Is obesity related with periprosthetic fractures around the knee?

Purpose

Periprosthetic fracture (PPF) is a devastating complication following primary total knee arthroplasty. Obesity is currently considered a risk factor for many complications in orthopaedics, but there is no evidence in literature about the relationship between obesity and PPF around the knee. The objective of this study was to determine whether obesity is associated with a higher incidence of PPF.

Methods

All patients diagnosed of a PPF around the knee from January 2010 to December 2013 were enrolled. Forty-nine PPF (47 women and 2 men) were included, and a total of 97 patients (80 women and 17 men) were randomly obtained as a control group. Body mass index (BMI) was obtained in both groups and classified as <25 (normal), overweight (25–29.9), obese (30–34.9), very obese (35–39.9), or morbid obesity (≥40). Both groups, were also divided into subpopulations depending on the age as follows: <70, 70–75, 75–80 and ≥80. Statistical analysis was performed to determine any difference in BMI ≥30 kg/m² distribution between groups.

Results

In the PPF group 61.22 % of the patients had a BMI over 30 kg/m² and likewise 62.88 % of the patients in the control group. No association was found between obesity and a higher risk of PPF (p?<?0.05).

Conclusion

As a conclusion, obesity (BMI ≥30 kg/m²) does not have any clinical relationship with the appearance of a periprosthetic fracture around the knee (相似文献   

Periprosthetic fractures of the proximal femur—Vancouver A type fracture

Introduction

Today, we encounter an increasingly high need for arthroplasty, with a high number of total hip arthroplasties. With this, complications also rise, such as periprosthetic fractures. The purpose of this article is to briefly expose the periprosthetic fracture type Vancouver A, which is located either around the greater or the lesser trochanter.

Lesser trochanter fractures

The fractures of the lesser trochanter occur either through a low-energy trauma or spontaneously in the context of an osteolysis after loosening of the stem. The healing can mostly be achieved conservatively. In rare cases, an operative treatment must be considered, as in cases of osteolysis or lack of medial support, where a stem revision can become necessary.

Greater trochanter fractures

Also, the greater trochanter fractures are an entity of low-energy trauma. In cases of little displacement or in patients with low demand, a conservative treatment is indicated. For all other cases, there are a number of different methods of fixation. They range from wire cerclages to angular stable plates or even gluteus maximus/fascia lata flap transfer. However, a relatively high incidence of non-unions has been reported with different fixation techniques. The high incidence of non-union of periprosthetic fractures of the greater trochanter could eventually solved with the use of angular stable implants. There seem to be certain advantages, but further and larger studies will be necessary to prove its value.     

Periarticular fractures around the hip and knee: fix or replace?

The number of periarticular fragility fractures around the hip and knee is increasing. If surgical treatment is indicated, open reduction and internal fixation or replacement can often be viable options. In contrast to secondary replacement, the use of replacement in the acute stage might be advantageous because early rehabilitation and weightbearing can be initiated. This article describes the current literature related to internal fixation or primary replacement in periarticular fractures around the hip and knee.     

Prevalence and characteristics of unilateral knee osteoarthritis in a community sample of elderly Japanese: do fractures around the knee affect the pathogenesis of unilateral knee osteoarthritis?

BackgroundThe purpose of this study was to investigate the prevalence and characteristics of unilateral knee osteoarthritis (KOA), to investigate what percent of contralateral healthy knees in patients with unilateral KOA progress to KOA, and to investigate whether knee fractures influence unilateral KOA.MethodsStudies were performed every two years from 1997 to 2009 in Miyagawa village, for a total of seven studies. A total of 1239 village inhabitants aged ≥65 years participated in these studies at least once. KOA was defined as a Kellgren–Lawrence (K/L) grade ≥2. Based on the knee X-ray at the first examination, participants were divided into three groups: no KOA (N group), unilateral KOA (U group), and bilateral KOA (B group). The U group was divided into two subgroups: K/L grade II-I combination (II-I group), and the U group without the II-I combination (G>2 group). To investigate whether knee fractures influence unilateral KOA, the fracture history was considered.ResultsThe percentages of participants classified into the N, B, and U groups (II-I and G>2 group) were 68.4, 21.6, and 10.0 % (7.8 and 2.1 %), respectively. Most of the U group had the II-I combination (78.7 %). The percentages of knee fractures in the N, B, II-I, and G>2 groups were 3.3, 5.3, 6.3, and 38.5 %, respectively. Overall, 49.2 % of the U group proceeded to bilateral KOA over an average of 5.3 years.ConclusionsThe prevalences of definite radiographic bilateral and unilateral KOA were 21.6 and 10.0 %, respectively. Overall, 49.2 % of the participants with unilateral KOA developed KOA in the contralateral knee over an average of 5.3 years. If bilateral KOA advanced simultaneously, the II-I group was considered to represent the midpoint of progression to bilateral KOA. Bilateral KOA advanced simultaneously except in cases with a history of knee trauma, such as fractures.     

