The purpose of this study was to determine whether there have been changes in the complexity of femoral fragility fractures presenting to our Dunedin Orthopaedic Department, New Zealand, over a period of ten years. Patients over the age of 60 presenting with femoral fragility fractures to Dunedin Hospital in 2009 −10 (335 fractures) were compared with respect to demographic data, incidence rates, fracture classification and treatment details to the period 2018-19 (311 fractures). Pathological and high velocity fractures were excluded. The gender proportion and average age (83.1 vs 83.0 years) was unchanged. The overall incidence of femoral fractures in people over 60 years in our region fell by 27% (p<0.001). Intracapsular fractures (31 B1 and B2) fell by 29% (p=0.03) and stable trochanteric fractures by 56% (p<0.001). The incidence of unstable trochanteric fractures (31A2 and 31A3) increased by 84.5% from 3.5 to 6.4/10,000 over 60 years (p = 0.04). The proportion of trochanteric fractures treated with an intramedullary (IM) nail increased from 8% to 37% (p <0.001). Fewer intracapsular fractures were treated by internal fixation (p<0.001) and the rate of acute total hip joint replacements increased from 13 to 21% (p=0.07). The incidence of femoral shaft fractures did not change significantly with periprosthetic fractures comprising 70% in both cohorts. While there has been little difference in the numbers there has been a decrease in the incidence of femoral fragility fractures likely due to the increasing use of bisphosphonates. However, the incidence of unstable trochanteric fractures is increasing. This has led to the increased use of IM nails which are increasingly used for stable fractures as well. The increasing complexity of femoral fragility fractures is likely to have an impact on implant use, theatre time and cost

Aim. Prosthetic joint infection (PJI) is a serious complication following total hip arthroplasty (THA) entailing increased mortality, decreased quality of life, and high healthcare costs. In 2009 a nationwide, multidisciplinary infection control program was launched in Sweden, PRISS, which aimed to reduce the PJI burden by 50%. The primary aim was to investigate whether the PRISS project reduced PJI incidence after primary THA; the secondary aim was to evaluate other possible benefits of PRISS, such as shorter time to diagnosis. Method. We obtained data on patients undergoing primary THA in Sweden (n = 45,723 patients, 49,946 THAs), 2012–2014. Using personal identity numbers, this cohort was matched with the Swedish Prescribed Drug Registry. Medical records of patients with ≥4 weeks antibiotic consumption were reviewed to verify PJI diagnosis (n = 2240, 2569 THAs). Results. The cumulative incidence of PJI following the PRISS project was 1.2% [95% CI 1.1–1.3] as compared to 0.9% [95% CI 0.8–1.0] before. Cox regression models for the PJI incidence post PRISS indicates there were no statistical significance difference versus pre PRISS (HR 1.1 [95% CI 0.9–1.3]. There were similar time to PJI diagnosis after the PRISS project 24 vs 23 days (p=0.5). Conclusions. Despite the comprehensive nationwide PRISS project, Swedish PJI incidence was higher after the project and time to diagnosis remained unchanged. Factors contributing to PJI, such as increasing obesity, higher ASA class, and more fractures as indications, explain the PJI increase among primary THA patients

Complex regional pain syndrome type 1 (CRPS-I) is a devastating complication that can occur after limb extremity injuries. The effectiveness of vitamin C in preventing CRPS-I incidence is debatable. Therefore, we conducted a systematic review and meta-analysis to assess the role of vitamin C in CRPS-I prevention and its effect on pain score, functional outcomes and complications rate after wrist, ankle, and foot fractures. We searched Medline, Embase, the Cochrane Library, . Clinicaltrial.gov. , and Google Scholar from infinity to May 2021 for relevant studies comparing the incidence of CRPS-I with administration of perioperative vitamin C versus placebo after wrist, ankle, and foot fractures. Continuous data such as functional outcomes and pain scores were pooled as mean differences (MD), whist dichotomous variables such as the incidence of CRPS-I and complications were pooled as odds ratios (OR), with 95% confidence interval (CI). Data analyses was done using R software (meta package, version 4.9-0) for Windows. Eight studies, including two quasi-experimental studies, were included. The timeframe for vitamin C administration ranged from 42 to 50 days post-injury and/or surgical fixation and the dosage was either 500 mg or 1000 mg. The results showed that vitamin C was associated with a lower rate of CRPS-I relative to a placebo (OR 0.33, 95% CI [0.17, 0.63]). No significant difference was found between vitamin C and placebo in terms of complications (OR 1.90, 95% CI [0.99, 3.65]), functional outcomes (MD 6.37, 95% CI [-1.40, 14.15]), and pain scores (MD -0.14, 95% CI [-1.07, 0.79]). The findings demonstrate that when compared to placebo, at least 42 days of vitamin C prophylaxis is associated with prevention of CRPS-I following wrist, ankle, and foot fractures, irrespective of vitamin C dosage or fracture type. No significant differences were found with secondary outcomes

