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Casas Reza P, Gestal Vázquez M, Sampayo Rodríguez L, Vilar Castro A, López-López D, García Romar A. Retrospective analysis of regional anaesthesia in hip surgery: A clinical audit. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00032-5. [PMID: 38354775 DOI: 10.1016/j.redare.2024.02.011] [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] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 07/08/2023] [Indexed: 02/16/2024]
Abstract
INTRODUCTION Total hip arthroplasty is one of the most frequent surgical interventions in the hospital setting. Nonetheless, the ideal method to manage post-operative pain is still unknown. Multimodal analgesia techniques based on regional anaesthesia are amongst the most promising solutions. OBJECTIVES The aim of this study was to evaluate postoperative pain after total hip arthroplasty according to whether peripheral nerve block was performed (femoral block, fascia iliaca block and pericapsular nerve group block). Intravenous morphine consumption during the patient's stay in the post-anaesthesia care unit was measured, as well as the number of opioid rescues at 24 and 48 h post intervention. As secondary objectives, the prevalence of nerve injury, prolonged quadricipital block, and morphine consumption were established according to other variables of interest. MATERIALS AND METHODS In this observational retrospective study, data was collected from the electronic medical record of 656 traumatological surgery patients from April 2018 to August 2020, with the following inclusion criteria: over 18 years old, ASA I-III, primary total hip arthroplasty under general anaesthesia or subarachnoid anaesthesia (only with hyperbaric bupivacaine) and use of levobupivacaine for peripheral nerve block. RESULTS A total of 362 patients were selected. The main surgical indication was coxarthrosis (61.3%), followed by hip fracture (22.6%). Peripheral nerve blocks were performed on 169 patients (66.3% femoral, 27.7% PENG, and 6.0% fascia iliaca). Mean postoperative opioid consumption in PACU was lower in patients in who received a PENG (2.2 mg) or a femoral (3.27 mg) block, compared to those who received neither (6.69 mg). There were no differences in opioid rescues at 24 and 48 h after the procedure. Nerve injury incidence was low (.8%), and not associated with nerve blocks. The incidence of prolonged quadricipital paralysis was also low (1.3%), and was mainly associated with femoral nerve block (75% of cases). CONCLUSIONS This retrospective study supports the use of regional blocks as opioid-sparing techniques, highlighting their role in rapid functional recovery with no motor impairment.
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Affiliation(s)
- P Casas Reza
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain.
| | - M Gestal Vázquez
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - L Sampayo Rodríguez
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - A Vilar Castro
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - D López-López
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
| | - A García Romar
- Departamento de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario de A Coruña, A Coruña, Galicia, Spain
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Giustra F, Cacciola G, Pirato F, Bosco F, De Martino I, Sabatini L, Rovere G, Camarda L, Massè A. Indications, complications, and clinical outcomes of fixation and acute total hip arthroplasty for the treatment of acetabular fractures: A systematic review. Eur J Orthop Surg Traumatol 2024; 34:47-57. [PMID: 37640795 PMCID: PMC10771595 DOI: 10.1007/s00590-023-03701-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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Acetabular fracture fixation can be challenging, especially in the elderly. Open reduction and internal fixation (ORIF) alone may not allow for early weight bearing and is associated with a high rate of secondary osteoarthritis; therefore, a combined hip procedure (CHP) or ORIF with acute total hip arthroplasty, may be beneficial in this population. The objective of this study was to perform a systematic review of all reported cases of CHP. METHODS PubMed, Embase, Scopus, and Cochrane databases were searched for studies analyzing acetabular fractures in the elderly managed with a combined hip procedure (CHP). The research was performed following the PRISMA guidelines. The included studies' methodological quality was evaluated using the MINORS score. The present study was registered on PROSPERO. RESULTS Eleven clinical studies were included in the final analysis. The mean age was 74.4 (63.2-78) years. Low-energy trauma was the most common mechanism of injury (64%). The most prevalent fracture pattern was the anterior column and posterior hemitransverse (ACPHT) (30.6%). The Kocher-Langenbeck approach was preferred for ORIF of posterior fractures and hip arthroplasty. The ilioinguinal approach and modified Stoppa were generally used for anterior fractures. The overall complication rate was 12.2%, and hip dislocation was the most frequent cause of reoperation (4.4%). The average Harris Hip Score reported postoperatively was 81.6 points, which was considered "good." CONCLUSIONS CHP is a safe treatment for elderly acetabular fractures with an acceptable complication and reoperation rate that results in good clinical outcomes. LEVEL OF EVIDENCE Level of evidence IV.
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Affiliation(s)
- Fortunato Giustra
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy
| | - Giorgio Cacciola
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Francesco Pirato
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
| | - Francesco Bosco
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy.
- Department of Orthopaedics and Traumatology, Ospedale San Giovanni Bosco di Torino - ASL Città di Torino, Turin, Italy.
| | - Ivan De Martino
- Istituto Ortopedico del Mezzogiorno d'Italia "Franco Scalabrino", Via Consolare Pompea, 98100, Messina, Italy
| | - Luigi Sabatini
- Ortopedia Protesica e Robotica - Humanitas Gradenigo, Turin, Italy
| | - Giuseppe Rovere
- Department of Orthopaedics and Traumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Lawrence Camarda
- Department of Orthopaedics and Traumatology (DiChirOnS), University of Palermo, Palermo, Italy
| | - Alessandro Massè
- Department of Orthopaedics and Traumatology, University of Turin, CTO Torino, Via Zuretti, 29, 10126, Turin, Italy
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Andrade PP, Lombardi RA, Marques IR, Braga ACDNAE, Isaias BRS, Heiser NE. Pericapsular Nerve Group (PENG) block versus fascia iliaca compartment (FI) block for hip surgery: a systematic review and meta-analysis of randomized controlled trials. Braz J Anesthesiol 2023; 73:794-809. [PMID: 37507071 PMCID: PMC10625158 DOI: 10.1016/j.bjane.2023.07.007] [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: 11/22/2022] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND This study compares Fascia Iliaca compartment (FI) block and Pericapsular Nerve Group (PENG) block for hip surgery. METHODS Pubmed, Embase and Cochrane were systematically searched in April 2022. Inclusion criteria were: Randomized Controlled Trials (RCTs); comparing PENG block versus FI block for hip surgery; patients over 18 years of age; and reporting outcomes immediately postoperative. We excluded studies with overlapped populations and without a head-to-head comparison of the PENG block vs. FI block. Mean-Difference (MD) with 95% Confidence Intervals (CI) were pooled. Trial Sequential Analyses (TSA) were performed to assess inconsistency. Quality assessment and risk of bias were performed according to Cochrane recommendations. RESULTS Eight RCTs comprising 384 patients were included, of whom 196 (51%) underwent PENG block. After hip surgery, PENG block reduced static pain score at 12h post-surgery (MD = 0.61 mm; 95% CI 1.12 to -0.09; p = 0.02) and cumulative postoperative oral morphine consumption in the first 24h (MD = -6.93 mg; 95% CI -13.60 to -0.25; p = 0.04) compared with the FI group. However, no differences were found between the two techniques regarding dynamic and static pain scores at 6 h or 24 h post-surgery, or in the time to the first analgesic rescue after surgery. CONCLUSION The findings suggest that PENG block reduced opioid consumption in the first 24 h after surgery and reduced pain scores at rest at 12 h post-surgery. Further research is needed to fully understand the effects of the PENG block and its potential benefits compared to FI block. PROSPERO REGISTRATION CRD42022339628 PROSPERO REGISTRATION: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=339628.
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Affiliation(s)
- Priscila P Andrade
- Hospital Regional de Sorocaba Adib Domingos Jatene, Divisão de Anestesiologia, Sorocaba, SP, Brazil
| | - Rafael A Lombardi
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, United States of America.
| | - Isabela R Marques
- Universitat Internacional de Catalunya, Division of Medicine, Barcelona, Spain
| | | | - Beatrice R S Isaias
- Universidade Federal de Mato Grosso do Sul, Divisão de Medicina, Campo Grande, MS, Brazil
| | - Nicholas E Heiser
- University of Nebraska Medical Center, Department of Anesthesiology, Omaha, United States of America
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Toro Tamargo E, Pedrera Mulero D, Meléndez Plumed M. [Hip joint status in adult patients with cerebral palsy]. Rehabilitacion (Madr) 2023; 57:100811. [PMID: 37542743 DOI: 10.1016/j.rh.2023.100811] [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] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 12/07/2022] [Accepted: 02/12/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION In cerebral palsy, femoral head migration is defined as the loss of coverage of the femoral head by the acetabulum and is measured using the Reimer index. Surgical treatment can be preventive, reconstructive, or salvage, and failure rates of surgery are high and related to the severity of cerebral palsy. The aim of our work is to assess the incidence of hip migration in our series of adult patients with cerebral palsy, to determine the outcome of those who have undergone surgery, and to establish recurrence rates after the various surgical techniques. MATERIAL AND METHODS We designed a retrospective observational study to determine the hip status of adult patients with cerebral palsy visiting the Unit between 2008 and 2021. RESULTS The overall incidence of hip displacement was 75%, patients with more extensive disability (GMFCS IV and V) were more predisposed to dislocation, also more severe. Soft tissue surgery made up 49.5% of the operations performed with a failure rate of up to 82%. Reconstructive surgery was performed in 45.5% of cases with a failure rate of more than 86%. CONCLUSION The current hip surveillance programmes have been implemented to improve follow-up and interventions in hip displacement, with the objective of maintaining optimal acetabular coverage and reducing the failure rate of potential surgeries.
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Affiliation(s)
- E Toro Tamargo
- Unidad Rehabilitación Infantil, Medicina Física y Rehabilitación, Hospital Universitario Vall d'Hebrón, Barcelona, España.
| | - D Pedrera Mulero
- Unidad Rehabilitación Infantil, Medicina Física y Rehabilitación, Hospital Universitario Vall d'Hebrón, Barcelona, España
| | - M Meléndez Plumed
- Unidad Rehabilitación Infantil, Medicina Física y Rehabilitación, Hospital Universitario Vall d'Hebrón, Barcelona, España
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Mao W, Yang AL, Chang SM, Li Y, Li LL, Ni HF, Dong YH. The Impact of Banana-Shaped Fragments on Trochanteric Hip Fractures Treated by PFNA. Indian J Orthop 2023; 57:1452-1460. [PMID: 37609008 PMCID: PMC10441983 DOI: 10.1007/s43465-023-00964-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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/25/2023] [Indexed: 08/24/2023]
Abstract
Background Regarding trochanteric hip fractures, one type of posterior coronal fragments was described as the "banana-shaped fragment", while the impact of the banana-shaped fragment on mechanical stability has not been further studied. The current study investigated the association between the banana-shaped fragment and mechanical complications after surgery. Methods This retrospective cohort study included 273 patients treated by proximal femoral nail antirotation (PFNA) in the full analysis. The age, the sex, the fracture side, the follow-up time, the American Society of Anesthesiologists classification, the operators, the fracture classification, the tip-apex distance, the blade positions, the reduction quality and the bone mineral density were analyzed in relation to mechanical complications, through univariate and multivariate approaches. Results Mechanical complications happened in 33 patients. The banana-shaped fragment (adjusted odds ratio 5.240, 95% CI 2.172 to 12.641; p < 0.001), the tip-apex distance and the reduction quality showed significant association with mechanical complications in both univariate and multivariate analysis. Moreover, for 118 patients with the banana-shaped fragment, we found that the use of wire cerclage couldn't significantly lower the rates of mechanical complications (p = 0.648). Conclusions The banana-shaped fragment had a negative impact on mechanical stability of trochanteric hip fractures treated by PFNA. In the perioperative period, the BSF should be carefully evaluated, and its specific handling deserves further study.
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Affiliation(s)
- Wei Mao
- Department of Orthopedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| | - Ao-lei Yang
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| | - Shi-min Chang
- Department of Orthopedic Surgery, Yangpu Hospital, School of Medicine, Tongji University, 450 Tengyue Road, Shanghai, 200090 People’s Republic of China
| | - Yan Li
- Division of Orthopaedics and Biotechnology, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Theme Trauma and Reparative Medicine, Department of Orthopedics and Traumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Lin-li Li
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
| | - Hao-fei Ni
- Department of Orthopaedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - You-hai Dong
- Department of Orthopedics, Shanghai Fifth People’s Hospital, Fudan University, No. 801 Heqing Rd, Minhang District, Shanghai, 200240 China
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Mimendia I, Lakhani K, Núñez JH, Barro V, Guerra-Farfán E, Collado D, Hernández A. Total hip arthroplasty associated with transverse subtrochanteric shortening osteotomy and conical stem fixation in Crowe type IV hip dysplasia. Musculoskelet Surg 2023; 107:367-372. [PMID: 36869994 DOI: 10.1007/s12306-023-00779-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
PURPOSE Total hip arthroplasty (THA) in high-dislocated hip dysplasia is a surgical challenge, presenting difficulties in the biomechanical reconstruction of the hip. The purpose of the present study is to analyze clinical and radiological outcomes of a series of patients with Crowe type IV hip dysplasia who underwent a THA with transverse subtrochanteric shortening osteotomy and conical stem fixation in our Hip surgery unit. METHODS This non-interventional retrospective study included all patients diagnosed with Crowe type IV hip dysplasia who underwent a THA using a subtrochanteric shortening osteotomy and uncemented conical stem fixation between January 1, 2008, and December 31, 2015. Demographic, clinical and radiologic data were analyzed, including Harris Hip Score and Oxford Hip Score. RESULTS Seventeen hips in 13 patients were included in the final analysis. All patients were women and mean age was 39 years (range 35-45). Mean follow-up was 5.6 years (range 1-8). Average length of the osteotomy was 3.4 cm (range 3-4.5) and mean lowering of the center of rotation was 5.67 cm (range 3.8-9.1). Mean time for bone union was 5.5 months. No nerve palsy or non-union was detected at the end of follow-up period. CONCLUSION The use of cementless conical stem fixation associated with a transverse subtrochanteric shortening osteotomy for treating Crowe type IV hip dysplasia permits to correct the rotational alterations of the femur and provides good stability of the osteotomy, with very low risk of nerve palsy and non-union rates.
