Total Joint Arthroplasty (TJA) is a successful orthopaedic procedure allowing dramatic clinical and functional improvements. Globally, there's been an increase in demand and performed cases associated with an increase in complications. Subsequently, focus on the prevention of complications has become important worldwide. The incidence of venous-thrombolic events (VTE) despite great attention has not diminished despite much investigation. A balance between efficacy and safety from the available agents is essential. Low molecular weight heparin (LMWH) has been commonly used, but oral anti-coagulants have become more popular. The aim of this study was to assess the adherence LMWH and the effectiveness and safety of preventing VTE in post-operative arthroplasty patients in a South African setting. We conducted a prospective cohort study that included hip and knee, primary and revision, arthroplasty patients who received thromboprophylaxis with one daily injection of LMWH for 14 days post discharge. Patients who omitted 1 or more doses during the follow up period were classified as “non adherent”. A questionnaire was used at follow up visits at least 6 weeks post-operatively. 100 consecutive patients were followed up. The mean age of patients was 63.45 years. There were 68 % female patients. There was a 92% compliance rate. 60 % of patients had the injection administered by a family member, 38 % administered it themselves and 2 % had the injection administered by health professionals. Venous thromboembolic events were confirmed in 5 % at 7.86 days after surgery. Three patients had persistent wound drainage after surgery, however, none required reoperation or readmission. Compliance with LMWH is high and is comparable with oral agents. It is effective in preventing VTE and safe with regards to bleeding and wound complications in a South African setting. Patient education regarding medications may improve compliance of the medication.
The role that fomites have to play in surgical site infection (SSI) and periprostheitic joint infection (PJI) has been observed and researched in the past. However the role that cellphones play in the transfer of microorganisms from hands to surgical sites and the indiscriminate use of cellphones within the Orthopaedics, could increase the risk of infection. This study aimed to measure the contamination of cellphones of health care workers (HCW's) in a South African tertiary hospital. Secondarily was to investigate the cellphone hygiene behaviour of HCW's. A prospective cross-sectional study was conducted in June 2022. Samples were taken from the the participant's cellphones under an aseptic technique and sent for microbiology. The participants also filled out a questionnaire on cellphone behaviour. The inclusion criteria was orthopaedic HCW's working in the institution; This included nurses and doctors in the orthopaedic theatres and main orthopaedic wards. Sixty-two participants were included; 54 from Orthopaedics and 7 from Anaesthesia. From the samples, 71% grew pathogens while 30,64% grew two or more colonies. This is slightly lower than other studies which showed contamination up to 100%. Micro-organisms cultured included Staphylococcus species; S.Epidermidis, Methycillin sensitive S.aureas; and E.Coli. Cellphone hygiene behaviour was also better than most other studies in terms of frequency of cleaning the devices and hand hygiene around cellphone usage. This which may be a contributing factor to the lower micro-organism contamination. This study should be the first of many as we have identified that there are indeed pathogens on cellphones transferable to patients; causing sepsis. Though cellphones have become vital in patients management in the hospital setting, factors such as improvement in cellphone hygiene through education and frequent cleaning of cellphones will aid in disabling the negative impact of cellphones in the orthopaedic environment.
In 2019, the incidence of fractures were 178 million globally, South Africa accounting for close to 600 000 of these fractures, an 18.53% increase since 1990. South Africa does not have the public infrastructure to adequately facilitate the optimal surgical management of this burden. This forces intensive labour practices among orthopaedic surgeons, often performing complex surgeries throughout the night. There is a direct correlation between “after-hour”operations and the increase in morbidities. A retrospective review of the orthopaedic surgical cases and orthopaedic surgical emergencies done at a tertiary institution in Johannesburg between 8th of August 2021 to 12th December 2022. The nature of the orthopaedic interventions, the date of booking of the surgical procedures, date of surgical procedures, as well as start and end time of the orthopaedic interventions were analysed. “After-Hours” orthopaedic interventions were defined as interventions done between 16:00 and 07:00. Orthopaedic emergencies were defined as: Open fracture debridements, external Fixator insertion, arthrotomies, fasciotomies and the insertion of steinmann pins. 1483 (27.92%) of 5310 operative cases done on the emergency board were orthopaedic cases. 1098 (74.04%) hardware-related cases and 535 (36.08%) orthopaedic emergencies were done. 854 (57.58%) cases were done “After-Hours” of which 433 (29.20%) cases were done during “Dead-Hours” (23:00–07:00). Of these 433 cases, only 173 (39.95%) were true orthopaedic emergencies. Although the proportion of emergencies done after hours were greater than during working hours, there is still a large proportion of intricate orthopaedic cases done between 16:00– 07:00 that should not be prioritized, due to an associated higher morbidity. Enhanced strategic planning is advisable in future in order to prioritize complex hardware cases during working hours, and due to the burden, prioritize minor relooks and simple skin- grafts for the latter aspects of the night. A dedicated Orthopaedic Trauma theatre is recommended.
