Concomitant low back pain impairs outcomes after primary total knee arthroplasty in patients over 65 years: a prospective, matched cohort study.

INTRODUCTION: Knee osteoarthritis and low back pain (LBP) are two conditions with relatively high prevalence in patients over 65 years. The objective was to determine the effect of symptomatic LBP on the patient-reported outcome after primary TKA. MATERIAL AND METHOD: A cohort of 48 patients with concomitant LBP was prospectively matched 1:2 with patients without LBP for gender, age, body mass index and preoperative knee function. LBP severity was measured with the Oswestry Disability Index (ODI). Patient-reported outcomes were assessed with reduced Short-Form (SF12), Western Ontario and McMaster Universities score (WOMAC), and visual analogue scale (VAS) for satisfaction. Functional outcome was assessed with the Knee Society Scores (KSS). RESULTS: The mean postoperative follow-up was 3.2 years. At last follow-up, LBP cohort had significantly worse SF12, WOMAC, KSS and VAS scores than those patients without LBP. Preoperative ODI score was significantly correlated with outcomes. CONCLUSION: Worse functional and patient-reported outcomes were obtained in patients over 65 years with concomitant LBP, and this was related to the intensity of preoperative LBP. Despite successful outcome in the knee, the LBP usually remains after TKA and this may impair satisfaction and patient-reported outcomes. These patients should be properly informed about their potential outcomes.

Early rehospitalization after hip fracture in elderly patients: risk factors and prognosis.

INTRODUCTION: Hip fracture usually occurs in older patients. These patients remain at risk for developing new medical complications even after discharge from the hospital. The objective of this study was to identify risk factors for hospital readmission 30 days after hip fracture and the prognosis of the readmitted patients. MATERIALS METHODS: A prospective, observational cohort study of 732 consecutive patients over 65 years surgically treated for hip fracture and discharged alive in 2010-2014 was conducted. The measurements were patient demographic characteristics, residential and discharge status, Katz Index, Merle D'aubigné Hip Score, Mini-Mental Test, comorbid conditions, Charlson Index, ASA group, type of fracture and repair, and postoperative complications. Patient characteristics were tested by bivariate and multivariate analyses. RESULTS: 8.3 % of patients were readmitted within 30 days (56.0 % of these within 2 weeks). Medical reasons were 13 times more frequent than surgical reasons. Diagnoses more prevalent for readmission were pulmonary disease, deep vein thrombosis, heart failure, and renal failure. Predictors of readmission were female gender (HR 1.9, 95 % CI 1.1-3.4), grade III-IV ASA (HR 2.1, 95 % CI 1.1-4.2), and pre-existing pulmonary disease (HR 5.3, 95 % CI 3.4-9.6). In-hospital mortality among readmitted patients was 22.9 %. In bivariate analyses, male gender, ASA III-IV, cognitive impairment, and more than two comorbidities were potential predictive factors for readmission, and in multivariate analysis only male gender and ASA III-IV. Mortality risk among readmitted patients was significantly higher compared to the in-hospital mortality in the overall cohort (OR 1.8, 95 % CI 1.5-2.3). CONCLUSIONS: Hospital readmissions after hip fracture were mainly due to medical complications and a fraction of these may be preventable. Readmission was associated with increased morbidity and mortality.

Prognostic factors of health-related quality of life in patients after tibial plafond fracture. A pilot study.

BACKGROUND: Tibial plafond fractures are a uncommon injury, and the outcomes described in literature are generally poor. The purposes were to determine the effect of the tibial plafond fractures on general health-related quality of life, and to examine the factors that influence these outcomes. METHODS: Retrospective study of 43 patients with average age of 45.6 (range 18-69) years who were also invited for a clinical and radiological reassessment. The primary outcome measure was quality of life assessed by the Short Form-36 questionnaire. Visual analogue scale for pain, and motion of both ankle and subtalar joints were also assessed. Radiological evaluation was performed to assess bone healing, fracture reduction quality, and tibial alignment. RESULTS: The mean follow-up at last visit was 8.1 (range, 4-12) years. Patients who had suffered plafond fracture had significantly poorer quality of life compared with age- and gender-matched general population of our country regardless of the treatment method used. Multivariate analyses showed that the age had influence on the emotional outcomes, educational level and fracture pattern on physical outcomes, and marital status, fracture reduction quality, and ankle motion on both physical and mental component summaries. CONCLUSION: Tibial plafond fractures have a significant negative impact on general health-related quality of life regardless of the operative treatment used which reflects injury severity. In addition, psychosocial characteristics of patients may influence the outcomes.

