Orthopedic Facilities Research Articles

Mirror foot : a case report of rare ten toes polydactyly

Background: A rare congenital abnormality known as "mirror image polydactyly" of the feet is typified by symmetrical duplication of the foot's fingers. According to Fukuzawa et al., only 28 cases—seven of which include treatment records—have been described in the English literature. Mirror foot can arise as a single congenital defect or a component of a hereditary syndrome involving several congenital defects. Methods: Our outpatient department received a referral for a 3-month-old infant who was born with unilateral mirror-image polydactyly of the foot, along with congenital talipes equinovarus (CTEV) and congenital genu recurvatum. A radiographic examination verified that the left foot had nine metatarsals and ten fingers. Five digits were ablation after preaxial duplicates of the first through fourth metatarsals were disarticulated. Results: Rebuilding a functional and aesthetically beautiful foot was the goal of the surgical care of this case, which will help orthopaedic surgeons manage CTEV for serial cast correction. The foot appeared excellent six months following the surgical procedure. The youngster was referred to the pediatric orthopaedic facility in Jakarta after the local orthopaedic department managed the CTEV without incident. Conclusion: Mirror feet are uncommon, and each patient needs treatment specifically designed for them. Coordination across various departments should be pursued to provide patients with the best care possible.

3D Reconstruction of Wrist Bones from C-Arm Fluoroscopy Using Planar Markers.

In orthopedic surgeries, such as osteotomy and osteosynthesis, an intraoperative 3D reconstruction of the bone would enable surgeons to quickly assess the fracture reduction procedure with preoperative planning. Scanners equipped with such functionality are often more expensive than a conventional C-arm fluoroscopy device. Moreover, a C-arm fluoroscopy device is commonly available in many orthopedic facilities. Based on the widespread use of such equipment, this paper proposes a method to reconstruct the 3D structure of bone with a conventional C-arm fluoroscopy device. We focus on wrist bones as the target of reconstruction in this research as this will facilitate a flexible imaging scheme. Planar markers are attached to the target object and are tracked in the fluoroscopic image for C-arm pose estimation. The initial calibration of the device is conducted using a checkerboard pattern. In general, reconstruction algorithms are sensitive to geometric calibration errors. To assess the practicality of the method for reconstruction, a simulation study demonstrating the effect of checkerboard thickness and spherical marker size on reconstruction quality was conducted.

Characteristics, Quality, and Safety Issues Identified During Intersocietal Accreditation Commission (IAC) Assessment of Orthopaedic Facilities Utilizing Cone-Beam CT Equipment

Category: Other Introduction/Purpose: The Intersocietal Accreditation Commission (IAC) began accrediting diagnostic CT facilities in 2007. Recently there has been an increase in the number of outpatient orthopaedic facilities that use cone beam CT (CBCT) equipment seeking accreditation. The accreditation process comprehensively evaluates a facility's daily operation, with quality determined by compliance with the IAC Standards and Guidelines for CT Accreditation. The Standards represent the minimum requirements for staff qualifications, instrumentation, quality assurance, physicist safety surveys, scan procedures, radiation dose optimization, interpretative accuracy, reporting, and quality improvement that a facility must meet to earn accreditation. The Standards are based on the published guidelines of 12 sponsoring professional medical societies, representing various specialties. This investigation aimed to discover characteristics of these facilities and to identify common quality and safety issues. Methods: To become accredited, facilities applying for IAC CT accreditation submit facility demographic data, staff qualifications, policies and procedures, sample quality assurance results, physicist survey reports, radiation dose logs, quality improvement data, and representative case studies via an online application process. The materials are evaluated by trained peer reviewers and findings are reported to the IAC CT Board of Directors for final accreditation decision. The IAC accreditation database was used to extract the characteristics and application findings of all orthopaedic facilities using CBCT that applied for accreditation from 2019-2021. Results: Facility Characteristics Currently, 41 orthopaedic facilities have achieved IAC CT accreditation (see map). The facilities perform a median of 378 scans per site annually (range 75-2400). On average, there were 4 physicians (range 1-20) and 2 technologists (range 0-15) per site. Most sites (n = 32) used CurveBeam CBCT equipment followed by Carestream (n=5) and Planmed (n=4). Facility Deficiencies Identified quality issues included poor scan quality (n=4) such as improper patient positioning or excessive motion artifact and inadequate reporting (n=14) such as inaccurate patient identification information, incomplete exam/technique documentation, or non-compliant report finalization/signature. Identified procedural issues included failure to perform/document routine quality control (n=12) such as phantom testing to ensure the safety of CT scanner operation; missing safety policies such as the medical emergency policy or incomplete clinical scan protocols (n=5); and lack of quality improvement activities (n=5).Finally, facility personnel did not meet staff qualification requirements at 11 sites. Conclusion: In summary, the IAC CT accreditation process rigorously evaluates CT facilities to improve quality and safety. Evaluation of the accreditation findings for outpatient orthopaedic facilities utilizing CBCT equipment and seeking IAC accreditation identified deficiencies at many sites. All facilities were required to rectify the deficiencies prior to being awarded IAC accreditation, and they must continue to monitor quality and safety to remain accredited.

