Similar Journals
|
Geriatric Orthopaedic Surgery Rehabilitation
Number of Followers: 5  Open Access journalISSN (Print) 2151-4585 - ISSN (Online) 2151-4593 Published by Sage Publications  [1176 journals]
|
- Exposing the Care Conundrum of Low-Energy Pelvic Ring Fractures in Older
Adults: A Review of 322 Patients
Authors: Bailey R. Abernathy, Fernando A. Huyke-Hernández, Rachael L. Rivard, Lisa K. Schroder, Julie A. Switzer
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionA care conundrum for low-energy pelvic ring fracture patients in which they face financial burden after not qualifying for an inpatient stay of 3 days or more has been noted in the literature. The purpose of this study was to identify factors that lead to inpatient length of stay (IP LOS) ≥3 days in older adults with nonoperative pelvic ring fragility fractures and to highlight the challenging financial decision-making of those with IP LOS
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-11-21T01:49:17Z
DOI: 10.1177/21514593231216390
Issue No: Vol. 14 (2023)
- Bone Health Management in Elective Orthopaedic Surgery: A Claims-Based
Observational Study
Authors: Kyle J. Jeray, Setareh A. Williams, Yamei Wang, Leny Pearman, Nick Pyrih, Karun Singla, Benjamin H. Han, Susan V. Bukata
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThere are limited data on the management of bone health, including bone mineral density (BMD) evaluation and osteoporosis (OP) treatment, in patients undergoing elective orthopaedic surgeries.MethodsThis was a retrospective cohort study using administrative claims data from Symphony Health, PatientSource for patients aged ≥50 years with documented kyphoplasty/vertebroplasty (KP/VP), total knee arthroplasty (TKA), and total hip arthroplasty (THA). Risk stratification to identify patients at very high risk for fracture (VHRFx) was based on clinical practice guideline recommendations to the extent information on variables of interest were available from the claims database.ResultsA total of 251 919 patients met inclusion criteria: KP/VP (31 018), TKA (149 849), and THA (71 052). The majority were female (80.3%) with a mean (SD) age of 68.5 (7.5) years. Patients undergoing KP/VP were older and had a greater comorbidity burden associated with risk for falls, mobility issues, muscle weakness, and respiratory and cardiovascular diseases. In the 6 months before surgery, 11.8% of patients were tested and/or received treatment for OP. Patients undergoing KP/VP were more likely to be tested and/or treated (17.5%) than patients undergoing TKA (11.0%) or THA (10.9%). Overall, men had a lower rate of testing and/or treatment than women (4.6% vs 13.5%). In the 12 months before surgery, patients with an OP diagnosis and at VHRFx (30.8%) had a higher rate of treatment and/or testing than those without OP (11.5%), or those without OP but with a fracture in the year preceding surgery (10.2%).ConclusionsBone health management is suboptimal in patients undergoing elective orthopaedic surgeries and is worse in men than in women. Proper management of OP before and after surgery may improve outcomes.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-11-18T02:26:22Z
DOI: 10.1177/21514593231216553
Issue No: Vol. 14 (2023)
- Predictors of 10-year Mortality After Hip Fracture Surgery in a
Pre-Pandemic Cohort
Authors: Bryan Loh, Lei Jiang, Liu Timing, Naomi Kong, Ganga Ganesan, Kelvin Bryan Tan, Suang Bee, Joyce Suang Bee Koh, Tet Sen Howe, Ng Yeong Huei
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThough hip fractures are associated with significant mortality and morbidity, increasing life expectancy in developed countries necessitates an analysis of mortality trends and factors predicting long term survival. The aim of this study is to identify the predictors of 10-year mortality as well as assess the correlation of Age-adjusted Charlson comorbidity index (ACCI) with 10-year mortality in a surgically treated Asian geriatric hip fracture population.Materials and MethodsFrom January 1, 2007 to December 31, 2009, 766 patients who underwent surgery for hip fracture with a minimum follow up of 10-years were recruited to the study (92% follow-up rate). A review of the patient’s electronic hospital records was performed to glean the following data: patient demographics, pre-existing comorbidities, operation duration, length of stay, fracture configuration, as well as mortality data up to 10 years. CCI scores and individual co-morbidities were correlated with inpatient, 30-day, 1-year, 5-year and beyond 10-year mortality.ResultsOf the 766 patients, the mortality rate for 30-day, 1-year, 5-year and 10-years was 2.9%, 12.0%, 38.9% and 61.6% respectively. The average ACCI was 5.31. The 10-year mortality for patients with ACCI ≤ 3, ACCI 4-5 and ACCI ≥ 6 are 29.4%, 57.4% and 77.5% respectively. End-Stage-Renal Failure (ESRF), liver failure and COPD were dominant predictors of mortality at 10 years, whereas cancer was the predominant predictor at 1 year.DiscussionACCI significantly correlates with the 10-year mortality after surgically treated hip fractures with a shift of the dominant predictors from cancer to ESRF and COPD. This could inform future health policy and resource planning. This data also represents recently available pre-pandemic survival trends after hip fracture surgery and serves as a baseline for post-pandemic outcome surveillance of interventions for fragility fractures.ConclusionThis study demonstrates that ACCI correlated with 10-year mortality after surgical treatment of hip fractures.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-11-16T11:23:56Z
