RESUMO
PURPOSE: With over 100,000 procedures completed per year, hip and knee arthroplasty are two of the most common surgical procedures performed in Canada. There has been literature indicating that patient reported outcome measures (PROM) will start to plateau between six and 12 months. The purpose of this paper was to analyze the trajectory of PROMs following total hip and knee arthroplasty (THA and TKA), as well as assess the impact of any potential confounders on this trajectory. The central research question was: At what point do PROMS plateau among patients that undergo elective THA and TKA? METHODS: This study was a retrospective analysis of data from a prospective database. Patients were eligible if they had undergone an elective, primary THA/TKA with Oxford Scores recorded pre-operatively, and at least at two of the following four time points: six weeks, six months, one year, and two years. RESULTS: Mean pre-operative Oxford scores were 18.0 (7.8) for THA, and 20.1 (7.5) for TKA. For both THA and TKA, there were statistically significant interval improvements in Oxford scores from six weeks [THA: 33.8 (7.9)/TKA: 28.7 (7.8)] to six months [THA: 40.2 (7.3)/TKA: 35.9 (8.3)], and from six months to one year [THA: 41.0 (7.3)/TKA: 37.3 (8.4)], but not from one to two years [THA: 40.0 (8.5)/TKA: 36.4 (9.6)]. CONCLUSIONS: Patients undergoing either primary THA or TKA can expect clinically meaningful improvements in the first six months after surgery. Beyond this time point, there is a plateau in PROMs. These findings are important for both setting patient expectations in pre-operative discussions, and allowing surgeons to have a realistic understanding of their patients' expected post-operative course.
RESUMO
Background and objective Intramedullary femoral nailing (IMN) is the gold standard for managing femoral shaft fractures (FSFs). Though good clinical outcomes and union rates have been reported following this procedure, it has also been commonly associated with perioperative complications. Positioning the patient in lateral decubitus, avoiding a fracture table, or using manual traction have been touted as possible techniques to reduce perioperative complications in IMN. However, given the scarce availability of comparative research, the decision to employ any of the techniques mentioned above is often guided by surgeon preference alone. In light of this, the purpose of this study was to determine whether the use of free-leg draping using either supine or direct lateral positioning with manual traction reduces perioperative complications among trauma patients undergoing an anterograde femoral nailing surgery when compared to using a fracture table. Methods Consecutive adult patients from a level-one trauma center undergoing unilateral antegrade femoral fixation surgeries between 2016 and 2020 were retrospectively evaluated for possible inclusion in the study. Relevant perioperative and postoperative data, including length of hospital or ICU stay and perioperative complications, were included in the analysis. This study received research ethics board approval before data collection began. Results A total of 91 patients were ultimately included in the final analysis: 61 patients were included in the free-leg draping with manual traction group (FL) and 30 patients were included in the traction table group (TT). Patients in the FL group had a similar operative and fluoroscopy time, blood loss, length of stay, and time on the ventilator. Subgroup analysis comparing positioning within the FL group revealed non-significant differences in fluoroscopy time (p=0.59) and length of stay (p=0.20) between the lateral and supine groups. Moreover, no differences in operative time, blood loss, and time on the ventilator were observed between lateral and supine groups. Conclusion Based on our findings, there were no significant differences in terms of operative or fluoroscopy time, perioperative complications, or length of time in the hospital or on the ventilator between the groups. Our study was limited by its small sample size and incomplete data. Further prospective randomized research is required to reach definitive conclusions on the appropriate manner to treat patients with these complex and morbid injuries.
