Long-Term Survival and Results at a Mean Follow-Up Period of 24 Years of a Tapered Straight,Collarless, Grit-Blasted,Titanium Alloy Stem

BackgroundThere is limited evidence on the survivorship of patients who undergo cementless stem implantation, beyond 20 years of the hip arthroplasty. We report implant survival and results of the CLS Spotorno femoral stem until 30 years from implantation.MethodsSurvival analysis of 147 CLS Spotorno stems in 119 patients for an average period of 24 years (20-30) from the date of implantation was performed. During the course of the follow-up period, 33 patients (39 hips) died. The information on the survival of their hip implant at the time of death was gathered from their relatives and general practitioners. Sixty-six patients (86 hips) undertook the complete survey along with radiographic examination, while 18 subjects (20 hips) were interviewed over the telephone. The factors influencing survival, functional outcomes, and level of satisfaction with surgery were evaluated.ResultsThe overall estimated survival of the stems was 89.9% after 30 years (95% confidence interval [CI] 83.5-93.9). Survival with femoral revision for aseptic loosening as an end point was 93.1% (95% CI 87.1-96.4). In the worst-case scenario, an overall implant survival of 77.2% (95 CI% 80.3-82.7) was observed after 24 years. Patients who were older than 50 in age at the time of surgery had better survival rates (P = .026). The mean Harris Hip Score at follow-up was 83.1 (range 43-100) and the level of satisfaction was 9/10. The main determinant of postsurgical satisfaction was Harris Hip Score, whereas radiographic alterations explained little with respect to the variation in the outcomes.ConclusionThe cementless CLS Spotorno stem displayed satisfactory results 24 years after implantation and high estimated survival until 30 years from surgery. However, patients below the age of 50 at the time of surgery have an increased risk of undergoing revision of their femoral stem.     

关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折

目的 分析关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折的临床疗效。方法 回顾性分析2014年3月至2017年2月中国人民解放军联勤保障部队第910医院骨科收治的跟骨关节内骨折患者55例。其中，男14例，女41例; 年龄47 ～ 76岁，平均（61.2±8.7）岁; 骨折Sanders分型: Ⅱ型12例，Ⅲ型17例，Ⅳ型26例。营养不良程度：中度40例，重度15例; 跟骨骨密度T值-5.2 ～ -2.7，平均-（4.1±0.6）。根据手术方式分为“关节镜+球囊”组15例、单纯球囊组12例、螺钉组8例和钢板组20例。记录手术时间、术中术后出血量、住院时间、术后B?hler角和Gissane角、各时间点关节面塌陷高度及各时间点VAS评分和AOFAS评分。结果 “关节镜+球囊”组手术时间长于单纯球囊组和螺钉组（P<0.01），但低于钢板组（P<0.01）；而术中、术后出血量和住院时间方面，与单纯球囊组、螺钉组差异无统计学意义（P>0.05），但低于钢板组（P<0.01）。“关节镜+球囊”组和单纯球囊组各时间点的VAS评分和AOFAS评分比较，差异无统计学意义（P>0.05）; 但“关节镜+球囊组”、单纯球囊组与螺钉组、钢板组比较，差异有统计学意义（P<0.01）。四组间术后B?hler角和Gissane角比较，差异无统计学意义（P>0.05）。在术后6、12、24个月时“关节镜+球囊”组和单纯球囊组比较关节面塌陷高度比较，差异无统计学意义（P>0.05）; 螺钉组和钢板组关节面塌陷高度比较，差异也无统计学意义（P>0.05）; 但“关节镜+球囊”组与螺钉组、钢板组，单纯球囊组与螺钉组、钢板组关节面塌陷高度比较，差异有统计学意义（P<0.01）。结论 关节镜辅助下球囊扩张成形术治疗中重度营养不良跟骨关节内骨折，具有操作简单、安全、康复期短的优点，值得临床推广。     

颅脑外伤性癫痫发病的危险因素分析

目的探讨颅脑外伤性癫痫(PTE)发病的危险因素。方法选取我院神经外科2016年1月至2019年10月收治的120例颅脑外伤患者,既往均有癫痫史,分为PTE组和非PTE组各60例。分析两组的临床因素,采用Logistic回归分析PTE发病的危险因素。结果单因素分析结果显示,PTE发病与年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折相关(P <0.05),与性别、蛛网膜下腔出血无相关性(P>0.05)。多因素Logistic回归分析结果显示,年龄(OR=0.652, 95%CI:1.246~2.419),严重程度(GCS)(OR=2.041, 95%CI:1.394~4.842)、受伤部位(OR=1.642, 95%CI:2.105~4.378)、凹陷性颅骨骨折(OR=6.548, 95%CI:1.541~3.547)为PTE发病的影响因素。结论年龄、严重程度(GCS)、受伤部位、凹陷性颅骨骨折为PTE发病的影响因素,临床中应针对PTE发病因素进行预防和及时治疗,以提高临床疗效和预后。     

Surgeon case volume and the risk of complications following surgeries of displaced intra-articular calcaneal fracture

