This study aimed to identify risk factors for development of deep periprosthetic joint infection (PJI) in patients following surgical treatment of neck of femur fracture. This study identified a consecutive series of 2,822 (2,052 female, 73%) patients who underwent either hemiarthroplasty (n=1,825, 65%) or fixation (DHS) (n=997, 35%) for fractured neck of femur performed between January 2009 and June 2015 at our institution. Full patient demographics, co-morbidity and peri-operative complication data were determined. The majority of patients were either ASA 2 (n=663, 23%) or ASA 3 (n=1,521, 54%), mean age = 81.3 years (SD 10.3). All patients were followed up post-operatively by a dedicated surgical site infection (SSI) monitoring team in order to identify patients who developed a PJI within 1 year. A stepwise multivariable logistic regression model was used to identify patient and surgical factors associated with increased risk of infection. Predictors with a p-value of <0.20 in the univariate analysis were included in the multivariate analysis.Aim
Method
The aim of this study was to review the role
of clinical trial networks in orthopaedic surgery. A total of two
electronic databases (MEDLINE and EMBASE) were searched from inception
to September 2013 with no language restrictions. Articles related
to randomised controlled trials (RCTs), research networks and orthopaedic
research, were identified and reviewed. The usefulness of trainee-led
research collaborations is reported and our knowledge of current
clinical trial infrastructure further supplements the review. Searching
yielded 818 titles and abstracts, of which 12 were suitable for
this review. Results are summarised and presented narratively under
the following headings: 1) identifying clinically relevant research
questions; 2) education and training; 3) conduct of multicentre
RCTs and 4) dissemination and adoption of trial results. This review
confirms growing international awareness of the important role research
networks play in supporting trials in orthopaedic surgery. Multidisciplinary
collaboration and adequate investment in trial infrastructure are crucial
for successful delivery of RCTs. Cite this article:
National Institute for Health and Clinical Excellence (NICE) guidelines recommend the use of total hip replacement (THR) for displaced intracapsular fractured neck of femur (NOF) in cognitively intact patients who were independently mobile prior to the injury. The National Joint Registry for England and Wales (NJR) has collected data on THRs performed since 2003. This retrospective cohort study explores risk factors independently associated with implant failure and perioperative mortality. NJR data recording a THR performed for acute fractured NOF between 2003 and 2010 were analysed. Cox proportional hazards models were used to analyse the extent to which risk of implant revision was related to specific covariates. Multivariable logistic regression was used to analyse factors affecting 90-day perioperative mortality. Significance was taken as p< 0.01.Introduction
Methods
Current analysis of unicondylar knee replacements (UKR) by national registries is based on the pooled results of medial and lateral implants. Using data from the National Joint Registry for England and Wales (NJR) we aimed to determine the proportion of lateral UKR implanted, their survival and reason for failure in comparison to medial UKR. By combining information on the side of operation with component details held on the NJR we were able to determine implant laterality (medial vs. lateral) for 32,847 of the 35,624 (92%) UKR registered before December 2010. Kaplan Meier plots, Life tables and Cox' proportion hazards were used to compare the risk of failure for lateral and medial UKRs after adjustment for patient and implant covariates.Background
Methods
Both surgeon and hospital volume influence patient outcomes following revision knee arthroplasty. To audit all centres performing revision knee procedures in England and Wales over a 2-year period. All centres were audited against two pre-defined standards linked to hospital volume Operative volume should be greater than 10 revisions per year; More than 2.5 revisions should be performed for every 100 primary arthroplasties implanted.Background
Purpose
Following in-depth analysis of the market leading brand combinations in which we identified implant influences on risk of revision, we compared revision in patients implanted with different categories of hip replacement in order to find implant with the lowest revision risk, once known flawed options were removed. All patients with osteoarthritis who underwent a hip replacement (2003–2010) using an Exeter-Contemporary (cemented), Corail-Pinnacle (cementless), Exeter-Trident (Hybrid) or a Birmingham Hip resurfacing (BHR) were initially included within the analysis. Operations involving factors that were significant predictors of revision were excluded. Cox proportional hazard models were then used to assess the relative risk of revision for a category of implant (compared with cemented), after adjustment for patient covariates.Introduction
Methods
To determine how patient characteristics; health status and pre-operative knee function effect patient reported satisfaction and operative success following total knee replacement (TKR). We hypothesised that a number of patient factors would influence the reported levels of symptomatic improvement (success) and satisfaction and that these two outcomes would represent different aspects of the patient's perception of outcome. Retrospective cohort analysis of patient reported outcome measures (PROMs) and National Joint Registry (NJR) data. Complete patient data was available for 9,874 TKRs performed for osteoarthritis between 1/8/08 and 31/12/10. The relationship of the background factors to patient perceived satisfaction and success was investigated using ordinal logistic regression and structural equation modelling (SEM).Purpose
Design
The most appropriate form of chemical thromboprophylaxis following knee replacement is a contentious issue. Most national guidelines recommend the use of low molecular weight Heparin (LMWH) whilst opposing the use of aspirin. We compared thromboembolic events, major haemorrhage and death after knee replacement in patients receiving either aspirin or LMWH. Data from the National Joint Registry for England and Wales was linked to an administrative database of hospital admissions in the English National Health Service. A total of 156 798 patients undergoing knee replacement between April 2003 and September 2008 were included and followed up for 90 days. Multivariable risk modelling was used to estimate odds ratios adjusted for baseline risk factors (AOR). An AOR < 1 indicates that risk rates are lower with LMWH than with aspirin.Background
Methods
To examine how patients viewed the outcome of their joint replacement at least one year post surgery. Emphasis was placed on investigating the relative influence of ongoing pain and functional limitation on patient satisfaction. Questionnaire based assessment of the Oxford Knee Score (OKS), patient satisfaction, and need for reoperation in a group of 10,000 patients who had undergone primary unilateral knee replacement between April and December 2003. Questionnaires were linked to the NJR database to provide data on background demographics, clinical parameters and intraoperative surgical information for each patient. Data was analysed to investigate the relationship between the OKS, satisfaction rate and the background factors. Multivariable logistic regression was performed to establish which factors influenced patient satisfaction.Purpose
Method
We have carried out a 15 year survival analysis of a prospective, randomised trial comparing cemented with cementless fixation of press-fit condylar primary total knee replacements. A consecutive series of 501 PFC knee replacements received either cemented (219 patients, 277 implants) or cementless (177 patients, 224 implants) fixation. No patients were lost to follow up. Revision was defined as further surgery, irrespective of indication, that involved replacement of any of the three originally inserted components (Femur, Tibia, Patella).Introduction
Methods
Electrolyte imbalance in the elderly is a clinical problem faced by both elderly care physicians and orthopaedic surgeons alike. Hyponatraemia is a common condition with a vague clinical profile and severe consequences if untreated. Recent medical editorials have criticised orthopaedic handling of this problem. We therefore sought to establish the incidence of hyponatraemia within our orthopaedic population and a similar age-matched elderly care population in the light of changing attitudes to fluid management. Retrospective, consecutive analysis of the serum sodium concentrations and fluid regimes of all patients admitted with a fractured neck of femur during a three-month period. An age-matched control group of elderly care patients was used for comparison. Data was analysed using paired t-test and independent t-test as appropriate.Introduction
Methods
