Secular Trends in Osteoporotic Pelvic Fractures in Finland: Number and Incidence of Fractures in 1970–1991 and Prediction for the Future

To improve the knowledge of the current trends in the number and incidence of osteoporosis-related pelvic fractures, patients who were admitted to Finnish hospitals in 1970, 1975, 1980, 1985, 1988, and 1991 for primary treatment of first osteoporotic pelvic fracture were selected from the National Hospital Discharge Register. The overall incidence (per 100,000 inhabitants) of osteoporosis-related pelvic fractures (high energy traumas were excluded) in a population aged 60 years or more was 20 in 1970 and 63 in 1991. The increase was most pronounced in the older age groups (patients aged 80 years or more) and was observed in both sexes. The proportion of these osteoporotic pelvic fractures of all pelvic fractures increased from 18% in 1970 to 52% in 1991. Similarly, the proportion of patients over 60 years of age increased from 28% in 1970 to 62% in 1991. In 1991, 78% of the patients with an osteoporotic pelvic fracture were women. Across the study period, the age-adjusted total incidence of osteoporotic pelvic fractures also increased in both women and men 60 years of age and over. The proportional increase was more pronounced in men. We conclude that the number of osteoporotic pelvic fractures in Finland is increasing more rapidly than can be accounted for by the demographic changes only and that effective preventive measures are urgently needed to control the increasing number of these age-related fractures.     

Incidence Patterns of Pediatric and Adolescent Orthopaedic Fractures According to Age Groups and Seasons in South Korea: A Population-Based Study

Background

Fractures which need urgent or emergency treatment are common in children and adolescents. This study investigated the incidence patterns of pediatric and adolescent orthopaedic fractures according to age groups and seasons in South Korea based on population data.

Methods

Data on the number of pediatric and adolescent patients under the age of 18 years who utilized medical services due to fractures were retrieved from the Health Insurance Review and Assessment service in South Korea. The data included four upper extremity and two lower extremity fractures according to four age groups (0-4 years, 5-9 years, 10-14 years, and 15-18 years). Incidences of the fractures were calculated as the incidence per 10,000 per year, and patterns according to age groups and seasons were demonstrated.

Results

The annual incidence of clavicle, distal humerus, both forearm bone, distal radius, femoral shaft and tibial shaft fractures were 27.5, 34.6, 7.7, 80.1, 2.5, and 9.6 per 10,000 per year in children and adolescents, respectively. Clavicle and distal radius fractures showed significant seasonal variation for all age groups but femoral shaft fracture showed no significant seasonal variation for any of the age groups.

Conclusions

The four upper extremity fractures tended to show greater variations than the two lower extremity fractures in the nationwide database in South Korea. The study results are believed to be helpful in the planning and assignment of medical resources for fracture management in children and adolescents.     

Case report: A 10 years follow-up of periprosthetic femoral fracture after total hip arthroplasty in osteopetrosis

Osteopetrosis is an inherited disorder characterized by increased bone density and brittle bone quality. Degenerative changes often occur after the age of 40 in patients with osteopetrosis. Operative intervention is the primary treatment option if the clinical manifestation of secondary osteoarthritis is severe. A 44-year-old male suffering autosomal dominant osteopetrosis and progressive unilateral hip osteoarthritis required a total hip arthroplasty. However, there were several technical challenges associated with this procedure including creating a femoral medullary canal and developing a Vancouver type B2 periprosthetic femoral fracture postoperatively. To afford some experience for the management of similar cases, we here present our technical solutions to these problems.     

Worldwide Trends of Research on Periprosthetic Osteolysis: A Bibliometric Study Based on VOSviewer