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Affiliation(s)
- I Mimendia
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - K Lakhani
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
- Traumatology and Rehabilitation, Vall d'Hebron University Hospital, Passeig de la Vall d'Hebrón, 119., 08035, Barcelona, Spain.
| | - J H Núñez
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - V Barro
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - E Guerra-Farfán
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - D Collado
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
| | - A Hernández
- Department of Traumatology and Orthopaedic Surgery, Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autónoma de Barcelona, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
- Hip Surgery Unit, Vall d'Hebron University Hospital, Barcelona, Spain
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Bizzoca D, Piazzolla A, Moretti L, Vicenti G, Moretti B, Solarino G. Physiologic postoperative presepsin kinetics following primary cementless total hip arthroplasty: A prospective observational study. World J Orthop 2023; 14:547-553. [PMID: 37485426 PMCID: PMC10359746 DOI: 10.5312/wjo.v14.i7.547] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/09/2023] [Accepted: 06/12/2023] [Indexed: 07/17/2023] Open
Abstract
BACKGROUND Presepsin is an emerging biomarker in the diagnosis of sepsis. In the field of orthopaedics, it could be useful in diagnosing and managing periprosthetic joint infections.
AIM To define the normal postoperative presepsin plasmatic curve, in patients undergoing primary cementless total hip arthroplasty (THA).
METHODS Patients undergoing primary cementless THA at our Institute were recruited. Inclusion criteria were: Primary osteoarthritis of the hip; urinary catheter time of permanence < 24 h; peripheral venous cannulation time of permanence < 24 h; no postoperative homologous blood transfusion administration and hospital stay ≤ 8 d. Exclusion criteria were: The presence of other articular prosthetic replacement or bone fixation devices; chronic inflammatory diseases; chronic kidney diseases; history of recurrent infections or malignant neoplasms; previous surgery in the preceding 12 mo; diabetes mellitus; immunosuppressive drug or corticosteroid assumption. All the patients received the same antibiotic prophylaxis. All the THA were performed by the same surgical and anaesthesia team; total operative time was defined as the time taken from skin incision to completion of skin closure. At enrollment, anthropometric data, smocking status, osteoarthritis stage according to Kellgren and Lawrence, Harris Hip Score, drugs assumption and comorbidities were recorded. All the patients underwent serial blood tests, including complete blood count, presepsin (PS) and C-reactive protein 24 h before arthroplasty and at 24, 48, 72 and 96 h postoperatively and at 3, 6 and 12-mo follow-up.
RESULTS A total of 96 patients (51 female; 45 male; mean age = 65.74 ± 5.58) were recruited. The mean PS values were: 137.54 pg/mL at baseline, 192.08 pg/mL at 24 h post-op; 254.85 pg/mL at 48 h post-op; 259 pg/mL at 72 h post-op; 248.6 pg/mL at 96-h post-op; 140.52 pg/mL at 3-mo follow-up; 135.55 pg/mL at 6-mo follow-up and 130.11 pg/mL at 12-mo follow-up. In two patients (2.08%) a soft-tissue infection was observed; in these patients, higher levels (> 350 pg/mL) were recorded at 3-mo follow-up.
CONCLUSION The dosage of plasmatic PS concentration is highly recommended in patients undergoing THA before surgery to exclude the presence of an unknown infection. The PS plasmatic concentration should be also assessed at 72 h post-operatively, evaluate the maximum postoperative PS value, and at 96 h post-operatively when a decrease of presepsin should be found. The lack of a presepsin decrease at 96 h post-operatively could be a predictive factor of infection.
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Affiliation(s)
- Davide Bizzoca
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Andrea Piazzolla
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | - Lorenzo Moretti
- DAI Neuroscienze, Organi di Senso e Apparato Locomotore, AOU Consorziale Policlinico di Bari, Bari 70124, Italy
| | | | - Biagio Moretti
- Di BraiN, University of Bari "Aldo Moro", Bari 70124, Italy
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Sun Y, Zhang J, Feng S. Remimazolam Supplemented to General Anesthesia Alleviates Stress and Cognitive Impairment in Elder Patients After Hip Surgery. Psychiatry Investig 2023; 20:301-306. [PMID: 37005384 PMCID: PMC10151658 DOI: 10.30773/pi.2022.0323] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/08/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE Stress and cognitive impairment are common postoperative complications in elder patients who have undergone hip surgery. The objective of the work is to evaluate the effects of remimazolam supplemented to combined general anesthesia in improving stress and cognitive performance. METHODS A total of 120 patients were included to receive a low dose of remimazolam (0.1 mg/kg/h) intravenously combined with general anesthesia or general anesthesia alone during hip surgery. Assessments were used for evaluating cognitive and psychological performance respectively before surgery (T0), 24 h (T5), and 72 h (T6) after surgery. Physiological parameters including mean artery pressure, heart rate, and blood oxygen levels (SpO2) were measured at T0, 30 min after anesthesia (T1), and completion of surgery (T2). Stress indexes including serum cortisol and norepinephrine levels were measured at T0, T5, and T6. The visual analog scale pain scores were also acquired at 6 h after surgery, 12 h after surgery, and T6. Serum interleukin-6 and tumor necrosis factor-α levels were acquired at T0, T2, and T6. RESULTS Heart rate and SpO2 levels in the combination group were significantly improved compared to the control group. Serum cortisol and norepinephrine levels were the highest at T1 and decline over time until T5 in both groups, the two stress indexes of the combination group were significantly lower at T1 and T2. CONCLUSION Remimazolam supplemented to combined general anesthesia demonstrated significant benefit in reducing stress and cognitive dysfunction in elder patients who underwent hip surgery.
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Affiliation(s)
- Yunyun Sun
- Department of Anesthesiology, Hefei Second People's Hospital, Hefei, Anhui, China
| | - Jun Zhang
- Department of Anesthesiology, Hefei Second People's Hospital, Hefei, Anhui, China
| | - ShanWu Feng
- Department of Anesthesiology, Nanjing Maternal and Child Health Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
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Wang Y, Wen H, Wang M, Lu M. The Efficiency of Ultrasound-Guided Pericapsular Nerve Group Block for Pain Management after Hip Surgery: A Meta-analysis. Pain Ther 2023; 12:81-92. [PMID: 36481969 PMCID: PMC9845468 DOI: 10.1007/s40122-022-00463-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Patients with hip surgery often experience moderate to severe postoperative pain, and need large doses of opioids to relieve it, which is not conducive to patient rehabilitation. Pericapsular nerve group (PENG) block is a new regional block technique that is considered to reduce postoperative pain and the use of opioids. The purpose of this study was to evaluate the efficacy and safety of PENG block for postoperative analgesia after hip surgery. METHODS We searched multiple databases for randomized controlled trials (RCTs) published in English, which compared PENG block with fascia iliaca compartment block (FICB). The primary outcome was 24 h postsurgical opioid consumption (OC). The secondary outcomes were pain scores (PSs) at different timepoints after surgery and the incidence of postoperative nausea and vomiting (PONV). RESULTS Five RCTs involving 234 patients were selected for our analysis. Our results show that the 24 h OC was drastically lower in PENG block versus FICB patients (SMD -0.60, 95% CI -1.08 to -0.11); P < 0.05, I2 = 69%). At the same time, there were no significant difference in postsurgical PSs between the two cohorts (6 h: MD -0.07, 95% CI -0.67 to 0.53; P = 0.82, I2 = 43%; 12 h: MD -0.60, 95% CI -1.40 to 0.19; P = 0.14, I2 = 31%; 24 h: MD 0.17, 95% CI -0.87 to 1.21; P = 0.75, I2 = 76%; 36 h: MD 0.80, 95% CI -0.92 to 2.51; P = 0.36, I2 = 73%; 48 h: MD -0.06, 95% CI -0.75 to 0.63; P = 0.86, I2 = 0%) and the incidence of PONV (RR 1.00, 95% CI 0.40-2.50, P = 1.00, I2 = 35%). CONCLUSIONS Our research shows that PENG block can reduce the use of opioids after hip surgery and is effective in postoperative analgesia. Future research should explore the injection method, concentration, and dosage.
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Affiliation(s)
- Yi Wang
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
| | - Huaichang Wen
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
| | - Mengli Wang
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
| | - Meijing Lu
- grid.452929.10000 0004 8513 0241Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zhe Shan Street, Wuhu, 241000 Anhui China
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10
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Perka C, Ascherl R. [Pitfalls in revision hip arthroplasty]. Orthopadie (Heidelb) 2023; 52:35-47. [PMID: 35841403 DOI: 10.1007/s00132-022-04282-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/27/2022] [Indexed: 01/19/2023]
Abstract
Significant key points for a successful revision surgery in hip arthroplasty are as follows: identification of the implants, preoperative clinical diagnoses, planning (including alternatives) as well as establishing a surgical strategy, selection of revision implants and provision with special tools, secure fixation of acetabular and femoral components and the reconstruction of a stable joint without risk of dislocation or impingement. It seems to be obvious that most problems can be avoided by clear and concise decision-making. Some tips and tricks are also presented.
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11
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Holleyman R, Sohatee MA, Lyman S, Malviya A, Khanduja V; NAHR User Group. Hip arthroscopy for femoroacetabular impingement is associated with significant improvement in early patient reported outcomes: analysis of 4963 cases from the UK non-arthroplasty registry (NAHR) dataset. Knee Surg Sports Traumatol Arthrosc 2023; 31:58-69. [PMID: 35833961 DOI: 10.1007/s00167-022-07042-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE Results from recent randomised controlled trials demonstrate the superiority of surgery over physiotherapy in patients with femoroacetabular impingement (FAI) of the hip in early follow-up. However, there is paucity of evidence regarding which factors influence outcomes of FAI surgery, particularly notable is the lack of information on the effect of impingement subtype (cam or pincer or mixed) on patient reported outcomes measures (PROMs). This study aims to evaluate the early outcomes of hip arthroscopy for FAI, and their determinants. METHODS This is a retrospective analysis of prospectively collected data from the UK Non-Arthroplasty Hip Registry (NAHR) of patients undergoing arthroscopic intervention for FAI between 2012 and 2019. The null hypothesis was that there is no difference in PROMs, based on morphological subtype of FAI treated or patient characteristics, at each follow-up timepoint. The outcome measures used for the study were the iHOT-12 score and the EQ5D Index and VAS 6- and 12-month follow-up. RESULTS A cohort of 4963 patients who underwent arthroscopic treatment of FAI were identified on the NAHR database. For all FAI pathology groups, there was significant improvement from pre-operative PROMs when compared to those at 6 and 12 months. Overall, two-thirds of patients achieved the minimum clinically important difference (MCID), and almost half achieved substantial clinical benefit (SCB) for iHOT-12 by 12 months. Pre-operatively, and at 12-month follow-up, iHOT-12 scores were significantly poorer in the pincer group compared to the cam and mixed pathology groups (p < 0.01). Multivariable analysis revealed PROMS improvement in the setting of a higher-grade cartilage lesion. CONCLUSION This registry study demonstrates that hip arthroscopy is an effective surgical treatment for patients with symptomatic FAI and results in a statistically significant improvement in PROMs which are maintained through 12 months follow-up. LEVEL OF EVIDENCE III.
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12
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Liu M, Yang C, Xu X, Ji S, Pan Y, Han N, Chang S, Sun G. The prognostic value of retinol binding protein in geriatric hip fractures after surgeries: A propensity score matching and 1-year follow-up study. BMC Musculoskelet Disord 2022; 23:1085. [PMID: 36510169 PMCID: PMC9743574 DOI: 10.1186/s12891-022-06068-0] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND We aimed to explore the predictive value of retinol binding protein (RBP) for outcomes of hip fractures. METHODS Patients with hip fractures who underwent hip surgeries between December 2017 and February 2021 and met the inclusion criteria were analyzed. Propensity score matching was used to reduce the bias of co-factors and ROC curves based on matched populations were created to determine the optimal cutoff point of RBP. The outcomes between patients with low levels of RBP and high levels of RBP were compared. RESULTS Four hundred eighty patients were enrolled in this study and 69 patients died within one year. After a 1:1 PSM, patients with more than 1-year survival had significantly higher RBP (p = 0.013) than those who died within one year, as well as patients divided by 6-months survival (p = 0.012). Logistics analysis showed that low RBP may be an independent risk factor for 3-month survival, 6-month survival, 1-year survival, and 3-month free walking ability. CONCLUSION RBP may be associated with the survival and 3-month walking abilities of patients with hip fractures.