Major Extremity Amputation: The Koforidua Experience

Background: Major extremity amputation is a relatively common surgical procedure but there is a paucity of local data concerning such an important part of surgical practice. This study was undertaken to unearth the demographics, the common indications, levels, revision and mortality rates of major extremity amputation in a large orthopaedic facility in Ghana.Methods: A retrospective study of 94 consecutive patients with 95 major limb amputations between September 2010 to August 2013 was conducted and the results analysed.Results: Overall, the commonest indication for amputation was trauma which was responsible for 44(46.3%) cases. Of the 95 amputations, 81(85.3%) were lower limb amputations with below knee amputations accounting for 45(47.3%) cases. The age group 21 – 40years had the highest number of amputations with 38(40%) and the commonest cause in this age group was trauma. Average duration of hospitalization was 32 days with 8 patients (8.4%) requiring re-amputation. Six patients (6.4%) died.Conclusion: Major limb amputation is drastically life altering especially in third world countries where livelihoods may depend on the ability to perform manual tasks and opportunities for changes in career paths/gainful rehabilitation do not abound. If traumaticconditions are prevented and expeditiously dealt with and chronic diseases like diabetes are carefully managed, there will be a significant reduction in limb loss following trauma or diabetic foot syndrome.

EPIDEMIOLOGICAL PROFILE OF SHOULDER PAIN PATIENTS AT A TERTIARY CARE CENTRE IN CENTRAL INDIA

Background/Aim: Shoulder pain is a common yet etiologically diversified complaint amongst patients presenting to an orthopaedic facility. In present study we describe the epidemiology and profile of shoulder pain patients. Methodology: This study was carried out over a period of three months at a tertiary care facility in Central India and included a total of 72 adult patients (>18 years) presenting with shoulder pain. Demographic profile, mode of injury, comorbidities, duration of pain, side involved, pain intensity (VAS) and Disability level (DASH) scores were noted. All the patients underwent clinical evaluation followed by radiological/MRI evaluation. Final diagnosis was based on MRI with clinical correlation. Mean age of patients was 47.88±12.56 years (range 23-69 years), majority were womenResults: (51.4%) with involvement of right side (55.6%). Mean duration of pain was 9.49±5.74 months. A total of 31 (43.1%) patients had no history of injury, Trauma (27.8%) and occupational injury (25%) were the most common modes. Diabetic history was positive in 37.5% patients. Mean pain and DASH scores were 7.36±70.88 and 54.40±14.80 respectively. Periarthritis shoulder (40.3%), rotator cuff injury (25%) and subacromial impingement (15.3%) were the most common diagnoses followed by ACJ and glenohumeral arthritis (8.3% each). There was 1 (1.4%) case each of calcific tendinitis and instable shoulder respectively. Shoulder pain patients presented with moderate to severe pain and aConclusion: high level of disability. Periarthritis shoulder and rotator cuff injury were the most common diagnoses.

