Tag Archives: Risk

New Protocol May Decrease Hip Dislocation Risk

Researchers from NYU Langone Orthopedics, Hospital for Special Surgery, and Mayo Clinic have developed a hip-spine classification system for use in revision total hip arthroplasty that may help decrease the risk of recurrent instability.

Their work, “Evaluation of the Spine is Critical in Patients with Recurrent Instability after Total Hip Arthroplasty,” has been accepted for publication in an upcoming 2019 issue of The Bone & Joint Journal.

Co-author Jonathan M. Vigdorchik, M.D., at the time of the study an orthopedic surgeon in the Division of Adult Reconstructive Surgery at NYU Langone Orthopedics in New York City, noticed a trend which, as he explained to OTW, prompted this study. “In clinical practice, being at a tertiary referral center, we get many referrals for revision THA [total hip arthroplasty]. As we started looking at our revisions for dislocation, we began noticing a trend—patients all had spine fusions or spines that were in bad shape. So, this launched us on a research path about spine fusions and hip replacement.”

The researchers collected data on 111 patients undergoing revision THA for recurrent instability and matched 1:1 to 111 revisions specifically performed for instability not using this protocol (the control group).

Dr. Vigdorchik, now an orthopaedic hip and knee replacement surgeon at Hospital for Special Surgery in New York, told OTW, “We found that spinal fusion, and also the higher number of spinal levels fused, caused higher dislocation rates. We also found that patients with spinal deformity had higher rates of dislocation.”

“So, we had a combined spine surgeons and hip surgeons conference to discuss. As a hip surgeon, I started looking at the hip and the pelvis like a spine surgeon and began noticing certain trends. When we applied this to dislocating hips, it became very clear why they were dislocating and explains a large group of patients where the doctors could never figure out why the X-rays looked good (or so they thought).

“But they were just looking at the wrong X-rays. So that is why I came up with this protocol, to teach them the right X-rays to do and then what to do with what they found.”

“Revising a hip that is dislocating has a really high complication rate, especially recurrent dislocation.

From : www.ryortho.com/

Outcomes of superficial and deep irrigation and debridement in total hip and knee arthroplasty

Researchers performed a retrospective study of 176 patients. that underwent irrigation and debridement(I&D) within 28 days of  TJA, to examine the role and outcomes of both superficial and deep I&D in patients with wound-related issues and/or suspected periprosthetic joint infection (PJI). For superficial I&D, the overall success was 84.28% compared to 68.86% for deep I&D. Outcomes support the viability of superficial I&D in patients with wound-related issues as long as joint aspiration is performed to rule out infection involving the prosthesis. They suggest opening fascia and exploring deeper tissues in case there are findings of no fluid or purulence.


Read the Full Article On : https://www.arthroplastyjournal.org/article/S0883-5403(19)30255-4/fulltext?rss=yes

Time to seriously consider focused mris for injured spines

Is it sufficient to only examine the injured part of the spine via focused magnetic resonance imaging (FMRI) or will that lead to missed problems?

In patients who sustain blunt trauma, CT is the initial screening modality of choice in most emergency departments in the United States to look for injury to various parts of the body—including the spine. If a fracture is seen in the thoracic or lumbar spine on CT, sometimes an MRI of the injured segment of the spine is useful to provide additional information about the injury to help physicians decide on a treatment plan.”

“The problem is that MRI is a relatively expensive and time-consuming test compared to CT, so every time we were ordering MRIs of the entire spine in this scenario, it seemed somewhat excessive. Since we are mostly interested in looking at the part of the spine that we already know is injured (based on the CT), we asked ourselves if just imaging the injured portion of the spine by MRI (a focused MRI) would be adequate to provide the information we need to decide on a treatment plan. The concern with this approach is whether we would miss injuries by not looking at the entire spine by MRI.”

To answer the question, the investigators reviewed records for all adult trauma patients who presented to Mass General’s emergency department between 2008 and 2016 with one or more fractures of the thoracic and/or lumbar spine—as identified using computed tomography (CT) and who underwent MRI of the entire thoracic and lumbar spine within 10 days.

The most important result of the test, said Dr. Karim, was “that performing a focused MRI of only the injured portion of the spine would lead physicians to missing some sort of injury in another portion of the spine about 15% of the time, but none of these ‘missed injuries’ would lead to any change in treatment plan or patient care if they are known.”

“This is a very practical study from our perspective because it affects the day-to-day work of radiologists, emergency room physicians, and spine surgeons. If they see a fracture in the thoracic or lumbar spine on CT that they want to better characterize on MRI, they should be comfortable obtaining just a focused MRI of the injured portion of the spine—saving time, money, and patient discomfort.”

Reference From : https://ryortho.com

Patient relevant outcomes of unicompartmental vs total knee replacement

Between 1 January 1997 and 31 December 2018, via searching Medline, Embase, Cochrane Controlled Register of Trials (CENTRAL), and Clinical Trials.gov, researchers provided a clear and comprehensive summary of the published data on unicompartmental knee replacement (UKA) or total knee replacement (TKA), comparing domains of outcome that have been shown to be important to patients and clinicians in order to enable informed decision making. Findings suggested that TKA and UKA are both viable treatment options for isolated unicompartmental osteoarthritis arthritis. This investigation shows better results for UKA in several outcome domains by directly comparing the two treatments. The risk of revision surgery for TKA, however, was lower. This information should be available to patients when selecting treatment options as part of the shared decision-making process.

Read the Full Article : https://www.bmj.com/content/364/bmj.l352

Reference From : www.mdlinx.com

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