DOI: 10.1177/21514593231216558
Issue No: Vol. 14 (2023)
- Delay to Surgical Treatment in Geriatric Hip Fracture Patients
Authors: Elias G. Joseph, Jordan Serotte, Mohammad N. Haider, Sonja Pavlesen, Mark Anders
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundHip fractures in the geriatric population are frequently encountered. There is increasing focus on minimizing the delay to surgery in these patients. This study was designed to evaluate factors responsible for a delay to surgery in a geriatric hip fracture population and how time to surgery affects mortality.MethodsA retrospective cohort of patients sustaining low energy geriatric hip fractures in either an American College of Surgeons (ACS) verified Level 1 trauma center or a local university affiliated community teaching hospital were reviewed. The following variables were evaluated as independent risk factors for delay to surgery: demographic data, surgical details, use of cardiology resources, treatment center, and comorbidities. As a secondary objective, the effect of time to surgery on 1 year mortality was analyzed.Results1157 patients met inclusion criteria. The following factors increased the risk of delay to surgery greater than 48 hours: male sex, treatment in a community hospital (versus trauma center), older age, multiple comorbidities (eg, cardiovascular-related conditions or other fractures), cardiology consultation, and an American Society of Anesthesiologists physical status score of 3 or 4. Cardiology consultation was the strongest independent predictor of risk for delay to surgery of>48 hours (odds ratio, 6.68; 95% confidence interval, 4.40 to 10.14; P < .001). The 1-year mortality of patients did not differ when surgical treatment occurred before 48 hours or after 48 hours (Log-rank test P = .109).ConclusionThe presence of cardiovascular comorbidities and cardiology consultations can delay surgical treatments for hip fractures in patients greater than 65 years old, but the delay did not influence 1-year all-cause mortality.Level of EvidenceLevel IV.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-10-19T04:58:39Z
DOI: 10.1177/21514593231204760
Issue No: Vol. 14 (2023)
- Temporary Partial Weight-Bearing Restriction in Elderly Patients Treated
With a Plate Fixation After a Distal Femur Fracture had a Negative
Long-Term Impact on Gait Recovery
Authors: Martin Paulsson, Carl Ekholm, Ola Rolfson, Mats Geijer, Roy Tranberg
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundRestricted weight-bearing is still used after lower extremity fracture surgery in elderly patients. The long-term effect on gait recovery in elderly patients with distal femur fractures (DFF) and their ability to comply with the restrictive weight-bearing regime is unknown. This study aimed to investigate the effect of restricted postoperative weight-bearing on gait recovery (actual weight-bearing and cadence) during a 1-year follow-up.MethodsThis study evaluated secondary outcomes from a randomized controlled trial (32 patients ≥65 years, with a traumatic DFF). Internal fixation was achieved using an anatomical lateral plate. Patients were allocated to either immediate full weight-bearing (FWB) or partial weight-bearing (PWB) (30% of body weight) for 8 weeks. Pressure-sensitive sensors (F-scan™ system, Tekscan, Massachusetts, USA) were used to measure weight-bearing and cadence postoperatively and at 8-, 16-, and 52-week follow-ups. Twenty-six patients with at least 1 measurement were included.ResultsThere was a statistically significant difference in actual weight-bearing between the PWB and FWB groups postoperatively of 32.3% (95% confidence interval CI, −50.0; −13.0, P < .001) and at the 8-week follow-up of 36.8% (95% CI −61.0; −18.0, P = .01), but not at later follow-ups. The PWB group presented a consistently lower cadence compared to the FWB group, which was statistically significant at the 16-week follow-up with 9.0 steps/min (95% CI -16.2; −1.1, P = .047) and 52-week follow-up with 9.3 steps/min (95% CI −18.0; −3.9, P = .009).ConclusionsRestricting postoperative weight-bearing in elderly patients with a DFF had a significant effect on postoperative weight-bearing. The effect lingered with a delayed return to FWB and persistent significantly lower cadence in the PWB group. These findings suggest that even temporary weight-bearing restrictions most likely have negative long-term effects on gait function at 1 year and, therefore, cannot be recommended.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-10-13T02:59:12Z
DOI: 10.1177/21514593231184945