RADIOLOGICAL RESULTS OF SEVERE SCFE TREATMENT AT IOT-FMUSP FROM 2012 TO 2018.

ABSTRACTObjective:To assess the complications in patients with severe slipped capital femoral epiphysis treated with the Dunn or modified Dunn procedure from 2012 to 2018 at the Institute of Orthopedics and Traumatology, Medical School, Universidade de São Paulo.Methods:Analysis of medical records, preoperative and postoperative radiographs with at least one year of radiographic follow-up of patients with severe slipped capital femoral epiphysis.Results:We reviewed the complications in 19 operated cases from 2012 to 2018, out of which 36.8% had osteonecrosis of the femoral head, one patient had chondrolysis, and another had postoperative infection.Conclusion:The osteonecrosis rate observed in this series of cases is similar to that described in other orthopedic facilities. We assessed factors that could potentially influence this outcome, including other characteristics of the patient (obesity, endocrine diseases, and history of sports activities) and of the health system. Level of Evidence III, Restropective Case Series.

Analyzing the Progress and Prevalence of Schedule II Opioid Prescription to Orthopedic Patients

In 2010, the Ambulatory Care Drug Database System (ACDD) reported that acetaminophen with hydrocodone topped the list of the three most prescribed medications across 49% of orthopedic facilities. Despite regulatory efforts radiated from the federal level, opioid prescription and addiction continues to exist among orthopedic patients.

Features of the physical rehabilitation program of preschool children with the consequences of hip joint dysplasia

The physical rehabilitation program was developed based on the previous clinical and instrumental screening of functional disorders of the hip joints, formed as a result of dysplasia in preschool children. This program included preventive and rehabilitation blocks. The first block was used during the year and included: morning hygienic gymnastics, exercise minutes and pauses, awakening gymnastics, self-massage, hardening procedures (water procedures, walking barefoot, air and sun baths), psycho-emotional unloading. The second block included therapeutic gymnastics (fitballs, roles Zelart Grid elastic band Thera-band, balancing platform (hemisphere) BOSU, balance discs, traverse walls Traverse, step platforms), hydrokinesiotherapy, moving games, therapeutic massage (local, general, hydromassage), physiotherapy, orthopedic facilities. The developed program provides for the implementation of a comprehensive approach to restoring the physical and functional state of the preschool ORA through the use of game, simulation, traction, relaxation, stretching, special power, breathing, corrective and various coordination exercises. There are a lot of features and benefits of the proposed program, such as many different types of physical exercises for the development of motor skills and motor training, conducting physical exercises in an imitation way, strict dosing and exercise control, purposefully load weakened muscle groups, which depend on the correction of physiological curves of the spine and other segments of the torso and limbs, to diversify each exercise and give it a playful color, stimulate the cardiorespiratory system, using static and dynamic breathing exercises in combination with swinging movements, increase the elasticity and flexibility of the joints of the spine and limbs, through traction exercises and exercises with full range of motion, to form a stereotype of the correct posture, actively using the positive psycho-emotional state of the child, to harmonize the state of the nervous system (processes of excitation and inhibition) due to the alternation of emotional game exercises, strength exercises with overcoming resistance and relaxation exercises, to motivate children to actively and systematically perform special physical exercises.

Normal Glenoid Ossification in Pediatric and Adolescent Shoulders Mimics Bankart Lesions: A Magnetic Resonance Imaging–Based Study