BackgroundDue to the increasing number of joint arthroplasty operations, surgeons have begun to devote more attention to the problem of periprosthetic osteolysis. In recent years, numerous studies have focussed on periprosthetic osteolysis, but there have been no relevant bibliometric studies.MethodsWe searched the Web of Science database for relevant articles concerning periprosthetic osteolysis published from 1965 to 2021. The following data were extracted: authors’ name, article title, publication journal, impact factor (IF) of the journal in the publication year, keywords, topic of the article, publication country/region, the sum of times cited, H-index and funding sources. VOSviewer and Excel 2019 were used to conduct the bibliometric study and visualise the analysis.ResultsA total of 1255 publications were included. In all selected articles, “orthopaedics” became the dominant topic (662 of 1255, 52.75%). The most productive years were 2018 and 2019, with a total of 83 publications. The Journal of Arthroplasty published the most articles on periprosthetic osteolysis (110 publications). The United States of America published the most articles (525, 41.83%). The latest keywords “continuous intramedullary infusion”, “erythromycin”, “autophagy”, “bone-resorbing cells” and “proinflammatory cytokines” both appeared in five articles in 2017.ConclusionThis bibliometric study showed that there is a growing trend in published articles related to periprosthetic osteolysis. Journal of Arthroplasty was the top productive journal on periprosthetic osteolysis. The United States of America dominates studies of periprosthetic osteolysis. “Continuous intramedullary infusion”, “erythromycin”, “autophagy”, “bone-resorbing cells” and “proinflammatory cytokines” may be new research hotspots in the field of periprosthetic osteolysis.     

The Management of Periprosthetic Fractures Oxford Trimodular Femoral Stem: A Survivorship Study

A consecutive series of 40 periprosthetic femoral fractures, treated with revision hip surgery using the Oxford trimodular femoral stem, were retrospectively studied, with an average follow-up of 7.9 years. Fractures were classified according to the Vancouver classification. There were 5 type B1 fractures, 28 type B2, and 7 type C. Radiographic union was achieved in 38 (95%) hips. The mean time to fracture union was 3.5 months. The prosthesis survival at 5 years was 95% (confidence interval, 88%-100%). Clinical results were good with a mean Oxford hip score of 30 (hip score maximum, 48). Complications included 1 nonunion, 1 infection, 1 dislocation, and 2 aseptic loosening. The Oxford trimodular femoral component is a safe and reliable prosthesis for the treatment of periprosthetic femoral fractures with satisfactory medium-term results.     

Incidence and Direct Medical Costs of Hospitalizations due to Osteoporotic Fractures in Switzerland

The objective of this study was to estimate the annual direct medical costs of hospitalizations due to osteoporotic fractures in Switzerland. Days of hospital stay in 1992 were quantified using the casuistic of the medical statistics department of VESKA (Vereinigung Schweizerischer Krankenh?user, the Swiss Hospital Association), which covers 43% of all hospital beds of that country. Number and incidence of total hospitalizations due to fractures were calculated by extrapolating to 100% the 43% VESKA-selected sample. To estimate number and incidence of hospitalizations due to osteoporotic fractures, internationally accepted age-specific osteoporosis attribution rates were applied. According to the latter the probability of a fracture being causes by osteoporosis increases with age. Mean length of stay for all fractures was calculated (= total hospital days divided by number of cases). By multiplying these mean lengths of stay by the number of osteoporosis-related fracture cases, the number of bed-days due to osteoporotic fractures was calculated. To compare the direct medical costs of hospitalization due to osteoporosis with those due to other frequent diseases, days of hospital stay caused by chronic obstructive pulmonary disease (COPD), stroke, acute myocardial infarction and breast cancer were estimated using the same methodology. A total estimate of 63 170 (f: 33 596, m: 29 574) hospitalizations due to fractures (and other osteoporosis-related diagnoses) was calculated, thus leading to overall annual incidence rates of hospitalizations for fractures of 950/100 000 women and 877/100 000 men. In women, 548 615 hospital days were found to be caused by osteoporosis, 353 654 days by COPD, 352 062 days by stroke, 200 669 days by breast carcinoma and 131 331 days by myocardial infarction. In men, COPD caused more hospitalization days (537 164) than myocardial infarction (196 793), stroke (180 524) or osteoporosis (152 857). Taking a mean price for a hospital day in Switzerland of 845 Swiss francs, the annual costs of acute hospitalizations due to osteoporosis and its complications were approximately 600 million Swiss francs (f: 464, m: 130 million Swiss francs) in 1992. We conclude that there is enough economic evidence to justify wide-scale interventions against osteoporosis in Switzerland.     

