Preoperative hypoalbuminemia: Poor functional outcomes and quality of life after hip fracture surgery.

AIMS: Hip fracture patients have severe deterioration of their quality of life and function after their injury. Markers of malnutrition such as low albumin and low body mass index (BMI) have been shown to increase mortality and complication rates but their effect on recovery of quality of life and function after hip fracture surgery is unclear. The main aim of this paper is to further investigate if low albumin affects recovery after hip fracture surgery, while additionally studying low BMI as a possible risk factor for poor recovery. PATIENTS AND METHODS: Retrospective analysis of 971 patients who underwent surgery for fragility hip fractures between January 2012 and December 2016 was performed. Demographic data, preoperative serum albumin and haemoglobin levels, BMI, Charlson Comorbidity Index (CCI), type of surgery (fixation vs replacement) and site of surgery were obtained. Patients were assessed using the Parker Mobility Scale (PMS), Harris Hip Score(HHS), Medical Outcomes Study 36-item Short-Form Health Survey (SF36) at pre-fracture, 6 weeks and 6 months after surgery. HHS was not available pre-operatively. Patients were grouped according to their albumin levels (low ≤35 g/L or normal) and BMI (underweight <18.5 or normal). Univariate and multivariate analyses were performed to examine the association between albumin and BMI and 6-month scores. RESULTS: On univariate analysis, patients with low albumin ≤35 g/L had lower baseline PMS and SF36 Physical Functioning (PF) score. On multivariate analysis, preoperative hypoalbuminemia was associated with lower 6-month HHS, PMS and SF36 PF scores even after accounting for baseline scores and other confounders. BMI had no effect on 6-month scores. CONCLUSION: Low albumin (≤35 g/L) is prevalent in elderly hip fracture patients and is associated with slower recovery of function and quality of life after surgery. Low albumin can be a useful prognostic tool to identify patients with poor recovery for further intervention or rehabilitation after hip fracture surgery.

Threshold scores for treatment success after arthroscopic bankart repair using Oxford Shoulder Instability Score, Constant-Murley Score, and UCLA shoulder score.

AIM: To determine the threshold score for Oxford Shoulder Instability Score (OSIS), Constant-Murley score (CMS), and University of California Los Angeles (UCLA) shoulder score that predict treatment success after arthroscopic bankart repairs. METHODS: 77 patients were followed up for 12-mmonth. Threshold scores were determined by Receiver Operating Characteristic (ROC) analyses with treatment success defined as improvement in pain, no re-dislocation, expectation and satisfaction met. RESULTS: The follow threshold scores were identified:6-month: OSIS 35, CMS 68,UCLA 2612-month: OSIS 24, CMS 84, UCLA 33. CONCLUSION: OSIS, CMS, and UCLA are good predictors of treatment success after arthroscopic bankart repair.Level of EvidenceIII.

Hybrid suture technique vs simple suture technique for antero-inferior labral tears: Two years' clinical outcomes.

BACKGROUND: We previously reported a hybrid suture technique, wherein mattress and simple suturing are used to create Mason-Allen configuration, with low recurrence rates. This comparative study looking at the two years' clinical outcomes of arthroscopic anterior labral repair using the hybrid suture technique versus simple suture technique. METHODS: We identified 103 patients who underwent arthroscopic anterior labral repair from 2010 to 2015 with 2-year follow-up. The patients were categorized into two groups: hybrid suture technique (65 patients) and simple suture technique (38 patients). Clinical outcomes measures included UCLA shoulder score, Constant Shoulder Score, Numerical Pain Rating Scale, and Oxford Instability score. RESULTS: Mean age of the patients was 27.02 ±â€¯9.76 years (17-63), with 91 males and 12 females. At 24 months, both groups showed significant improvement in post-operative clinical scores compared to pre-operation. The patients in hybrid sutures technique demonstrated significant improvement in Constant Shoulder Score, UCLA shoulder score and Oxford Instability score compared to simple suture group at 3 months follow up. (121.98 ±â€¯21.05 vs 109.32 ±â€¯21.15, p < 0.05; 65.5 ±â€¯19 vs 57.4 ±â€¯17.6, p < 0.05; 27.3 ±â€¯5.7 vs 23.7 ±â€¯5.0, p < 0.05; 29.3 ±â€¯8.9 vs 33.4 ±â€¯8.2, p < 0.05). The postoperative recurrence rate was comparable between both groups (hybrid suture group 7.81% vs simple suture group 7.84%). CONCLUSIONS: Arthroscopic anterior labral repair with hybrid suture technique offers significant early improvements in clinical scores and low recurrence rate compared to simple suture technique at 2-year follow-up. LEVEL OF EVIDENCE: Level III; Retrospective Cohort Design; Treatment study.

Strain behavior of native and reconstructed medial patellofemoral ligaments during dynamic knee flexion - a cadaveric study.

BACKGROUND: Surgical reconstruction of the Medial Patello-Femoral Ligament (MPFL) has been recognized as an effective treatment for patients with instability despite conservative treatment. The purpose of this cadaveric study is to compare the strain patterns within the native and reconstructed single and double-bundle MPFL. This will help ascertain if the native biomechanics are restored with the reconstructions. METHODS: Twelve cadaveric knees were dissected and the native MPFL of each specimen was identified. The knees were subjected to dynamic flexion using a customized jig. Continuous strain measurements were taken for each knee from 0 to 120 degrees flexion and then back to full extension using differential variable reluctance transducers (DVRTs). The MPFL was then cut. Six single bundle and six double bundle MPFL reconstructions were performed using hamstring tendon grafts. The DVRTs were reattached to the grafts and strain measurements were retaken. Statistical analysis was performed using a paired t-test. RESULTS: Strain patterns of the native and reconstructed MPFL showed an increase in strain from 0 to 120 degrees of flexion except for the inferior bundle of the double bundle reconstruction. The strain patterns in the intact specimens were higher than the reconstructed MPFL through different degrees of knee flexion. In the double-bundle group, the superior graft had statistically significantly lower strains compared to the native MPFL with p-value <.05 at all flexion angles. The reconstructed inferior band showed loss of tension as the knee flexed. Higher strain with statistical significance (p-value <.05) was found in the single-bundle compared to the superior band of the double-bundle reconstruction at flexion angles less than 90 degrees. CONCLUSION: The strain variation at progressive angles of knee flexion is dissimilar between the native and reconstructed MPFL. The reconstructed MPFL exhibited non-physiological biomechanics with the inferior band losing tension. Although the single-bundle reconstruction shows a better strain profile compared to double-bundle reconstruction, the grafts are significantly stiffer than the native MPFL.

Reverse shoulder arthroplasty: The Singapore General Hospital experience and a simple method of measuring change in the center-of-rotation.

INTRODUCTION: This study reviews the outcomes of reverse shoulder arthroplasty (RSA) and introduces a novel method of measuring changes in the center-of-rotation (COR) of the shoulder joint post-operatively. METHODS: We performed 10 reverse shoulders in 2011. Patients were evaluated pre-operatively and post-operatively using the Constant Score. The COR of the shoulder was determined pre- and post-operatively on radiographs and the differences were analysed. RESULTS: There was significant improvement in Constant Scores post-operatively with reduction in pain and increase in strength. Medialisation but not distalisation of the COR was achieved. DISCUSSION: Longer follow-up studies and studies on survivalship are required.