The purpose of this descriptive study was to define patterns of ossification and fusion of growth centers around the pediatric and adolescent glenoid as a function of age using 3-dimensional, frequency-selective, fat-suppressed spoiled gradient recalled echo magnetic resonance (MR) imaging sequences, with a particular focus on the anterior glenoid rim because of its clinical relevance as a potential confounder of glenohumeral instability. Picture Archiving and Communication System records at an urban academic tertiary care orthopaedic facility from October 2005 to December 2018 were queried for shoulder MRI in patients aged 9 to 17years. Patients were excluded if they had any diagnoses that could alter glenoid development. All images were independently evaluated by a musculoskeletal fellowship-trained radiologist. Secondary ossification centers were characterized as cartilage anlage, ossified, or fused at 3 anatomic sites: the anterior glenoid rim, coracoid, and superior glenoid rim. A total of 250MR examinations (143 males, 107 females) were assessed in this study. The glenoid develops in a predictably sequential manner with ossification at the anterior glenoid rim lagging behind the coracoid and superior glenoid rim. The earliest age of anterior glenoid rim ossification was 11years for both males (range 11-17) and females (range 11-12). Anterior glenoid rim ossification peaked at age 16 among males (34.8%, 8/23) and age 11 among females (27.3%, 3/11). Glenoid ossification and fusion progress in a predictable and chronological manner. This pattern should be used as a guideline when interpreting pediatric shoulder MRI examinations. In particular, an anterior glenoid ossification center should not be confused with an anterior glenoid injury (e.g., Bankart lesion), particularly in males 11 to 17years old and females 11 to 12years old. IV (case series).

Relationship between X-ray findings of lumbar spondylosis and knee pain

BackgroundThe aim of this study was to investigate the correlation between radiographic measurement in lumbar spine and clinical information including symptoms or results of functional testing using a baseline data of longitudinal cohort study.MethodsA total of 314 elderly subjects were recruited from 5 orthopedic clinics or affiliated facilities. Data for the present investigation were collected via an interviewer-administered questionnaire, which included questions on past medical history, drug history, pain area. And also results of functional testing and X-ray imaging of the lumbar spine were collected. Analysis was carried out to determine any correlation between results of X-ray imaging of the lumbar spine and other collected data, and sorted regarding Akaike Information Criterion (AIC). The correlations among these variables and odds ratio were also analyzed.ResultsT12/L1% disc height showed a minimum AIC value with buttock pain (− 4.57) and history of vertebral fracture (− 4.05). The L1/L2, L2/L3, and L3/L4% disc height had a minimal AIC value with knee pain (− 4.11, − 13.3, − 3.15, respectively), and odds ratio of knee pain were 3.5, 3.8, and 2.7, respectively.ConclusionsCorrelation was recognized between the T12/L1% disc height and both buttock pain and previous vertebral fractures, and the L1/L2, L2/L3, and L3/L4% disc height showed a correlation with knee pain. Especially the L2/L3% disc height and knee pain had a strong correlation. It was suggested that these findings may provide additional basis to the concept that lumbar spinal lesion associates with knee pain clinically.

National survey of prevalence and prognosis of thanatophoric dysplasia in Japan.

BackgroundThanatophoric dysplasia (TD) is a rare congenital disease of the skeletal system, with an incidence of 1.68–8.3 per 100 000 births, but statistical data on the estimated number of TD patients across Japan are not available. The aim of this study was therefore to investigate the prevalence and prognosis of TD in Japan.MethodsA nationwide primary questionnaire survey was conducted.ResultsA total of 127 obstetric, 186 pediatric, and 115 orthopedic facilities provided responses. Excluding duplications, we identified 73 patients with TD. Of the 73 cases, 15 were abortions, four were stillbirths, 51 were live births, and three had unknown details. Of the 51 live newborns, 27 died ≤7 days after birth, with an early neonatal mortality rate of 56%. Of the 24 newborns who survived the early neonatal period, 16 survived for ≥1 year. All of the 24 newborns received respiratory management and survived during the early neonatal period. Of the 51 live newborns, 25 did not receive respiratory management and died ≤2 days after birth.ConclusionsThe prevalence of TD in Japan is estimated to be at 1.1 (95%CI: 0.84–1.37) per 100 000 births, but the actual incidence is expected to be higher. To our knowledge, we have confirmed for the first time that newborns with TD may not always die during the early neonatal period but can survive the early neonatal period with appropriate respiratory management. Therefore, the term “thanatophoric dysplasia” does not accurately reflect the nature of the disease.

