Aims. A recent study used the RAND Corporation at University of California, Los Angeles (RAND/UCLA) method to develop anatomical total shoulder arthroplasty (aTSA) appropriateness criteria. The purpose of our study was to determine how patient-reported outcome measures (PROMs) vary based on appropriateness. Methods. Clinical data from a multicentre database identified patients who underwent primary aTSA from November 2004 to January 2023. A total of 390 patients (mean follow-up 48.1 months (SD 42.0)) were included: 97 (24.9%) were classified as appropriate, 218 (55.9%) inconclusive, and 75 (19.2%) inappropriate. Patients were classified as “appropriate”, “inconclusive”, or “inappropriate”, using a modified version of an appropriateness algorithm, which accounted for age, rotator cuff status, mobility, symptomatology, and Walch classification. Multiple pre- and postoperative scores were analyzed using Pearson’s chi-squared test and one-way analysis of variance (ANOVA). Postoperative complications were also analyzed. Results. All groups achieved significant improvement in mean PROM scores postoperatively. “Appropriate” patients experienced significantly greater improvement in visual analogue scale (VAS) and American Shoulder and Elbow Surgeons (ASES) score compared to “inconclusive” and “inappropriate”. The appropriate group had a significantly greater proportion of patients who achieved minimal clinically important difference (MCID) (95.8%; n = 93) and substantial clinical benefit (SCB) (92.6%; n = 89). Overall, 13 patients had postoperative complications. No significant differences in postoperative complications among classifications were found. Conclusion. Our data clinically validate the RAND/UCLA aTSA appropriateness criteria algorithm, allowing for more rapid and reliable determination of aTSA candidacy. “Appropriate” patients were more likely to achieve MCID and SCB for ASES scores compared to “inappropriate” patients. Among “appropriate” patients who did not achieve SCB, 50% (n = 4) had a postoperative complication. There was a significantly higher proportion of postoperative complications among those who did not achieve SCB across all three groups. Only 7.1% (n = 1) of patients who did not achieve SCB in the inappropriate group had a postoperative complication. Thus, it can be inferred that the failure to reach SCB in the appropriate group was likely to be due to a postoperative complication, whereas for patients deemed “inappropriate”, failure to reach SCB may be secondary to factors accounted for within our algorithm. Cite this article: Bone Joint J 2024;106-B(12):1451–1460

Māori consistently have poorer health outcomes compared to non-Māori within Aotearoa. Numerous worldwide studies demonstrate that ethnic minorities receive less analgesia for acute pain management. We aimed to compare analgesic management of a common orthopaedic injury, tibial shaft fracture, between Māori and non-Māori. A retrospective cohort study from January 1. st. , 2015, to December 31. st. 2020 inclusive. Eligible patients were 16–65 years old and had isolated closed tibial shaft fractures. 104 patients were included in the study, 48 Māori and 56 Non-Māori. Baseline demographics were similar between the 2 cohorts. The primary outcome measure was type of analgesia charted on the ward. Secondary outcome measures were pre-hospital medications given, pain scores on arrival to the emergency department (ED) and the ward, time to analgesia in ED and type of analgesia given in ED. Statistics were calculated using Fisher's exact test, Pearson's chi-squared test or Wilcoxson's rank sum test as appropriate. No statistically significant differences were found in opiates or synthetics charted to Māori vs Non-Māori (83% vs 89% and 77% vs 88% respectively), opiates given in ED, time to analgesia in ED or ED and ward arrival pain scores. Of statistical significance is that Māori were less likely to receive pre-hospital medication compared to Non-Māori (54% vs 80% respectively, p=0.004). Māori were significantly less likely to receive pre-hospital pain medication compared to Non-Māori. However no other statistically significant findings were found when comparing pain scores, time to analgesia or type of pain relief charted for Māori vs non-Māori. The reasons for Māori receiving significantly less prehospital medication were not explored in this study and further investigation is required to reduce the bias that exists in this area

Introduction. Hip arthroplasty is one of the most common procedures performed every year however complications do occur. Prior studies have examined the impact of insurance status on complications after TJA in small or focused cohorts. The purpose of our study was to utilize a large all-payer inpatient healthcare database to evaluate the effect of patient insurance status on complications following hip arthroplasty. Methods. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing hip arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical complications, surgical complications and mortality during the same hospitalization. A secondary analysis was performed using a matched cohort comparing patients with Medicare vs private insurance using the coarsened exact matching algorithm. Pearson's chi-squared test and multivariate regression were performed. Results. Overall, 1,011,184 (64.8% Medicare, 29.3% private insurance, 3.7% Medicaid or uninsured, 2.0% Other) patients fulfilled criteria for inclusion into the study. Most were primary total hip arthroplasties (64.2%) and primary hip hemiarthroplasty (29.8%), with 6% revision hip arthroplasties. Multivariate regression analysis showed that patients with private insurance had fewer complications (OR 0.8, p=<0.001) and those with Medicaid or no insurance had more medical complications (OR 1.06, p=0.005) compared to Medicare patients. Similar trends were found for surgical complications and mortality. The matched cohort showed Medicare and private insurance patients had similar complication rates. The most common complication was postoperative anemia, occurring in 22.6% of Medicare patients and 21.1% of patients with private insurance (RR=1.06, p<0.001). Discussion and. Conclusion. This data reveals that patients with Medicare, Medicaid or no insurance have higher risk of medical complications, surgical complications and mortality following hip arthroplasty. Using a matched cohort to directly compare Medicare and private insurance patients, the risk of postoperative complications are similar and generally low with the notable exception of the most common complication, postoperative anemia, which occurs more frequently in patients with Medicare