Depression is a common co-morbidity in Total Hip Arthroplasty (THA). Chronic pain and depression influence one another. Postoperative outcomes and satisfaction rates are affected by depression. The aim of the study was to determine the impact of pre-operative depression on patient functional outcomes and satisfaction rates after THA. A secondary objective was to assess potential change in the incidence of depression at mid-term post-operative follow-up.Introduction
Objectives
Hip arthroscopy is a rapidly growing, evolving area within arthroscopic Orthopaedic Surgery, with annual rates increasing as much as 25-fold each year. Despite improvements in equipment and training, it remains a challenging procedure. Rates of revision surgery have been reported as 6.3% to 16.9%. The primary objective was to determine the success of joint preservation after hip arthroscopy. The secondary objective was to determine whether patient characteristics or PROM functional score trends could predict revision hip arthroscopy or Total Hip Arthroplasty (THA).Background
Objectives
The prevalence of immunocompromised patients undergoing Total Hip Arthroplasty (THA) is increasing worldwide as a consequence of advances in treatment. HIV is presenting in an older population group and concerns of higher rates of infection, early failures and dangers posed to healthcare workers exist. This study is imperative to predict future burden of THA and make subsequent provisions The objective was to determine the seroprevalence of HIV in patients presenting for THA in an academic institution in a developing country. Secondarily, the aim was to determine if there is any difference in the seroprevalence of patients undergoing THA and TKA and finally to assess the status of disease control in seropositive patients eligible for TJA on pre-existing HAART.Background
Objectives
A longitudinal study was done assessing the latest radiographs available in a series of collarless Corail uncemented stems which have reported survival rates of 95% at 20 years. Parameters scored included the degree of “Ghosting” or delamination, the Gruen, the stem fit in the femoral canal and the degree of calcar resorption. Patient and implant demographics were noted. At 3 years the loosening rate was 23% reaching 64% at 6 years after the index procedure. It was present in all age groups, with a peak in the 24 to 49 year age group. Males and females had the same occurrence. When it was present this was always in zone 1. It was present in 6% of patients in zone 7, but then always associated with zone 1 changes. High and standard off-set stems had the same loosening rates. The looser fit of the stem the higher the incidence of loosening. There was no correlation to the type of bearing surface or the degree of calcar resorption. Those patients with a BMI of 25 – 35 had lower loosening rates compared to those with higher or lower BMI's. We postulate that cancellous bone on-growth onto the hydroxyapatite coating associated with loading flexural micro-motion leads to hydroxyapatite being pulled off the smooth stem substrate in zone 1. Progressive delamination of the hydroxyapatite then occurs. The triple-tapered design though imparts continued stability. We report high loosening rates in the Corail stem and suggest a mechanism for its development.
Total Hip Replacement (THR) is a proven and effective surgical procedure. One of the main limiting factors of the longevity of THR is the performance of the bearing surface. The optimum bearing surface choice, however, remains controversial. We wanted to understand what influenced the choice of bearing surfaces amongst South African orthopaedic surgeons. We also wanted to know if there was any consensus between surgeons and the orthopaedic trade. There is no epidemiological registry-based data available in South Africa in respect of bearing surfaces used in hip replacements. We sent out an electronic survey to all members of the South African Orthopaedic Association as well as to trade representatives. Patient parameters influencing the choice of bearing surfaces were surveyed and these included age, gender, level of activity and diagnosis. We used a regressional and tree analysis methodology to interpret the results.Introduction:
Aims, material and methods:
Meniscal tears in middle-aged patients are common. There is a lack of consensus regarding the optimum management of these injuries. Although arthroscopic partial meniscectomy (APM) is a frequently performed surgical option, literature has failed to prove its effectiveness over conservative approaches. We retrospectively reviewed 102 middle-aged (age > 40 years) patients who had been treated for meniscal tears between January 2010 and December 2012. We followed these patients up telephonically to assess knee outcome satisfaction rates, any early (6 weeks) improvements in pain and knee function and their pre-morbid and post-treatment activity levels (Tegner Activity Scale).Introduction
Materials and Methods
We report on a series of long-stemmed femoral components used in revision total hip replacements which fractured, and were subsequently revised. All explanted stems were analysed in respect of the reasons for failure. The patient's serial radiographs and clinical records were also analysed. All stems demonstrated some fixation distally. They all showed little proximal osteo-integration. A biomechanical analysis confirmed the vulnerability of these long stemmed modular prostheses in respect of mechanical failure. The resultant unprotected lever-arms led to local stresses in the prosthesis constructs which were above the failure threshold resulting in prosthesis fractures. These fractures all occurred at points where the prostheses were structurally most vulnerable.Methods