Prosthetic Joint Infection Trends at a Dedicated Orthopaedics Specialty Hospital.

Introduction Historically, a majority of prosthetic joint infections (PJIs) grew Gram-positive bacteria. While previous studies stratified PJI risk with specific organisms by patient comorbidities, we compared infection rates and microbiologic characteristics of PJIs by hospital setting: a dedicated orthopaedic hospital versus a general hospital serving multiple surgical specialties. Methods A retrospective review of prospectively collected data on 11,842 consecutive primary hip and knee arthroplasty patients was performed. Arthroplasty cases performed between April 2006 and August 2008 at the general university hospital serving multiple surgical specialties were compared to cases at a single orthopaedic specialty hospital from September 2008 to August 2016. Results The general university hospital PJI incidence rate was 1.43%, with 5.3% of infections from Gram-negative species. In comparison, at the dedicated orthopaedic hospital, the overall PJI incidence rate was substantially reduced to 0.75% over the 8-year timeframe. Comparing the final two years of practice at the general university facility to the most recent two years at the dedicated orthopaedics hospital, the PJI incidence was significantly reduced (1.43% vs 0.61%). Though the overall number of infections was reduced, there was a significantly higher proportion of Gram-negative infections over the 8-year timeframe at 25.3%. Conclusion In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the PJI incidence has been significantly reduced despite a greater Gram-negative proportion (25.3% versus 5.3%). These results suggest a change in the microbiologic profile of PJI when transitioning to a dedicated orthopaedic facility and that greater Gram-negative antibiotic coverage could be considered.

Fracture Liaison Services - Polish Experience. Methods of Secondary Prevention of Osteoporotic Fractures.

Fragility fractures are a major challenge to health systems around the world. The risk of a subsequent fracture may increase even 11-fold after one's first fracture event. A coordinator-based system (Fracture Liaison Services) was established in Poland in order to fill the gap in the care of patients with osteoporotic fractures. In the past years, the FLS has become a crucial part of orthopaedic facilities worldwide, bringing benefits to patients and savings to health systems' budgets. In 2015, the European Foundation of Osteoporosis and Musculoskeletal Diseases (EFOM) implemented the FLS in Poland under the name "System Zapobiegania Złamaniom (SZZ)". It was established in 16 centres in different parts of Poland. During the preparation phase, 42 healthcare professionals from 17 sites participated in courses organized by EFOM. A total of 1,579 patients were included in the SZZ, with a total of 746 DXA scans performed in that group. Patients were educated about osteoporotic fractures, including the methods of prevention (causes of fractures, problem of falls, vitamin D and calcium supplementation). The number of patients receiving antiresorptive treatment increased by 74.1%. The percentage of patients taking vitamin D and calcium supplements increased by an average of 10.8%. Although all the participating patients had suffered a fragility fracture, only 42% fulfilled the WHO clinical criteria for osteoporosis. 1. The implementation of the Fracture Liaison Service concept in Poland is possible and beneficial for the patients and healthcare system. 2. The current WHO definition of osteoporosis might be insufficient. 3. The use of an integrated database in different facilities, in terms of fracture epidemiology, significantly improves the quality of data being collected.

Abnormal Joint Moment Distributions and Functional Performance During Sit-to-Stand in Femoroacetabular Impingement Patients

