Age at hip or knee joint replacement surgery predicts likelihood of revision surgery

We compared revision and mortality rates of 4668 patients undergoing primary total hip and knee replacement between 1989 and 2007 at a University Hospital in New Zealand. The mean age at the time of surgery was 69 years (16 to 100). A total of 1175 patients (25%) had died at follow-up at a mean of ten years post-operatively. The mean age of those who died within ten years of surgery was 74.4 years (29 to 97) at time of surgery. No change in comorbidity score or age of the patients receiving joint replacement was noted during the study period. No association of revision or death could be proven with higher comorbidity scoring, grade of surgeon, or patient gender. We found that patients younger than 50 years at the time of surgery have a greater chance of requiring a revision than of dying, those around 58 years of age have a 50:50 chance of needing a revision, and in those older than 62 years the prosthesis will normally outlast the patient. Patients over 77 years old have a greater than 90% chance of dying than requiring a revision whereas those around 47 years are on average twice as likely to require a revision than die. This information can be used to rationalise the need for long-term surveillance and during the informed consent process. © 2011 British Editorial Society of Bone and Joint Surgery

Closing the loop: feedback to accident and emergency SHOs on their referrals to hospital specialists.

OBJECTIVES: To determine whether A&E SHOs in the Anglia and Oxford region receive regular case-specific feedback on their referrals to hospital specialists. METHODS: A telephone survey of an A&E SHO from each hospital in the region, using a semi-structured questionnaire and written protocol. The main questions asked were: (i) do you receive regular feedback about specific patients you refer to other specialties? If so, which one(s)? and (ii) do you think personal regular case-specific feedback about your referrals would be useful? RESULTS: Overall, 18 A&E SHOs and one staff grade were interviewed, one from each hospital (response rate 100%). Over the whole region, there were 106 hospital specialties to which A&E SHOs could directly refer out-patient cases. However, regular case-specific communication or feedback was received by the referring A&E SHO from only 5 (4.7%). There were 237 hospital specialties to which A&E SHOs could directly refer in-patients. However, regular case-specific feedback was received by the referring A&E SHO from only 3 specialities (1.3%). The A&E doctors at 18 of the 19 hospitals (95%) felt regular case-specific feedback would be useful. Of these, 13 (72%) would prefer written feedback - 5 (38%) would prefer a copy of the discharge summary or GP clinic letter, 6 (46%) a letter written specifically to the A&E SHO, 1 a letter to be sent via the A&E consultant, and 1 wished for 'any written feedback'. All 18 doctors wanted feedback from at least one of the specialties of general medicine, paediatrics, trauma and orthopaedics, and general surgery. CONCLUSIONS: A&E SHOs in the Anglia and Oxford region do not receive regular case-specific feedback on their referrals to hospital specialists. Almost all A&E SHOs in this study would welcome it. The situation could be rectified by routinely sending them copies of clinic letters or discharge summaries

Factors predicting outcome after whiplash injury in subjects pursuing litigation

Records of 277 patients presenting for medicolegal reporting following isolated whiplash injury were studied retrospectively. A range of pre-accident, accident and response variables were recorded. Multivariate analysis was used to determine the main factors that predict physical and psychological outcome after whiplash injury. The factors that showed significant association with poor outcome on both physical and psychological outcome scales were pre-injury back pain, high frequency of General Practitioner attendance, evidence of pre-injury depression or anxiety symptoms, front position in the vehicle and pain radiating away from the neck after injury. The strongest associations were with factors that are present before impact. In this selected cohort of patients, there is a physical and a psychological vulnerability that may explain the widely varied response to low violence indirect neck injury

Patella in total knee arthroplasty: to resurface or not to—a cohort study of staged bilateral total knee arthroplasty

The aim of this study was to assess medium term results of patellar resurfacing in total knee arthroplasty, specifically looking at anterior knee pain, patellofemoral function and need for reoperation. A prospective cohort study was conducted with patients undergoing staged bilateral knee arthroplasty with the patella being resurfaced only on one side. This was due to change in the clinical practice of the senior author. Sixty patients were reviewed clinically and radiologically on a regular basis. The surgery was either performed or supervised by the senior author in all cases. All patients received the cemented press-fit condylar© prosthesis. The Knee Society clinical rating system was used. Scores were recorded pre-operatively and post-operatively at three months, one year, two years and three yearly thereafter. The mean age of patients in the study group was 75 years (range: 62–89 years). There were 42 women and 18 men in the study. The mean duration of follow-up was 4.5 years (range: 2–12 years). There was no significant difference in the pre-operative scores in both groups. There were significantly better scores (p < 0.05) on the resurfaced side as compared to the non-resurfaced side at final follow-up. No revision was carried out for patellofemoral complications on the resurfaced side. Four patients required revision in the form of patellar resurfacing on the non-resurfaced side for persistent anterior knee pain. Patellar resurfacing is recommended in total knee arthroplasty for better functional outcome with regards to anterior knee pain and patellofemoral function

Acetabular revision with freeze-dried irradiated and chemically treated allograft: a minimum 5-year follow-up of 17 cases

We reviewed the results of 17 consecutive revision total hip arthroplasties performed with the use of freeze-dried irradiated bone allograft in 15 patients. These allografts were used in conjunction with five Kerboull rings, two steel meshes and ten cemented isolated cups. All the patients have had a follow-up of at least 5 years. The patients were evaluated clinically and radiographically. No revisions were necessary and X-rays confirmed partial or total ingrowth of the allografts. In acetabular revision surgery, hip reconstruction can be successfully treated by freeze-dried irradiated and chemically treated allografts. Additional studies with longer term follow-up are necessary to confirm this outcome

Early outcomes of patella resurfacing in total knee arthroplasty

Background Patella resurfacing in total knee arthroplasty is a contentious issue. The literature suggests that resurfacing of the patella is based on surgeon preference, and little is known about the role and timing of resurfacing and how this affects outcomes. Methods We analyzed 134,799 total knee arthroplasties using data from the Australian Orthopaedic Association National Joint Replacement Registry. Hazards ratios (HRs) were used to compare rates of early revision between patella resurfacing at the primary procedure (the resurfacing group, R) and primary arthroplasty without resurfacing (no-resurfacing group, NR). We also analyzed the outcomes of NR that were revised for isolated patella addition. Results At 5 years, the R group showed a lower revision rate than the NR group: cumulative per cent revision (CPR) 3.1% and 4.0%, respectively (HR = 0.75, p < 0.001). Revisions for patellofemoral pain were more common in the NR group (17%) than in the R group (1%), and “patella only” revisions were more common in the NR group (29%) than in the R group (6%). Non-resurfaced knees revised for isolated patella addition had a higher revision rate than patella resurfacing at the primary procedure, with a 4-year CPR of 15% and 2.8%, respectively (HR = 4.1, p < 0.001). Interpretation Rates of early revision of primary total knees were higher when the patella was not resurfaced, and suggest that surgeons may be inclined to resurface later if there is patellofemoral pain. However, 15% of non-resurfaced knees revised for patella addition are re-revised by 4 years. Our results suggest an early beneficial outcome for patella resurfacing at primary arthroplasty based on revision rates up to 5 years