The aim of this study was to examine the incidence of obesity in patients undergoing primary total shoulder replacement (TSR) (stemmed and reverse) for osteoarthritis (OA) in Australia compared to the incidence of obesity in the general population. A 2017–18 cohort of 2,621 patients from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) who underwent TSR, were compared with matched controls from the Australian Bureau of Statistics (ABS) National Health Survey from the same period. The two groups were analysed according to BMI category, sex and age. According to the 2017–18 National Health Survey, 35.6% of Australian adults are overweight and 31.3% are obese. Of the primary TSR cases performed, 34.2% were overweight and 28.6% were obese. The relative risk of requiring TSR for OA increased with increasing BMI category. Class-3 obese females, aged 55–64, were 8.9 times more likely to require TSR compared to normal weight counterparts. Males in the same age and BMI category were 2.5 times more likely. Class-3 obese patients underwent TSR 4 years (female) and 7 years (male) sooner than their normal weight counterparts. Our findings suggest that the obese population is at risk for early and more frequent TSR for OA. Previous studies demonstrate that obese patients undergoing TSR also exhibit increased risks of longer operative times, higher superficial infection rates, higher periprosthetic fracture rates, significantly reduced post-operative forward flexion range and greater revision rates. Obesity significantly increases the risk of requiring TSR. To our knowledge this is the first study to publish data pertaining to age and BMI stratification of TSR Societal efforts are vital to diminish the prevalence and burden of obesity related TSR. There may well be reversible pathophysiology in the obese population to address prior to surgery (adipokines, leptin, NMDA receptor upregulation). Surgery occurs due to recalcitrant or increased pain despite non-op Mx

The purpose of this study was to determine the incidence of graft-tunnel mismatch (GTM) when performing anatomic anterior cruciate ligament reconstruction (ACLR) using bone-patella tendon-bone (BPTB) grafts and anteromedial portal drilling. Beginning in November 2018, 100 consecutive patients who underwent ACLR by two sports fellowship-trained, orthopedic surgeons using BPTB autograft and anteromedial portal drilling were prospectively identified. The BPTB graft dimensions and the femoral tunnel distance, tibial tunnel distance, intra-articular distance, and total distance were measured. Surgeons determined the depth and angle of tunnels based on the patella tendon graft length dimensions in each case. After passage of the graft, the distance from the distal graft tip to the tibial cortex aperture was measured. GTM was defined as the need for additional measures to obtain satisfactory tibial graft fixation (< 1 5e20 mm of bone fixation). The incidence of mismatch was 6/100 (6%). Five cases involved the graft being too long, with the tibial bone plug protruding excessively from the tibial tunneld4/5 had a patella tendon length ? 50 mm. Three cases were managed with femoral tunnel recession, and two were treated with a free bone plug technique. One patient with a patella tendon length of 35 mm had a graft that was too short, with the tibial bone plug recessed in the tibial tunnel. Of patients whose tibial tunnel distance was within 5 mm of the patella tendon length, only 1/46 (2%) patients had mismatch, whereas 5/54 (9%) of patients who had >5 mm difference had mismatch. The incidence of grafttunnel mismatch after anatomic ACLR using BTPB and anteromedial portal drilling in this study is 6%. To limit the occurrence of GTM where the graft is too long, surgeons should drill tibial tunnel distances within 5 mm of the patella tendon length