BackgroundFemoroacetabular impingement (FAI) is a morphological abnormality of the hip joint that causes pain when performing a mechanically demanding activity of daily living such as the sit-to-stand (STS) task. Previous studies have assessed lower extremity joint mechanics during an STS task in various pathologies, yet the STS task has not been studied in FAI patients. ObjectiveThe objective of this study was to identify differences in joint kinetics and performance between FAI patients and healthy controls during a STS task. It was hypothesized that FAI patients would exhibit altered time needed to complete the STS task, as well as altered lower extremity biomechanics, when compared to healthy controls. DesignThis was a cross-sectional cohort study. SettingThe study took place at a motion capture laboratory at an institutional orthopedic facility. ParticipantsBiomechanical analysis was performed in 17 FAI patients and 31 age- and body mass index (BMI)−matched healthy controls during the STS task. MethodsSagittal plane joint moments, total support moment (TSM), joint contributions to the TSM, and functional measures during the STS task were compared between groups. Main Outcome MeasurementsPeak joint moments, TSM and joint contributions to the TSM were assessed during the STS task. In addition, the time to and value of the peak vertical ground reaction force (vGRF), limb symmetry index at peak vGRF, loading rate, and total time needed to perform the STS task were determined. ResultsCompared to the control participants, the FAI patients exhibited worse Hip Disability and Osteoarthritis Outcome Score (HOOS) pain and function subscores. No group differences were observed in peak sagittal joint moments during the STS task. However, when compared to controls, the FAI patients demonstrated reduced knee joint contributions to the TSM. In addition, the FAI patients exhibited increased time needed to perform the STS task, increased time to reach peak vGRF, and reduced lower extremity loading rate during the STS task. ConclusionsFAI patients demonstrated abnormal joint contributions to TSM and altered functional performance during the STS task. These altered movement patterns during the STS task may be compensatory mechanisms used by the FAI patients to reduce pain and to improve function. Level of EvidenceNot applicable.

Group health education in inpatient rehabilitation: Patients’ role perceptions

Objective: Group health education is an important aspect of medical rehabilitation. While interaction and active involvement are important characteristics of group health education, little is known about patients’ understanding of their role in this form of education. This study explored patients’ understanding of their role in group health education as part of inpatient rehabilitation. Design: Qualitative, in-depth study. Setting: Six orthopaedic rehabilitation facilities in Germany. Methods: A total of 30 patients participated in six focus groups, and data were analysed using interpretative phenomenological analysis. Results: Findings reveal a complex picture concerning patient role both during and after group health education. Participants expected that patients should fulfil an active patient role and be good patients, but also said that some patients did not always comply with these expectations. Participants perceived that personal, group health education–related and environmental factors can affect the fulfilment of their role. Conclusion: Group health education should not be seen in isolation but in the context of the complex network of personal, group health education–related and environmental factors. Engagement with these factors can contribute to patients’ fulfilment of an active patient role and sustainable success after rehabilitation.

Antoni marian gabryszewski as a pioneer of orthopaedics and rehabilitation in poland.

This article describes the work of Dr. Antoni Marian Gabryszewski, orthopaedic surgeon, associate professor at Lvov University, towards the development of orthopaedics and rehabilitation in Poland before World War I. It is based on archival materials, publications in medical journals and articles from the daily press of that time. The author presents little-known facts concerning Dr. Gabryszewski's occupational and academic activity and his work at the Surgery Dept. of Lvov University as well as his habilitation dissertation, regarded as the first attempt to position orthopaedics as distinct from surgery in Poland. The article also describes his long-term work at the private Orthopaedic Facility established in 1898 in Lvov which later incorporated the Zander Institute in 1908. The Zander Institute was the first in Galicia to offer exercise machines designed by Dr. Gustav Zander, imported from Stockholm and enjoying an extraordinary popularity in the world. Dr. Gabryszewski's practice as a spa doctor, which he pursued in Iwonicz Zdrój in the summer months, is also presented. Dr. A. Gabryszewski introduced comprehensive rehabilitation to the treatment of orthopaedic patients both at the Surgery Dept. of Lvov University and at his Orthopaedic Facility. He used therapeutic gymnastics (particularly mechanotherapy), therapeutic massage, physical therapy and orthopaedic aids. Analysis of the source materials leads to unequivocal conclusions attesting to Dr. A. Gabryszewski's pioneering role and significant contribution to the development of orthopaedics and rehabilitation in Poland.