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Affiliation(s)
- Mingchong Liu
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
| | - Chensong Yang
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
| | - Xian Xu
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
| | - Shengchao Ji
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
| | - Yutao Pan
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
| | - Ning Han
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
| | - Shimin Chang
- grid.24516.340000000123704535Yangpu Hospital, School of Medicine, Tongji University, Shanghai, 200092 China
| | - Guixin Sun
- grid.452753.20000 0004 1799 2798Department of Traumatic Surgery, School of Medicine, Shanghai East Hospital, Tongji University, Shanghai, 200092 China
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13
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Casas Reza P, Gestal Vázquez M, López Álvarez S. New ultrasound-guided capsular blocks for hip surgery: A narrative review. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:556-566. [PMID: 36220728 DOI: 10.1016/j.redare.2021.04.006] [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: 11/28/2020] [Accepted: 04/27/2021] [Indexed: 06/16/2023]
Abstract
Surgery on the hip joint is very common. Improving pain management has been and is one of the fundamental pillars to optimize the functional recovery of patients. To do this, we must design a multimodal anesthetic-analgesic plan that covers the entire perioperative period. Peripheral nerve blocks and fascial blocks are an important component of multimodal analgesic strategies. Traditional blocks have moderate efficacy, prolonged motor impairment, and increased risk of falls. As an alternative, capsular blocks ("ileopsoas plane block" or "IPB" and pericapsular nerve group block or "PENG block") have recently been described that aim to avoid motor impairment while maintaining optimal analgesic efficacy. The objective of this review is to describe the new capsular blocks and to analyze whether they allow to improve postoperative analgesia and promote functional recovery with fewer complications, based on the innervation of the hip. To do this, a bibliographic review was carried out in the PubMed, Embase and Cochrane Library databases from January 2018 to June 2020.
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Affiliation(s)
- P Casas Reza
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain.
| | - M Gestal Vázquez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - S López Álvarez
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
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Anido Guzmán JA, Robles Barragán FJ, Funcia de la Torre I, Alfonso Sanz F, Becerra Cayetano IA, de la Hoz Serrano C. Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:502-505. [PMID: 36088271 DOI: 10.1016/j.redare.2021.05.017] [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: 10/30/2020] [Accepted: 05/24/2021] [Indexed: 06/15/2023]
Abstract
Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block-a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.
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Affiliation(s)
- J A Anido Guzmán
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain.
| | - F J Robles Barragán
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - I Funcia de la Torre
- Servicio de Anestesiología y Reanimación, Hospital Vega Baja, Orihuela, Alicante, Spain
| | - F Alfonso Sanz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
| | - I A Becerra Cayetano
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - C de la Hoz Serrano
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, Spain
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15
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Han SB, Kim SB, Shin KH. Risk factors for postoperative pneumonia in patients undergoing hip fracture surgery: a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:553. [PMID: 35676675 DOI: 10.1186/s12891-022-05497-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postoperative pneumonia (POP) is a devastating complication that can frequently occur after hip fracture surgery. This study aimed to quantitatively and comprehensively summarize the risk factors for POP following hip fracture surgery. METHODS PubMed, Embase, and Cochrane Library were systematically searched for studies assessing risk factors for POP following hip fracture surgery. The pooled odds ratio (OR) and standardized mean difference (SMD) between patients with and without POP were calculated. Evidence was assessed using the Newcastle-Ottawa scale. RESULTS Ten studies including 37,130 patients with hip fractures were selected. POP occurred in 1768 cases with an accumulated incidence of 7.8% (95% confidence interval [CI]: 0.061-0.094). Advanced age (SMD: 0.50, 95% CI: 0.10-0.90), male sex (OR: 1.50, 95% CI: 1.12-2.01), American Society of Anesthesiologists physical status scale ≥3 (OR: 3.17, 95% CI: 1.25-8.05), chronic obstructive pulmonary disease (OR: 2.05, 95% CI: 1.43-2.94), coronary heart disease (OR: 1.82, 95% CI: 1.27-2.60), arrhythmia (OR: 1.49, 95% CI: 1.04-2.15), congestive heart failure (OR: 1.41, 95% CI: 1.14-1.75), chronic kidney disease (OR: 2.09, 95% CI: 1.28-3.41), and cerebrovascular accident (OR: 2.14, 95% CI: 1.60-2.85) were risk factors for POP. Hemoglobin (SMD: -0.14, 95% CI: - 0.25 to - 0.03), albumin (SMD: -0.97, 95% CI: - 1.54--0.41), blood urea nitrogen (SMD: 0.20, 95% CI: 0.03-0.37), alanine aminotransferase (SMD: 0.27, 95% CI: 0.10-0.44), arterial oxygen pressure (SMD: -0.49, 95% CI: - 0.71--0.27), time from injury to surgery (SMD: 0.13, 95% CI: 0.08-0.17), and surgery within 48 h (OR: 3.74, 95% CI: 2.40-5.85) were associated with the development of POP. CONCLUSION Patients with the aforementioned risk factors should be identified preoperatively, and related prophylaxis strategies should be implemented to prevent POP following hip fracture surgery.
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Badina A, du Cluzel de Remaurin X, Khouri N. Long-term outcomes of hip reconstruction surgery in children with GMFCS III diplegic cerebral palsy. Orthop Traumatol Surg Res 2022; 109:103344. [PMID: 35660081 DOI: 10.1016/j.otsr.2022.103344] [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: 02/23/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The results of hip reconstruction surgery are known for non-walking (GMFCS IV and V) and walking (GMFCS I and II) patients. Few studies deal with GMFCS III patients in isolation. Their intermediate functional status can be deteriorated by asymmetrical contractures, hip dislocation, multi-level deformities of the lower limbs, leading to motor function degradation, and possibly losing their ability to walk. The aim of our study was to establish whether surgical results were maintained over time and whether the functional status changed. MATERIAL AND METHODS Fifteen patients with GMFCS III spastic diplegia, treated for hip subluxation, were reviewed. The mean age at the time of surgery was 10 years old. The mean follow-up after surgery was 11 years. Reconstructive surgery was performed on 21 hips including pelvic osteotomy in all cases, with associated femoral osteotomy in 19 cases. Clinical (pain, joint mobility, walking aids, walking distance, GMFCS level) and radiological data (Melbourne Cerebral Palsy Hip Classification, standard coxometry) were recorded preoperatively and at the last follow-up. RESULTS Preoperatively, 6 patients were losing their ability to walk due to pain and flexion-adduction contracture. At the last follow-up, no patients had pain and joint mobility was improved in all cases. For one patient, recovery to their previous functional state required a period of two years. In the long term, 14 patients were GMFCS III and only one patient was GMFCS IV due to reasons unrelated to hip surgery. The radiological parameters improved significantly. The Melbourne score was IV preoperatively for all patients. At the last follow-up, 10 hips were grade I, 6 hips were grade II and 5 hips were grade III. DISCUSSION Correction of architectural disorders of the subluxed hip by pelvic osteotomy, in most cases associated with femoral osteotomy, improves functional and radiological status for GMFCS III patients. This improvement is maintained in the long-term. Complementary surgeries correcting the other deformities of the lower limbs were necessary in more than half of the patients. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Alina Badina
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Xavier du Cluzel de Remaurin
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France
| | - Nejib Khouri
- Service de chirurgie orthopédique pédiatrique, Hôpital Necker Enfants Malades, Université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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Xiong H, Chen X, Zhu W, Yang W, Wang F. Postoperative analgesic effectiveness of quadratus lumborum block: systematic review and meta-analysis for adult patients undergoing hip surgery. J Orthop Surg Res 2022; 17:282. [PMID: 35590364 DOI: 10.1186/s13018-022-03172-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Quadratus lumborum block is a truncal block with several technique variations. It has been reported as providing effective analgesia for postoperative pain. The aim of this study is to determine the efficacy of the QL block in providing postoperative analgesia for hip surgery when compared with placebo or no block or other analgesic techniques. METHODS Randomized trials evaluating quadratus lumborum block benefits in elective hip surgery were sought. The primary outcome was the 24 h opioid requirement after surgery. Two independent reviewers selected the studies and extracted the data. RESULTS Thirteen randomized-controlled trials were included in this study. The included studies had significant heterogeneity regarding comparator groups; therefore, a limited quantitative analysis was undertaken for the comparison of QL block versus no block or placebo only. QL block reduced the opioid use by 15.78 (95% CI, 2.31 to 29.26) mg IME in the first postoperative 24 h compared with no block or placebo with no difference in static pain scores, pain grade was reduced by 2.95 (95% CI, 2.40 to 3.60) in the QL block group compared with placebo or no block in the first postoperative 24 h during movement. CONCLUSIONS Our meta-analysis indicates that QL block may be effective for analgesia in patients after hip surgery compared with placebo or no block. There is currently limited evidence comparing QL block with other analgesic techniques for hip surgery.
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Chen X, Zhang J, Lin Y, Liu Z, Sun T, Wang X. Risk factors for postoperative mortality at 30 days in elderly Chinese patients with hip fractures. Osteoporos Int 2022; 33:1109-1116. [PMID: 34993561 DOI: 10.1007/s00198-021-06257-y] [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: 07/28/2021] [Accepted: 11/29/2021] [Indexed: 10/19/2022]
Abstract
UNLABELLED Arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery. It is important to improve short-term survival rates by optimizing the respiratory and cardiac function of geriatric patients before they undergo surgery. INTRODUCTION This study aims to investigate the 30-day mortality and related risk factors for elderly patients following surgery for hip fractures. METHODS This retrospective study examined chart reviews for evaluating associations of gender, age, fracture site, biochemical indicators, pre-surgery comorbidities, number of pre-surgery comorbidities, time to surgery and anesthesia and surgery methods with postoperative 30-day mortality in elderly hip fracture surgery patients. RESULTS A total of 1,004 patients were included in the study and 43 (4.3%) patients died within 30 days after surgery. Univariate analysis showed that patients in the non-survival group had a higher mean age, higher leukocyte counts, lower hemoglobin and albumin levels, a higher proportion of arrhythmias, pneumoniae and cardiac insufficiency and number of presurgical comorbidities than the survival group (all P-values < 0.05). Multivariate logistic analysis further confirmed that arrhythmia (OR = 2.033, P = 0.038), pneumonia (OR = 2.246, P = 0.041), cardiac insufficiency (OR = 2.833, P = 0.029), high leukocyte count (OR = 1.139, P = 0.009), and low albumin (OR = 0.925, P = 0.041) were all significant risk factors for mortality 30 days after surgery. CONCLUSIONS This study demonstrates that arrhythmia, pneumonia, cardiac insufficiency, a high leukocyte count, and low albumin concentrations were associated with increased 30-day mortality in elderly hip fracture patients after surgery.
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Affiliation(s)
- X Chen
- Department of Orthopaedics, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - J Zhang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - Y Lin
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - Z Liu
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - T Sun
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China
| | - X Wang
- Department of Orthopaedics, The Seventh Medical Center, Chinese PLA General Hospital, No. 5 Nanmencang, Beijing, 100700, China.
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Li YY, Wang JJ, Huang SH, Kuo CL, Chen JY, Liu CF, Chu CC. Implementation of a machine learning application in preoperative risk assessment for hip repair surgery. BMC Anesthesiol 2022; 22:116. [PMID: 35459103 PMCID: PMC9034633 DOI: 10.1186/s12871-022-01648-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/07/2022] [Indexed: 12/22/2022] Open
Abstract
Background This study aims to develop a machine learning-based application in a real-world medical domain to assist anesthesiologists in assessing the risk of complications in patients after a hip surgery. Methods Data from adult patients who underwent hip repair surgery at Chi-Mei Medical Center and its 2 branch hospitals from January 1, 2013, to March 31, 2020, were analyzed. Patients with incomplete data were excluded. A total of 22 features were included in the algorithms, including demographics, comorbidities, and major preoperative laboratory data from the database. The primary outcome was a composite of adverse events (in-hospital mortality, acute myocardial infarction, stroke, respiratory, hepatic and renal failure, and sepsis). Secondary outcomes were intensive care unit (ICU) admission and prolonged length of stay (PLOS). The data obtained were imported into 7 machine learning algorithms to predict the risk of adverse outcomes. Seventy percent of the data were randomly selected for training, leaving 30% for testing. The performances of the models were evaluated by the area under the receiver operating characteristic curve (AUROC). The optimal algorithm with the highest AUROC was used to build a web-based application, then integrated into the hospital information system (HIS) for clinical use. Results Data from 4,448 patients were analyzed; 102 (2.3%), 160 (3.6%), and 401 (9.0%) patients had primary composite adverse outcomes, ICU admission, and PLOS, respectively. Our optimal model had a superior performance (AUROC by DeLong test) than that of ASA-PS in predicting the primary composite outcomes (0.810 vs. 0.629, p < 0.01), ICU admission (0.835 vs. 0.692, p < 0.01), and PLOS (0.832 vs. 0.618, p < 0.01). Conclusions The hospital-specific machine learning model outperformed the ASA-PS in risk assessment. This web-based application gained high satisfaction from anesthesiologists after online use.
Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01648-y.
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Affiliation(s)
- Yu-Yu Li
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sheng-Han Huang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chi-Lin Kuo
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
| | - Chin-Chen Chu
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
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Abstract
Background Hip fracture and surgery are associated with moderate to severe pain, which hampers early mobilization and extends the hospital stay. Femoral nerve block and fascia iliaca compartment block could provide effective postoperative pain relief. Unfortunately, they could weaken the strength of the quadriceps muscle and increase the risk of falls. Iliopsoas plane block (IPB) is a novel motor-sparing regional technique, which targets the sensory branches of the hip joint originating from the femoral nerve. However, the analgesic effect of IPB has not been confirmed yet. Case presentation In the present case series, IPB and lateral femoral cutaneous nerve block were implemented under the guidance of ultrasound for eight patients with hip fractures. The median (IQR) visual analog scale (VAS) score (0–10; 0: no pain, 10: worst pain) decreased from 1.5 (0.25–2) before IPB to 0 (0–0) 0.5h after IPB at rest. The median (IQR) VAS score decreased from 8 (7–8) before IPB to 2 (1–2) 0.5h after IPB during flexion of hip 30°. Pain score was no more than one at rest and three during flexion of the hip 30° within 48h after surgery. Furthermore, the MMT grades of quadriceps strength were no less than four after IPB. Conclusions Our case series firstly highlights that IPB might be an effective analgesic technique for hip fracture and surgery, while retaining motor function.
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Affiliation(s)
- Chun-Guang Wang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China.
| | - Yang Yang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China
| | - Ming-Yu Yang
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China
| | - Xiu-Li Wang
- Department of Anesthesiology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yan-Ling Ding
- Department of Anesthesiology, The First Central Hospital of Baoding, Northern Great wall Street 320#, Baoding, 071000, Hebei, China
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Guo LS, Wang LN, Xiao JB, Zhong M, Zhao GF. Association between anesthesia technique and complications after hip surgery in the elderly population. World J Clin Cases 2022; 10:2721-2732. [PMID: 35434108 PMCID: PMC8968814 DOI: 10.12998/wjcc.v10.i9.2721] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/24/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Spinal anesthesia is superior to general anesthesia for postoperative recovery in older patients (≥ 65 age). However, evidence for this is lacking.
AIM To evaluate the effect of anesthesia on postoperative complications in older patients undergoing hip surgery.
METHODS This is a retrospective, propensity score-matched, cohort study. Patients ≥ 65-years-old who underwent hip surgery at the Traditional Chinese Medicine of Guangdong Provincial Hospital in China from October 2016 to June 2020 were included. The operative methods were femoral fracture’s internal fixation and hip replacement. The orthopedic doctors in different hospitals of our group have varied requirements for patients’ out-of-bed time after surgery. Therefore, spinal anesthesia or general anesthesia was selected according to the requirements of the orthopedic doctors. The primary outcome of this study was complications during the hospitalization of the postoperative patient. The length of hospital stay, postoperative blood transfusion, routine blood analysis, renal function, coagulation function, and inflammatory correlations were secondary outcomes. Propensity score matching (PSM) was performed utilizing logistic regression.
RESULTS Among the 864 patients identified from the electronic medical record data database, we screened out those with incomplete medical record data. After PSM of the baseline values of the two groups of patients, data of 309 patients (206 patients in spinal anesthesia group and 103 patients in general anesthesia) were utilized in this study. 67/309 patients had complications, including postoperative limb dysfunction, pulmonary infection, delirium, lower extremity venous thrombosis, and shock. The incidence of complications was not related to anesthesia methods (P > 0.05), but the levels of D-Dimer (P = 0.017), fibrinogen (P = 0.005), and high-sensitivity C-reactive protein (hsCRP) (P = 0.002) in the spinal anesthesia group were significantly higher than those in the general anesthesia group.
CONCLUSION Anesthesia technology is not a risk factor for postoperative complications of hip surgery. The levels of D-Dimer and hsCRP were higher in the spinal anesthesia group.
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Affiliation(s)
- Ling-Song Guo
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Li-Nan Wang
- Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
| | - Jian-Bing Xiao
- Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (the Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou 510000, Guangdong Province, China
| | - Min Zhong
- Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (the Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou 510000, Guangdong Province, China
| | - Gao-Feng Zhao
- Department of Anaesthesiology, Guangdong Provincial Hospital of Chinese Medicine (the Second Affiliated Hospital of Guangzhou University of Chinese Medicine), Guangzhou 510000, Guangdong Province, China
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22
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Gomes D, Ribeiro DC, Ferreira T, da Costa GV, Canella RP, de Castro MP. Knee and hip dynamic muscle strength in individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy: A case-control study. Clin Biomech (Bristol, Avon) 2022; 93:105584. [PMID: 35149303 DOI: 10.1016/j.clinbiomech.2022.105584] [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: 07/26/2021] [Revised: 12/09/2021] [Accepted: 01/24/2022] [Indexed: 02/07/2023]
Abstract
Background The primary aim of this study was to compare knee and hip dynamic muscle strength of individuals with femoroacetabular impingement (FAI) syndrome scheduled for hip arthroscopy with healthy controls. Our secondary aim was to compare hip and knee muscle strength between male and female patients with FAI syndrome. Methods One hundred and thirty-four individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy and 134 healthy controls matched for sex and age (within 5 years range) underwent an isokinetic assessment of knee extension and flexion and hip abduction, adduction, external rotation and internal rotation dynamic muscle strength. Two MANOVAs were conducted to compare isokinetic peak torque and total work between groups and sexes. Findings Individuals with femoroacetabular impingement syndrome demonstrated lower values of all variables representing knee and hip isokinetic peak torque and total work measures when compared to healthy controls, with differences ranging from 0.09 Nm/kg (95%CI: 0.06-0.12 Nm/kg) to 0.64 Nm/kg (95%CI: 0.49-0.79 Nm/kg). Female participants from both FAI syndrome and control group showed less knee and hip muscle strength compared to male participants. There was no significant interaction between group and sex regarding knee or hip isokinetic peak torque and total work (p > 0.05). Interpretation Individuals with femoroacetabular impingement syndrome scheduled for hip arthroscopy present impairments in knee or hip dynamic muscle strength when compared to controls. Female participants present less knee and hip muscular strength compared to male participants, these between-sex differences are similar for both FAI syndrome and control group participants.
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Affiliation(s)
- Diogo Gomes
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil; Rehabilitation Sciences Department, Biomechanics Laboratory, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Daniel C Ribeiro
- Centre for Health, Activity and Rehabilitation Research (CHARR) School of Physiotherapy - University of Otago, New Zealand
| | - Taylor Ferreira
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil
| | - Guilherme V da Costa
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil
| | - Richard P Canella
- Core Centre of Orthopedics and Rehabilitation, Florianópolis, Brazil
| | - Marcelo P de Castro
- LaBClin Neuromusculoskeletal Rehabilitation and Clinical Biomechanics Laboratory, Florianópolis, Brazil.
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23
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Schwarz TJ, Maderbacher G, Leiss F, Grifka J, Heers G, Matussek J. Three-dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position using an external fixator as navigation tool during reorientation procedure. Arch Orthop Trauma Surg 2022; 142:381-6. [PMID: 33098458 DOI: 10.1007/s00402-020-03632-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Bernese periacetabular osteotomy is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection with residual dysplasia or femoroacetabular impingement. Thus, we wanted to find a simple method to control the effect of correction in the sagittal and coronal plane. METHOD The acetabular coordinates are shown by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the acetabular fragment with two Schanz screws. This method enables the isolated acetabular reorientation in the coronal, sagittal, and transverse plane. In a sawbone pelvis model, the acetabular rim is marked with a copper wire and a silicon adherent. To show the radiographic effect on acetabular parameters and the rim position, we visualized correction in the coronal and sagittal plane under fluoroscopic control. RESULTS Lateral rotation of the acetabular fragment had the highest impact on radiographic lateral coverage of the femoral head. But also ventral coverage increased during isolated lateral rotation. Anterior rotation showed almost no effect on lateral coverage and just a little effect on ventral coverage but caused severe total acetabular retroversion. CONCLUSION Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and under-correction. Isolated lateral rotation of the acetabular fragment should be the predominant direction of correction during periacetabular osteotomy. Ambitious anterior correction may be the main source for severe acetabular retroversion following periacetabular osteotomy.
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24
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Labanca L, Ciardulli F, Bonsanto F, Sommella N, Di Martino A, Benedetti MG. Balance and proprioception impairment, assessment tools, and rehabilitation training in patients with total hip arthroplasty: a systematic review. BMC Musculoskelet Disord 2021; 22:1055. [PMID: 34930190 PMCID: PMC8690357 DOI: 10.1186/s12891-021-04919-w] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 11/28/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Osteoarthritis and subsequent total hip arthroplasty (THA) lead to damages to hip joint mechanoceptors, which in turns lead to impairments in proprioception. One of the abilities mainly affected by an altered joint proprioception is balance. The aim of this work was to investigate the balance and proprioception impairments, current assessment tools, and rehabilitation training after THA. METHODS A systematic literature revision was conducted on PubMed, Web of Science and Cochrane databases. Articles reporting balance and proprioception impairments, current assessment tools, or rehabilitation interventions were included. Methodological quality was assessed using the Downs and Black checklist. A total of 41 articles were included, 33 discussing balance and proprioception assessment, and 8 dealing with training. Data related to type of surgical approach, type and timing of assessment protocols, assessment instrumentation, and type, volume and duration of the rehabilitation training were extracted from each study. RESULTS Thirty-one studies were of high quality, 2 of moderate quality and 8 of low-quality. Literature review showed an improvement in balance following THA in comparison with the pre-operative performance, although balance abnormalities persist up to 5 years after surgery, with THA patients showing an increased risk for falls. Balance training is effective in all the rehabilitation phases if specifically structured for balance enhancement and consistent in training volume. It remains unclear which assessments are more appropriate for the different rehabilitation phases, and if differences exist between the different surgical procedures used for THA. Only two studies assessed proprioception. CONCLUSION Balance and proprioception show impairments up to 5 years after THA, increasing the risk of falls. However, patients with THA may benefit of an adequate balance training. Further research is needed to investigate the gaps in balance and proprioception assessment and training following THA surgery.
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Affiliation(s)
- Luciana Labanca
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy. .,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Francesca Ciardulli
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Fabio Bonsanto
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Nadia Sommella
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy
| | - Alberto Di Martino
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,I Orthopaedic Clinic, IRCSS- Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Maria Grazia Benedetti
- Physical Medicine and Rehabilitation Unit, IRCCS - Istituto Ortopedico Rizzoli, Via Giulio Cesare Pupilli 1, 40136, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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Anido Guzmán JA, Javier Robles Barragán F, Funcia de la Torre I, Alfonso Sanz F, Becerra Cayetano IA, de la Hoz Serrano C. Bilateral pericapsular nerves group (PENG) block for analgesia in pediatric hip surgery. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00189-4. [PMID: 34538664 DOI: 10.1016/j.redar.2021.05.018] [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] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/07/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
Effective management and control of peri- and postoperative pain in hip surgery is essential in order to minimize the use of opioids and their adverse effects. Effective regional analgesia for hip pain is made particularly challenging by the complex innervation of the hip joint. Standard regional techniques can be associated with complications, including incomplete anesthesia, hypotension, or lower limb weakness. We present the case of a 5-year-old girl with a history of infantile cerebral palsy who underwent bilateral varus derotation osteotomy and adductor tenotomy due to paralytic dislocation. She received bilateral PENG block and femoral cutaneous nerve block - a simple technique that covers all the nerves involved in the sensory innervation of the joint capsule without the need for multiple injections.
