The incidence of subsequent contralateral hip fracture and factors associated with increased risk:The IMPACT Contralateral Fracture Study

IntroductionHip fractures are associated with high morbidity and mortality and patients that sustain a subsequent contralateral fracture experience inferior outcomes. The risk of contralateral fracture is highest within the first year, however the incidence and associated factors remain poorly understood. The aims were to investigate i) the incidence of a subsequent contralateral hip fracture within the first year ii) identify factors associated with an increased risk of contralateral fracture, and iii) compare early mortality risk after index versus contralateral hip fracture. MethodsThis study included all patients aged over 50 years admitted to NHS hospitals in Scotland between 1st March 2020 and 31st December 2020 (n=5566) as routine activity of the Scottish Hip Fracture Audit (SHFA). Multivariate logistic regression was used to examine factors associated with 30-day mortality and cox regression was used to identify factors associated with a contralateral fracture. ResultsDuring the study period 2.5% (138/5566) of patients sustained a contralateral hip fracture within 12 months of the index hip fracture. Socioeconomic deprivation was inversely associated with increased risk of contralateral fracture (odds ratio 2.64, p&lt;0.001), whilst advancing age (p=0.427) and sex (p=0.265) were not. After adjusting for significant cofounders there was no significant difference in 30-day mortality following contralateral fracture compared to index fracture (OR 1.22, p=0.433). ConclusionOne in 40 (2.5%) hip fracture patients sustained a contralateral fracture within 12 months of their index fracture and deprivation was associated with a reduced risk of contralateral fracture. No difference in 30-day mortality was found. <br/

Effect of oral nutritional supplementation on outcomes in older adults with hip fractures and factors influencing compliance

AIMS: Hip fractures are a major cause of morbidity and mortality, and malnutrition is a crucial determinant of these outcomes. This meta-analysis aims to determine whether oral nutritional supplementation (ONS) improves postoperative outcomes in older patients with a hip fracture.METHODS: A systematic literature search was conducted in August 2022. ONS was defined as high protein-based diet strategies containing (or not containing) carbohydrates, fat, vitamins, and minerals. Randomized trials documenting ONS in older patients with hip fracture (aged ≥ 50 years) were included. Two reviewers evaluated study eligibility, conducted data extraction, and assessed study quality.RESULTS: There were 812 studies identified, of which 18 studies involving 1,522 patients met the inclusion criteria. The overall meta-analysis demonstrated that ONS was associated with significantly elevated albumin levels (weighted mean difference (WMD) 1.24 (95% confidence interval (CI) 0.95 to 1.53)), as well as a significant risk reduction in infective complications (odds ratio (OR) 0.54 (95% CI 0.39 to 0.76)), pressure ulcers (OR 0.54 (95% CI 0.33 to 0.88)), and total complications (OR 0.57 (95% CI 0.42 to 0.79)). Length of hospital stay (LOS) was also significantly reduced (WMD -2.36 (95% CI -4.14 to -0.58)), particularly in rehabilitation LOS (WMD -4.17 (95% CI -7.08 to -1.26)). There was a tendency towards a lower mortality risk (OR 0.93 (95% CI 0.62 to 1.4)) and readmission (OR 0.52 (95% CI 0.16 to 1.73)), although statistical significance was not achieved (p = 0.741 and p = 0.285, respectively). The overall compliance with ONS ranged from 64.7% to 100%, but no factors influencing compliance were identified.CONCLUSION: This meta-analysis is the first to quantitatively demonstrate that ONS could nearly halve the risk of infective complications, pressure ulcers, total complications, as well as improve serum albumin and reduce LOS. ONS should be a regular and integrated part of the perioperative care of these patients, especially given that the compliance with ONS is acceptable.</p

Total knee arthroplasty in patients with severe obesity:outcomes of standard keeled tibial components versus stemmed universal base plates

Background: Patients with severe obesity [body mass index (BMI) ≥ 40 kg/m2] potentially overload the tibial component after total knee arthroplasty (TKA), risking tibial subsidence. Using a cemented single-radius cruciate-retaining TKA design, this study compared the outcomes of two tibial baseplate geometries in patients with BMI ≥ 40 kg/m2: standard keeled (SK) or universal base plate (UBP), which incorporates a stem. Methods: This was a retrospective, single-centre cohort study with minimum 2 years follow-up of 111 TKA patients with BMI ≥ 40 kg/m2: mean age 62.2 ± 8.0 (44–87) years, mean BMI 44.3 ± 4.6 (40–65.7) kg/m2 and 82 (73.9%) females. Perioperative complications, reoperations, alignment and patient-reported outcomes (PROMS): EQ-5D, Oxford Knee Score (OKS), Visual Analogue Scale (VAS) pain score and satisfaction were collected preoperatively, and at 1 year and final follow-up postoperatively. Results: Mean follow-up was 4.9 years. SK tibial baseplates were performed in 57 and UBP in 54. There were no significant differences in baseline patient characteristics, post-operative alignment, post-operative PROMs, reoperations or revisions between the groups. Three early failures requiring revision occurred: two septic failures in the UBP group and one early tibial loosening in the SK group. Five-year Kaplan–Meier survival for the endpoint mechanical tibial failure was SK 98.1 [94.4–100 95% confidence interval (CI)] and UBP 100% (p = 0.391). Overall varus alignment of the limb (p = 0.005) or the tibial component (p = 0.031) was significantly associated with revision and return to theatre. Conclusions: At early to mid-term follow-up, no significant differences in outcomes were found between standard and UBP tibial components in patients with BMI ≥ 40 kg/m2. Varus alignment of either tibial component or the limb was associated with revision and return to theatre.</p