The Epidemiology and National Trends of Bearing Surface Usage in Primary Total Hip Arthroplasty in Korea

Background

We analyzed the data for primary total hip arthroplasty (THA) in the Korean nationwide database to assess (1) the epidemiology and national trends of bearing surface usage in THAs and (2) the prevalence of each type of bearing surface according to age, gender, hospital type, primary payer, and hospital procedure volume.

Methods

A total of 30,881 THAs were analyzed using the Korean Health Insurance Review and Assessment Service database for 2007 through 2011. Bearing surfaces were sub-grouped according to device code for national health insurance claims and consisted of ceramic-on-ceramic (CoC), metal-on-polyethylene (MoP), ceramic-on-polyethylene (CoP), and metal-on-metal (MoM). The prevalence of each type of bearing surface was calculated and stratified by age, gender, hospital type, primary payer, and procedure volume of each hospital.

Results

CoC was the most frequently used bearing surface (76.7%), followed by MoP (11.9%), CoP (7.3%), and MoM (4.1%). The proportion of THAs using a CoC bearing surface increased steadily from 71.6% in 2007 to 81.4% in 2011, whereas the proportions using CoP, MoP, and MoM bearing surfaces decreased. The order of prevalence was identical to that in the general population regardless of age, gender, hospital type, primary payer, and hospital procedure volume.

Conclusions

The trends and epidemiology of bearing surface usage in THAs in Korea are different from those in other countries, and the CoC bearing surface is the most prevalent articulation. In future, the results of a large-scale study using nationwide data of THAs involving a CoC bearing surface will be reported in Korea.     

Retrospective Population-Based Cohort Study of Incidence,Complications, and Survival of 202 Operatively Treated Periprosthetic Femoral Fractures

BackgroundThe aim of this study is to investigate the population and primary total hip arthroplasty (THA)-based incidences, fracture types, complications, and survival of operatively treated periprosthetic femoral fracture (PFF).MethodsThis retrospective study reviewed 202 cases of operatively treated PFFs in a study period from January 2004 to December 2016. The Vancouver classification was used to classify PFFs.ResultsThe incidence of PFF related to 1000 primary THAs per year was 2.7 (standard deviation 1.0, range 0.9-4.5) at a defined hospital district area during the study period. The mean population-based incidence of operatively treated PFFs raised from 1.6 to 4.5 per 100,000 person-years during the study period. The B1-type fracture was the most common fracture type in 71 of 202 (35%) of these PFFs. The cumulative incidence of re-revision was 10.9% at 1 year and 15.6% at 15 years (95% confidence interval [CI] 10.9-21.0). The cumulative incidence for other major complications was 6.4% at 1 year and 9.9% at 15 years (95% CI 5.9-15.0). The cumulative incidence of death after PFF was 7.4% at 1 year and 56.3% at 15 years (95% CI 41.3-68.8) during the follow-up time from January 1, 2004 to December 31, 2019.ConclusionThis country-specific study showed a 3-fold increasing trend in the incidence of operatively treated PFFs from 2004 to 2016 per 1000 THAs. The Vancouver type B1 fracture was the most common type. A high number of complications were associated with PFFs and 7.4% of the patients had died within 1 year after PFF surgery.     

Incidence and costs of hip fractures compared to acute myocardial infarction in the Italian population: a 4-year survey

Introduction Few data are available about the incidence and costs of hip fractures in Italy. We aimed to determine the impact of hip fractures vs. acute myocardial infarction (AMI). Methods We studied the national hospitalization database to calculate their incidence and costs in adults aged ≥45 between 1999 and 2002. Results In 2002, there were 86,719 hip fractures with a 10.0% increase over 4 years. We observed a predominance of women (77.1%) and a strong age effect: 92.7% of patients were ≥65 years old and 80% of fractures occurred in women aged ≥75, showing a clear relationship with the incidence of osteoporosis. Hospitalizations due to AMI after 45 years of age in 1999 were only 9% higher than those for hip fracture, although this difference increased over the 4 examined years up to 24%. Considering the DRGs costs, hip fractures resulted in being more expensive than AMI overall and concerning elderly people. Conclusions This study shows that in the Italian population aged ≥45, hospitalizations following hip fracture and AMI between 1999 and 2002 were comparable, while hip fractures’ direct costs were higher and grew faster than costs for AMI. Hip fractures in Italy are a serious medical problem and a leading health-cost driver.     