Since the advent of the COVID-19 pandemic, there has been a technologically based progression to almost every sector of society. This has led to an influx of e-hailing motorcycle drivers (online based consumable transportation platforms) and thus an increase in road traffic accidents. This group experiences an abundance of Orthopaedic related trauma with a considerable economic burden. Therefore, the study aimed to determine the incidence of this study group as well as quantify the severity and cost implications thereof for the sake of public health and epidemiology. This was an observational study whereby a prospective cohort analysis was respectively conducted at a single centre to determine the incidence, of the study group, over a seven-month period. The study included any e-hailing motorcycle driver who sustained Orthopaedic related trauma, whilst on duty, within the catchment area whereas all other patients were excluded and used as a comparator. A descriptive statistical analysis was done to further delineate the severity of injury by comparing the type of injury, anatomical location injured, and management plan incurred. A total of 5096 individuals experienced Orthopaedic related trauma with 60 individuals (1.18%) being e-hailing motorcyclists who sustained injury whilst on duty. The incidence being 118 per 10000 patients. Further analysis revealed that 78.33% of the population experienced fractures or dislocations with 52.31% of these injuries requiring surgical intervention. The Upper limb (53.85%) and Lower limb (43.08%) were the most affected anatomical locations. The Orthopaedic care for this population group places a meaningful burden on the South African Health sector. These drivers work in unsafe environments and sustain high energy impacts, yet very little oversight exists. Therefore, continued research with new regulations needs to be drafted, looking into vehicle safety, working conditions, operative hours, and the need for public awareness

Aim. Rifampicin as a biofilm-active antibiotic drug has a significant role in the treatment of periprosthetic joint infection (PJI). However, rifampicin resistance is an increasing threat to PJI treatment. This study aimed to evaluate the prevalence of rifampicin resistant staphylococci over time and its association with infection-free survival after PJI in a single centre in Sweden. Methods. We included 238 PJIs in 238 patients who had undergone PJI revision surgery from 2001 to 2020 on whom the causative bacteria were staphylococci, and the agent was tested for rifampicin resistance. Data regarding agents, rifampicin resistance, treatment and outcome was obtained. Kaplan-Meier survival analysis and a Cox regression model with adjustment for age, sex, localisation (hip or knee) and type of prosthesis (primary or revision) were used to calculate infection-free survival rates and adjusted risk ratios (HRs) of the risk of treatment failure. Treatment failure was defined as any reoperation or suppression treatment with antibiotics due to prolonged infection. Results. Among the included 238 PJIs, 40 rifampicin-resistant staphylococci [93% Coagulase Negative Staphylococci (CoNS)] and 29 treatment failures were identified. The proportion of rifampicin resistant agents decreased from 25% in 2010–2015 to 12% in 2016–2020. The 2-year infection-free survival rates were 79.0% (95% CI 0.66–0.92) for the rifampicin resistant and 90% (95% CI 0.86–0.94) for the rifampicin sensitive group. Patients with PJI caused by rifampicin resistant bacteria had a significantly higher risk of treatment failure than those caused by sensitive bacteria (HR 2.5; 95% CI 1.0–6.2). Conclusions. The incidence of PJI caused by rifampicin resistant staphylococci decreased in Uppsala, Sweden over the past 20 years. PJI caused by rifampicin-resistant staphylococci has a two-fold risk for treatment failure compared to PJI caused by rifampicin-sensitive staphylococci, which stresses the importance of retaining rifampicin resistance low. Additionally, the increased risk of treatment failure when PJI is caused by a rifampicin-resistant bacteria warrants consideration of a more conservative treatment strategy

