Management of traumatic patellar dislocation in a regional hospital in Hong Kong

Introduction: The role of surgery for acute patellar dislocation without osteochondral fractures is controversial. The aim of this study is to report the short-term results of management of patellar dislocation in our institute. Methods: Patients who had patella dislocation seen in our institution from January 2011 to April 2014 were managed according to a standardized management algorithm. Pre-treatment and one-year post-treatment International Knee Documentation Committee (IKDC) score, Tegner activity level scale and presence of apprehension sign were analysed. Results: 41 patients were studied. 20 patients were first time dislocators. 21 patients were recurrent dislocators. Among the first time dislocators, there was significant difference between patients receiving conservative treatment and surgical management. The conservative treatment group had 33% recurrent dislocation rate, whereas there were no recurrent dislocations for the surgery group. However, there was no difference in Tegner activity level scale and apprehension sign before and one year after treatment. Among the recurrent dislocators who received surgery, there was significant difference between patients receiving conservative treatment and surgical management. Recurrent dislocation rate was 71% in the conservative treatment group, whereas there were no recurrent dislocations for the surgery group. There was also significant improvement of IKDC score from 67.7 to 80 (p=0.02), and of apprehension sign from 62% to 0% (p<0.01). Conclusions: A management algorithm for patellar dislocation is described. Surgery is preferable to conservative treatment in treating patients suffering from recurrent patellar dislocations, and may be preferable for patients suffering from acute patellar dislocations.published_or_final_versio

Perioperative antithrombotic management in joint replacement surgeries

Objectives To determine optimal perioperative antithrombotic management for patients with cardiac diseases undergoing joint replacement surgeries. Data sources MEDLINE and PubMed database search up to January 2013. Study selection Those dealing with perioperative antithrombotic management of patients undergoing orthopaedic operations, especially joint replacement, and also those undergoing general surgery. Various combinations of the following key words were used in our search: 'antiplatelet', 'antithrombotic', 'anticoagulant', 'coronary stent', 'perioperative', 'venous thromboembolism', 'cardiovascular', 'surgery', 'orthopaedic', 'knee replacement', 'hip replacement', 'joint replacement', and 'arthroplasty'. Data extraction Literature review, original articles, and best practice guidelines. Data synthesis Patients should be stratified according to their risk of developing arterial thromboembolism in order to decide the most appropriate perioperative antiplatelet or anticoagulant regimen for them. After recent coronary stenting, including bare-metal stents implanted within 6 weeks and drug-eluting stents implanted within 6 months, surgery should be deferred. For venous thromboembolism prophylaxis in patients already on aspirin, the dosage should be adjusted as necessary or additional low-molecular-weight heparin administered. Conclusion The perioperative management of patients with cardiac diseases in receipt of antithrombotic agents is based upon a delicate balance between the perceived risk of arterial thromboembolism and the perceived risk of perioperative bleeding. One must exercise good judgement in deciding the most appropriate perioperative antithrombotic regimen. Venous thromboembolism is also a common problem after joint replacement surgeries. For patients already on aspirin, optimal venous thromboembolism prophylaxis is still being debated.published_or_final_versio

Case control study of DHS-blades versus conventional DHS

Conference Theme: Trauma Management - The Global Perspective

Antithrombotic Therapy in patients undergoing Joint Replacement Surgery - How Common is it?

Conference Theme: Defying the Aging SpineConcurrent Free Papers 4: Hips and Knees IIntroduction: It is common for patients on antithrombotic therapy to undergo joint replacement surgeries nowadays. This study aimed to document the locoregional prevalence and to explore whether there is an increasing number of these patients. Materials and Methods: Patients who underwent elective primary total knee replacement (TKR) and primary total hip replacement (THR) surgeries in 2007 and 2012 in Queen Mary Hospital were searched via the electronic clinical management system. The electronic patient records were reviewed to identify those who were on antithrombotic therapy. Data of these patients were then analysed using IBM SPSS Statistics v21.0. Statistical significance was performed using Pearson Chi-square test. Results: A total of 131 patients (mean age, 64.8 years; 61.8% with TKR and 38.2% with THR) and 324 patients (mean age, 67.9 years; 78.4% with TKR and 21.6% with THR) received total joint replacement surgeries in 2007 and 2012, respectively. The proportion of patients who were on antithrombotic therapy was significantly higher in 2012 (16%) compared with that in 2007 (8.4%) [p = 0.032]. The most common antithrombotic therapy was aspirin monotherapy (88.9%). The most common indication for antithrombotic therapy was ischaemic heart disease (44.4%). Discussion and Conclusion: There is an increasing trend of patients undergoing total joint replacement surgeries who are on antithrombotic therapy. It is increasingly important for the orthopaedic surgeon to be familiar with the perioperative management of patients on antithrombotic therapy

Sliding hip screw versus sliding helical blade for intertrochanteric fractures: a propensity score-matched case control study

The spiral blade modification of the Dynamic Hip Screw (DHS) was designed for superior biomechanical fixation in the osteoporotic femoral head. Our objective was to compare clinical outcomes and in particular the incidence of loss of fixation. In a series of 197 consecutive patients over the age of 50 years treated with DHS-blades (blades) and 242 patients treated with conventional DHS (screw) for AO/OTA 31.A1 or A2 intertrochanteric fractures were identified from a prospectively compiled database in a level 1 trauma centre. Using propensity score matching, two groups comprising 177 matched patients were compiled and radiological and clinical outcomes compared. In each group there were 66 males and 111 females. Mean age was 83.6 (54 to 100) for the conventional DHS group and 83.8 (52 to 101) for the blade group. Loss of fixation occurred in two blades and 13 DHSs. None of the blades had observable migration while nine DHSs had gross migration within the femoral head before the fracture healed. There were two versus four implant cut-outs respectively and one side plate pull-out in the DHS group. There was no significant difference in mortality and eventual walking ability between the groups. Multiple logistic regression suggested that poor reduction (odds ratio (OR) 11.49, 95% confidence intervals (CI) 1.45 to 90.9, p = 0.021) and fixation by DHS (OR 15.85, 95%CI 2.50 to 100.3, p = 0.003) were independent predictors of loss of fixation. The spiral blade design may decrease the risk of implant migration in the femoral head but does not reduce the incidence of cut-out and reoperation. Reduction of the fracture is of paramount importance since poor reduction was an independent predictor for loss of fixation regardless of the implant being used