Issue No: Vol. 14 (2023)
- Effects of Fracture Liaison Service on Outcomes of Patients with Hip
Fracture in Rural Area of an Asian Country
Authors: Chien-Chieh Wang, Hsuan-Chih Liu, Ming-Tsung Lee, Wen-Tsung Huang
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionFracture Liaison Services (FLS) has been proven effective in reducing subsequent fractures and related mortality. However, more research is needed on the impact of FLS on the 30-day readmission rate and its effectiveness in rural hospitals. This study aims to assess the impact of FLS on clinical outcomes including readmission rates, subsequent fractures, and fracture-related mortality in rural areas of an Asain country.Materials and methodsIn a rural hospital in Taiwan, we conducted a two-year prospective cohort study on elderly individuals with fragility hip fractures. The study compared the clinical outcomes between the control group and the FLS-cohort group. Logistic regression analysis was used to identify factors contributing to 1-year mortality after injury.Results556 patients were enrolled. (304 in the control group and 252 in the FLS group) The mean age was 79.8 years. The findings revealed that the introduction of FLS did not result in significant differences in mortality, readmission, complication, subsequent fractures, or secondary hip fractures. However, there were notable improvements in the length of hospital stay and the proportion of patients receiving surgery within 48 h following the implementation of FLS. Subgroup analysis showed that FLS patients who received anti-osteoporotic treatment had lower mortality and 30-day readmission rates. Factors associated with higher 1-year mortality included male, high ASA level, and delayed surgery.DiscussionThis study provides the real-life evidence of the effect of intensive FLS model in a rural hospital in an Asian country.ConclusionWhile FLS did not show significant differences in certain clinical outcomes, it led to shorter hospital stays and increased timely surgeries. FLS patients receiving anti-osteoporotic treatment had better mortality and readmission rates. Further research is necessary to gain a comprehensive understanding of the impact of FLS care in rural areas of Asia.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-09-26T06:40:30Z
DOI: 10.1177/21514593231204783
Issue No: Vol. 14 (2023)
- Perception of Goals and Expected Outcomes in Older Hip Fracture Patients
and Their Medical Staff: A Cross Sectional Study
Authors: Hanna S. Schroeder, Avi Israeli, Meir (Iri) Liebergall, Omer Or, Wiessam Abu Ahmed, Ora Paltiel, Dan Justo, Eyal Zimlichman
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundGoal-oriented patientcare is a key element in qualityhealthcare. Medical-caregiver’s (MC) are expected to generate a shared decision-making process with patients regarding goals and expected health-outcomes. Hip-fracture patients (HFP) are usually older-adults with multiple health-conditions, necessitating that agreed-upon goals regarding the rehabilitation process, take these conditions into consideration. This topic has yet to be investigated by pairing and comparing the perception of expected outcomes and therapeutic goals of multidisciplinary MCs and their HF patient’s. Our aim was to assess in a quantitative method whether HFPs and their multidisciplinary MCs agree upon target health-outcomes and their most important goals as they are reflected in the SF12 questionnaire.MethodsThis was a cross-sectional, multi-center, study of HFPs and their MCs. Patients and MCs were asked to rate their top three most important goals for rehabilitation from the SF12 eight subscales: physical functioning, physical role limitation, bodily pain, general health, vitality, social functioning, emotional role limitation and mental health, and indicate their expected outcome. Descriptive statistics and mixed effect logistic-regression were used to compare concordance of the ratings. Agreement between patients and MCs was assessed using interclass coefficients (ICCs).ResultsA total of 378 ratings were collected from 52 patients, 12 nurses, 12 physicians and 6 paramedical personnel. Each patient had between 3 and 9 raters. Patients considered physical functioning and physical role limitation more important than did MCs. Physicians and nurses emphasized the importance of bodily pain while patients referred to it as relatively less significant. The total ICC was low (2%) indicating poor agreement between MCs and patients. With the exception of physical-functioning, MCs predicted a less optimistic outcome in all of the SF12's subscales in comparison to HFPs.ConclusionEffective intervention in HFPs requires constructive communication between MCs and patients. The study suggests that caregivers have an insufficient understanding of the expectations of HFPs. More effective communication channels are required in order to better understand HFPs’ needs and expectations.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-09-22T02:48:46Z
DOI: 10.1177/21514593231202735
Issue No: Vol. 14 (2023)