Abstract. Introduction. Acute kidney injury (AKI) is a common post-operative complication which, in turn, significantly increases risk of other post-operative complications and mortality. This quality improvement project (QIP) aimed to evaluate and implement measures to decrease the incidence of AKI in post-operative Trauma and Orthopaedics (T&O) patients. Methods. Three data collection cycles were conducted using all T&O patients admitted to a single UK West Midlands NHS trust across three six-month periods between December 2018 and December 2020 (n=8215). Patients developing a post-operative AKI were identified using the Acute Kidney Injury Network criteria. Data was collected for these patients including demographic details and AKI risk factors such as ASA grade, hypovolaemia and use of nephrotoxic medications. Results. The percentage of post-operative AKI decreased from 2% (71 patients from 5899 operations) in the first cycles to 1.5% (19 from 1273 operations) by the final cycle. There was a high prevalence of modifiable risk factors for AKI, including post-operative hypovolaemia (50%) and use of nephrotoxic aminoglycosides (81%). Measures implemented between cycles included a pre-operative medication review identifying nephrotoxic medications, early post-operative assessment for consideration of intravenous fluids and junior doctor teaching on fluid therapy. There was a substantial decrease in use of multiple nephrotoxic medications (98% to 59%) and in use of aminoglycosides (88% to 42%) between the final cycles which may explain the reduction in observed AKI incidence. Conclusion. This QIP highlights the benefits of a multifaceted approach in the peri-operative period, through targeting of risk factors in preventing post-operative AKI

Aim. Acute post-surgical infection is one of the most serious complications after instrumented thoracolumbar fusion with an incidence of 0.7%-12%. Acute infection can lead to an increase in morbidity, mortality, and economic costs for the healthcare system. The main objective of our study was to determine the variables associated with a higher risk of acute infection after thoracolumbar instrumentation in our center. Methods. We conducted an observational case-control study including instrumented fusions of the thoracolumbar spine performed between 2015 and 2021 at our institution. We included patients with thoracolumbar fusions after a fracture or for the treatment of degenerative pathology. We analyzed demographic variables related to the surgical procedure, the causative microorganism of infection, the outcome of infection treatment, and complications. We performed a descriptive analysis of all variables and a univariate comparison of cases and controls. The dichotomous variables were compared using the Fisher test, while the quantitative variables were compared using the Student's T-test. A p-value of <0.05 is taken into account to consider the statistical significance. SPSS v25 Windows program was used for statistical analyses. Results. 455 patients were included, 53% were male with a mean age of 60 years. 35% of patients had a BMI (Body Mass Index) >30, 21.1% were classified as ASA (American Society of Anesthesiologists) >3, 15.8% were diabetic, and 2.6% were under chronic corticosteroid treatment. In 34.1% of the fusions, the procedure lasted more than 3 hours. We identified 26 post-surgical acute infections (5.7%). Patients with an infection had a higher prevalence of diabetes (14.7% vs 34.6% p=0.012), chronic corticosteroid treatment (2.1% vs 11.5% p=0.026), and a higher percentage of surgeries with duration > 3 hours (32.4% vs. 61.1%, p=0.019). A trend towards significance was also observed in patients classified as ASA >3 (20.3% vs. 34.6%, p=0.088), and BMI >30 (33.8% vs. 53.8%, p=0.054). No significant differences were observed in the rest of the variables studied. The most frequent causative microorganism was S.epidermidis (38%), followed by S.aureus (34%) and polymicrobial infections (34%). Conclusions. There is a significant increase in infection in diabetic patients, patients with chronic corticosteroid treatment, and in surgeries lasting > 3 hours

Introduction. Schatzker V & VI tibial plateau fractures are serious life-changing injuries often resulting in significant complications including post-traumatic arthritis. Reported incidence of secondary TKA following ORIF of all tibial plateau fractures is 7.3% and 13% for Schatzker V & VI tibial. This study reports a 15-year single centre experience of CEF of Schatzker V & VI fractures including PROMs and incidence of secondary TKA. This study was approved by the local Institutional board. Materials & Methods. All patients from 2007 – 2022 with Schatzker V or VI fractures treated with CEF were identified from a departmental limb reconstruction registry and included in this retrospective study. Patients’ demographics were collected from electronic institutional patient system. Further data was collected for secondary intervention, adverse events, and alignment at discharge. All deceased patients at the time of the study were excluded. Each participant completed a questionnaire about secondary intervention, EQ-5D-3L and Oxford Knee Score (OKS). Results. 90 patients (from 130 eligible) with an average age of 58.3 years completed the questionnaire. At an average follow up of 7.4 years (SD=3.8) the incidence of secondary TKA was 7.8%. There was no significant correlation between articular incongruity and the incidence of secondary TKA. The mean OKS score was 31.7 (SD=13.3). The mean EQ-VAS was 69.3 (SD=23.3) and the mean EQ-5D Index was 0.595 (SD=0.395), both were significantly lower than UK normal population means. Conclusions. This study is probably one of the largest and with the longest follow-up reporting the outcomes of Schatzker V and VI fractures treated with CEF. It appears that articular incongruity has no significant correlation with secondary TKA. Patients reported EQ-5D-3L scores were significantly lower than those for the normal UK population, and the average EQ-VAS has deteriorated with time. This study would be relevant in counselling and consenting patients with this severe injury