Early mobilisation after hip fracture surgery is associated with improved patient outcomes:a systematic review and meta-analysis

Introduction:- The aims of this systematic review and meta-analysis were to determine if after hip fracture surgery 1) early mobilisation is associated with improved clinical outcomes, and if so 2) are benefits directly proportional to how soon after surgery the patient mobilisesMethods:- A PRISMA systematic review was conducted using four databases to identify all studies that compared postoperative early mobilisation with delayed mobilisation in patients after hip fracture surgery. The Critical Appraisal Skills Programme checklist was employed for critical appraisal and evaluation of all studies that met the inclusion criteria. Results:- A total of thirteen studies including 297,435 patients were identified, of which 235,275 patients were mobilised early and 62,160 were mobilised late. Six studies assessed 30- day mortality, of which two also investigated 30-day complication rates. Pooled meta-analysis demonstrated that there were significantly lower 30-day mortality rates (OR 0.35, 95% CI 0.31 - 0.41, p&lt;0.001) and complication rates (OR 0.43, 95% CI 0.36 - 0.51, p&lt;0.001) in patients mobilising early after hip fracture surgery. Five studies investigated length of stay and metaanalysis revealed no difference between groups (mean difference -0.57 days, 95%CI -1.89 - 0.74, p=0.39). Conclusion:- Early mobilisation in hip fracture patients is associated with a reduction in 30-day mortality and complication rates compared to delayed mobilisation, but no difference in length of stay. These findings illustrate that early mobilisation is associated with superior post operative outcomes. However, a direct casual effect remains to be demonstrated, and further work on the factors underlying delayed mobilisation is required

Golfers have a greater improvement in their hip specific function compared to non-golfers after total hip arthroplasty but less than three-quarters returned to golf

AIMS: Golf is a popular pursuit among those requiring total hip arthroplasty (THA). The aim of this study was to determine if participating in golf is associated with greater functional outcomes, satisfaction, or improvement in quality of life (QoL) compared to non-golfers. METHODS: All patients undergoing primary THA over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on outcomes. RESULTS: The study cohort consisted of a total of 308 patients undergoing THA, of whom 44 were golfers (14%). This included 120 male patients (39%) and 188 female patients (61%), with an overall mean age of 67.8 years (SD 11.6). Golfers had a greater mean postoperative Oxford Hip Score (OHS) (3.7 (95% confidence interval (CI) 1.9 to 5.5); p < 0.001) and EuroQol visual analogue scale (5.5 (95% CI 0.1 to 11.9); p = 0.039). However, there were no differences in EuroQoL five-dimension score (p = 0.124), pain visual analogue scale (p = 0.505), or Forgotten Joint Score (p = 0.215). When adjusting for confounders, golfers had a greater improvement in their Oxford Hip Score (2.7 (95% CI 0.2 to 5.3); p < 0.001) compared to non-golfers. Of the 44 patients who reported being golfers at the time of their surgery, 32 (72.7%) returned to golf and 84.4% of those were satisfied with their involvement in golf following surgery. Those who returned to golf were more likely to be male (p = 0.039) and had higher (better) preoperative health-related QoL (p = 0.040) and hip-related functional scores (p = 0.026). CONCLUSION: Golfers had a greater improvement in their hip-specific function compared to non-golfers after THA. However, less than three-quarters of patients return to golf, with male patients and those who had greater preoperative QoL or hip-related function being more likely to return to play. Cite this article: Bone Jt Open 2022;3(2):145–151

Does Time to Surgery Influence Outcomes for Those Undergoing Total Hip Arthroplasty for Hip Fracture?:A Nationwide Study from The Scottish Hip Fracture Audit

IntroductionPatients undergoing total hip arthroplasty for hip fracture (THA#) commonly experience surgical delay in order to access sufficient procedural expertise. There are established links between delay and poorer outcomes in hip fracture patients overall, but there is little evidence regarding the impact in the less frail THA# group. We therefore set out to establish the influence of surgical delay on key healthcare outcomes in this setting.MethodsA retrospective cohort study was undertaken using patient data from the Scottish Hip Fracture Audit (SHFA) covering 2016-2020. Only patients undergoing THA# were included, with categorisation according to surgical management within 36 hours of admission. Those who had delays related to being “medically unfit” were excluded. The primary outcome was 30-day survival. Costs were estimated in relation to length of stay differences.Results:There were 1375 patients that underwent THA#, with 397 (28.9%) experiencing a surgical delay &gt;36 hours. There were no significant differences in the age; sex; residence prior to admission; and Scottish Index of Multiple Deprivation (SIMD) for those with, and without, surgical delay. Both groups had similar 30-day (99.7% vs 99.3%, p=0.526) and 60-day (99.2% vs 99.0%, p=0.876) survival. There was however a significantly longer length of stay for the delay group (acute:7.0 vs delayed:8.9 days, p&lt;0.001; overall: 8.7 vs 10.2 days, p&lt;0.002). Operative delay did not significantly affect 30-day readmission (p=0.085) or discharge destination (p=0.884). Results were similar following adjustment for potential confounding. Estimated additional cost from surgical delay was £1,178 per delayed patient.Conclusion:Operative delay does not appear to be associated with increased mortality, contradictory to evidence for the wider hip fracture population. Delayed patients do however appear to have a longer length of stay, which had financial consequences. Clinicians must balance ethical considerations, local service provision and optimisation of outcomes when determining the need to delay a patient for THA#

Lateral wall thickness is not associated with revision risk of medially stable intertrochanteric fractures fixed with a sliding hip screw

Funding Information: The authors report that they received open access funding for this manuscript from the National Key R&D Program of China (2021YFC2501702), Suzhou Key Disciplines (SZXK202104).Peer reviewe