Predictive Value of the Risk Assessment and Prediction Tool (RAPT) Score for Primary Hip and Knee Arthroplasty Patients: A Single-Center Study.

The Risk Assessment and Prediction Tool (RAPT) was developed to predict patient discharge destination for arthroplasty operations. However, since Enhanced Recovery After Surgery (ERAS) programs have been utilized in the UK, the RAPT score has not been validated for use. The aim of the current study was to evaluate the predictive validity of the RAPT score in an ERAS environment with short length of stay. Data were compiled from 545 patients receiving a primary elective total hip or total knee arthroplasty in a district general hospital over 12 months. RAPT scores, length of stay, and discharge destinations were recorded. Patients were classified as low, intermediate, or high risk as per their RAPT score. Length of stay was significantly different between groups (p = 0.008), with low-risk patients having shorter length of stay. However, RAPT scores did not predict discharge destination; the overall correct prediction was only 31.9%. Furthermore, the most likely discharge destination was directly home in ≤3 days in all groups (68.5%, 60.2%, and 40% for the low-, intermediate-, and high-risk groups, respectively). The RAPT score is not an adequate tool to predict the discharge disposition following primary total knee and hip replacement surgery in a UK hospital with a standardized modern ERAS program. Alternative predictive tools are required.

Lessons learnt from managing an avulsion fracture of the tibial tubercle extending into the tibial physis.

Acute avulsions of the tibial tubercle apophysis are uncommon, with reported incidence of 0.4-2.7% of all physeal injuries. In our case the extent of the injury was not realised at first presentation and initial internal fixation was attempted. At first outpatient follow-up, repeat radiographs indicated the fracture was not reduced and further CT imaging requested. The three-dimensional CT reconstructed images provide considerably more information on the fracture pattern and retrospectively these may have been helpful during the initial procedure. Therefore we would recommend obtaining a preoperative CT scan if extension of the fracture into the tibial physis is suspected. During the second procedure arthroscopy was tried to aid fracture reduction, but visualisation of the anterior articular surface under the anterior horns of the menisci was difficult through the anterior portals with a standard 30° arthroscope and we further recommend having a 70° scope available to ensure optimal visualisation.

Minimum 5-year follow-up after Cormet hip resurfacing. A single surgeon series of 234 hips.

The performance of the Cormet hip resurfacing device was evaluated after a minimum of 5 years in 234 hips. The mean age of the patients was 54 years; there were 135 men and 80 women. The primary diagnosis was osteoarthritis in 78% of the patients. Outcome measures were the Harris Hip Score and implant survival. The overall survival rate was 94% with 12 revisions in women and 3 in men. There were 7 femoral and 5 acetabular failures and two revisions for groin pain. Cumulative survival rate in men and women was 98% and 89%, in patients with a femoral component larger than 44 mm and smaller than 44 mm 97% and 89% respectively. Patients with primary osteoarthritis had a 95% cumulative survival rate at 5 years. The risk of failure was 6.4 times higher in women than in men. Our results suggest that hip resurfacing with the Cormet device is an acceptable alternative for active patients with hip arthritis, but patient selection is crucial for good long-term results.

The nature and dissemination of UHMWPE wear debris retrieved from periprosthetic tissue of THR.

The role of wear debris in provoking joint replacement failure through bone resorption is now supported by much research. This study presents the analysis of 104 tissue samples using laser diffraction wear particle analysis in conjunction with standard histologic methods. The number and volume distributions were correlated to a range of joint and patient parameters. The median particle diameter by number was 0.69 microm. No particles smaller than 0.113 microm were resolved. No variation in terms of particle distribution was found among joint types. The ability of particles to migrate away from their point of origin was found to be inversely proportional to their size. The numbers of particles per gram of tissue found in various regions around the prosthesis varied little. Further, the numbers of particles in tissue samples shown to have a chronic foreign-body reaction was > 1 x 10(9) particles/gram.