Objectives. Open fracture classification systems are limited in their use. Our objective was to classify open tibia and femur fractures using the OTS classification system in a region with high incidence of gunshot fractures. One hundred and thirty-seven patients with diaphyseal tibia and femur open fractures were identified from a prospectively collected cohort of patients. This database contained all cases (closed and open fractures) of tibial and femoral intramedullary nailed patients older than 18 years old during the period of September 2017 to May 2021. Exclusion criteria included closed fractures, non-viable limbs, open fractures > 48 hours to first surgical debridement and patients unable to follow up over a period of 12 months (a total of 24). Open fractures captured and classified in the HOST study using the Gustilo-Anderson classification, were reviewed and reclassified using the OTS open fracture classification system, analysing gunshot fractures in particular. Ninety percent were males with a mean age of 34. Most common mechanism was civilian gunshot wounds (gsw) in 54.7% of cases. In 52.6% of cases soft tissue management was healing via secondary intention, these not encompassed in the classification. Fracture classification was OTS Simple in 23.4%, Complex B in 24.1% and 52.6% of cases unclassified. The OTS classification system was not comprehensive in the classification of open tibia and femur fractures in a setting of high incidence of gunshot fractures. An amendment has been proposed to alter acute management to appropriate wound care and to subcategorise Simple into A and B subdivisions; no soft tissue intervention and primary closure respectively. This will render the OTS classification system more inclusive to all open fractures of all causes with the potential to better guide patient care and clinical research

Aim. Strenuous efforts to minimize postoperative infection rates have been made, including the Swedish nation-wide initiative Prosthesis Related Infections Shall be Stopped (PRISS). The aim of this study was to calculate the incidence rate of periprosthetic joint infections (PJI) following primary total knee arthroplasty (TKA) before and after PRISS. Method. All 45,438 primary TKAs registered in the Swedish knee arthroplasty register (SKAR) during 2007–2008 and 2012–2013 were included. Matched data on antibiotic prescriptions were obtained from the Swedish Prescribed Drug Register (SPDR). All patients with ≥28 days of continuous antibiotic treatment within 2 years of primary surgery had their medical charts reviewed to identify cases of PJI. Results. 644 PJIs were identified, equaling a 2-year cumulative incidence rate of 1.42% (95% CI: 1.31–1.53). The incidence rate was 1.41% before PRISS and 1.43% after. Diagnosis was made within 30 days of primary TKA in 52%, and within 90 days in 73% of the cases. 603 cases were reoperated. Debridement with exchange of the insert was performed in 32.1% and 62.5% of cases before and after PRISS respectively. Conclusions. No reduction in cumulative PJI incidence was seen after the PRISS initiative

Introduction. Superficial pin site infection is a common problem associated with external fixation, which has been extensively reported. However, the incidence and risk factors with regards to deep infection is rarely reported in the literature. In this study, we investigate and explore the incidence and risk factors of deep infection following circular frame surgery. For the purpose of this study, deep infection was defined as: persistent discharge or collection for which surgical intervention was recommended. Materials and Methods. Retrospective review of all patients whom underwent frame surgery between 1. st. of April 2015 to 1. st. April 2019 in our unit with a minimum of 1 year follow up following frame removal. We recorded patient demographics, patient risk factors, trauma or elective procedure, number of days the frame was in situ, location of infection and fracture pattern. Results. 304 patients were identified. 27 patients were excluded as they were lost to follow up or had their primary frame surgery as a treatment for infection. This provided us with 277 patients for analysis. Mean age was 47 years (range 9–89 years), the male to female ratio was 1.5:1 and 80% were trauma frames. 13 patients (4.69%) developed deep infection and all occurred in trauma patients. Of the 13 patients who developed deep infection, 4 had infection before frame removal and 9 occurred after frame removal. 8 deep infections occurred within a year of frame removal, 1 occurred between 1 and 2 years. Within the 13 frame procedures for trauma, 12 were periarticular multifragmentary fractures, 3 of which were open, and the remaining was an open diaphyseal fracture. The periarticular fractures were more likely to develop deep infection than diaphyseal fractures (p–0.033). 12 patients (out of 13) also had concurrent minimally invasive internal fixation with screws in very close proximity of the wires. Conclusions. The rate of deep infection following circular frame surgery appears to be low. Pooled, multicentre data would be required to analyse risk factors however multifragmentary, periarticular fracture and the requirement for additional internal fixation appears to be an associated factor

