EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Bicompartmental knee replacement and patellar resurfacing: A prospective study with a minimum follow-up of ten years

PubMed: 10509198We avoid routine patellar resurfacing during knee replacement because of the risk of major complications. We undertook a prospective study to evaluate the functional outcome of the patients who had no patellar resurfacing. Eleven patients (17 knees) who met the criteria for inclusion participated in the study. The preoperative diagnosis was osteoarthritis in all patients. A lateral retinacular release was performed when necessary. The knees were evaluated using the Hospital for Special Surgery knee scoring system. The mean follow-up was 10.5 years (range: 10 to 10.8 years). The average HSS score raised from 40 points to 83 points. The mean postoperative range of motion of the knee joint was 105°. Postoperative radiographic evaluation revealed that there was no correlation between the integrity of the cartilage and the degree of pain. We concluded that patellar resurfacing is not a routine procedure in knee replacement when the diagnosis is osteoarthritis

Salter innominate osteotomy for the treatment of developmental dysplasia of the hip: 37 years of follow-up

In this article, we report the radiological and clinical status at postoperative 37th year of a 39-year-old male patient who was treated with bilateral Salter innominate osteotomy due to bilateral developmental dysplasia of the hip when he was two years old. The patient expressed that he had no complaint including pain or limitation in range of motion in both hip joints for 37 years. Pain started six months ago in right hip joint. Patient used cortisone for 12 months with a diagnosis of Henoch-Schonlein purpura five years ago. Radiologic imaging revealed findings of bilateral Salter innominate osteotomy and avascular osteonecrosis on the right femoral head. Kirschner wires which were used during operations 37 years ago remained buried in pelvic bone. Bilateral development of acetabulum and femoral head was very good. Anteroposterior and lateral radiographs of right hip joint revealed degenerative osteoarthritis secondary to avascular osteonecrosis on the right femoral head. Except for the last six months, patient has been living without pain or limitation in range of motion for postoperative 37 years

Burden of osteoporosis

The number of the people with osteoporosis increases as the population ages. Increasing numbers of patients with osteoporotic fractures may have a serious economic impact on society and on the quality of life of the patient. We review some literature and provide expert opinion on the burden of osteoporosis. Awareness among clinicians and health care professionals on osteoporosis should be increased to overcome the burden of the disease. Although most of the osteoporotic fractures are treated by orthopaedic surgeons, many patients with these problems are not diagnosed appropriately and treated for probable osteoporosis. Appropriate diagnosis of the disease is essential to prevent osteoporotic fractures and related mortality and morbidity. Indirect costs and sociologic and psychological impact of fractures should be evaluated together with the direct costs of the disease