Results
Valgus knees are generally more difficult to get acceptable alignment and balance than the varus knee. Most of these are due to anatomical variations in both the diaphysis of the femur, with low valgus angles (angle between the anatomic and mechanical axis of the femur) and the tibial diaphysis. In addition there are those with dysplastic lateral distal femoral condyle s and low external femoral angles (below 84 degrees) To assess the clinical results, patient satisfaction and alignment and balance achieved in those with a pre-operative mechanical valgus above 10 degrees.Introduction
Aim
Low back pain is a common complaint and reason for patients to seek medical help. Studies have shown that 80% of people over 60 yrs of age will have suffered from it at one point in their lives. Low back pain, after the common cold, is the 2nd most common reason for patients to visit medical practitioners. The purpose of this survey was to establish a patient profile, risk factors, previous management and care strategies for patients presenting to the Orthopaedic Out Patient Department at an Academic Hospital with low back pain. We reviewed 257 patients during a 6 month period from July 2010- December 2010.0. Patients were excluded if there were: XR deformities (eg. spondylolistheses, masses, cysts etc); associated neurology, incontinence or constitutional symptoms; previous vertebral column fracture or surgery or current malignancy. Patients referred for first visits were also excluded.Aim.
Method.
Pelvic fractures in children are rare and potentially disastrous injuries. Using medical records and radiographs over a three year period from January 2008 to March 2011 at an academic hospital we retrospectively analysed the incidence, the associated data and management of these injuries. During this time period 633 paediatric patients where admitted with trauma related injuries; only 19 had pelvic fractures, an incidence of 0.03%. The majority of these patients (13) were involved in PVA's; while MVA (3), fall from height (1) and sports injuries (1) made up the rest. Males (13) were injured more commonly and the average age of the patients was 9 years (3–14). There is debate of over the ideal paediatric pelvic fracture classification system in the literature. However, 13 pelvic fractures were classified stable; 3 were unstable fractures with disruption of the pelvic ring. In addition 2 iliac wing fractures and 1 avulsion (apophyseal) fracture were found. 58% of the patients had associated injuries, however, only 2 of the 19 had associated abdominal viscus injuries. Neither of these required exploratory laparotomy and were managed conservatively. The treatment of these pelvic fractures in our unit was patient specific and largely conservative. 17 patients' pelvic fractures were treated with bed rest, analgesia and mobilisation as pain allowed while the remaining 2 had pelvic external fixators. No ORIF's were performed. Associated orthopaedic injuries were managed accordingly. The average hospital stay of a patient with a pelvic fracture was 15 days (3–48 days). There were no mortalities during this time period.Results
Research projects are a compulsory part of the postgraduate curriculum in most Academic Departments. To not only fulfil study requirements, but to ensure noteworthy and accurate results meticulous and reliable data collection is necessary. Our aim was to better understand what preferences health care professionals have in undertaking data collection. We did a choice based conjoint analysis with an online data collection survey. This study type allows the evaluation of the relative importance of component attributes. We used 4 major criteria to evaluate preferences when performing data collection. These were: 1. Time to complete the form, 2. Remuneration and recognition, 3. Study design and 4. Responsibilities at the time of collection. We sent electronic questionnaires to doctors in the Orthopaedic, Ophthalmology and Plastic Surgery Departments at a Johannesburg Academic Institution.Aim
Methods
Penetrating injuries of the hand and forearm may cause significant morbidity for a patient. Our aim was to evaluate the accuracy of initial examination of forearm lacerations and pre-operative examination and compare both to the actual findings on surgical exploration. We wanted to identify any factors which may influence the accuracy of the initial examination. Existing literature indicates that there are differences between initial and subsequent examination in terms of picking up injuries. 65 consecutive patients with penetrating injuries to the hand/forearm were studied. The admitting casualty doctor/s completed an admission form indicating their findings on examination. Factors which may have hampered history taking and examination were noted on the form. The same form was filled in prior to surgery by one of the hand registrars after re-examining the patient prior to surgery. A separate surgical form was filled in by the surgeon indicating the actual findings at surgery.Purpose
Methods