Incidence and Risk Factors for Pregnancy-Related de Quervain’s Tenosynovitis in South Korea: A Population-Based Epidemiologic Study

BackgroundAlthough pregnant or lactating women have been recognized to be predisposed to de Quervain’s tenosynovitis (DQT), there is a lack of epidemiologic evidence. The purpose of this study was to estimate the nationwide incidence of pregnancy-related DQT (PRDQT) and to analyze risk factors using the Korean National Health Insurance (NHI) database.MethodsA retrospective epidemiologic study of pregnant women in South Korea from 2013 to 2017 was conducted using the NHI claims database. Using corresponding diagnostic codes, we identified women diagnosed with DQT during pregnancy or the postpartum period. We calculated the cumulative incidence and analyzed risk factors such as demographics, pregnancy type, delivery method, gestational complications, and comorbidities using multivariate logistic regression analysis.ResultsBetween 2013 and 2017, 34,342 patients with PRDQT were identified among 1,601,501 pregnant women, representing a cumulative incidence of approximately 2.1%. Age ≥ 30 years, multiple gestation, cesarean delivery, hypertensive disorders in pregnancy, and underlying rheumatoid arthritis were all identified as significant risk factors for the occurrence of PRDQT, whereas diabetic disorders in pregnancy and underlying diabetes mellitus were not.ConclusionsIn South Korea, PRDQT was found to affect approximately 2.1 out of 100 pregnant women between 2013 and 2017. The incidence and risk factors identified in this study can be used for clinical consultations and prediction, as well as for development of national health policies.     

Does Early Debridement,Antibiotic Therapy and Implant Retention (DAIR) have a Role in Managing Periprosthetic Joint Infection of the Knee in Indian Scenario: A Retrospective Analysis of Outcomes

PurposeTo report outcomes of Debridement, Antibiotic therapy and Implant Retention (DAIR) for periprosthetic knee joint infections (PJI) in the Indian population and to study factors influencing outcomes.MethodsThis was a Retrospective study of 80 cases of acute PJI after total knee arthroplasty who were treated by DAIR, within 2 weeks of onset of infection. A standardised institutional management protocol was applied to all cases. Patients were followed up for a minimum 1 year. Outcomes of DAIR were classified as successful or unsuccessful based on resolution or persistence of infection, and subsequent requirement of revision surgery. Influence of factors, like comorbidities, culture status and microbiological characteristics of causative organism, on outcomes was assessed.ResultsOverall 55 patients (68.75%) had successful eradication of infection after DAIR. 27 (33.7%) patients were culture negative and 53 (66.2%) patients grew organisms on culture. There was no statistically significant difference in outcomes (p = 0.082) between culture-positive cases (69.8% success rate) and (66.7% success rate) in culture negative cases. Furthermore, no difference in outcomes was observed in culture-positive patients between those who grew Gram-positive organisms versus Gram-negative organisms (p = 0.398) Similarly, patient comorbidities did not significantly alter the outcomes after DAIR (p = 0.732).ConclusionOur study demonstrates that early DAIR within 2 weeks of onset of infection using a standard protocol during surgery and postoperatively can result in good outcomes. Patient comorbidities, culture status (positive versus negative), Gram staining characteristics of organisms and the identity of pathogenic bacteria did not influence outcomes of DAIR for acute PJI.     

Incidence and risk of developing rheumatic diseases in 19,724 patients with palindromic rheumatism in South Korea: A nationwide population-based study