Postoperative Blood Use Following Elective Total Hip and Total Knee Arthroplasty

Abstract 1181Use of allogeneic blood in elective procedures should be minimized due to risks of transfusion, potential adverse impact on outcomes, inconvenience to the patient, high cost and limited supply of blood. The purpose of this study was to examine the rate of transfusion following elective total hip (THA) and total knee arthroplasties (TKA) within a preoperative and perioperative blood management program and to examine the relationship between clinical and surgical parameters and blood transfusion. Methods:This was a secondary analysis of prospectively collected data of all consented patients who had undergone joint arthroplasty surgery between January and December, 2011. All patients attended a preoperative clinic 7–14 days prior to their surgery. The preoperative hemoglobin (Hgb) was measured. Transfusion rate was calculated for type of surgery (primary vs. revision and unilateral vs. bilateral). Impact of preoperative Hgb, age, sex, Body Mass Index (BMI), estimated blood loss, type of anaesthetic, type of anticoagulant (rivaroxaban vs. no rivaroxaban), surgeon and drop in hemoglobin (preoperative hemoglobin minus lowest post-operative hemoglobin documented on postoperative day 1, 2 or 3) were examined. Descriptive statistics examined the rate of transfusion in different procedures. Univariate analysis examined the relationship between each factor and having a transfusion. Stepwise logistic regression examined the impact of all factors together. Statistical significance was set at p<0.05. Results:1605 patients [989 females (62%), mean age 66 (SD:11)] had surgery during 2011. Primary TKA: Unilateral 821 (51%), Bilateral TKA: 41 (3%), Revision TKA: 91 (6%), Primary THA: 588 (37%), Bilateral THA: 4 (0.02%), Revision THA: 60 (4%). Four percent (4%) of females had an Hgb <120 mg/L and 3% of males had an Hgb <130 mg/L at the preoperative visit. There were 1555 cases done under regional anaesthesia (spinal or epidural) and 129 cases received a general anaesthetic. Sixty-seven patients (4%) had a blood transfusion while in hospital. Thirty percent (30%) of the transfused women and 9% of the men had a low pre-operative Hgb. THA procedures required more transfusions than TKA (p=0.0012). Transfusion was associated with the following individual factors: age ≥ 80 years, female sex, low BMI (<18.5), increased estimated blood loss, larger drop in hemoglobin, type of anticoagulant (4% in rivaroxaban vs. 8% in non-rivaroxaban), revision surgery (vs. primary), simultaneous bilateral arthroplasty, general anesthesia (vs. spinal), and surgeon. Stepwise logistic regression analysis maintained the intra-operative blood loss, drop in Hgb, female sex, and age as significant independent factors in explaining the variation in blood transfusion. Discussion:This study was carried out in an independent orthopaedic facility for elective joint surgery. All patients are assessed medically prior to surgery and advised to take supplemental iron for 2 months prior to surgery. Four percent of females and 3% of males were found to be anemic preoperatively. Patients are admitted the morning of their surgery. Approximately 97% of the consented patients had a regional anesthetic (spinal and/or epidural) with sedation. Patients are transferred into the operating room after the anaesthetic was administered. Surgery is carried out without the routine use of cell saver, tranexamic acid or drains. Approximately 50% of the surgeons deflate the tourniquet in a total knee arthroplasty prior to closure of the capsule. Thromboprophylaxis is initiated with rivaroxaban 10 mg on postoperative day 1. The general transfusion trigger for symptomatic patients is a hemoglobin of 80 g/L. Transfusions can be ordered by staff surgeon, hospitalist, medical consultant or Orthopaedic fellow. The blood bank does not group and screen patients scheduled for routine primary total hip or total knee arthroplasty. Following these practices, we observed a transfusion rate for primary THA of 5% and primary TKA of 3% while using rivaroxaban for thromboprophylaxis starting on postoperative day 1. Conclusion:The present study confirmed that intra-operative blood loss, drop in the hemoglobin, being a female, and older than 80 years of age as risk factors in relation to need for blood transfusion following elective total joint arthroplasty. Transfusion rates were not higher when rivaroxaban was used for thromboprophylaxis. Disclosures:Murnaghan:Bayer Healthcare: Honoraria, Research Funding. Off Label Use: Rivaroxaban was used perioperatively for thromboprophylaxis. Our protocol gave the intial dose on postoperative day 1 rather than the 6–10 hours post-operatively recommended by the manufacturer in product monograph. Gollish:Bayer Healthcare: Honoraria, Research Funding.

