Improving fragility hip fracture care through data: a multicentre experience from a country with an emerging economy during the COVID-19 pandemic.

INTRODUCTION: In low-to-middle-income countries (LMIC), the orthogeriatric model of care is still in its early stages of development. This study describes the initial results of the first online fragility hip fracture database to be setup in the Philippines using a modified minimum common dataset to generate outcomes data based on current hospital practices. METHODS: A multicentre prospective cohort study among 12 Philippine hospitals was conducted from June 2020 to February 2021. Thirty-day mortality, morbidity and mobility were measured. Significant factors associated with mortality were determined. RESULTS: 158 elderly patients with fragility hip fractures were included in the study. Nine patients (5.7%) were confirmed or suspected to have COVID-19 infection. Median time of injury to admission was at least 3 days (IQR: 1.0-13.7). Overall, 80% of patients underwent surgical intervention with a median time from admission to surgery of at least 5 days (IQR: 2.5-13.6). Thirty-day mortality and morbidity rates for acute fragility fractures were 3.7%. Factors significantly associated with early mortality were poor prefracture mobility, COVID-19 infection, radiograph of the abnormal chest and conservative treatment. Non-surgical patients had no functional mobility or were wheelchair users and had a significantly higher morbidity rate than surgically treated patients (13.6% vs 1.8%; p=0.031). CONCLUSION: Despite treatment delays unique to an LMIC, short-term outcomes remain favourable for non-COVID-19 fragility hip fracture patients treated with surgery. Prompt admission and multidisciplinary care for elderly hip fracture patients while maintaining protective measures for COVID-19 infection control are recommended. The quality of data collected illustrates how this online database can provide a framework for a sustainable audit or registry as well as provide a platform for the introduction of orthogeriatric concepts at a multiregional scale.

Morphometric analysis of the Filipino knee and its implication in total knee arthroplasty prosthesis design.

BACKGROUND: Prosthesis factors account for a quarter of the dissatisfaction rates among post-total knee replacement (TKR) patients. In the Philippines, the available prostheses have pre-determined sizes and dimensions that are based on Caucasian morphometric data. This can pose a problem, since according to previous studies Asian knees have smaller dimensions compared to Caucasians. Since there is a paucity of research looking into the fitness of these prostheses to the Filipino knee, this study was pursued. METHODS: This study measured 675 knees of 675 adult Filipinos from January 2018 to December 2020. The morphometric measurements were performed on T1-weighted magnetic resonance images. The distal femoral morphometry included: the anteroposterior distance, lateral and medial anteroposterior distances, mediolateral distance, anterior and posterior mediolateral distances, and the femoral aspect ratio. The proximal tibial morphometry included: the anteroposterior distance, mediolateral distance, the medial and lateral anteroposterior distances, and the tibial aspect ratio. The patellar height, width, and thickness were also determined. Statistical analyses were done by using SPSS (version 26) and Microsoft Excel (version 2016). RESULTS: The mean femoral medial and lateral anteroposterior distances were 57.6 mm and 57.1 mm, respectively. The femoral mediolateral distance was 69.3 mm, and the mean femoral aspect ratio was 1.21. The mean proximal tibial antero-posterior and mediolateral distances were 45.3 mm and 71.9 mm, respectively. The mean tibial aspect ratio was 1.66. Most TKR prostheses can be fitted to the Filipino knee but underhang on the mediolateral aspect is commonly observed in both the femoral and tibial components. The mean patellar height and width of Filipinos were 39.6 mm and 42.6 mm, respectively while the average thickness was 23.1 mm. CONCLUSION: Most prostheses available in the Philippine and Asian markets can be fitted into Filipino knees albeit the underhang observed in the mediolateral aspects of both femoral and tibial components. Potential patellar complications are unlikely given the adequate thickness. To avoid the potential mismatch, the best approach is to design a prosthesis aptly suited for the Filipino knees.