ObjectivesThe spectrum of progression of palindromic rheumatism (PR) to chronic diseases is quite variable. Hence, this study aimed to investigate the incidence and risk of developing rheumatic diseases in PR using nationwide, population-based medical claims data from Korea.MethodsWe assessed the incidence rate (IR) of PR in the population in the given year. After matching individuals with PR with those without PR (1:10) for age, gender, and the index year, we calculated the hazard ratios (HRs) with 95% confidence intervals (CIs) using the Cox proportional hazard model.ResultsA total of 19,724 newly diagnosed incident PR cases were identified from 2010 to 2016. The mean age was 50.2 ± 14.9 years. The incidence of PR was 7.02 (95% CI 6.92–7.12) per 100,000 person-years (6.22 and 7.80 in men and women, respectively). During observation, 8.79% patients with PR and 0.30% individuals without PR developed various outcome diseases. Patients with PR had an increased risk of seropositive rheumatoid arthritis (HR 46.51, 95% CI [41.05–52.69]), psoriatic arthritis (44.79 [15.16–132.35]), systemic lupus erythematosus (24.53 [16.15–37.24]), mixed connective tissue disease (22.01 [7.65–63.34]), Behçet's disease (21.04 [13.81–32.06]), Sjögren's syndrome (12.36 [8.54–17.88]), ankylosing spondylitis (9.00 [6.67–12.15]), dermatomyositis/polymyositis (6.14 [2.55–14.82]), and systemic sclerosis (3.75 [1.47–9.58]) compared with individuals without PR.ConclusionsThis nationwide, population-based cohort study demonstrated that about one-eleventh of patients with PR eventually develop systemic rheumatic diseases and that patients with PR have an increased risk of developing various rheumatic diseases including seropositive rheumatoid arthritis.     

A Retrospective Review of the Dall-Miles Plate for Periprosthetic Femoral Fractures: Twenty-seven Cases and a Review of the Literature

A retrospective review of the use of the Dall-Miles plate for periprothetic femoral fractures was performed at our institution. Twenty-seven fractures around a hip replacement were fixed using a Dall-Miles plate within 34 months. The mean age at operation was 74 (33-90) years. Twenty fractures were Vancouver B1, two B2, and five type C. Mean follow-up was 11 (2–41) months. Two fractured plates required revision and two fixations loosened, developing varus malunion. One malunion was related to deep infection. All four events occurred within six months of fixation. Two individuals were deceased within 3 months of surgery. Similar complications were evident in nine series published between 1990 and 2012. Increased incidence of periprosthetic femoral fractures is anticipated in a population with significant co-morbidities. Cortical strut allograft, iliac autograft and orthobiological supplementation remain options where non-union is anticipated.     

Current epidemiology and antenatal presentation of posterior urethral valves: Outcome of BAPS CASS National Audit

Aim

Posterior urethral valves (PUVs) are the most common cause of congenital bladder outlet obstruction (BOO) in boys and end-stage renal failure (ESRF) in childhood. In the 1980s, 1 in 4000 boys had PUV. Presentation was 1/3 antenatal/neonatally, 1/3 postnatal, 1/3 late (> 1?year). This study aimed to describe the current proportions in a contemporary cohort.

An Increasing Trend in the Number of Anterior Cruciate Ligament Reconstruction in Korea: A Nationwide Epidemiologic Study

BackgroundMost epidemiologic studies of anterior cruciate ligament reconstruction (ACLR) to date have been conducted in Western populations, whereas no studies have been conducted in Asian populations. In this study, the incidence and trend of ACLR in Korea were investigated through an epidemiological big data analysis.MethodsThe data were collected by the Health Insurance Review and Assessment Service from 2008 to 2016 in Korea. Patient records with the coding of cruciate ligament reconstruction were allocated, and ACLR patients were further refined by medical diagnosis coding. The total number and incidence of ACLR procedures per 100,000 person-years were investigated and more detailed analysis was conducted according to sex and age. Furthermore, concomitant surgical procedures performed during ACLR were investigated.ResultsThe total number and incidence of ACLR procedures rose from 10,248 and 21.8 to 14,500 and 29.1 between 2008 and 2016, respectively. The incidence of ACLR procedures increased by 33.5% over this 9-year period. Over this period, the total number and incidence increased from 8,543 and 36.4 to 11,534 and 46.4, respectively, in males and from 1,705 and 7.2 to 2,966 and 11.9, respectively, in females. ACLR was performed more frequently in males than in females; however, the increase rate was higher in females than males. ACLR was performed most frequently in patients in their 20s, followed by patients in their 30s, 40s, and 10s. The most frequent concomitant procedures performed during ACLR were meniscectomy (13.6% in 2008 and 9.8% in 2016) and meniscal repair (5.8% in 2008 and 8.8% in 2016).ConclusionsThe incidence of ACLR consistently rose between 2008 and 2016 in Korea. The current study will enhance our understanding of the epidemiology of ACLR, which is needed to devise cost-effective preventive measures.