Revision total knee arthroplasty (TKA) procedures performed secondary to periprosthetic joint infection (PJI) are associated with significant morbidity and mortality. These poor outcomes may be further complicated by the development of postoperative infection requiring aggressive antibiotic treatment. However, this antibiotic overuse may suppress patients' native bacterial flora, leading to Clostridium difficile infection (CDI). With the increased demand for primary TKAs and expected rise in revision TKA due to PJI, it is important to identify factors contributing to CDI. Therefore, we aimed to study the: 1) incidence, 2) demographics, length of stay (LOS), and total costs, and 3) risk factors and mortality associated with CDI in revision TKA patients. The National Inpatient Sample database was queried for all individuals diagnosed with PJI and who underwent revision TKA between 2009 and 2013. Patients who developed CDI during their in-patient hospital stay were identified, yielding 83,806 patients (799 with CDI) with a mean age of 65 (S.D.=11.2). Logistic regression analysis was conducted to assess the association between hospital- and patient-specific characteristics and the development of CDI. During the study period, the overall incidence of CDI after revision TKA was 1%. These patients were significantly older (mean age 69.05 vs. 65.52 yrs), had greater LOS (median 11 vs. 5 days), had greater costs ($30,612.93 vs. 18,873.75), and had higher in-hospital mortality (3.6 vs. 0.5%, p < 0 .001 for all) compared to those without infection. Patients with CDI were more likely to be treated in urban, not-for-profit, medium or large bed-sized hospitals located in the Northeast or Midwest (p < 0 .05 for all). Patients with underlying depression (OR 4.267, p=0.007) or fluid/electrolyte disorders (OR 3.48, p=0.001) were more likely to develop infection. Although CDI is a rare event following revision TKA, it can have detrimental consequences. Our report demonstrates that CDI is associated with longer LOS, higher costs, and greater in-hospital mortality. With increased legislative pressure to lower healthcare expenditures, it is crucial to identify means of preventing costly complications

Aim. The purpose of this study is to analyze the demographic and microbiological variables of acute ankle infections posterior to ankle osteosynthesis and to determine the different characteristics of patients withE. cloacae infection. Method. A multicenter retrospective observational study (4 national hospitals) of acute post osteosynthesis infections of ankle fracture operated between 2015 and 2018 was implemented. The demographic and microbiological variables relating to the surgical intervention and the antibiotic treatment performed were collected. A descriptive assessment of all the variables and a univariate comparison between patients with E. cloacae infection and patients with alternative microorganism infections were performed. The SPSS v25 program for Windows was the choice for statistical analysis. Results. 71 Patients with an average age of 57 years were included, the majority being males (55%). 31% of patients were diabetic, 27% had vascular pathology, and 18.3% had a BMI greater than 35. Trimalleolar fracture was the most common in our study being 52%. 26.8% were open fractures. The microorganisms isolated were: 25% S. aureus, 22.5% E. cloacae and 22.5% polymicrobial. Accounting for polymicrobial infections, the presence of E. cloacae rises to 32%. In the univariate analysis, only significant differences were found in age (patients with E. cloacae infection were older) and the use of VAC therapy. Conclusions. In our series, higher percentages of E. cloacae infection were observed than those described in the literature. There are statistically significant differences in the variables of age and need for VAC therapy. The high incidence of E. cloacae infections suggests the vital importance of adapting antibiotic prophylaxis, ensuring the coverage of this microorganism