- In-Hospital Mortality Risk and Discharge Disposition Following Hip
Fractures: An Analysis of the Texas Trauma Registry
Authors: Victor H. Martinez, Jaime A. Quirarte, Rebecca N. Treffalls, Sekinat McCormick, Case W. Martin, Christina I. Brady
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundIn-hospital mortality and discharge disposition following traumatic hip fractures previously reported in the literature, has mainly focused on a nationwide scale, which may not be reflective of unique populations.ObjectiveOur aim was to characterize demographics, hospital disposition, and associated outcomes for patients with the most common hip fractures.MethodsA retrospective study utilizing the Trauma Registry from the Texas Department of State Health Services. Patient demographics, injury characteristics, and outcomes, such as in-hospital mortality, and discharge dispositions, were collected. The data were analyzed via univariate analysis and multivariate regressions.ResultsThere were 17,104 included patients, composed of 45% femoral neck fractures (FN) and 55% intertrochanteric fractures (IT). There were no differences in injury severity score (ISS) (9 ± 1.8) or age (77.4 ± 8 years old) between fracture types. In-hospital mortality risk was low but different among fracture types (intertrochanteric, 1.9% vs femoral neck, 1.3%, P = .004). However, when controlling for age, and ISS, intertrochanteric fractures and Hispanic patients were associated with higher mortality (P < .001, OR 1.5, 95% CI 1.1-2.0). Uninsured, and Black/African American (P = .05, OR 1.2, 95% CI 1.1-1.3) and Hispanic (P < .001, OR 1.2, 95% CI 1.1-1.3) patients were more likely to be discharged home after adjusting for age, ISS, and payment method.ConclusionRegardless of age, severity of the injury or admission hemodynamics, intertrochanteric fractures and Hispanic/Latino patients had an increased risk of in-hospital mortality. Patients who were uninsured, Hispanic, or Black were discharged home rather than to rehabilitation, regardless of age, ISS, or payment method.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-09-09T10:06:35Z
DOI: 10.1177/21514593231200797
Issue No: Vol. 14 (2023)
- Displaced Geriatric Femoral Neck Fractures: A Retrospective Comparison of
Total Hip Arthroplasties Versus Hemiarthroplasty
Authors: Steven Morgan, Stephanie Jarvis, Alexander Conti, Kelsey Staudinger, Cassandra Reynolds, David Bar-Or
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionControversary exists around the best surgical management for traumatic geriatric displaced femoral neck fractures. The study objective was to compare outcomes among those managed with a total hip arthroplasty (THA) to those managed with a hemiarthroplasty (HA).MethodsThis retrospective matched cohort study included geriatric hip fractures (≥65 y/o) admitted 7/1/16-3/31/20. Patients were matched on having an advanced directive, pre-existing dementia, and age. Outcomes included: time to surgery, length of stay (LOS), blood loss volume, and discharge destination. THAs were compared to HAs; an alpha of
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-09-07T04:56:50Z
DOI: 10.1177/21514593231198949
Issue No: Vol. 14 (2023)
- Influence of Proximal Humeral Cortical Bone Thickness on the Radiographic
Outcome After Osteosynthesis of Proximal Humeral Fractures: Propensity
Matching Score Analysis
Authors: Ryogo Furuhata, Atsushi Tanji, Satoshi Oki, Yusaku Kamata
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionOsteoporosis can affect the surgical outcomes of proximal humeral fractures in older people. Recently, the cortical bone thickness of the proximal humerus on plain radiograph has been proposed to reflect local osteoporosis of the proximal humerus; however, its effect on the surgical outcome of proximal humeral fractures remains unclear. The purpose of this study is to investigate the influence of cortical bone thickness on postoperative radiographic outcomes after osteosynthesis for proximal humeral fractures.Materials and MethodsWe retrospectively identified 190 patients (≥50 years) who underwent osteosynthesis with an intramedullary nail or plate for proximal humeral fractures. The patients were categorized into 2 groups according to the cut-off value of an average proximal humerus cortical bone thickness of 6 mm on plain radiographs: patients with and without local osteoporosis. After propensity score matching, we compared the incidence of postoperative radiographic complications between the 2 groups. We also performed subgroup analyses of outcomes in a subgroup of patients who underwent intramedullary nailing and those who underwent plate fixation.ResultsPropensity score matching yielded 60 patients in each group. No significant difference in complication rates was observed between the 2 groups. However, in the intramedullary nailing subgroup, the incidence of reduction loss was significantly higher in patients with local osteoporosis than in those without local osteoporosis (51.7% vs 14.3%, P = .002).DiscussionThe proximal humeral cortical bone thickness had no significant effect on the overall radiographic outcome; however, reduction loss after intramedullary nailing was susceptible to local osteoporosis of the proximal humerus.ConclusionOur study suggests that plate fixation is advantageous in preventing postoperative reduction loss in patients with lower cortical bone thickness.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-24T07:37:41Z