Introduction. Knee arthroplasty is one of the most common inpatient surgeries procedures performed every year however complications do occur. Prior studies have examined the impact of insurance status on complications after TJA in small or focused cohorts. The purpose of our study was to utilize a large all-payer inpatient healthcare database to evaluate the effect of patient insurance status on complications following knee arthroplasty. Methods. Data was obtained from the Nationwide Inpatient Sample between 2004 and 2011. Analysis included patients undergoing knee arthroplasty procedures determined by ICD-9 procedure codes. Patient demographics and comorbidities were analyzed and stratified by insurance type. The primary outcome was medical complications, surgical complications and mortality during the same hospitalization. A secondary analysis was performed using a matched cohort comparing patients with Medicare vs private insurance using the coarsened exact matching algorithm. Pearson's chi-squared test and multivariate regression were performed. Results. Overall, 1,352,505 (57.8% Medicare, 35.6% private insurance, 2.6% Medicaid or uninsured, 3.3% Other) patients fulfilled criteria for inclusion into the study. Most were primary total knee arthroplasties (96.1%) with 3.9% revision knee arthroplasties. Multivariate regression analysis showed that patients with private insurance had fewer complications (OR 0.82, p=<0.001) compared to Medicare patients. Similar trends were found for surgical complications and mortality. Patients with Medicare or no insurance had more surgical complications but equivalent rates of medical complications and mortality. The matched cohort showed Medicare and private insurance patients had overall low mortality rates and complication. The most common complication was postoperative anemia, occurring in 16.2% of Medicare patients and 15.3% of patients with private insurance (RR=1.06, p<0.001). Mortality (RR 1.34), wound dehiscence (RR 1.32), CNS, GI complications, although rare, were all statistically more common in Medicare patients (p<0.05) while cardiac complications (RR 0.93, p=0.003) was more common in patients with private insurance. Discussion and Conclusion. This data reveals that patients with Medicare insurance have higher risk of medical complications, surgical complications and mortality following knee arthroplasty. Using a matched cohort to directly compare Medicare and private insurance patients, the risk of postoperative complications were low overall (with the exception of postoperative anemia), but in general were more common in Medicare patients

Aim. The aim of this study was to determine the factors which were responsible for differences between patients achieving the Trust target of discharge on post-operative day 5 after a primary total knee replacement and those not achieving it, in the cohort of over 75 year olds. Methods and Results. Of all the patients undergoing a TKR at Addenbrooke's Hospital in 2008, those over 75 were identified (n=103). From the literature pre-, intra- and post-operative factors that had previously been shown to affect length of stay were identified. Patient notes were examined for details on each of these and the patients divided into 2 groups according to whether their discharge was achieved by day 5 or not. Data from 74 operations was available at the time of submission of this abstract. Pearson's Chi-squared test, student's independent t-test or the Mann-Whitney U test were performed on the data depending on the nature of the variable analysed. The following factors were found to be significantly different between the 2 groups at the 95% confidence level: pre-operative use of a walking aid (p=0.033), pre-operative Hb (p=0.003), post-operative Hb (p=0.001), post-operative requirement of a blood transfusion, post-operative complication (p<0.001), post-operative day on which active knee flexion to 90° was achieved (p=0.003). In addition the following factors were found to be significant at the 90% confidence level: age (p=0.082), comorbidity (p=0.086), marital status (p=0.095) and mobilisation by post-operative day 2 (p=0.082). Conclusion. Pre-operative use of any walking aid, peri-operative haemoglobin concentration and post-operative complications (including the need for a blood transfusion) seem to be the significant factors associated with a prolonged stay in hospital in the over 75 year olds. A few other factors are bordering on significance and they warrant further investigation in a larger patient cohort