Aims. The incidence of thigh pain with the short stem varies widely across different studies. We aimed to evaluate the incidence and characteristics of post-operative thigh pain after using a particular bladed short stem and its potential risk factors. Patients and Methods. We respectively reviewed 199 consecutive patients who underwent unilateral total hip replacement using the Tri-lock stem from 2013–2016, of which 168 patients were successfully followed up with minimum two year clinical follow-up. All information about thigh pain and pre- and postoperative HHS score were gathered and all preoperative and immediate postoperative radiographs were available for review. Any complications were recorded. Results. Of the 168 patients, 34 (20.2%) patients reported thigh pain at a mean 3.1 years after surgery. Of these, 2 (5.9%) reported severe pain (NRS 5 or more). The pain was persistent (from surgery to final follow-up) in 13 patients (38.2%) and subsided within 2 years in 10 cases (29.4%). The most common site of pain was the lateral thigh (70.6%). The HHS improved from a mean 54.2 points preoperatively to 79.8 postoperatively. In 123 cases with radiographs at more than 2 years follow-up, all femoral stems were well-fixed and no revision surgery was needed at the latest. BMI and CFI were found to be independent risk factors for thigh pain after using this particular stem component. Conclusions. The incidence of thigh pain in Chinese THA patients with a bladed short stem component design is as high as 20%. Among them, nearly 40% will have some disruption in sleep or daily life. More than one-third of the cases of thigh pain were persistent. A larger BMI and patients with a funnel-type morphology of the femoral canal are independent risk factors for thigh pain in the setting of this particular stem component

Periprosthetic joint infection (PJI) is a devastating complication of total hip arthroplasty (THA). According to registry-based studies, some bearing couples are associated with an increased risk of PJI. The recent International Consensus on Periprosthetic Joint Infection stated that metal-on-metal (MOM) bearing surface appeared to be associated with a higher incidence of PJI. Based on emerging reports, the incidence of PJI appears to be different among different bearing surfaces. We conducted a multi-institutional study attempting to study this exact issue. The purpose of the study was to determine whether there was any difference in the incidence of PJI in two commonly used bearing couples (metal- on-polyethylene versus ceramic-on-polyethylene). Based on a retrospective multi-institutional query all patients who received primary THA with MOP or COP bearing surfaces performed during 2005–2009 in two high-volume arthroplasty centers were identified. Demographic factors, comorbidities, length of hospital stay, complications and other relevant information were extracted. PJI was defined based on the MSIS (International Consensus) criteria. Multivariate analysis was performed to determine whether bearing coupling was independently correlated with PJI. In our data, 25/2,921 (0.9%) patients with MOP and 11/2,643 (0.4%) patients with COP developed PJI. This difference was statistically significant (p=0.01). After the multivariate analysis, controlling for potential confounders (age, body mass index and length of hospital stay, Charlson comorbidity index), MOP bearing surface was found to be an independent factor correlating with higher incidence of PJI (odds ratio: 2.6, 95% confidence interval: 1.02–6.54, p=0.04). The finding of this study, and others from centers in Europe, suggest that the bearing surface may have an influence on the incidence of PJI. Although, we had originally thought that ceramic bearing surfaces may be used in younger and healthier patients, the multivariate analyses that controlled for all these variables confirms that use of metal femoral head is an independent risk factor for development of PJI. The finding of this study is compelling and begs for future basic science mechanistic investigations

Aim. The incidence of prosthetic joint infections can be severe to monitor, as they are rare events. Recent publications from National registries points toward a significant underestimation of reported infections. The aim of this project was to develop a complication register that could report the “true” and momentaneous incidence of prosthetic infections after total knee and hip arthroplasty. Method. All patients operated with total hip arthroplasty (THA) or total knee arthroplasty (TKA) at our hospital were included in a local quality registry. All complications were reported at follow-up at 2 and 3 months for total knee and hip arthroplasties respectively, and at 1-year follow up. Both primary and revision surgeries were included. In order to monitor complications of special interest, such as deep postoperative infections, key variables were presented in a g-chart. This chart shows the number of uncomplicated surgeries between each complication (such as infection) in a bar diagram. This diagram is easily read as high bars indicate a low incidence of complications and low bars indicate a high incidence. The diagram is updated and distributed for information every month. Results. From September 2010 till December 2015 we included 2093 primary total hip arthroplasties and 272 hip revisions. The overall incidence for prosthetic infection after primary THA within 1 year after surgery was 1.8% and for hip revisions 3.4%. The momentaneous incidence in December 2015 was 3% for both primary and revision THA together. In the same period 1555 total knee arthroplasties and 155 knee revisions were included. The overall incidence of prosthetic infection after primary TKA within 1 year after surgery was 1.2% and for knee revisions 2.2%. The momentaneous incidence in December 2015 was 2.5% for primary and revision TKA together. Conclusions. Reporting the number of uncomplicated surgeries between every unwanted event or complication, such as postoperative infections, is a good method for describing rare events. This method will reveal changes in the trend at an earlier stage and can be an important tool in the work on preventing postoperative infections. A local quality register can be important in order to report a “true” incidence of postoperative infections, as the risk of underestimation is lower than in a national registry