DOI: 10.1177/21514593231198645
Issue No: Vol. 14 (2023)
- Postoperative Outcomes Among Dialysis Patients Undergoing Hip Fracture
Repair
Authors: Conover Benjamin M, Wukich Dane K, Sambandam Senthil
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundGeriatric hip fractures are strongly correlated with increased morbidity. Even so, postoperative outcomes following surgical repair of hip fractures for patients with end stage renal disease lack extensive investigation. Chronic kidney disease (CKD) poses unique risks for surgical procedures as it has been associated with several complications. Little information is available regarding the outcomes of patients whose renal function decline necessitates dialysis usage. The purpose of this study was to compare post-surgical outcomes based on dialysis usage among CKD patients requiring hip fracture repair.Materials and MethodsWe used the PearlDiver database to identify hip fracture repair patients diagnosed with stages 3, 4, and 5 CKD. We matched the populations according to patient characteristics and comorbidities. We then compared patient complication rates among dialyzed and non-dialyzed CKD patients following hip fracture repair at 30 days, 90 days, and 1 year following the procedure.ResultsDialyzed patients were more likely to experience myocardial infarction within 30 days (P = .02) and 90 days (P = .002). Dialyzed patients suffered cardiac arrest at higher rates within the same time intervals (P = .02; P = .002). Furthermore, dialysis patients developed sepsis (P = .005) and pneumonia (P = .005) at higher rates within 30 days of operation. Dialysis patients did not have increased risk of blood transfusion within 30 days of the operation (P = .07).DiscussionWe found significant increases in myocardial infarction, cardiac arrest, pneumonia, and sepsis risk among dialyzed CKD patients. Blood transfusion risk failed to reach statistical significance. Our findings are consistent with previous research regarding CKD pathophysiology and associated perioperative outcomes.ConclusionGiven the drastic decline of renal function among patients on dialysis, our findings may be attributable to decreased glomerular filtration rate in CKD as well as dialysis itself. Regardless, multidisciplinary collaboration should be employed when performing hip fracture repair on a patient who is actively undergoing hemodialysis.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-17T08:03:33Z
DOI: 10.1177/21514593231195992
Issue No: Vol. 14 (2023)
- Timing of Complications Following Surgery for Distal Femur Fractures in
Older Adults
Authors: Naoko Onizuka, Samuel Farmer, Jessica M. Wiseman, Gabriel Alain, Catherine C. Quatman-Yates, Carmen E. Quatman
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe purpose of this study was to identify the timing and nature of complications associated with distal femur fracture surgery in patients aged 65 and older using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database.MethodsThe ACS NSQIP database was queried for adults aged 65 and older who received surgical treatment for a distal femur fracture between 01 January 2015 and 31 December 2021. Cox regression models and risk tables adjusted for baseline clinical characteristics were created for 14 complications (Superficial Surgical Site Infection (SSI), Deep SSI, Organ/Space SSI, Pneumonia, Pulmonary Embolism (PE), Deep Venous Thrombosis (DVT), Urinary Tract Infection (UTI), Stroke/Cerebrovascular accident (CVA), Myocardial Infarction (MI), Renal Failure, Cardiac Arrest (CA), Re-operation, Sepsis, and Death within 30 days of surgery). Model summaries were used to identify significant variables with a Bonferroni correction applied.ResultsA total of 3956 adults met inclusion criteria and were included in analysis. The most common complications were UTI (5.2%), death (4.1%), and pneumonia (3.4%). Complications typically occurred within 14 days after surgery, except for SSI, which occurred between post-op days 11 and 24.ConclusionsDistal femur fractures are a substantial source of morbidity and mortality in the older adult population. Our findings underscore the need for comprehensive preoperative risk assessment and patient management strategies to mitigate the impact of identified risk factors in this vulnerable population.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-16T12:20:27Z
DOI: 10.1177/21514593231195539
Issue No: Vol. 14 (2023)
- Effects of Mind-Body Exercises for Osteoporosis in Older Adults: A
Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Haili Li, Haobo Jiang, Jingye Wang, Jin Zhou, Hao Liang, Guangxue Chen, Zehua Guo, Shaofeng Yang, Yonghui Zhang
