The effect of shortening and varus collapse of the femoral neck on function after fixation of intracapsular fracture of the hip: a multi-centre cohort study.

We have studied the effect of shortening of the femoral neck and varus collapse on the functional capacity and quality of life of patients who had undergone fixation of an isolated intracapsular fracture of the hip with cancellous screws. After screening 660 patients at four university medical centres, 70 patients with a mean age of 71 years (20 to 90) met the inclusion criteria. Overall, 66% (46 of 70) of the fractures healed with > 5 mm of shortening and 39% (27 of 70) with > 5 degrees of varus. Patients with severe shortening of the femoral neck had significantly lower short form-36 questionnaire (SF-36) physical functioning scores (no/mild (<5 mm) vs severe shortening (> 10 mm); 74 vs 42 points, p < 0.001). A similar effect was noted with moderate shortening, suggesting a gradient effect (no/mild (< 5 mm) vs moderate shortening (5 to 10 mm); 74 vs 53 points, p = 0.011). Varus collapse correlated moderately with the occurrence of shortening (r = 0.66, p < 0.001). Shortening also resulted in a significantly lower EuroQol questionnaire (EQ5D) index scores (p = 0.05). In a regression analysis shortening of the femoral neck was the only significant variable predictive of a low SF-36 physical functioning score (p < 0.001).

Communicating study results to our patients: which way is best?

Before we are able to communicate evidence and evidence results to patients we must first be familiar with the common ways by which results may be presented to our patients. We describe five approaches (relative risk, risk reduction, odds ratio, absolute risk difference and number needed to treat) of transforming the results of an orthopaedic study for communication with patients.

Grading the evidence: levels of evidence and grades of recommendation.

Evidence-based medicine is using the best available evidence in order to make accurate and knowledgeable treatment decisions. It is not the automatic gainsay of "low quality" evidence and acceptance of randomized controlled trials (RCT's). To be able to make a sound recommendation for a therapy based on the best available evidence, it is necessary to follow steps in acquiring literature, appraising it for study design and quality, and to assess its results, as well as look at the net benefits and net harms.

Acute colonic pseudo-obstruction after elective total joint arthroplasty.

A retrospective review of 31 patients who developed acute colonic pseudo-obstruction (ACPO) after total joint arthroplasty was undertaken to determine predisposing factors related to, and outcomes following, therapeutic intervention. Comparison with all patients who underwent total joint arthroplasty revealed an overall 1.2% incidence of ACPO. There was a higher incidence of ACPO in patients undergoing sequential bilateral total knee arthroplasty (3.4%) compared with unilateral total knee arthroplasty (0.3%) and a higher incidence in patients undergoing revision total hip arthroplasty (5.6%) compared with primary total hip arthroplasty (1.4%). Additional risk factors for developing ACPO included slow postoperative mobilization and male gender. No association was found with respect to body mass index, age, comorbidity, anesthetic type, international normalized ratio level, or postoperative analgesia. There were no deaths, and 2 patients required operative intervention. The remaining cases of ACPO resolved with nonsurgical treatment. In all cases, there was a prolonged length of hospitalization (mean, 13.2 days) compared with all other arthroplasties performed at our institution (mean, 7.5 days).