Interprosthetic fractures—a challenge of treatment

The incidence of periprosthetic femoral fractures rises continuously as both the number of hip and knee replacements and the life expectancy of the population are increasing. Likewise, interprosthetic femoral fractures, occurring between ipsilateral total hip and total knee arthroplasties, are an increasingly common and challenging problem. The majority of these fractures is localized at the femoral supracondylar region. Their treatment is not only technically demanding but also susceptible to complications. It has to be decided depending on the fracture type, surrounding bone stock, fracture localization, stability of the prosthesis, and the general condition of the often multimorbid patients whether osteosynthesis, revision of the prosthesis, or—when combined with periprosthetic infection—an amputation is indicated in the individual case. The modified Vancouver classification for interprosthetic femoral fractures was used for a systematic presentation of the indications, surgical techniques, and results.     

Is the fracture pattern in periprosthetic fractures around the knee related with the anterior femoral notch?

Introduction

Periprosthetic fractures around the knee (PPF) are a devastating complication of total knee arthroplasty (TKA). Anterior femoral notching during TKA is considered a risk factor for PPF. The aim of this paper is to determine if an anterior femoral notch after total knee arthroplasty may affect the fracture pattern when a PPF appears postoperatively.

What is the best treatment for displaced Salter–Harris II physeal fractures of the distal tibia?

Background and purpose — The optimal treatment of displaced Salter–Harris (SH) II fractures of the distal tibia is controversial. We compared the outcomes of operative and nonoperative treatment of SH II distal tibial fractures with residual gap of >3?mm. Factors that may be associated with the incidence of premature physeal closure (PPC) were analyzed.

Patients and methods — We retrospectively reviewed 95 patients who were treated for SH II distal tibial fractures with residual gap of >3?mm after closed reduction. Patients were assigned to 1 of 2 groups: Group 1 included 25 patients with nonoperative treatment, irrespective of size of residual gap (patients treated primarily at other hospitals). Group 2 included 70 patients with operative treatment. All patients were followed for ≥ 12 months after surgery, with a mean follow-up time of 21 months. Logistic regression analyses were performed to identify risk factors for the occurrence of PPC.

Results — The incidence of PPC in patients who received nonoperative treatment was 13/52, whereas PPC incidence in patients who received operative treatment was 24/70 (p = 0.1). Multivariable logistic regression analysis determined that significant risk factors for the occurrence of PPC were age at injury, and injury mechanism. The method of treatment, sex, presence of fibular fracture, residual displacement after closed reduction, and implant type were not predictive factors for the occurrence of PPC.

Interpretation — Operative treatment for displaced SH II distal tibial fractures did not seem to reduce the incidence of PPC compared with nonoperative treatment. We cannot exclude that surgery may be of value in younger children with pronation–abduction or pronation–external rotation injuries.     

What is the best treatment of postpneumonectomy empyema?

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether an open surgical approach is superior to minimally invasive surgery in patients with postpneumonectomy empyema (PPE). Overall 171 papers were found using the reported search, of which 12 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results are tabulated. We conclude that open surgical approaches are superior to minimally invasive surgery in terms of empyema recurrence rate, mortality and reintervention rate. Minimally invasive surgery includes chest tube drainage with or without chemical irrigation and video-assisted thoracoscopic surgery debridement. Whereas open surgery includes open debridement, open window thoracostomy (OWT) and thoracomyoplasty. To allow for an accurate comparison, success of an intervention was defined as prevention of empyema recurrence. Two studies reported surgical outcomes of patients treated with minimally invasive treatment options. They found high mortality rates (17.1%) and low success rates (31%) in patients treated by chest tube drainage with chemical irrigation. Five studies treated PPE using a combination of minimally invasive and open surgical approaches and reported a high reintervention rate of 3.5 (range 3-5) and an empyema recurrence rate of 13.3%. Higher success rates (6.7 vs. 95%), lower mortality rates (33 vs. 0%) and shorter hospital stay (47.5 vs. 17.6?days) were all noted with thoracomyoplasty compared to chest tube drainage therapy. Five studies managed PPE using OWT or thoracomyoplasty. The time between empyema diagnosis to resolution (3 vs. 38?months) was much shorter with immediate OWT than with delayed OWT therapy. The Clagett procedure resulted in a mean hospital stay of 12.9?days, an operative mortality rate of 7.1% and an overall success rate of 81%. Thoracomyoplasty led to a mean hospital stay of 34?days with a mortality rate of 6%. The shorter hospital stay, lower empyema recurrence rates and lower mortality rates may make open surgical approaches a more effective treatment option to minimally invasive options.     

Arthroscopy prior to osteotomy around the knee?