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionOsteoporosis is a major cause of fractures and even life-threatening fractures in the elderly. Mind-body exercise is a beneficial intervention to improve flexibility, control body balance and reduce pain. We aimed to evaluate the effects of physical and mental exercise on osteoporosis in the elderly.MethodsRandomized controlled trials (RCTs) focusing on mind-body exercises for osteoporosis were included. Web of Science, PubMed, Science Direct, Medline, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang were searched from inception to January 2023. Outcomes included bone mineral density (BMD), bone mineral content (BMC), body balance (BB), pain, indicators of bone metabolism (BMI), lower extremity function, fearing level, and quality of life (QOL). The quality of study reporting was rated by 2 reviewers independently, and Review Manager software (version 5.3) was used for meta-analysis.ResultsThirty-nine trials with 2325 participants were included. The pooled results showed that mind-body exercises have encouraging effect on elderly people with osteoporosis, especially in aspects of BMD, BMC, QOL, improving the function of lower extremity, reducing pain and fearing level. While, dance and eight-section brocade could not improve the quality of life,or dance and eight-section brocade have no effect on BMD.ConclusionsMind-body exercises may have potential efficacy for osteoporosis in the elderly. However, due to the poor methodological quality of the included trials, more clinical trials with precise methodological design and rigorous reporting are needed.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-14T10:38:21Z
DOI: 10.1177/21514593231195237
Issue No: Vol. 14 (2023)
- Use of a Hindfoot Nail Without Separate Subtalar and Tibiotalar Joint
Preparation to Treat Geriatric Ankle and Distal Tibia Fractures: A Case
Series
Authors: Priya Duvvuri, Sally May Trout, Christine Decker Bub, Ariel Tenny Goldman
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionAnkle fractures in geriatric patients can be devastating injuries, as they limit an individual’s mobility, autonomy, and quality of life. This study examines the functional outcomes and complications related to hindfoot nails (HFN) in geriatric patients who have suffered an ankle malleolar or distal tibia fracture.Materials and MethodsThis is a single-surgeon case-series of patients who underwent HFN for acute fixation or delayed reconstruction after an ankle or distal tibia fracture. Demographic information, comorbidities, baseline functional status, AO/OTA classification, surgical indications, need for external fixation, total operative time, length of stay (LOS), ambulation at discharge, and discharge disposition were recorded. Primary outcomes included 30-day complications, ambulation at follow-up, and time to fracture union and fusion.ResultsThere were 22 patients, with average age 80.8 years. Mean LOS was 7.0 days, and 68.2% were discharged to subacute rehabilitation. Within 30 days, 1 patient developed a deep vein thrombosis and bilateral pulmonary emboli, and 2 experienced wound dehiscence requiring antibiotics. At 6-weeks, 1 patient sustained a fall with periprosthetic fracture requiring HFN revision, and another developed cellulitis necessitating hardware removal. Fracture healing was seen in 72.7% at 19.4 weeks, while radiographic fusion occurred in 18.2% at 43.0 weeks. 72.7% were ambulating with an assistive device at discharge, and 100.0% at 12-weeks post-operatively or last follow-up. Upon final examination, all patients were ambulating without pain.DiscussionHFNs provide a reliable alternative to traditional open reduction internal fixation and have the ability to improve quality of life for geriatric patients through a faster return to weight-bearing. Additionally, radiographic fusion rates show that patients have favorable functional outcomes even without formal arthrodesis.ConclusionHFN is beneficial for elderly patients with low functional demand and complex medical comorbidities, as it allows for early mobility after sustaining an ankle or distal tibia fracture.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-12T09:18:46Z
DOI: 10.1177/21514593231195239
Issue No: Vol. 14 (2023)
- Psoas Muscle Morphology as a Sarcopenia Marker to Predict Outcomes of
Geriatric Trauma Patients: A Systematic Review and Meta-analysis
Authors: Yang Wang, Lei Li, Qinmei Pan, Ying Zhong, Xinmei Zou
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
