Is It Safe to Perform Revision Hip Arthroplasty Without Suction Drains?

Background There is a number of studies showing no significant benefit of using drains after primary hip arthroplasty. However, there is no consensus in the literature about the usage of drains in revision hip replacement. This study aims to assess the effect of drains in revision hip arthroplasty. Methods A retrospective analysis was performed of all consecutive revision hip replacement surgeries performed at our unit over a five-month period (November 2018 to March 2019). Case notes, laboratory investigations, and operative records were reviewed. The effects of drains on postoperative hemoglobin (Hb), transfusion rate, and complications were analyzed. Results Overall, 92 patients were analyzed who underwent revision hip replacement during the study period. There were 46 male and 46 female patients with a mean age of 72 years. Aseptic loosening was the most common indication for the revision (41 patients) followed by instability (21 patients), infection (11 patients), and periprosthetic fractures (eight patients). Seventy-two patients had no drains while suction drains were used in 20 patients. Both groups were similar regarding age, sex, and indications for revision surgery. There was a significantly higher drop in postoperative Hb in patients with drains than those without drains (33 g/L: 27 g/L, p=0.03). There were significantly more blood transfusions in patients with drains as compared to those without drains (15%: 8%, relative risk 1.8, and odds ratio 1.94). There was no difference in both groups with regard to returning to the theater. Discussion Use of suctions drains in revision hip surgery was associated with increased postoperative blood loss and increased requirement for postoperative blood transfusion. Revision hip surgery without routine usage of suction drains did not increase wound complications. Conclusion Revision surgery without routine usage of drains is safe and may decrease postoperative blood loss and the rate of transfusion.

Outcomes of Allograft Medial Patellofemoral Ligament Reconstruction in Children and Adolescents with Hypermobility.

Introduction: Medial patellofemoral ligament (MPFL) reconstruction is used to treat patellofemoral instability either in isolation or in combination with other procedures. Use of allograft can preserve native tissue in children and can be advantageous in patients with connective tissue disorders, including ligamentous laxity. There is limited evidence regarding functional outcomes of allograft MPFL reconstruction in children and adolescents. This study aimed to assess the short to mid-term results of allograft MPFL reconstruction in children with hypermobility at a tertiary pediatric orthopedic center. Materials and Methods: We retrospectively reviewed all children and adolescents who had undergone allograft MPFL reconstruction over 4 years. The primary outcome measure was the validated Kujala score for patellofemoral disorders. The secondary outcome measures included complications such as redislocation of the patella needing revision surgery. Patients with hypermobility were quantified using Beighton criteria. Statistical analysis was performed using Graph Pad Prism (V6). Results: Between 2012 and 2016, the senior author performed 76 allograft MPFL reconstructions in 57 patients. Nineteen patients had bilateral surgery. The mean age was 14 (7-16) years with a female: male ratio of 3:1. The mean Beighton score was 7. Hypermobility was part of a syndrome in ten patients. The mean follow-up was 3 (1-4) years. Nine patients had trochleoplasty and six patients had tibial tubercle osteotomy, in addition to allograft MPFL reconstruction. These fifteen patients, who had additional procedures, were excluded during the analysis of the outcome measures. The mean Kujala score was 89 (80-100). The overall complication rate was 11% (9/76). These included two patella fractures and seven (9%) patients with recurrent instability needing revision surgery. There was no significant difference in complication rates between syndromic and nonsyndromic patients (P = 0.9). Conclusion: Our study shows excellent short to mid-term functional outcomes of allograft MPFL reconstruction in children and adolescents with hypermobility.

Unusual osteochondral fracture of the second metatarsal head in a paediatric patient treated with bioabsorbable pin.

Osteochondral second metatarsal head fractures are rare. Various management options have been described in the published literature. We used bioabsorbable pin (Activa Pin) system for our case of second metatarsal head fracture. This method not only achieves good compressive fixation, it also eliminates the risk of implant-related issues such as implant irritation. To our knowledge, no such paediatric case managed with this technique has been published in the literature.

Has the modern design of Attune total knee replacement improved outcome in patients with isolated patellofemoral arthritis?

INTRODUCTION AND AIM: Modern knee replacements aim to improve patient function in arthritis affecting different compartments of the knee. This study evaluates the Patient Reported Outcome Measure (PROM) and functional outcome of a modern total knee replacement (Attune, DePuy) in patients with isolated patellofemoral arthritis. METHODS: A total of 50 consecutive patients with isolated unilateral patellofemoral arthritis having had Attune total knee replacements at a single institution between 2010 and 2016 were prospectively studied. Five patients who developed symptoms on the opposite side during the study and two patients lost to follow-up were excluded. One patient needed early revision for loosening, leaving a total of 42 patients to be followed up over a period of 4 years. The Oxford Knee score (OKS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) recorded pre-operatively and at follow-up was compared. A Functional assessment at around 8 months after operation was undertaken. RESULTS: At average follow-up of 24 months the mean OKS score improved by 15 points and the KOOS score improved by 20 points. Final KOOS sub-score for Pain was 80, Symptom 80, and ADL 82, Sports & Recreation 32 and QOL 60. Functional assessment at mean 8 months showed that a significant number of patients were able to Kneel (50%); Sit cross legged (23%); sit on their heel (23%) and were able do a single leg dip test (86%). CONCLUSION: This unique study of a modern design total knee replacement (Attune) in patients with isolated unilateral patellofemoral arthritis shows good PROM scores at 2 years and good functional assessment results at 8 months. The PROM scores are marginally better than the published results with Attune's predecessor, in a similar cohort of patients, but falls short of the published results of patellofemoral replacement implants. Large randomised comparative studies between traditional and the modern implant design is recommended to answer the question if design modification has influenced clinical outcome in patients with patellofemoral arthritis.

UK national survey of venous thromboembolism prophylaxis in ankle fracture patients treated with plaster casts.

BACKGROUND: Ankle fractures are one of the commonest orthopaedic injuries. A substantial proportion of these are treated non-operatively at outpatient clinics with cast immobilization. We conducted this survey to assess the current practice in UK regarding thromboembolism prophylaxis in these patients. METHODS: A telephonic survey was carried out on junior doctors within orthopaedic departments of 56 hospitals across the UK. A questionnaire was completed regarding venous thromboembolism risk assessment, prophylaxis, hospital guidelines, etc. RESULTS: 84% (n=47) hospitals did not routinely use any prophylaxis for these patients, while 7% (n=4) hospitals used chemo-prophylaxis. Only 5.3% (n=3) hospitals had DVT prophylaxis guidelines regarding these patients while other 9% (n=5) hospitals were in process of developing such guidelines. In 64% (n=36) hospitals, no formal DVT risk assessment was carried out. CONCLUSION: A large variation exists across NHS hospitals and a poor risk assessment is being carried out in these patients. Development of local guidelines and extension of national guidelines to include high risk outpatients may improve the situation.