Introduction  Osteotomy around the knee is well established in orthopaedic surgery in cases of congenital/posttraumatic leg deformities with mono-compartment osteoarthritis of the knee. However, there is no consensus whether there should be an arthroscopy prior to osteotomy in the same operative session, either for diagnostic or therapeutic reasons. Patients and methods  This prospective study included 340 cases of osteotomy around the knee with a routine arthroscopy. During arthroscopy indication for osteotomy was checked first. Then cartilage status was determined to modify type and degree of correction osteotomy accordingly. Finally therapeutic procedures were performed in cases of intraarticular pathologies. Results  Indication was rejected in 47 cases with ten patients receiving endoprosthetic treatment. In 157 cases the degree of correction was modified, in eleven cases the level of osteotomy. Under the 330 non-endoprothetic sessions there were 316 arthroscopies with therapeutic treatments. Conclusion  This study could demonstrate that arthroscopy in the same session is indispensable, to check the indication for osteotomy, to modify type and degree of correction according to cartilage status and to perform therapeutic procedures.     

Results of operative treatment of acetabular fractures from the Third World—how local factors affect the outcome

The objective of this study was to assess the outcome of operations on acetabular fractures from a developing country in the presence of locally available facilities. Sixty-three acetabular fractures were assessed at an average follow up of 52.94 months after operation. Twenty-six patients operated upon in the first three years and 37 operated thereafter were separately studied to discover the effect of the learning curve. Regarding the fractures, 47 of 63 (74.6%) had excellent/good results (Harris Hip Score>80). The complications included broken drill bit in eight patients (12.69%), deep infection and heterotopic ossification in five patients (7.93%), avascular necrosis and sciatic nerve palsy in two patients (3.17%) and implant failure in one patient (1.58%). The results collected during the learning curve were inferior in the complex fractures (p value<0.001). Complications were common in patients opting for local implants and in those operated after over 2 weeks delay.     

Femoral shaft fractures in children—a comparison of treatment

Between April 1986 and March 1997, 83 femoral-shaft fractures in children 4-8 years old were treated at Christian Medical College and Hospital, Ludhiana, India. Among 35 patients with a minimum of 12 months follow-up, 14 were treated with Hamilton-Russell (HR) skin traction and 14 with proximal tibial skeletal traction. The group treated with HR traction had a shorter duration of (a) hospital stay (average 16.8 days versus 29.7 days for skeletal traction, p=0.02), (b) time to fracture consolidation (average 8.8 weeks versus 10.8 weeks for skeletal traction, p=0.04), and (c) return to normal activities (average 12.2 weeks versus 17.2 weeks for skeletal traction, p=0.03). At final follow-up (minimum 1 year), there were no significant differences in functional outcomes. Conservative management is still a gold standard for treatment of closed femoral shaft fractures in children 4-8 years of age. There appears to be no advantage to skeletal traction over skin traction in this age group.     

Long-term results after operative treatment of osteochondritis dissecans of the knee joint—30 year results

Osteochondritis dissecans (OD) mostly appears at the knee joint on the weight-bearing part of the medial femoral condyle. A multi-factorial event is most likely responsible for the triggering of OD. The aim of this retrospective study was to carry out long-term assessment of the results of operative treatment. Between 1959 and 1976, 148 patients were treated for OD by an open technique. For this purpose, a total number of 38 patients were analysed after approximately 30 years. Twenty-six patients were evaluated clinically by means of standardised questionnaires and also radiologically; 12 patients were analysed only by questionnaire. In order to verify the clinical findings and the subjective assessment, radiographs were done and analysed according the Kannus score. The Brückl score was used to evaluate the results of the OD. Twenty-four knee joints were analysed by radiographs. Sixty percent of the operated joints showed poor results in the analysis according to Kannus. Only four patients showed an excellent result by using the clinical scoring system. Nevertheless, we were able to prove a markedly higher rate of osteoarthrosis. The causal explanation for this lies in the patient selection. Most of the patients were above average age, and the OD was discovered quite late, and thus the disease had already progressed to a higher degree. In 74% of all cases, an extirpation of the osteochondral fragment was performed, whereas today there are several operative options. In our view, therefore, the need arises to conduct further follow-up examinations with comparative time spans, as well as to conduct a parallel analysis of corresponding control groups in order to evaluate the aetiology of the increased rate of osteoarthrosis.     

The diagnosis and treatment of the ‘mixed’ type of depressed fractures of the calcaneum

Summary The mixed type of depressed fractures of the calcaneum is described and a classification proposed. During a six year period, 78 patients with fractures of the calcaneum were seen. Of these 32 were of the mixed type and 23 were treated by sub-talar arthrodesis and restoration of the calcaneal outline. Very good or good results were obtained in all patients subjected to operation.

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Résumé L'auteur décrit un type de fracture du calcanéum par enfoncement «mixte» (i. e. à la fois vertical et horizontal) et il en propose une classification. Sur 78 fractures du calcanéum observées en six ans, 32 étaient de ce type «mixte» et 23 d'entre elles furent traitées par arthrodèse sous-astragalienne avec reconstitution de la forme du calcanéum. D'excellents ou de bons résultats ont été obtenus chez tous les blessés qui ont bénéficié de cette intervention.