ObjectiveTo provide pooled evidence on the association between central sarcopenia and risk of mortality and/or complications among geriatric patients with moderate to severe trauma.MethodsWe conducted a systematic search in PubMed, EMBASE, and Scopus databases for relevant observational studies documenting the association of central sarcopenia with the risk of mortality and/or complications in geriatric patients with moderate to severe trauma. The studies reported computerized tomography (CT) based assessments of the psoas muscle cross-sectional area. We used a random effects model for the analysis and reported effect sizes as pooled odds ratios (ORs) or hazards ratios (HRs) along with 95% confidence intervals.ResultsWe analyzed data from 13 studies and found an association between the presence of psoas muscle size reduction and the risk of in-hospital mortality (OR, 1.47; 95% CI, 1.13, 1.90). In addition, we found increased risk of mortality within 24 months of follow-up in patients with sarcopenia (HR, 2.40; 95% CI, 1.11-5.17). We found each unit increase in psoas muscle cross-sectional area to be significantly associated with reduced risk of mortality within 24 months of follow-up (HR, .92; 95% CI, .90-.95). Patients with sarcopenia also had an increased risk of complications (OR, 1.69; 95% CI, 1.08-2.63).ConclusionCentral sarcopenia, assessed using psoas muscle morphology, among geriatric patients with moderate to severe trauma appears to be significantly associated with increased risks of mortality and complications.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-12T02:27:20Z
DOI: 10.1177/21514593231195244
Issue No: Vol. 14 (2023)
- Prospective Associations Between Fear of Falling, Anxiety, Depression, and
Pain and Functional Outcomes Following Surgery for Intertrochanteric Hip
Fracture
Authors: Mahmut Kalem, Hakan Kocaoğlu, Berker Duman, Ercan Şahin, Yener Yoğun, Sancar A. Ovali
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
ObjectiveFear of falling, anxiety, depression, and pain levels are important risk factors for poor functional outcomes that may potentially be modifiable. We aimed to examine prospective associations between those factors following surgery for intertrochanteric hip fracture.MethodsThis study is a prospective observational cohort study of patients aged over 65 diagnosed with isolated intertrochanteric hip fracture. Three hundred and seventy patients who underwent intramedullary fixation surgery were screened; 188 cases were included in our final evaluation. Patients with any concomitant fracture, major psychiatric/neurocognitive and neurological disorders and those with any other major disease were excluded from the study. Age, Charlson Comorbidity Index (CCI), Geriatric Depression Scale (GDS), State–Trait Anxiety Inventory (STAI), Falls Efficacy Scale International (FES-I), and Visual Analog Scale (VAS) scores on the day of surgery (baseline) were evaluated as predictors of poor/good outcome at 90 days after surgery, by Harris Hip Score (HHS) with a cut-off score of 70.ResultsHHS score was significantly predicted at baseline by the full model [χ2 (7) = 18.18, P = .01]. However, only STAI-state scores were significantly added to the model [Exp (B) 95% CI: .92 (.86-.99)].ConclusionsIn this prospective cohort study, we found that higher levels of anxiety state on the day of surgery predicts a poor outcome at 90 days following surgery. We did not find significant associations between other variables, including age, GDS, STAI-trait, FES-I, VAS, and CCI. This potentially modifiable psychological factor may inform surgeons and could be a potential mediator. Future prospective studies are needed to replicate these findings.Level of evidencePrognostic level I.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-08-04T08:10:59Z
DOI: 10.1177/21514593231193234
Issue No: Vol. 14 (2023)
- Elective Foot and Ankle Procedures in the Patients Greater than 65 Years
of Age: Worth the Mobility Gains
Authors: Wesley Manz, Joseph Novack, Juliet Fink, Joseph Jacobson, Jason Bariteau
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
Chronic, non-traumatic pathologies of the foot and ankle can be mobility-limiting for patients of all ages. The objective of this study was to compare postoperative changes in LifeSpace Mobility Assessment (LSA) scores of adult and elderly patients following elective foot and ankle surgery. A prospective study of 184 patients undergoing elective ankle, hindfoot, and midfoot procedures conducted by one surgeon between 2015 and 2019 was undertaken. Patient-reported LSA scores were collected at preoperative, 6-month, and 12-month follow-up. Patient data was compared using an independent sample t-test for continuous, normally distributed data and a chi-squared or Fischer’s exact test for categorical data. Alpha and beta were .05 and .8. Patients were divided based on age. 140 patients were observed in the younger (
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-07-21T01:52:23Z
DOI: 10.1177/21514593231184316
Issue No: Vol. 14 (2023)
- Frailty and Pre-Frailty in the Setting of Total Joint Arthroplasty: A
Narrative Review
Authors: Adam Pearl, Aya Ismail, Tariq Alsadi, Zachary Crespi, Mohammad Daher, Khaled Saleh
