ABSTRACT
BACKGROUND: Hospital readmissions following arthroplasty represent a considerable burden to the community. The present study investigates the magnitude of this problem and the reasons for early readmission. METHODS: The medical records of patients who underwent primary knee joint replacements between July 1989 and December 1994 were reviewed retrospectively. Readmission within 12 months of surgery was noted and the prognosis of these patients assessed. RESULTS: A total of 160 patients (180 arthroplasties) were appropriate for review. The readmission rate for knee-related morbidity was 18%. The main reasons for this included pain, stiffness, and the investigation/management of an inflamed joint. Notably, patellofemoral disease was common, particularly in the group without resurfaced patellae, manipulation of a stiff joint was rarely effective unless instituted early and aetiologies aside from sepsis often resulted in the patient returning with an inflamed joint. CONCLUSIONS: Readmission is a significant problem which heralds a poor 12-month prognosis.
Subject(s)
Knee Prosthesis/adverse effects , Patient Readmission , Adult , Aged , Aged, 80 and over , Arthritis/etiology , Female , Humans , Male , Medical Audit , Middle Aged , Morbidity , Pain/etiology , Prognosis , Retrospective Studies , Surgical Wound Infection/etiologyABSTRACT
A retrospective review of 1900 road accident victims attending the emergency departments of two Melbourne hospitals was undertaken to identify Injury Severity Score levels which could distinguish between minor, moderate, severe and critical injury. Injuries scoring ISS 6 or below were designated 'minor' because they were associated with a low risk of requiring admission to hospital. Case notes of patients scoring above ISS 6 were then reviewed by a panel of clinicians, who independently rated each patient's overall injury severity as moderate, severe or critical according to what was recorded in the notes and their 'clinical' judgement. ISS values were compared with clinicians' ratings. Measures of each clinician's individual rating consistency, and correlation between pairs of clinicians with respect to inter-rater consistency, were made. By combining data from both hospitals it emerged that 'moderate' injury corresponded to ISS 8-13, 'severe' to ISS 14-20 and 'critical' to ISS 21 and above. These ISS breakpoints will be useful in selecting groups of injured patients for future trauma audit studies.
Subject(s)
Accidents, Traffic , Injury Severity Score , Medical Audit , Trauma Severity Indices , Wounds and Injuries/pathology , Australia , Humans , Retrospective StudiesABSTRACT
Arterial complications occurring in association with knee replacement surgery are rare, even though most patients having this operation are elderly and therefore more likely to have peripheral vascular disease. We report a patient who developed an arterial complication during the course of a knee replacement operation, as well as the results of a survey of Fellows of the Australian Orthopaedic Association. Recommendations to minimise this serious complication are proposed.
Subject(s)
Arterial Occlusive Diseases/etiology , Arthritis, Rheumatoid/surgery , Femoral Artery , Knee Prosthesis , Popliteal Artery , Arterial Occlusive Diseases/surgery , Humans , Male , Middle Aged , Postoperative Complications/etiology , Thrombosis/etiology , Thrombosis/surgeryABSTRACT
An operation to reconstruct a neglected rupture of the tendo achillis is described using the aponeurosis of the gastrocnemius-soleus muscle fashioned into a tube. The repair is strong and effective and has given good results in five patients.
Subject(s)
Achilles Tendon/injuries , Achilles Tendon/surgery , Adult , Female , Humans , Male , Middle Aged , Rupture/surgery , Tendon Transfer/methodsABSTRACT
Over recent years it has been demonstrated that there is a significant incidence of osteomalacia in elderly patients presenting with fractures of the femoral neck. The results of a survey carried out on all patients admitted to St Vincent's Hospital, Melbourne, with fractures of the upper end of the femur over a 12-month period are presented, and the condition of osteomalacia in the elderly is discussed. It is concluded that in this community osteomalacia does not present as a practical problem except in those patients who have the condition as a result of a definite predisposing factor.
Subject(s)
Femoral Fractures/etiology , Osteomalacia/complications , Aged , Female , Femoral Fractures/diagnosis , Femoral Fractures/pathology , Femur/pathology , Humans , Male , Osteomalacia/diagnosis , Osteomalacia/pathologyABSTRACT
Two cases of clostridial cellulitis are presented in patients who had Charnley total hip joint replacement for severe osteoarthritis. Early deep infection can be a major problem in this operation, and is usually due to Staphylococcus aureus.