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Affiliation(s)
- J A Anido Guzmán
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, España.
| | - F Javier Robles Barragán
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - I Funcia de la Torre
- Servicio de Anestesiología y Reanimación, Hospital Vega Baja, Orihuela, Alicante, España
| | - F Alfonso Sanz
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
| | - I A Becerra Cayetano
- Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen Macarena, Sevilla, España
| | - C de la Hoz Serrano
- Servicio de Anestesiología y Reanimación, Complejo Hospitalario Universitario de Badajoz, Badajoz, España
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Tarekegn F, Sisay A. A review of evidence-based clinical practice on fascia iliaca compartment block for lower limb injury. Ann Med Surg (Lond) 2021; 69:102758. [PMID: 34484728 PMCID: PMC8391022 DOI: 10.1016/j.amsu.2021.102758] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/22/2021] [Accepted: 08/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The main objective of this study was to resolve fascia iliaca compartment block controversies by putting the currently available evidences applied for knee, femoral shaft, and hip bone injury or related to surgery. METHODS The databases PubMed, Cochrane Review, and Google Scholar were searched without regard to language or publication type for fascia iliaca compartment block before December 2020. After eligibility sorting and duplicate removal, a total of 26,609 articles were identified, with 21 of them being included for review. DISCUSSION In the emergency department, fascia iliaca compartment block (FICB) has now become the standard of practice. Various evidence suggested that 20-40 ml of local anesthetic was required for an effective block in adult patients. CONCLUSION For the knee, femoral bone, and hip region surgery, the fascia iliaca compartment block (FICB) provided better anesthesia quality, reduced systemic morphine consumption, and had fewer complications than epidural anesthesia. Anesthetists and surgical department staff should promote the FICB's benefits by emphasizing its superiority in pain management.
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Affiliation(s)
| | - Amanuel Sisay
- Department of Anesthesia, Bahir Dar University, Ethiopia
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27
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Verbeek T, Adhikary S, Urman R, Liu H. The Application of Fascia Iliaca Compartment Block for Acute Pain Control of Hip Fracture and Surgery. Curr Pain Headache Rep 2021; 25:22. [PMID: 33694008 DOI: 10.1007/s11916-021-00940-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE OF REVIEW Over 300,000 patients are hospitalized annually following hip fractures in the USA. Many patients experienced inadequate analgesia. We will review the perioperative effects of the fascia iliaca compartment block (FICB) in hip fracture patients. RECENT FINDINGS FICB by injecting local anesthetics beneath the fascia iliaca results in significant pain relief in hip fractures. Neuropathies and vascular injuries are almost unlikely. Single-shot FICB is faster to place, yet providing about 8 h of analgesia when bupivacaine is used. Continuous FICB provides prolonged titratable analgesia, improved patient satisfaction, and leads to faster hospital discharge. FICB reduces opioid consumption, decreases morbidity and mortality, reduces hospital stay, reduces delirium, and improves satisfaction. FICB should form part of a multimodal analgesic regime, in the context of a multidisciplinary approach to the management of hip fracture patients. More clinical investigations are needed to validate the long-term outcome benefits of FICB in hip fracture patients.
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28
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Zhou X, Zhang Y, Teng Y, Chen AC, Liu T, Yang H, He F. Predictors of postoperative acute kidney injury in patients undergoing hip fracture surgery: A systematic review and meta-analysis. Injury 2021; 52:330-338. [PMID: 33039183 DOI: 10.1016/j.injury.2020.09.060] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/22/2020] [Revised: 08/06/2020] [Accepted: 09/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND The present study aimed to summarize the predictors of acute kidney injury (AKI) in patients after hip surgery. METHODS A literature search was performed using PubMed, EMBASE, Cochrane Library, and Web of Science for studies assessing the predictors of AKI after hip fracture surgery. Pooled odds ratio (OR) and mean difference (MD) of those who experienced AKI compared to those who did not were calculated for each variable. Evidence was assessed using the Newcastle-Ottawa Scale. RESULTS Ten studies with 34 potential factors were included in the meta-analysis. In the primary analysis, 12 factors were associated with AKI, comprising males (OR 1.25; 95% confidence interval (CI) 1.14-1.36), advanced age (MD 2.28; 95% CI 0.80-3.75), myocardial infarction (OR 1.39; 95% CI 1.18-1.63), hypertension (OR 1.46; 95% CI 1.13-1.89), diabetes (OR 1.84; 95% CI 1.40-2.42), chronic kidney disease (OR 3.66; 95% CI 2.21-6.07), hip arthroplasty (OR 1.35; 95% CI 1.22-1.50), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers use (OR 2.28; 95% CI 1.68-3.08), more intraoperative blood loss (MD 44.06; 95% CI 2.88-85.24), higher preoperative blood urea nitrogen levels (MD 5.29; 95% CI 3.38-7.20), higher preoperative serum creatinine levels (MD 0.4; 95% CI 0.26-0.53), and lower preoperative estimated glomerular filtration rate (MD -19.59; 95% CI -26.92--12.26). Another 13 factors related to AKI in individual studies were identified in the systematic review. CONCLUSION Related prophylaxis strategies should be implemented in patients involved with the above-mentioned characteristics to prevent AKI after hip surgery.
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Affiliation(s)
- Xinfeng Zhou
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou 215006, China; Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, China
| | - Yijian Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou 215006, China; Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, China
| | - Yun Teng
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou 215006, China; Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, China
| | - Angela Carley Chen
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario NZL 3G1, Canada
| | - Tao Liu
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou 215006, China
| | - Huilin Yang
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou 215006, China; Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, China
| | - Fan He
- Department of Orthopaedics, The First Affiliated Hospital of Soochow University, Soochow University, Suzhou 215006, China; Orthopaedic Institute, Medical College, Soochow University, Suzhou 215007, China.
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29
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Ma J, Li C, Zhang W, Zhou L, Shu S, Wang S, Wang D, Chai X. Preoperative anxiety predicted the incidence of postoperative delirium in patients undergoing total hip arthroplasty: a prospective cohort study. BMC Anesthesiol 2021; 21:48. [PMID: 33579195 PMCID: PMC7879687 DOI: 10.1186/s12871-021-01271-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/08/2021] [Indexed: 12/16/2022] Open
Abstract
Background Delirium was characterized with a series of symptoms of a sudden onset of disturbances in attention, a loss in memory loss and defects in other cognitive abilities that were also appeared in the syndrome of anxiety. Even though there are overlapped clinical symptoms existed in anxiety and delirium, the relationship between anxiety and delirium was still unclear. The propose of this study was to investigated the effect of preoperative anxiety on postoperative delirium. Methods Three hundred and seventy-two adults undergoing total hip arthroplasty were enrolled from October 2019 to May 2020 in the study. The preoperative anxiety was measured with the Hospital Anxiety and Depression Scale-Anxiety (HADS-A). The participants were allocated into anxiety group (HADS-A≧7) and non-anxiety group (HADS-A < 7). The primary outcome was the incidence of the postoperative delirium assessed with the Confusion Assessment Method (CAM). The secondary outcomes were the duration and the severity of delirium evaluated with the Memorial Delirium assessment Scale (MDAS). The risks of delirium were also evaluated with logistic regression analysis. Results There were 325 patients enrolled in the end, 95 of whom met the criteria for anxiety. The incidence of delirium was 17.8% in all participants. The patients with anxiety had a higher incidence of delirium than the non-anxiety patients (25.3% vs. 14.8%, odds ratio (OR) = 0.51, 95% confidence interval (CI) = 0.92–0.29, p = 0.025). However, no significant differences were found in the duration and the severity of the delirium between the above two groups. The age, alcohol abuse, history of stroke, scores of the HADS-A, and education level were considered to be predictors of delirium. Conclusions The preoperative anxiety predicted the incidence of the postoperative delirium in total hip arthroplasty patients. The related intervention may be a good point for delirium prophylaxis. Trial registration It was registered at Chinese Clinical Trial Registry (www.chictr.org.cn) with the name of “the effect of preoperative anxiety on the postoperative cognitive function” (ChiCTR1900026054) at September 19, 2019.
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Affiliation(s)
- Jun Ma
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Chuanyao Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Wei Zhang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Ling Zhou
- Anhui Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.,Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Shuhua Shu
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Sheng Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Di Wang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China
| | - Xiaoqing Chai
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Hefei, 230001, Anhui, China.
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Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKM. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop 2021. [PMID: 32862265 DOI: 10.1007/s00264-020-04739-y/figures/2] [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] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. METHODS A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. RESULTS Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. CONCLUSION COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
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Affiliation(s)
- A Narang
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - G Chan
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - A Aframian
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Z Ali
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - A Carr
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - H Goodier
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - C Morgan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - C Park
- St Mary's Hospital, London, London, UK
| | - K Sugand
- St Mary's Hospital, London, London, UK
| | - T Walton
- Brighton and Sussex University Hospitals, Brighton, UK
| | - M Wilson
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - A Belgaumkar
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK
| | - K Gallagher
- Poole General Hospital & the Royal Bournemouth Hospital, Poole, UK
| | - K Ghosh
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - C Gibbons
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - A Keightley
- Royal Surrey Hospital NHS Foundation Trust, Guildford, UK
| | - Z Nawaz
- Frimley Park Hospital, Camberley, UK
| | - C Wakeling
- Western Sussex Hospitals NHS Foundation Trust, Chichester, UK
| | - K Sarraf
- St Mary's Hospital, London, London, UK
| | - B A Rogers
- Brighton and Sussex University Hospitals, Brighton, UK
| | - W K M Kieffer
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Canada Avenue, Redhill, Surrey, RH1 5RH, UK.
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Lim MA, Pranata R. Coronavirus disease 2019 (COVID-19) markedly increased mortality in patients with hip fracture - A systematic review and meta-analysis. J Clin Orthop Trauma 2021; 12:187-193. [PMID: 32958988 PMCID: PMC7495188 DOI: 10.1016/j.jcot.2020.09.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [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: 07/30/2020] [Revised: 08/21/2020] [Accepted: 09/14/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION This systematic review and meta-analysis aimed to evaluate the prevalence of coronavirus disease 2019 (COVID-19) and its impact on mortality in patients with hip fracture. METHODS We performed a systematic literature search in PubMed, Cochrane Central Database, and medRvix from inception up to July 13, 2020 on research articles that enrolled hip fracture patients who had information on COVID-19 and clinically validated definition of death. RESULTS A total of 984 participants from 6 studies were included in our study. The pooled prevalence of COVID-19 was 9% [95% CI: 7-11%]. The mortality rate in patients with concomitant hip fracture and COVID-19 was found to be 36% (95% CI: 26-47%), whereas the mortality rate in hip fracture without COVID-19 is 2% (95% CI: 1-3%). Meta-analysis showed that COVID-19 was associated with a seven-fold increase in risk (RR 7.45 [95% CI: 2.72, 20.43], p < 0.001; I2: 68.6%) of mortality in patients with hip fracture. Regression-based Harbord's test showed no indication of small-study effects (p = 0.06). CONCLUSION The present meta-analysis showed that COVID-19 increased the risk of mortality in patients with hip fracture. TRIAL REGISTRATION This study is registered with PROSPERO, July 21, 2020, number CRD42020199618. Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020199618.
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Affiliation(s)
- Michael Anthonius Lim
- Corresponding author. Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
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Pang C, Aqil A, Mannan A, Thomas G, Hossain FS. Hip fracture patients admitted to hospital on weekends are not at increased risk of 30-day mortality as compared with weekdays. J Orthop Traumatol 2020; 21:23. [PMID: 33263820 PMCID: PMC7710845 DOI: 10.1186/s10195-020-00558-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 10/29/2020] [Indexed: 11/27/2022] Open
Abstract
Background Hip fractures remain a major health concern owing to the increasing elderly population and their association with significant morbidity and mortality. The effects of weekend admission on mortality have been studied since the late 1970s. Despite most studies showing that mortality rates are higher for patients admitted on a weekend, the characteristics of the admitted patients have remained unclear. We aim to investigate this ‘weekend effect’ at our hospital in patients presenting with a hip fracture. Methods Patients undergoing acute hip fracture surgery were identified from the local National Hip Fracture Database. Patient demographics, fracture type, co-morbidities and admission blood parameters were examined. The outcome analysed was 30-day mortality. The data were analysed with regard to day of admission, i.e. weekday (Monday to Friday) or weekend (Saturday and Sunday). Results A total of 894 patients were included. Results demonstrated that 30-day mortality was similar on the weekend compared with the weekday (6.96% versus 10.39%, OR 0.65, 95% CI 0.36–1.14, p = 0.128) for patients who sustained an acute hip fracture. The total number of deaths within 30 days was 85 (69 weekday versus 16 weekend). This remained non-significant after adjusting for several variables: age and sex only (OR = 0.65, 95% CI 0.37–1.16, p = 0.146), age, sex, and care variables (OR = 0.59, 95% CI 0.33–1.06, p = 0.080), age, sex, and blood test results (OR = 0.62, 95% CI 0.35–1.12, p = 0.111), and all covariates (OR = 0.69, 95% CI 0.29–1.62, p = 0.392). In the fully adjusted model, the following variables were independent predictors of mortality: sex (male) (OR = 1.93, 95% CI 1.11–3.35, p = 0.019) and ASA > 2 (OR = 2.6, 95% CI 1.11–6.11, p = 0.028) and age (1.08, 95% CI 1.04–1.13, p < 0.001). Conclusion The evidence for a ‘weekend effect’ in patients with a hip fracture is absent in this study. However, we have shown other factors that are associated with increased mortality such as increased age, male sex and higher ASA grade. Level of evidence Level 3.