Background. There are few reports including natural course of initial gap in total hip arthroplasty. The purpose of this study is to investigate the incidence of initial gap in the PSL type shells and its natural course. Methods. Total of 386 THAs with Trident or TriAD PSL shells were performed between January 2000 and December 2014. Exclusion criteria were shells with screw fixations (n=189), previous pelvic osteotomy (n=15) and less than 3 years’ follow-up (n=11). Finally, our study included 171 hips. Average age was 56.8 (17∼83) years at THA and average follow-up time was 8.3 (3∼16.3) years; 112 (66%) were women; and 120 hips (70.2%) had osteoarthrosis. As radiographic evaluation, we checked presence or absence of initial gap, maximum size of it, gap filling and cup stability. The presence of initial gap was defined as gap present on post-operative anteroposterior X-ray measuring 1mm or greater. Gap filling was defined as confirmed trabecular formation between the cup and acetabular floor without cup migration. And we determined the time to gap filling. As clinical evaluation, we retrospectively checked Harris Hip Score (HHS) at pre-operative and final follow-up period, and presence of shell revision. Furthermore, we compared clinical results with or without initial gap. Results. Initial gap was confirmed at 85 hips (49.7%) and mean maximum size was 2.1 (1∼6.3) mm. Mean gap filling occurred at 2.5 (± 1.4) years and there was no unstable cup. Comparing clinical results with or without initial gap, pre-operative HHS was not significantly associated with initial gap (57.8 and 56.3, respectively, p=0.41). HHS at final follow-up period was also not significantly associated with initial gap (88.4 and 87.5, respectively, p=0.49). There was no shell revision with or without initial gap. Discussion. Initial gap of hemispherical type shell is reported that its incidence is 16∼38% and initial gap is not associated with clinical outcome. Our results show that PSL type shell occurs initial gap more frequently than hemispherical type shells. Conclusion. Initial gap of PSL type shell was confirmed at 85 hips (49.7%) and mean gap filling occurred at 2.5 years. Initial gap did not affect shell revision and clinical outcome

Ceramic bearings are currently the most widely used alternative to metal-on-polyethylene bearings in total hip arthroplasty (THA). A workgroup at International Consensus Meeting (ICM) analyzed the potential link between the type of bearing surface and the subsequent periprosthetic joint infection (PJI), and found a higher incidence of PJI when using a metal-on-metal (MoM) bearing surface. A potential reason is that the failure of a MoM bearing surface can result in adverse local tissue reactions (ALTR), which might provide a favorable environment for bacterial proliferation. In the last few years, several observational studies including national registries, showed that metal-on-polyethylene (MoP) bearing surfaces are associated with a higher rate of infection following total hip arthroplasty (THA) compared to ceramic bearings, in particular with the use of ceramic-on-ceramic bearing (CoC) surfaces. After adjusting for selection bias and various confounding factors, patients treated with ceramic bearings experienced reduced risk of infection and MoP bearing surface is an independent risk factor correlating with higher incidence of PJI. The meta-analysis by Lee et al. comparing MoM with CoC cementless THA confirmed that the MoM is associated with a significantly higher revision rate than CoC group for any reason as well as for PJI. Furthermore, initial in-vitro studies have shown lower bacterial biofilm formation on ceramic bearing surfaces. Summarizing the current literature, ceramic bearings are associated with a lower risk of infection following THA