Recovery in horizontal gait after hip resurfacing vs. total hip arthroplasty at 6-month follow-up - a randomized clinical trial

Standard total hip arthroplasty (THA) is the established surgical treatment for patients older than 65 years with progressive osteoarthritis. However, implant survivorship curves decline more rapidly in patients younger than 50 years. Resurfacing hip arthroplasty has therefore been suggested as an alternative for younger more active patients. Walking ability is one of the most common and useful outcome measures used in hip replacement patients, and the ability to safely ambulate is considered a pre-requisite for discharge from most orthopedic facilities. Improvements in walking ability and kinematics have been suggested after hip resurfacing, but no study sofar has objectively assessed this aspect in a randomized trial including standard THA. Purpose: To test the hypothesis that (i) a superior recovery in gait would be observed following resurfacing total hip arthroplasty compared to standard total hip arthroplasty and (ii) to investigate the hypothesized relationship between mechanical hip and knee muscle performance and horizontal gait function in patients with total hip replacement. Methods: Forty-three patients were randomized into either standard or resurfacing THA. Three-dimensional gait data were collected at self-selected normal and maximal walking speed. Primary outcome was gait speed while secondary outcomes comprised selected temporospatial and kinematic parameters obtained during horizontal walking. Explorative outcome was the relationship between isolated mechanical hip and knee muscle performance and horizontal gait function in younger THA patients 56 ± 6 years (range 44-64). Data was collected pre-operatively, 2 and 6 months post-operatively Results: There was no effect of treatment on horizontal self-selected normal speed, however an effect of treatment was observed on maximal walking speed where standard THA subjects walked faster than the hip resurfacing subjects (P = 0.03). No differences in the recovery of spatiotemporal parameters were observed. Also, peak hip flexion and peak hip adduction angles recorded during the stance phase were similar in both groups. Maximal isometric knee and hip muscle strength were positively associated with gait speed, step length and cadence during maximal walking (R2= 0.13-0.37, P < .05). Conclusions: The present data could not provide evidence to support the hypothesis that resurfacing total hip arthroplasty should lead to a superior recovery in gait and hip kinematics compared to standard 28-mm hip arthroplasty in younger hip arthritis patients. Maximal isolated leg muscle strength was a predictor of horizontal gait performance, and thus provides an important and valid functional outcome measure for individuals undergoing total hip arthroplasty.

The role of footwear in attenuating impact loads in individuals with knee osteoarthritis

The role of footwear in attenuating impact loads in individuals with knee osteoarthritis

Modular socket system versus traditionally laminated socket

Using the new modular socket system (MSS) to produce a prosthetic socket directly on the patient has the potential of being easier and quicker to manufacture but also incurring higher costs. The purpose of the study was to compare the costs of manufacturing a transtibial prosthetic socket using either a MSS or a standard laminated socket (PC). Concurrent controlled trial. A total of 20 patients at two orthopaedic facilities were followed with regards to the cost of manufacturing a prosthetic socket using either MSS or PC. Time aspects and material costs were considered in the cost analysis. Other factors studied include delivery time and number of visits. For the cost analysis, only direct costs pertaining to the prosthetic socket were considered. The total cost of MSS was found to be significantly higher (p < 0.01) compared to PC. However, the production and time cost was significantly lower. Delivery time to the patient was 1 day for MSS compared to 17 days for PC. Our study shows that the direct prosthetic cost of treating a patient using MSS is significantly higher than treating a patient using PC. However, the MSS prosthesis can be delivered significantly faster and with fewer visits. Further studies taking the full societal costs of MSS into account should therefore be performed. This study shows that the direct prosthetic cost of treating a patient with Modular Socket System is significantly higher than treating a patient with plastercasting with standard laminated socket. However, the Modular Socket System prosthesis can be delivered significantly faster and with fewer visits.