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Affiliation(s)
- Calver Pang
- Division of Surgery and Interventional Science, Royal Free Hospital, University College London, 9th Floor, 10 Pond Street, London, NW3 2PS, UK.
| | - A Aqil
- Yorkshire and Humber Deanery, Yorkshire, UK
| | - A Mannan
- Harrogate and District NHS Foundation Trust, Lancaster Park Road, Harrogate, HG2 7SX, UK
| | - G Thomas
- Airedale NHS Foundation Trust, Skipton Road, Steeton, Keighley, BD20 6TD, UK
| | - F S Hossain
- Manor Hospital, Walsall Healthcare NHS Trust, Moat Road, Walsall, WS2 9PS, UK
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Narang A, Chan G, Aframian A, Ali Z, Carr A, Goodier H, Morgan C, Park C, Sugand K, Walton T, Wilson M, Belgaumkar A, Gallagher K, Ghosh K, Gibbons C, Keightley A, Nawaz Z, Wakeling C, Sarraf K, Rogers BA, Kieffer WKM. Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study. Int Orthop 2021; 45:23-31. [PMID: 32862265 DOI: 10.1007/s00264-020-04739-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 07/15/2020] [Indexed: 11/21/2022]
Abstract
Purpose Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients. Methods A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019. Results Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57–5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification. Conclusion COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.
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Rosanò E, Tavoletti D, Luccarelli G, Cerutti E, Pecora L. [Incidence of epidural spread after Chayen's approach to lumbar plexus block: a retrospective study]. Rev Bras Anestesiol 2020; 70:202-208. [PMID: 32527500 DOI: 10.1016/j.bjan.2020.03.003] [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] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/15/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The lumbar plexus block (LPB) is a key technique for lower limb surgery. All approaches to the LPB involve a number of complications. We hypothesized that Chayen's approach, which involves a more caudal and more lateral needle entry point than the major techniques described in the literature, would be associated with a lower rate of epidural spread. METHOD We reviewed the electronic medical records and chart of all adult patients who underwent orthopedic surgery for total hip arthroplasty (THA) and hip hemiarthroplasty due to osteoarthritis and femoral neck fracture with LPB and sciatic nerve block (SNB) between January 1, 2002, and December 31, 2017, in our institute. The LPB was performed according to Chayen's technique using a mixture of mepivacaine and levobupivacaine (total volume, 25 mL) and a SNB by the parasacral approach. The sensory and motor block was evaluated bilaterally during intraoperative and postoperative period. RESULTS A total number of 700 patients with American Society of Anesthesiologists (ASA) physical status I to IV who underwent LPB met the inclusion criteria. The LPB and SNB was successfully performed in all patients. Epidural spread was reported in a single patient (0.14%; p <0.05), accounting for an 8.30% reduction compared with the other approaches described in the literature. No other complications were recorded. CONCLUSIONS This retrospective study indicates that more caudal and more lateral approach to the LPB, such as the Chayen's approach, is characterized by a lower epidural spread than the other approach to the LPB.
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Affiliation(s)
- Elisabetta Rosanò
- Ospedali Riuniti, Marche Polytechnic University, Department of Emergency, Clinic of Anesthesia and Intensive Care Unit, Ancona, Italy.
| | - Diego Tavoletti
- Ospedali Riuniti, Marche Polytechnic University, Department of Emergency, Clinic of Anesthesia and Intensive Care Unit, Ancona, Italy
| | - Giulia Luccarelli
- Ospedali Riuniti, Marche Polytechnic University, Department of Emergency, Clinic of Anesthesia and Intensive Care Unit, Ancona, Italy
| | - Elisabetta Cerutti
- Ospedali Riuniti Ancona, Department of Emergency, Anesthesia and Intensive care of Transplantation and Major Surgery, Ancona, Italy
| | - Luca Pecora
- Ospedali Riuniti Ancona, Department of Emergency, Anesthesia and Intensive care of Transplantation and Major Surgery, Ancona, Italy
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Canetti R, de Saint Vincent B, Vieira TD, Fière V, Thaunat M. Spinopelvic parameters in greater trochanteric pain syndrome: a retrospective case-control study. Skeletal Radiol 2020; 49:773-778. [PMID: 31828381 DOI: 10.1007/s00256-019-03359-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Greater trochanteric pain syndrome (GTPS) is a condition resulting in lateral hip pain, most commonly caused by tendinosis or tear of the gluteus medius and minimus tendons, and greater trochanteric bursitis. Our aim was to assess pelvic parameters and proximal femoral anatomy in patients suffering from surgical-stage GTPS compared with a control group. METHODS This retrospective, case-control study assessed 43 patients suffering from GTPS, matched according to age, gender, body mass index and level of sport and physical activity to 43 control patients, between 2013 and 2018. Pelvic parameters, including pelvic incidence (PI), pelvic tilt (PT) and sacral slope (SS), and proximal femoral anatomy, including femoral offset (FO) and neck-shaft angle (NSA), were measured using the EOS Imaging™ system. RESULTS GTPS patients had a significantly lower mean (± SD) SS than control patients (33.1 ± 10.4 vs. 39.6 ± 9.7°, respectively; p < 0.05). There was no significant difference in PT (21.3 ± 7.1 vs. 19.0 ± 7.2°), PI (53.5 ± 11.6 vs. 57.7 ± 10.5°), FO (40.4 ± 8 vs. 42.2 ± 6.8°) or NSA (125.1 ± 5.8 vs. 124.4 ± 4.7°). There was no difference in lower back pain symptoms in a subgroup analysis of GTPS patients. CONCLUSIONS Sacral slope was lower in patients with surgical-stage GTPS than in asymptomatic hip patients, using the EOS Imaging™ system.
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Affiliation(s)
- Robin Canetti
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Benoit de Saint Vincent
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Thais D Vieira
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Vincent Fière
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Mathieu Thaunat
- Ramsay Générale de Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
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Ueno T, Kabata T, Kajino Y, Inoue D, Ohmori T, Yoshitani J, Ueoka K, Yamamuro Y, Tsuchiya H. Risk factors for pressure ulcers from the use of a pelvic positioner in hip surgery: a retrospective observational cohort study in 229 patients. Patient Saf Surg 2020; 14:10. [PMID: 32280374 PMCID: PMC7137331 DOI: 10.1186/s13037-020-00237-7] [Citation(s) in RCA: 5] [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] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/30/2020] [Indexed: 01/01/2023] Open
Abstract
Background Intraoperatively acquired pressure ulcers are serious postsurgical complications requiring additional treatment, reoperation, and extended hospitalization. No study has investigated the frequency of the ulcers caused by compression with a pelvic positioner, which is used in hip surgeries to stabilize patients in the lateral decubitus position. Methods This retrospective study investigated the risk factors and the frequency of the ulcers caused by the use of pelvic positioners in hip surgeries. The records of patients who underwent surgical procedures under general anesthesia at our institution between January 1, 2016 and March 31, 2018 were reviewed. The inclusion criterion for the assessment of risk factors was hip surgery in the lateral decubitus position stabilized by a pelvic positioner. The exclusion criteria were patients with trauma, missing data, or a pre-existing pressure ulcer. Finally,.the study included 229 patients (265 hip surgeries). All the patients were positioned in the lateral decubitus position with the assistance of either a pelvic positioner, which had a single support fixture located over the pubic symphysis or a double support fixture located over the bilateral anterior superior iliac spine. Intraoperatively acquired pressure ulcers were diagnosed when ulcers were absent on admission and the redness that was observed immediately after surgery remained after 24 h. Multivariate analysis was used to identify factors associated with an increased risk for ulcers. Results Ulcers developed in 8 of 1810 (0.44%) patients who underwent orthopedic surgery. Seven of the 265 (2.64%) patients who underwent hip surgery in the lateral decubitus position stabilized by a pelvic positioner developed ulcers. All ulcers were located on areas of the body that were compressed by the pelvic positioner. After identifying controls for patient height (less than 154 cm), surgery duration (longer than 180 min), blood loss (more than 355 ml), and type of pelvic positioner used, we identified the independent risk factors for ulcers to be patient height < 154 cm (adjusted odds ratio, 12.8; p-value, 0.032) and the use of pelvic positioners with pubic bone support (adjusted odds ratio, 10.53; p-value, 0.047). Conclusion The use of pelvic positioners with pubic bone support should be avoided in patients with a height of < 154 cm to decrease the risk of ulcers.
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Affiliation(s)
- Takuro Ueno
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Tamon Kabata
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Yoshitomo Kajino
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Daisuke Inoue
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Takaaki Ohmori
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Junya Yoshitani
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Ken Ueoka
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Yuki Yamamuro
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Kanazawa University Graduate School of Medical Sciences, 13-1 Takaramachi, Kanazawa, Ishikawa 920-8641 Japan
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Jaja PT, Allen-Taylor A. Early outcomes of post-operative hip and proximal thigh wounds dressed with post-op opsite™ versus povidone-iodine based dressing: Protocol for a randomized trial. Contemp Clin Trials Commun 2020; 17:100526. [PMID: 31989059 PMCID: PMC6971335 DOI: 10.1016/j.conctc.2020.100526] [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] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/26/2019] [Accepted: 01/11/2020] [Indexed: 11/26/2022] Open
Abstract
This is a parallel group, randomized controlled trial to compare the early outcomes of post-operative wounds around the hip and proximal thigh dressed with povidone-iodine soaked gauze dressings versus post-operative opsite™ dressings. Ninety-eight patients undergoing orthopaedic surgeries around the hip and proximal thigh in the Department of Orthopaedics, University College Hospital Ibadan will be recruited via block randomization into two intervention arms. A datasheet will be filled, to collect socio-demographic data of the respondents, type of surgery, implant status, dressing application, day of first change of wound dressing after surgery and the indication for the change, number of wound dressing changes, pain score at wound dressing change and presence or absence of skin blistering and maceration at the operation site. Data entry, collation and analyses will be done using statistical packages; binary variables using chi-square and continuous variables using z-test, regression studies will also be done. The findings from the study would improve knowledge in the care of post-operative patients in Orthopaedics and help with developing a protocol for care of wounds in the hip and proximal thigh.
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Affiliation(s)
| | - Adeoye Allen-Taylor
- Department of Orthopaedics and Trauma, University College Hospital, Ibadan, Nigeria
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Morioka N, Moriwaki M, Tomio J, Kashiwagi M, Fushimi K, Ogata Y. Structure and process of dementia care and patient outcomes after hip surgery in elderly people with dementia: A retrospective observational study in Japan. Int J Nurs Stud 2019; 102:103470. [PMID: 31810019 DOI: 10.1016/j.ijnurstu.2019.103470] [Citation(s) in RCA: 4] [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: 08/13/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Japan introduced the financial incentives for dementia special care at hospitals in the fee schedule in April 2016. OBJECTIVE To investigate whether the financial incentives for dementia special care contributed to better patient outcomes after hip surgery for older adults with dementia. DESIGN Retrospective observational study using the Diagnosis Procedure Combination database and the Reporting on medical functions of hospital beds data. SETTING Acute care hospitals adopting the Diagnosis Procedure Combination system in Japan. PARTICIPANTS A total of 20,393 eligible patients aged 65 years or older with dementia who underwent hip surgeries and discharged from 405 hospitals from April 2016 to March 2017. METHODS There are two levels of dementia care quality categories in the financial incentives for dementia special care as follows: Type 1 requires a multidisciplinary team with geriatric and dementia care expertise and Type 2 requires to assign trained nurses who underwent dementia training at every general ward. The outcomes were in-hospital mortality, readmission within 30 days, and length of hospital stay. We performed generalized estimating equation model or logistic generalized estimating equation models adjusting for individual and hospital characteristics. RESULTS Among the 405 hospitals, the numbers of hospitals without dementia care incentive, those with Type 1, and those with Type 2 were 207, 99, and, 99, respectively. Overall, the prevalence of in-hospital death and readmission within 30 days was 2.01% and 2.70%, respectively. Overall, the mean (standard deviation, SD) length of hospital stay was 32.0 (20.0) days. There were no significant associations between dementia special care and in-hospital mortality in Type 1 (adjusted OR [odds ratio] =0.87, 95% confidence interval [CI] = 0.66-1.16) and Type 2 (adjusted OR = 1.18, 95% CI = 0.92-1.52), and readmission within 30 days in Type 1 (adjusted OR = 1.11, 95% CI = 0.89-1.38) and Type 2 (adjusted OR = 1.03, 95% CI = 0.83-1.29). Length of hospital stay was not significantly different among hospitals with and without incentive, Type 1 (coefficient -0.23, 95% CI = -2.64-2.18.), and Type 2 (coefficient 0.87, 95% CI = -1.54-3.28). An increase in patient-to-nurse ratio was significantly associated with 2.25 days longer length of hospital stay (95% CI 1.00-3.51). CONCLUSION Dementia care incentive was not associated with better outcomes in elderly with dementia who underwent hip surgery in Japan, but the worse nurse workload was associated with longer length of hospital stay. Further long-term assessment is necessary.