Debridement with prosthesis retention and antibiotherapy vs. two-stage revision for periprosthetic knee infection within 3 months after arthroplasty: a case-control study.

Sixty-four patients with periprosthetic infection within 3 months of index arthroplasty, of whom 39 underwent debridement with prosthesis retention and antibiotherapy (DPRA), and 25 underwent two-stage revision (2SR), were compared regarding control of infection and functional outcomes by use of Knee Society scores. Failure was defined as the need for subsequent surgery to control infection. The failure rate after DPRA was 61.5%, and that after 2SR was 12.0% (p 0.001). The failure risk was not significantly associated with the duration of symptoms (≤4 weeks). The only predictor of failure was isolation of Staphylococcus aureus or Staphylococcus epidermidis. Treatment with 2SR required fewer surgical operations, a shorter duration of hospitalization, and a shorter duration of treatment. All patients who required a second debridement ultimately underwent prosthesis removal. The functional outcome was significantly better for 2SR at the last follow-up.

Artrodesis sin fusión ósea con clavo modular intramedular para revisión de prótesis total de rodilla infectada / Arthrodesis without bone fusion with an intramedullary modular nail for revision of infected total knee arthroplasty

Objetivo. Evaluar los resultados de la fijación de rodilla sin fusión ósea, con clavo intramedular e interposición de cemento. Material y métodos. Estudio retrospectivo de 29 prótesis total de rodilla infectadas con datos recogidos prospectivamente y seguimiento medio de 4,2 años (3-5). Resultados. Las complicaciones fueron 2 infecciones recurrentes, una fractura periimplante y una erosión cortical en la punta del componente femoral, siendo todas revisadas con buen resultado. La dismetría media fue 0,8 cm, con 24 < 1 cm. Veinticinco pacientes no referían dolor. El valor medio de WOMAC-dolor fue 86,9, WOMAC-función 56,4, SF12-físico 45,1, y SF12-mental 53,7. Cuatro pacientes precisaron andador y solo 2 eran dependientes para actividades diarias. Conclusiones. El clavo Endo-Model Link® es un efectivo método de fijación de rodilla, restaurando la alineación del miembro y adecuada longitud del mismo (AU)

Objective. To evaluate the outcome of knee fixation without bone fusion using an intramedullary modular nail and interposed cement. Material and methods. Retrospective study of 29 infected total knee arthroplasties with prospective data collection and a mean follow-up of 4.2 years (3-5). Results. Complications included 2 recurrent infections, 1 peri-implant fracture, and 1 cortical erosion due to the tip of the femoral component. All of these were revised with successful results. The mean limb length discrepancy was 0.8 cm, with 24 < 1 cm. Twenty-five patients reported no pain. The mean WOMAC-pain was 86.9, WOMAC-function 56.4, SF12-physical 45.1, and SF12-mental 53.7. Four patients needed a walking frame, and only two were dependent for daily activities. Conclusions. The Endo-Model Link nail is an effective method for knee fixation that restores the anatomical alignment of the limb with adequate leg length (AU)

[Arthrodesis without bone fusion with an intramedullary modular nail for revision of infected total knee arthroplasty]. / Artrodesis sin fusión ósea con clavo modular intramedular para revisión de prótesis total de rodilla infectada.

OBJECTIVE: To evaluate the outcome of knee fixation without bone fusion using an intramedullary modular nail and interposed cement. MATERIAL AND METHODS: Retrospective study of 29 infected total knee arthroplasties with prospective data collection and a mean follow-up of 4.2 years (3-5). RESULTS: Complications included 2 recurrent infections, 1 peri-implant fracture, and 1 cortical erosion due to the tip of the femoral component. All of these were revised with successful results. The mean limb length discrepancy was 0.8 cm, with 24<1cm. Twenty-five patients reported no pain. The mean WOMAC-pain was 86.9, WOMAC-function 56.4, SF12-physical 45.1, and SF12-mental 53.7. Four patients needed a walking frame, and only two were dependent for daily activities. CONCLUSIONS: The Endo-Model Link nail is an effective method for knee fixation that restores the anatomical alignment of the limb with adequate leg length.