Background: To determine patients clinical and haematological characteristics that could affect the use of blood and infection incidence with hip fractures (HF) treated with a dynamic hip screw (DHS). Patients and Methods: A retrospective study of all the HF patients during 5 years (January1995- December1999) who were treated with a dynamic hip screw (DHS ïf’, Synthes-Stratec, Oberdof, Switzerland) at one unique university hospital. No patient was excluded. Age, gender, elapsed time, anaesthesia risk (ASA clasification), type of HF (internationalAO classification), transfusion procedure and the total used; haemoglobin (Hb) at days 0 (incoming to urgency service) and first postoperative (POD ï€1) were examined. We also analyzed the infection incidence (CDC criteria), place and severity. The statistical univariate analysis included Student’s t-test for numeric variables and Pearson’s chi-squared test for string variables. There was considered to be a statistically significant difference (SSD) when p< 0.05. A multivariate stepwise logistic regression model was used. Results: Three hundred and one patients with HF were studied. 125 A1 and 176 A2, according to the AO classification. Male/female ratio: 76/225 (25.2%/74.8%); age 78.97 years old (range: 23–104); ASA: I 53 (17.6%); II 97 (32.2%); III 138 (45.8%) and IV 13 (4.3%). Hb Values on the day of admission: 128.7 g/L (range: 81.7–176.7) and POD ï€1: 101 g/L (range: 54.7–150.7). 186 (61.8%) patients were transfused with an average 1.42 red cell concentrate (range: 0–6). 89 (29.6%) had an infection diagnosis: 79 (26.2%) urinary tract infection (UTI), 7 (2.3%) pneumonia and 8 (2.7%) superficial wound. 18 (6%) died in the first month. At univariant study of transfusion act, the transfused patients were older (p< 0.001), suffered more infections (p:0.019), more UTI (p:0.003), had lower Hb day 0 (p< 0.001) and POD ï€1(p< 0.001). When analyze the infection, the patients were older (p< 0.001), had higher ASA (p:0.019), lower Hb at day0 (p< 0.026), longer stay (p< 0.001), were more transfused (p:0.019), and received more transfusions (p:0.004). The logistic regression analysis identified only the type of HF, the age and the Hb level (p< 0.05) as independent predictors of transfusion. Comments: In patients with HF the Hb is the most important predictor of blood transfusion, and it is associated with a higher rate of post surgical infection and longer hospital stays. These complications may be explained by the possible inmunomodulation effect of allogenic blood transfusion

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The purpose of this study was to compare reoperation and revision rates of double plating (DP), single plating using a lateral locking plate (SP), or distal femoral arthroplasty (DFA) for the treatment of periprosthetic distal femur fractures (PDFFs).

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In the Netherlands, general practitioners (GPs) can request radiographs. After a radiologically diagnosed fracture, patients are immediately referred to the emergency department (ED). Since 2020, the Máxima Medical Centre has implemented a new care pathway for minor trauma patients, referring them immediately to the traumatology outpatient clinic (OC) instead of the ED. We investigated whether this altered care pathway leads to a reduction in healthcare consumption and concomitant costs.

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To explore the clinical efficacy of using two different types of articulating spacers in two-stage revision for chronic knee periprosthetic joint infection (kPJI).

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The volume of ambulatory total hip arthroplasty (THA) procedures is increasing due to the emphasis on value-based care. The purpose of the study is to identify the causes for failed same-day discharge (SDD) and perioperative factors leading to failed SDD.

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Venous tumour thrombus (VTT) is a rare finding in osteosarcoma. Despite the high rate of VTT in osteosarcoma of the pelvis, there are very few descriptions of VTT associated with extrapelvic primary osteosarcoma. We therefore sought to describe the prevalence and presenting features of VTT in osteosarcoma of both the pelvis and the limbs.

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Our primary aim was to assess reoperation-free survival at one year after the index injury in patients aged ≥ 75 years treated with internal fixation (IF) or arthroplasty for undisplaced femoral neck fractures (uFNFs). Secondary outcomes were reoperations and mortality analyzed separately.

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Unicompartmental knee arthroplasty (UKA) is the preferred treatment for anterior medial knee osteoarthritis (OA) owing to the rapid postoperative recovery. However, the risk factors for UKA failure remain controversial.

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Lower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation.

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The present study investigated receptor activator of nuclear factor kappa-Β ligand (RANKL), osteoprotegerin (OPG), and Runt-related transcription factor 2 (RUNX2) gene expressions in giant cell tumour of bone (GCTB) patients in relationship with tumour recurrence. We also aimed to investigate the influence of CpG methylation on the transcriptional levels of RANKL and OPG.

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The aims of this study were to assess quality of life after hip fractures, to characterize respondents to patient-reported outcome measures (PROMs), and to describe the recovery trajectory of hip fracture patients.

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To identify variables independently associated with same-day discharge (SDD) of patients following revision total knee arthroplasty (rTKA) and to develop machine learning algorithms to predict suitable candidates for outpatient rTKA.

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Total hip arthroplasty (THA) is a common procedure to address pain and enhance function in hip disorders such as osteoarthritis. Despite its success, postoperative patient recovery exhibits considerable heterogeneity. This study aimed to investigate whether patients follow distinct pain trajectories following THA and identify the patient characteristics linked to suboptimal trajectories.

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We first sought to compare survival for patients treated surgically for solitary and multiple metastases in the appendicular skeleton, and second, to explore the role of complete and incomplete resection (R0 and R1/R2) in patients with a solitary bony metastasis in the appendicular skeleton.

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This study aimed to compare mortality in trochanteric AO/OTA A1 and A2 fractures treated with an intramedullary nail (IMN) or sliding hip screw (SHS). The primary endpoint was 30-day mortality, with secondary endpoints at 0 to 1, 2 to 7, 8 to 30, 90, and 365 days.