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Affiliation(s)
- Noriko Morioka
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan.
| | - Mutsuko Moriwaki
- Department of Tokyo Metropolitan Health Policy Advisement, Graduate School of Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Jun Tomio
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Masayo Kashiwagi
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Kiyohide Fushimi
- Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University (TMDU), Japan
| | - Yasuko Ogata
- Graduate School of Health Care Sciences, Tokyo Medical and Dental University (TMDU), 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
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El-Boghdadly K, Short AJ, Gandhi R, Chan VWS. Addition of dexamethasone to local infiltration analgesia in elective total hip arthroplasty: a double-blind, randomized control trial. Reg Anesth Pain Med 2019; 44:rapm-2019-100873. [PMID: 31563881 DOI: 10.1136/rapm-2019-100873] [Citation(s) in RCA: 5] [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: 07/24/2019] [Revised: 08/24/2019] [Accepted: 09/04/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Pain following total hip arthroplasty is significant, and effective analgesia is associated with an improvement in functional outcomes. Dexamethasone may facilitate the action of local anesthesia, but its role as an additive to a local infiltration analgesia (LIA) mixture in hip arthroplasty settings has not been investigated. We hypothesized that the addition of dexamethasone to local anesthetic infiltration improves analgesic outcomes following total hip arthroplasty. METHODS We performed a double-blind, randomized control trial of 170 patients undergoing total hip arthroplasty. Patients were randomized to receive LIA mixed with either 2 mL of saline 0.9% or 2 mL of dexamethasone 4 mg/mL. The primary outcome was 24 hours oral morphine consumption. Secondary outcomes included short-term and long-term analgesic and functional outcomes and adverse events. RESULTS 85 patients were included in each arm. 24 hours morphine consumption was similar between saline and dexamethasone groups, with a median (IQR (range)) of 75 (45-105 (0-240)) and 62.5 (37.5-102.5 (0-210)) mg, respectively (p=0.145). However, patients receiving dexamethasone had significantly reduced opioid consumption for their total in-hospital stay, but not at any other time points examined. Functional outcomes were similar between groups. The incidence of postoperative nausea and vomiting was reduced in patients receiving dexamethasone. CONCLUSIONS The addition of 8 mg dexamethasone to LIA did not reduce 24 hours morphine consumption but was associated with limited improvement in short-term analgesic outcomes and a reduction in postoperative nausea and vomiting. Dexamethasone had no effect on functional outcomes or long-term analgesia. TRIAL REGISTRATION NUMBER NCT02760043.
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Affiliation(s)
- Kariem El-Boghdadly
- Department of Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, UK
- King's College London, London, UK
| | - Anthony James Short
- Department of Anaesthetics, Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Rajiv Gandhi
- Division of Orthopedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Kotera A. Geriatric Nutritional Risk Index and Controlling Nutritional Status Score can predict postoperative 180-day mortality in hip fracture surgeries. JA Clin Rep 2019; 5:62. [PMID: 32026110 PMCID: PMC6967303 DOI: 10.1186/s40981-019-0282-6] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/09/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Geriatric Nutritional Risk Index (GNRI) based on serum albumin level and body weight and the Controlling Nutritional Status Score (CONUT) based on serum albumin level, total cholesterol level, and total lymphocyte count were created to evaluate objectively a patient's nutritional status in 2005. Here we validated the usefulness of the GNRI and the CONUT as a prognostic factor of the 180-day mortality in patients who underwent hip fracture surgeries. We retrospectively collected data from patients with hip surgeries performed from January 2012 to December 2018. The variables required for the GNRI and the CONUT and the factors presumably associated with postoperative mortality including the patients' characteristics were collected from the medical charts. Intergroup differences were assessed with the χ2 test with Yates' correlation for continuity in category variables. The Mann-Whitney U test was used to test for differences in continuous variables. We validated the power of the GNRI and the CONUT values to distinguish patients who died ≤ 180 days post-surgery from those who did not, by calculating the area under the receiver operating characteristic curve (AUC). The correlation between these two models was analyzed by Spearman's rank correlation (ρ). RESULTS We retrospectively examined the cases of 607 patients aged 87 ± 6 (range 70-102) years old. The 180-day mortality rate was 5.4% (n = 33 non-survivors). The GNRI value in the non-survivors was 83 ± 9 (range 66-111), which was significantly lower than that in the survivors at 92 ± 9 (range 64-120). The CONUT value in the non-survivors was 6 ± 3 (range 1-11), which was significantly higher than that in the survivors at 4 ± 2 (range 0-11). The AUC value to predict the 180-day mortality was 0.74 for the GNRI and 0.72 for the CONUT. The ρ value between these two models was 0.61 in the total of 607 patients and was 0.78 in the 33 non-survivors. CONCLUSIONS Our results suggest that the GNRI and the CONUT are a simple and useful tool to predict the 180-day mortality in patients who have undergone a hip surgery.
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Affiliation(s)
- Atsushi Kotera
- Department of Anesthesiology, Kumamoto Central Hospital, 955 Muro, Ozu-machi Kikuchi-gun, Kumamoto, 869-1235, Japan.
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Agrawal S, Turk R, Burton BN, Ingrande J, Gabriel RA. The association of preoperative delirium with postoperative outcomes following hip surgery in the elderly. J Clin Anesth 2019; 60:28-33. [PMID: 31437598 DOI: 10.1016/j.jclinane.2019.08.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/19/2019] [Revised: 06/26/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Abstract
STUDY OBJECTIVE To determine the association of preoperative delirium with postoperative outcomes following hip surgery in the elderly. DESIGN Retrospective cohort study. SETTING Postoperative recovery. PATIENTS 8466 patients all of whom were 65 years of age or older undergoing surgical repair of a femoral fracture. Of the total population studied, 1075 had preoperative delirium. Of those with preoperative delirium, 746 were ASA class 3 or below and 327 were ASA class 4 or above. Of the 7391 patients without preoperative delirium, 5773 were ASA class 3 or below and 1605 were ASA class 4 or above. The remainder in each group was of unknown ASA class. INTERVENTIONS We used multivariable logistic regression to explore the association of preoperative delirium with 30-day postoperative outcomes. The odds ratio (OR) with associated 95% confidence interval (CI) was reported for each covariate. MEASUREMENTS Data was collected regarding the incidence of postoperative outcomes including: delirium, pulmonary complications, extended hospital stay, infection, renal complications, vascular complications, cardiac complications, transfusion necessity, readmission, and mortality. MAIN RESULTS After adjusting for potential confounders, the odds of postoperative delirium (OR 9.38, 95% CI 7.94-11.14), pulmonary complications (OR 1.83, 95% CI 1.4-2.36), extended hospital stay (OR 1.47, 95% CI 1.26-1.72), readmission (OR 1.27, 95% CI 1.01-1.59) and mortality (OR 1.92, 95% CI 1.54-2.39) were all significantly higher in patients with preoperative delirium compared to those without. CONCLUSIONS After controlling for potential confounding variables, we showed that preoperative delirium was associated with postoperative delirium, pulmonary complications, extended hospital stay, hospital readmission, and mortality. Given the lack of studies on preoperative delirium and its postoperative outcomes, our data provides a strong starting point for further investigations as well as the development and implementation of targeted risk-reduction programs.
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Affiliation(s)
- Shubham Agrawal
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Robby Turk
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Brittany N Burton
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Jerry Ingrande
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, San Diego, CA, USA
| | - Rodney A Gabriel
- Department of Anesthesiology, Division of Regional Anesthesia and Acute Pain, University of California, San Diego, San Diego, CA, USA; Department of Medicine, Division of Biomedical Informatics, University of California, San Diego, San Diego, CA, USA.
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Koizia LJ, Wilson F, Reilly P, Fertleman MB. Delirium after emergency hip surgery – common and serious, but rarely consented for. World J Orthop 2019; 10:228-234. [PMID: 31259146 PMCID: PMC6591697 DOI: 10.5312/wjo.v10.i6.228] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/30/2019] [Revised: 05/10/2019] [Accepted: 05/22/2019] [Indexed: 02/06/2023] Open
Abstract
A quarter of patients admitted with a proximal femoral fracture suffer from an acute episode of delirium during their hospital stay. Yet it is often unrecognised, poorly managed, and rarely discussed by doctors. Delirium is important not only to the affected individuals and their families, but also socioeconomically to the broader community. Delirium increases mortality and morbidity, leads to lasting cognitive and functional decline, and increases both length of stay and dependence on discharge. Delirium should be routinely and openly discussed by all members of the clinical team, including surgeons when gaining consent. Failing to do so may expose surgeons to claims of negligence. Here we present a concise review of the literature and discuss the epidemiology, causative factors, potential consequences and preventative strategies in the perioperative period.
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Affiliation(s)
- Louis J Koizia
- Geriatric Medicine, Imperial College NHS Trust, London W2 1NY, United Kingdom
| | - Faye Wilson
- Geriatric Medicine, City Hospitals Sunderland, Sunderland SR4 7TP, United Kingdom
| | - Peter Reilly
- Department of Trauma and Orthopaedics, Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom
| | - Michael B Fertleman
- Geriatric Medicine, Imperial College NHS Trust, London W2 1NY, United Kingdom
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You Y, Zhang Y, Qiang L, Sun Y, Zhang J, Bou E, Yan M, Dai K, Ding M. Prevalence and risk factors for perioperative complications of CKD patients undergoing elective hip surgery. J Orthop Surg Res 2019; 14:82. [PMID: 30894199 PMCID: PMC6425709 DOI: 10.1186/s13018-019-1118-9] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 03/06/2019] [Indexed: 01/24/2023] Open
Abstract
PURPOSE Chronic kidney disease (CKD) is known to increase morbidity and mortality after orthopedic surgery. The purpose of this study is to investigate how CKD affects perioperative complications in hip surgery patients. MATERIAL AND METHODS From 2013 to 2016, a total of 230 patients (30 patients with CKD and 200 without CKD) undergoing hip surgery were enrolled in this study. Preoperative, intraoperative, and postoperative data was collected and analyzed between CKD and non-CKD patients. Logistic regression was used to evaluate the independent risk factor for postoperative complications. RESULTS There were significant differences in the number of people with hypertension (90.0% vs 27.3%, P < 0.001), diabetes (33.3% vs 8.7%, P = 0.01), coronary heart disease (20.0% vs 2.0%, P = 0.001), smoking habits (56.7% vs 22.7%, P = 0.016), anemia (90.0% vs 19.3%, P < 0.001), and low hemoglobin levels (94.1 ± 19.7 vs 121.3 ± 18.8, P < 0.001) between CKD and non-CKD patients before surgery. Receiving a blood transfusion was significantly more common in CKD patients (50% vs 28.5%, P = 0.018). Postoperatively, significant differences were detected in the average number of patients who transferred to the ICU (73.3% vs 19.3%, P < 0.001). Furthermore, differences were found in the quantity of hemoglobin (92.5 ± 16.8 vs 107.5 ± 18.3, P < 0.001) and albumin (32.4 ± 4.1 vs 34.9 ± 5.5, P = 0.02) measured between CKD and non-CKD patients. Logistic regression analysis indicated that diabetes, alcohol, and anemia were all independent risk factors for obtaining a blood transfusion, while age, CKD, and osteoporosis were all independent risk factors for ICU transfers. CONCLUSION Compared with non-CKD patients, CKD patients were accompanied with more cardiac diseases preoperatively. In addition, CKD patients were more likely to receive a blood transfusion and transfer to the ICU after hip surgery. Preoperative anemia should be restored sufficiently to decrease the incidence of blood transfusions.
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Affiliation(s)
- Yongqing You
- Department of Nephrology, Affiliated Hospital of Nanjing Medical University, North District of Suzhou Municipal Hospital, Suzhou, China.
| | - Yijian Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Lei Qiang
- Southwest Jiaotong University College of Medicine, 610031, No.111, North Section,2nd Ring Road, Chengdu, Sichuan, China.,Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Ye Sun
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Junxin Zhang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Emily Bou
- Biochemistry Department, University of Waterloo, Waterloo, Canada
| | - Moqi Yan
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, 215006, China
| | - Kerong Dai
- Shanghai Key Laboratory of Orthopaedic Implants, Department of Orthopaedic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Muliang Ding
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China.
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44
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van der Valk MR, Veltman ES, Assink J, Veen MR. Synovial chondromatosis of the hip, a case report and literature review. J Orthop 2019; 16:249-253. [PMID: 30923422 DOI: 10.1016/j.jor.2019.02.010] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/17/2019] [Indexed: 12/31/2022] Open
Abstract
A case of giant synovial chondromatosis of the hip with extra-articular localisation in the ileopectineal bursa is presented and the literature concerning this condition is reviewed. Synovial chondromatosis is a rare condition of unknown aetiology. A literature search was performed to identify studies describing outcome after surgical treatment of synovial chondromatosis of the hip. Thirteen studies including two hundred-ninety patients could be included. Mean follow-up was fifty-six months. Seven out of two hundred-ninety developed a complication after surgical resection of the lesion. Recurrence rate of synovial chondromatosis is about 19%. Malignant transformation of synovial chondromatosis to chondrosarcoma is extremely rare. No wound infections were reported and avascular necrosis of the femoral head occurred in one patient who was treated with dislocation of the hip during surgery. After resection of synovial chondromatosis excellent functional outcome can be expected.
