ABSTRACT
Dislocation is a frequent and costly complication of hip arthroplasty. The purpose of this study was to assess the financial impact on the treating institution of this complication in patients with primary hemiarthroplasty (HA), total hip arthroplasty (THA) and revision surgery (RTHA). Between October 2001 and August 2009, 2014 consecutive hip arthroplasties were performed at our institution, of which 87 (18 HA, 44 THA and 25 RTHA) dislocated within 6 weeks of the primary operation. The average cost of treating implant dislocation by closed reduction, open reduction or revision was assessed and expressed as a percentage cost increase compared to an uncomplicated procedure. Of the 87 dislocated implants all needed one or more closed reductions and 52 eventually required revision surgery. An early dislocation increased the cost of HA, THA and RTHA by 472%, 342% and 352%, respectively.
Subject(s)
Arthroplasty, Replacement, Hip/adverse effects , Hip Dislocation/economics , Hip Dislocation/surgery , Hospital Costs , Aged , Aged, 80 and over , Female , Femur Head Necrosis/economics , Femur Head Necrosis/surgery , Hip Dislocation/etiology , Hip Dislocation, Congenital/economics , Hip Dislocation, Congenital/surgery , Hip Fractures/economics , Hip Fractures/surgery , Humans , Male , Middle Aged , Osteoarthritis, Hip/economics , Osteoarthritis, Hip/surgery , Postoperative Complications/economics , Postoperative Complications/etiology , Prosthesis Failure , Reoperation/economicsABSTRACT
We aimed to verify the clinical and economic effects of uniportal video-assisted thoracic surgery (VATS) in patients with primary spontaneous pneumothorax (PSP) compared to traditional three-port VATS technique. We analyzed 51 consecutive patients (23 three-port VATS and 28 uni-port VATS), treated by bullectomy and pleural abrasion, to detect differences between the two groups with regard to intraoperative management, postoperative course, pain, paraesthesia and costs. Data about pain and paraesthesia were collected by telephonic interview within a minimum follow-up period of six months. Compared to three-port VATS, patients treated by the uni-port VATS were discharged more quickly (3.8 days vs. 4.9 days, P=0.03) and experienced paraesthesia less frequently (35% vs. 94%, P<0.0001). No difference in chronic pain was observed between the two groups (numeric pain score: 0.6 uni-port vs. 1.3 three-port, P=0.2). Compared to three-port VATS, we found a significant reduction in postoperative costs for the patients operated on by the uni-port technique (euro1407 vs. euro1793, P=0.03), without any increase in surgical costs. In conclusion, uniportal VATS appears to offer better clinical (postoperative stay and rate of paraesthesia) and economic (postoperative costs) results than the standard three-port VATS for treating primary spontaneous pneumothorax.
Subject(s)
Hospital Costs/statistics & numerical data , Pneumothorax/surgery , Thoracic Surgery, Video-Assisted/instrumentation , Thoracoscopes/economics , Adult , Female , Follow-Up Studies , Humans , Male , Pneumothorax/diagnostic imaging , Pneumothorax/economics , Postoperative Complications , Radiography , Retrospective Studies , Thoracic Surgery, Video-Assisted/economicsABSTRACT
PURPOSE: We recently showed that androgen receptors are expressed in Dupuytren's contracture. The aim of the present work was to test the responsiveness of Dupuytren's fibroblasts to 5 alpha-dihydrotestosterone (5 alpha-DHT), the active form of testosterone. RESULTS: Cultured palmar fascia cells from 10 patients with Dupuytren's contracture and 4 normal subjects were exposed to 5 alpha-DHT (10 or 100 ng/mL) for 1, 3, 7, and 15 days. Their phenotype was analyzed immunohistochemically for alpha-smooth muscle actin and androgen receptor expression and proliferation rates were studied. RESULTS: At 15 days the higher concentration of 5 alpha-DHT induced an increase in Dupuytren's fibroblast proliferation, whereas anti-alpha-smooth muscle actin exhibited the strongest expression. At the same time point androgen receptor expression decreased with the lower concentration and disappeared altogether with the higher dose of 5 alpha-DHT. CONCLUSIONS: The palmar fascia is a target tissue for androgen action via androgen receptors. Further studies are required to determine whether control of androgen receptor may control the evolution of Dupuytren's disease.
