The impact of smoking on orthopaedic patients

Smoking has devastating effects on general health, including the outcome after surgery. There were three main objectives in this thesis. Firstly, to investigate the effect of smoking on complications after orthopaedic surgery. Secondly, to evaluate whether the negative effect of smoking on the complication rate after acute orthopaedic surgery was reversible after smoking cessation therapy and thirdly, to evaluate whether the administered smoking cessation therapy had any long-lasting effect on the smoking abstinence rate. Study I included 906 patients with surgically treated ankle fractures. Background data were collected from patient charts and the outcome regarding postoperative complications was recorded prospectively in a clinical audit. Studies II and III were based on the same population from a single-blinded, randomized, controlled, clinical, multicenter trial at three hospitals in Stockholm, Sweden. We randomized 105 daily smokers with an acute fracture of a lower or upper extremity requiring acute surgical procedures into an intervention group (smoking cessation therapy) or into a control group. The primary outcome in Study II was any complication occurring, as predefined in the study protocol, within 6–12 weeks. The outcome in Study III was medium- and long-term successful smoking cessation. In Study IV the background data were taken from the SALT cohort in the Swedish Twin Registry. The SALT data were then linked to the Swedish Inpatient Registry, identifying 8773 individuals who had had orthopaedic surgery and who also had had a complication from that surgery. In Study I it was shown that 30.1% of the smokers had a postoperative complication compared to 20.3% of the non-smokers (OR 1.9, CI: 1.3–2.8, p=0.005). In study II the administered smoking cessation therapy significantly reduced the number of postoperative complications (p=0.048). Study III showed that the administered smoking cessation therapy had a significant effect during the first 6–12 weeks, but not after one year. Study IV demonstrated that smokers had a significantly increased risk of developing complications requiring inpatient care; among the smokers, 14.9%, compared to 11.4% of the non-smokers, had such a complication (HR 1.27, CI: 1.10–1.48, p=0.002). Smoking is a strong and significant factor associated with development of postoperative complications. Smoking cessation intervention program during the first six weeks after acute fracture surgery decreases the risk of postoperative complications. Smoking patients in need of both acute and elective orthopaedic surgery should be offered an intensive smoking cessation programme

Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial

Tobacco smoking is a major health and economic concern and is also known to have a significant negative effect on surgical outcomes. The benefits of a smoking cessation intervention prior to elective orthopaedic surgery have been evaluated previously. Our aim was to assess whether a smoking cessation program, initiated during the acute hospitalization period and carried out for six weeks, could reduce the number of complications following emergency surgical treatment of fractures

Artificial intelligence for the classification of fractures around the knee in adults according to the 2018 AO/OTA classification system.

BackgroundFractures around the knee joint are inherently complex in terms of treatment; complication rates are high, and they are difficult to diagnose on a plain radiograph. An automated way of classifying radiographic images could improve diagnostic accuracy and would enable production of uniformly classified records of fractures to be used in researching treatment strategies for different fracture types. Recently deep learning, a form of artificial intelligence (AI), has shown promising results for interpreting radiographs. In this study, we aim to evaluate how well an AI can classify knee fractures according to the detailed 2018 AO-OTA fracture classification system.MethodsWe selected 6003 radiograph exams taken at Danderyd University Hospital between the years 2002-2016, and manually categorized them according to the AO/OTA classification system and by custom classifiers. We then trained a ResNet-based neural network on this data. We evaluated the performance against a test set of 600 exams. Two senior orthopedic surgeons had reviewed these exams independently where we settled exams with disagreement through a consensus session.ResultsWe captured a total of 49 nested fracture classes. Weighted mean AUC was 0.87 for proximal tibia fractures, 0.89 for patella fractures and 0.89 for distal femur fractures. Almost ¾ of AUC estimates were above 0.8, out of which more than half reached an AUC of 0.9 or above indicating excellent performance.ConclusionOur study shows that neural networks can be used not only for fracture identification but also for more detailed classification of fractures around the knee joint

HOPE-trial : hemiarthroplasty compared to total hip arthroplasty for displaced femoral neck fractures in the elderly-elderly, a randomized controlled trial

Background: A femoral neck fracture (FNF) is a common cause of suffering and premature death in the elderly population. Optimizing the treatment for improved outcome and a reduced need for secondary surgery is important both for the patient and the society. The choice of primary total or hemiarthroplasty in patients over eighty years are controversial. We hypothesized that total hip arthroplasty has an equal or better outcome in patient-reported outcome compared with hemiarthroplasty. Methods/Design: A prospective, randomized, single-blinded trial will be conducted. We will include 120 patients, 80 years of age and over with an acute (<36 h) displaced femoral neck fracture. The patients will be randomized in a 1: 1 ratio to either total hip arthroplasty or hemiarthroplasty. The primary endpoints are Harris hip Score and EQ-5D. Secondary endpoints include pain measured with visual analogue scale, surgical time, reoperations, complications and radiological measurement of erosion in patients operated with hemiarthroplasty. Follow-up will be performed postoperatively after three months, 1, 2, 4 and 10 years. Discussion: To our knowledge, this is the first randomized controlled trial comparing total hip arthroplasty and hemiarthroplasty for displaced femoral neck fracture in patients age 80 years and over