between-group differences in upper limb activity as measured by the Patient-Rated Wrist Evaluation at week 7 and week 24 assessments (mean difference -4 units, 95% CI -10 to 2; mean difference 0 units, 95% CI -3 to 3, respectively), or QuickDASH at week 7 and week 24 assessments (mean difference -5 units, 95% CI -16 to 6; mean difference 0.3 units, 95% CI -6 to 7, respectively). The secondary outcomes did not demonstrate any significant between-group effects. CONCLUSION The prescription of exercise in addition to a structured advice program over three physiotherapy consultations may convey no extra benefit following distal radial fracture managed in a cast. TRIAL REGISTRATION ACTRN12612000118808. [Bruder AM, Shields N, Dodd KJ, Hau R, Taylor NF (2016) A progressive exercise and structured advice program does not improve activity more than structured advice alone following a distal radial fracture: a multi-centre, randomised trial.Journal of Physiotherapy62: 145-152].
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Affiliation(s)
| | - Nora Shields
- School of Allied Health, La Trobe University; Department of Allied Health, Northern Health
| | - Karen J Dodd
- College of Science, Health and Engineering, La Trobe University
| | - Raphael Hau
- Department of Orthopaedic Surgery, Northern Health
| | - Nicholas F Taylor
- School of Allied Health, La Trobe University; Allied Health Clinical Research Office, Eastern Health, Melbourne, Australia
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Snowdon DA, Hau R, Leggat SG, Taylor NF. Does clinical supervision of health professionals improve patient safety? A systematic review and meta-analysis. Int J Qual Health Care 2016; 28:447-55. [DOI: 10.1093/intqhc/mzw059] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2016] [Indexed: 12/20/2022] Open
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Bowen W, Hau R, Li P, Kidgell D. The importance of the contralateral limb in unilateral knee osteoarthritis. J Sci Med Sport 2014. [DOI: 10.1016/j.jsams.2014.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
The evidence for optimal management of Mason type III fracture of radial head is unclear hence a systematic review of the published literature was performed in April 2012. This review includes 5 prospective studies (including 2 randomized trials), 4 retrospective studies and 9 case series. No study can be interpreted as level 1 evidence. Level 2 and 3 evidence provides some insight into the success of each modality through subjective and objective measurements of function and complication rates. Radial head replacement, open reduction internal fixation (ORIF) and radial head resection all provide satisfactory outcomes for patients in most cases. One treatment modality cannot be recommended over any other due to the small number of clinical trials and cases included in each study. Further randomized control trials are needed to evaluate the full benefits and shortcomings of each of the different surgical treatment modalities.
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Affiliation(s)
- George Miller
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Ali Humadi
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia,Address for correspondence: Dr. Ali Humadi, Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, Australia. E-mail:
| | - Raghavan Unni
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
| | - Raphael Hau
- Department of Orthopaedic, The Northern Hospital, 185 Cooper St, Epping, Victoria, 3076, Australia
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Gosling C, Richardson M, Brown G, Hau R, Pirpiris M, Edwards E. Patient outcomes following traumatic fracture of the femoral shaft. Does surgical approach influence outcomes? Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590b.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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