PurposeThis study aimed to address the relationship between surgeon volume and the risk of complications following surgeries of displaced intra-articular calcaneal fractures (DIACFs).MethodsWe retrospectively reviewed the medical records and the follow-up registers for patients who underwent open reduction and internal fixation with plate/screws in our center between January 2015 and June 2020. Surgeon volume was defined as the number of surgically treated calcaneal fractures within the past 12 months, and was dichotomized on basis of the optimal cut-off value. The outcome measure was the documented overall complications within 1 year after surgery. Four logistics regression models were constructed to examine the potential relationship between surgeon volume and complications.ResultsAmong 585 patients, 49 had documented complications, representing an overall rate of 8.4%. The overall complication rate was 20.0% (22/111) in patients operated on by the low-volume surgeons and 5.7% (27/474) by the high-volume surgeons, with a significant difference (p < 0.001). The 4 multivariate analyses showed steady and robust inverse volume-complication relationship, with OR ranging from 3.8 to 4.4. The restricted cubic splines adjusted for total covariates showed the non-linear fitting “L-shape” or “reverse J-shape” curve (p = 0.041), and the OR was reduced until 10 cases, beyond which the curve leveled.ConclusionsOur findings reflected the important role of maintaining necessary operative cases, potentially informing optimized surgical care management.     

Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real Concern

BackgroundAcetabular fractures often require surgical intervention for fracture fixation and can result in premature osteoarthritis of the hip joint. This study hypothesized that total hip arthroplasty (THA) in patients with a prior acetabular fracture who had undergone open reduction and internal fixation (ORIF) is associated with a higher rate of subsequent periprosthetic joint infection (PJI).MethodsAbout 72 patients with a history of acetabular fracture that required ORIF, undergoing conversion THA between 2000 and 2017 at our institution, were matched based on age, gender, body mass index, Charlson comorbidity index, and date of surgery in a 1:3 ratio with 215 patients receiving primary THA. The mean follow-up for the conversion THA cohort was 2.9 years (range, 1-12.15) and 3.06 years (range, 1-12.96) for the primary THA.ResultsPatients with a previous acetabular fracture, compared with the primary THA patients, had longer operative times, greater operative blood loss, and an increased need for allogeneic blood transfusion (26.4% vs 4.7%). Most notably, PJI rate was significantly higher in acetabular fracture group at 6.9% compared with 0.5% in the control group. Complications, such as aseptic revision, venous thromboembolism, and mortality, were similar between both groups.ConclusionThe present study demonstrates that conversion THA in patients with prior ORIF of acetabular fractures is associated with higher complication rate, in particular PJI, and less optimal outcome compared with patients undergoing primary THA. The latter findings compel us to seek and implement specific strategies that aim to reduce the risk of subsequent PJI in these patients.     

Procedure Duration,Time Under Anesthesia,and Readmissions in Direct Anterior and Posterior Approach Total Hip Arthroplasty

BackgroundOperative time is related to complications in primary total hip arthroplasty (THA). This study compared operative time in direct anterior (DA) and posterior approach THA and whether differences were related to increased hospital readmissions within 90 days of discharge.MethodsProspectively documented data on 3,152 consecutively performed THAs by 16 surgeons at a large Midwestern United States academic healthcare system were retrospectively reviewed. All surgeons were beyond their learning curve. Cases characterized by factors extending operative time were excluded. A total of 1,235 analysis cases were performed with the DA approach and 1,608 with the posterior approach. DA patients had lower mean body mass index (P < .001), were more likely to be classified as American Society of Anesthesiologists Physical Status 1 or 2 (P < .001), and more likely to have surgery in an ambulatory setting (P < .001).ResultsTime under anesthesia was significantly longer for DA procedures by 19 to 27 minutes in hospital and ambulatory settings, respectively (P < .001). Increasing body mass index had a greater impact on anesthesia time for DA patients (P = .020). There were no differences in nontraumatic readmissions within 90 days of surgery based on surgical approach (P ≥ .480); however, significantly more DA patients classified as ASA-PS 3 or 4 were readmitted compared to those classified as ASA-PS 1 or 2 (P < .001), a difference not observed for posterior approach patients.ConclusionAnesthesia time is a modifiable risk factor for patient safety and an important factor in healthcare resource utilization. Consideration of ways to reduce DA operative times is encouraged.     

High Incidence of Intraoperative Fractures With a Specific Cemented Stem Following Intracapsular Displaced Hip Fracture

BackgroundTo reduce costs of orthopedic implants, the government decided to standardize implants used across different specialties in a group of hospitals located in the same geographic area. The usual cemented stem used in the context of intracapsular displaced geriatric hip fractures was replaced by another stem. Abnormal intraoperative calcar and trochanteric fractures were noted. The purpose of this study is to determine the incidence of intraoperative periprosthetic fractures following an intracapsular displaced hip fracture treated with this specific cemented stem compared to the previous implant.MethodsThis is a retrospective cohort study comparing an historic cohort of hip fractures treated with the OmniFit EON (Stryker, Kalamazoo, MI) cemented stem with a new cohort of patients who received the Corail (DePuy Synthes, Warsaw, IN) cemented stem. Four orthopedic surgeons reviewed operative reports and postoperative radiographs.ResultsThe treatment group included 348 patients who received the Corail stem. The control group included 77 patients. The 2 groups had similar baseline characteristics (P > .05) except for the presence of dementia. Incidence of intraoperative calcar or greater trochanteric fracture was 15.5% for the Corail group and 2.7% for the control group (P < .05). No patient-related factors or surgeon-related factors were related to a higher number of fractures in the treatment group (P > .05).ConclusionThe Corail cemented stem presents an abnormal number of iatrogenic intraoperative fractures following displaced femoral neck fracture in our geriatric population. No external factor seems to explain this high number of fractures. Implant design should be questioned.Level of EvidenceIII.