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Affiliation(s)
- Mara R van der Valk
- Department of Orthopaedic and Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
| | - Ewout S Veltman
- Department of Orthopaedic and Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
| | - Joeri Assink
- Department of Radiology, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
| | - M Remmelt Veen
- Department of Orthopaedic and Trauma Surgery, St. Antonius Ziekenhuis, Soestwetering 1, 3543 AZ, Utrecht, the Netherlands
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45
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Abstract
The hip is the joint most exposed to orthopaedic complications in cerebral palsy (CP), which is the main cause of spasticity in paediatric patients. The initial immaturity of the hip allows the forces applied by the spastic and retracted muscles to displace the femoral head, eventually causing it to dislocate. The risk of hip dislocation increases with the severity and extent of CP, exceeding 70% in the most severe cases. Hip dislocation causes pain in up to 30% of cases, carries a risk of orthopaedic and cutaneous complications and hinders patient installation and nursing care. These adverse outcomes warrant routine screening, which has been proven effective in lessening the frequency and severity of hip displacement. Preventive techniques including physical therapy, orthoses and treatments to alleviate spasticity are strongly recommended in every case. The beneficial effects of treating spasticity, if needed via neurosurgical procedures, have been convincingly established. Orthopaedic surgery is required when prevention fails. Soft-tissue release is designed to correct the asymmetry in the forces applied by the muscles. Femoral osteotomy creates the possibility for spontaneous correction of secondary acetabular dysplasia. Progress has been made in standardising the use of multilevel surgery involving the soft tissues, femur and pelvis, which is often effective in correcting the morphological abnormalities and stabilising the joint. When hip pain or alterations are severe, hip resection or total hip arthroplasty are highly effective in alleviating the pain and improving patient comfort. The spastic hip is a complex condition in which currently available screening protocols and treatment strategies have been proven effective in benefitting patient outcomes.
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46
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Ahiskalioglu A, Yayik AM, Alici HA. Response to Ince et al.: Ultrasound-guided quadratus lumborum plane block for congenital hip dislocation surgery: Dermatomes and osteotomes 'J Clin Anesth. 2018;54:140'. J Clin Anesth 2019; 56:39-40. [PMID: 30684924 DOI: 10.1016/j.jclinane.2019.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 12/26/2018] [Accepted: 01/18/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Ali Ahiskalioglu
- Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.
| | - Ahmet Murat Yayik
- Regional Training Hospital, Department of Anaesthesiology and Reanimation, Erzurum, Turkey
| | - Haci Ahmet Alici
- Department of Anaesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.
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47
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Zhang H, Fan Q, Zhang J, Wu B, Wang X, Zhang Y, Wang A. Effect of ultrasound-guided lumbar plexus block on emergence agitation in children undergoing hip surgery: study protocol for a randomized controlled trial. Trials 2019; 20:22. [PMID: 30616597 PMCID: PMC6323822 DOI: 10.1186/s13063-018-3140-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/07/2018] [Accepted: 12/17/2018] [Indexed: 11/16/2022] Open
Abstract
Background Emergence agitation (EA) is a common postoperative issue in children that causes self-injury, increases stress on healthcare team members, and even leads to postoperative maladaptive behavioral changes in children. Clear answers regarding a ‘gold standard’ for prevention of EA are not available. Pain is regarded as an important causative factor of EA, and ultrasound-guided lumbar plexus block is a safe and efficient anesthetic method that can provide satisfactory pain relief in pediatric hip surgery. The purpose of our study is to determine whether ultrasound-guided lumbar plexus block can reduce the incidence of EA in children undergoing hip surgery. Methods/design We designed a prospective, randomized, controlled, blinded trial to determine the effect of ultrasound-guided lumbar plexus block on EA. A total of 100 American Society of Anesthesiologists class I–II children (1–6 years old) scheduled for elective hip surgery will be recruited for this study. Participants will be randomized at a 1:1 ratio to receive either ultrasound-guided lumbar plexus block or fentanyl after the induction of general anesthesia. The primary outcome is the incidence of EA 30 min after emergence from anesthesia using the Pediatric Anesthesia Emergence Delirium (PAED) score. The secondary outcomes are the severity and duration of EA 30 min after emergence from anesthesia using the PAED score, postoperative pain evaluated by the Children’s Hospital of Eastern Ontario Pain Scale, and the incidence of postoperative adverse events. Randomization will be conducted using a computer-generated randomization schedule. Outcome assessors and data collectors will be blinded to the group allocations. Assessments will be performed before surgery, intraoperatively, and postoperatively at every time point. Discussion Our hypothesis in this trial is that ultrasound-guided lumbar plexus block can decrease the incidence of EA in children undergoing elective hip surgery. This trial will provide clinical answers to verify our hypothesis. If our hypothesis is confirmed, the results could provide a safe method to prevent EA. Trial registration Chinese Clinical Trial Registry, ChiCTR-INR-17011525. Registered on 30 May 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3140-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hui Zhang
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China
| | - Qing Fan
- Department of Pediatric Orthopedics, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Junfeng Zhang
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China
| | - Bin Wu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China
| | - Xiaofeng Wang
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China
| | - Yu Zhang
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China
| | - Aizhong Wang
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, No. 600, Yishan Road, Shanghai, 200233, China.
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Stravinskas M, Tarasevicius S, Laukaitis S, Nilsson M, Raina DB, Lidgren L. A ceramic bone substitute containing gentamicin gives good outcome in trochanteric hip fractures treated with dynamic hip screw and in revision of total hip arthroplasty: a case series. BMC Musculoskelet Disord 2018; 19:438. [PMID: 30522476 PMCID: PMC6284312 DOI: 10.1186/s12891-018-2360-8] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 11/22/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The primary objective was to investigate the clinical and radiological outcome in patients undergoing major hip surgery using a novel antibiotic containing bone substitute for local augmentation in trochanteric fracture fixation or revision of total hip arthroplasty (THA). METHODS We implanted a novel biphasic bone substitute CERAMENT™|G consisting of hydroxyapatite, calcium sulphate and gentamicin for bone regeneration and local antibiotic delivery in 20 patients treated surgically for trochanteric femoral fracture or uncemented hip revision. Preoperative, postoperative, 3 months and 1 year clinical and radiological assessment were performed including registration of any complications. In one trochanteric fracture patient, histological analyses were performed of bone biopsies taken at removal of hardware. RESULTS None of the trochanteric fractures or revision of THA showed any large migration. No local wound disturbances were seen and no infection was observed at one year follow-up. All trochanteric fractures healed at 3 months with a minimal sliding screw displacement on average 3 mm. Radiological analysis showed signs of bone remodeling and new bone formation in the substitute, illustrated also by histology in the biopsies taken from one trochanteric fracture at one year post-op. CONCLUSIONS Local CERAMENT™|G was shown to be safe in a limited prospective major hip surgery study. Remodeling of the bone graft substitute was observed in all patients. TRIAL REGISTRATION EU-CTR2018-004414-18 Retrospectively registered on November 20, 2018.
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MESH Headings
- Aged
- Aged, 80 and over
- Anti-Bacterial Agents/administration & dosage
- Arthroplasty, Replacement, Hip/adverse effects
- Arthroplasty, Replacement, Hip/instrumentation
- Arthroplasty, Replacement, Hip/methods
- Bone Remodeling
- Bone Screws
- Bone Substitutes
- Calcium Sulfate
- Drug Combinations
- Durapatite
- Feasibility Studies
- Female
- Follow-Up Studies
- Fracture Fixation, Internal/adverse effects
- Fracture Fixation, Internal/instrumentation
- Fracture Fixation, Internal/methods
- Gentamicins/administration & dosage
- Hip/diagnostic imaging
- Hip/surgery
- Hip Fractures/diagnostic imaging
- Hip Fractures/surgery
- Humans
- Male
- Middle Aged
- Osteogenesis
- Postoperative Complications
- Prospective Studies
- Radiography
- Reoperation/adverse effects
- Reoperation/instrumentation
- Reoperation/methods
- Treatment Outcome
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Affiliation(s)
| | | | | | - Malin Nilsson
- Department of Orthopedics, Lund University Hospital, Lund, Sweden
| | | | - Lars Lidgren
- Department of Orthopedics, Lund University Hospital, Lund, Sweden
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49
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Rhon DI, Snodgrass SJ, Cleland JA, Sissel CD, Cook CE. Predictors of chronic prescription opioid use after orthopedic surgery: derivation of a clinical prediction rule. Perioper Med (Lond) 2018; 7:25. [PMID: 30479746 PMCID: PMC6249901 DOI: 10.1186/s13741-018-0105-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 06/09/2018] [Accepted: 09/24/2018] [Indexed: 01/19/2023] Open
Abstract
Background Prescription opioid use at high doses or over extended periods of time is associated with adverse outcomes, including dependency and abuse. The aim of this study was to identify mediating variables that predict chronic opioid use, defined as three or more prescriptions after orthopedic surgery. Methods Individuals were ages between 18 and 50 years and undergoing arthroscopic hip surgery between 2004 and 2013. Two categories of chronic opioid use were calculated based on individuals (1) having three or more unique opioid prescriptions within 2 years and (2) still receiving opioid prescriptions > 1 year after surgery. Univariate elationships were identified for each predictor variable, then significant variables (P > 0.15) were entered into a multivariate logistic regression model to identify the most parsimonious group of predictor variables for each chronic opioid use classification. Likelihood ratios were derived from the most robust groups of variables. Results There were 1642 participants (mean age 32.5 years, SD 8.2, 54.1% male). Nine predictor variables met the criteria after bivariate analysis for potential inclusion in each multivariate model. Eight variables: socioeconomic status (from enlisted rank family), prior use of opioid medication, prior use of non-opioid pain medication, high health-seeking behavior before surgery, a preoperative diagnosis of insomnia, mental health disorder, or substance abuse were all predictive of chronic opioid use in the final model (seven variables for three or more opioid prescriptions; four variables for opioid use still at 1 year; all< 0.05). Post-test probability of having three or more opioid prescriptions was 93.7% if five of seven variables were present, and the probability of still using opioids after 1 year was 69.6% if three of four variables were present. Conclusion A combination of variables significantly predicted chronic opioid use in this cohort. Most of these variables were mediators, indicating that modifying them may be feasible, and the potential focus of interventions to decrease the risk of chronic opioid use, or at minimum better inform opioid prescribing decisions. This clinical prediction rule needs further validation.
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Affiliation(s)
- Daniel I Rhon
- 1Center for the Intrepid, Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam, Houston, TX 78234 USA.,2Doctoral Program in Physical Therapy, Baylor University, San Antonio, TX USA.,3School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW Australia
| | - Suzanne J Snodgrass
- 3School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan, NSW Australia
| | - Joshua A Cleland
- 4Department of Physical Therapy, Franklin Pierce University, Manchester, NH USA
| | - Charles D Sissel
- 5Program Analysis and Evaluation Division, US Army Medical Command, Joint Base San Antonio - Fort Sam Houston, San Antonio, TX 78234 USA
| | - Chad E Cook
- 6Division of Physical Therapy, Department of Orthopedics, Duke University, Duke MSK, Duke Clinical Research Institute, Durham, NC USA
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50
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Li M, Xu C, Xie J, Hu Y, Liu H. Comparison of collum femoris-preserving stems and ribbed stems in primary total hip arthroplasty. J Orthop Surg Res 2018; 13:271. [PMID: 30373613 PMCID: PMC6206737 DOI: 10.1186/s13018-018-0981-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/14/2018] [Accepted: 10/18/2018] [Indexed: 01/15/2023] Open
Abstract
Background This retrospective study investigated the relative benefits of using a collum femoris-preserving prosthesis or ribbed stem during total hip arthroplasty (THA). Methods The clinical results were compared of patients who underwent THA, between January 2010 and December 2012, with either a CFP prosthesis or a ribbed stem (66 and 75 patients, respectively, aged 43.4 ± 10.8 and 42.3 ± 9.8 years). Patients were assessed using the Harris Hip Score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), 12-Item Short Form Health Survey (SF-12), and physical component summary (PCS) score. Intraoperative and postoperative complications and leg-length differences were noted. Results The mean follow-up times of the CFP and ribbed groups were 67.2 ± 7.5 and 68.3 ± 7.2 months, respectively. The HHS, SF-12 MCS, SF-12 PCS, and WOMAC scores of the two groups were similar. The rates of periprosthetic femoral fractures and leg-length differences > 10 mm in the CFP group (10.6% and 13.6%, respectively) were significantly higher than those in the ribbed group (1.3% and 2.7%). The groups were similar regarding complications of osteolysis, ectopic ossification, dislocation, deep infection, deep venous thrombosis, thigh pain, and aseptic loosening. The survival rates of the CFP and ribbed groups were comparable (98.5% and 97.8%). Conclusion The clinical results of the CFP and ribbed prostheses in young patients given THA were similar for Chinese patients. However, the CFP stem should be used with caution, given the high incidence of technical problems associated with implantation especially for Chinese patients.
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Affiliation(s)
- Mingqing Li
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Can Xu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Jie Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Yihe Hu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China
| | - Hua Liu
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People's Republic of China.
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