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundTotal joint arthroplasties are among the most common surgical procedures performed in the United States. Although numerous safeguards are in place to optimize patient health and safety pre-, intra-, and postoperatively, patient frailty is often incompletely assessed or not assessed at all. Frailty has been shown to increase rates of adverse events and length of stay. We discuss the impact of frailty on patient outcomes and healthcare economics as well as provide widely accepted models to assess frailty and their optimal usage.MethodsSeveral databases were searched using the keywords “frailty,” “TJA,” “THA,” “frailty index,” “frailty assessment,” and “frailty risk.” A total of 45 articles were used in this literature review.ResultsIt is estimated that nearly half of patients over the age of 85 meet criteria for frailty. Frailty in surgical patients has been shown to increase total costs as well as length of stay. Additionally, increased rates of numerous adverse events are associated with increased frailty.ConclusionsThe literature demonstrates that frailty poses increased risk of adverse events, increased length of stay, and increased cost. There are several models that accurately assess frailty and can feasibly be implemented into preoperative screening.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-07-10T12:51:48Z
DOI: 10.1177/21514593231188864
Issue No: Vol. 14 (2023)
- Compensation Claims After Hip Fracture Surgery in Norway 2008-2018
Authors: John Magne Hoseth, Tommy Frøseth Aae, Rune Bruhn Jakobsen, Anne Marie Fenstad, Ida Rashida Khan Bukholm, Jan-Erik Gjertsen, Per-Henrik Randsborg
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundSurgical complications contribute to the significant mortality following hip fractures in the elderly. The purpose of this study was to increase our knowledge of surgical complications by evaluating compensation claims following hip fracture surgery in Norway. Further, we investigated whether the size and location of performing institutions would influence surgical complications.MethodsWe collected data from the Norwegian System of Patient Injury Compensation (NPE) and the Norwegian Hip Fracture Register (NHFR) from 2008 to 2018. We classified institutions into 4 categories based on annual procedure volume and geographical location.Results90,601 hip fractures were registered in NHFR. NPE received 616 (.7%) claims. Of these, 221 (36%) were accepted, which accounts for .2% of all hip fractures. Men had nearly a doubled risk of ending with a compensation claim compared to women (OR: 1.8, CI, 1.4-2.4, P < .001). Hospital-acquired infection was the most frequent reason for accepted claims (27%). However, claims were rejected if patients had underlying conditions predisposing to infection. Institutions treating fewer than 152 hip fractures (first quartile) annually, had a statistically significant increased risk (OR: 1.9, CI, 1.3-2.8, P = .005) for accepted claims compared to higher volume facilities.DiscussionThe fewer registered claims in our study could be due to the relatively high early mortality and frailty in this patient group, which may decrease the likelihood of filing a complaint. Men could have undetected underlying predisposing conditions that lead to increased risk of complications. Hospital-acquired infection may be the most significant complication following hip fracture surgery in Norway. Lastly, the number of procedures performed annually in an institution influences compensation claims.ConclusionsOur findings indicate that hospital acquired infections need greater focus following hip fracture surgery, especially in men. Lower volume hospitals may be a risk factor.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-07-08T04:17:40Z
DOI: 10.1177/21514593231188623
Issue No: Vol. 14 (2023)
- Peripheral Nerve Block and Peri-operative Neurocognitive Disorders in
Authors: Bin Jia, Yiyang Tang, Chenpu Wei, Gaofeng Zhao, Xiangyu Li, Yongyong Shi
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundPoor pain control and opioid use are risk factors for perioperative neurocognitive disorders (PND). The peripheral nerve block (PNB) can reduce pain and opioid consumption. This systematic review aimed to investigate the effects of PNB on PND in older patients with hip fractures.MethodsThe PubMed, Cochrane Central Registers of Controlled Trial, Embase and ClinicalTrials.gov databases were searched from inception until November 19, 2021 for all randomized controlled trials (RCTs) comparing PNB with analgesics. The quality of the selected studies was assessed according to Version 2 of the Cochrane tool for assessing the risk of bias in RCTs. The primary outcome was the incidence of PND. Secondary outcomes included pain intensity and the incidence of postoperative nausea and vomiting. Subgroup analyses were based on population characteristics, type and infusion method of local anesthetics, and type of PNB.ResultsEight RCTs comprising 1015 older patients with hip fractures were included. Compared with analgesics, PNB did not reduce the incidence of PND in the elderly hip fracture population comprising patients with intact cognition and those with pre-existing dementia or cognitive impairment (risk ratio [RR] = .67; 95% confidence interval [CI] = .42 to 1.08; P = .10; I2 = 64%). However, PNB reduced the incidence of PND in older patients with intact cognition (RR = .61; 95% CI = .41 to .91; P = .02; I2 = 0%). Fascia iliaca compartment block, bupivacaine, and continuous infusion of local anesthetics were found to reduce the incidence of PND.ConclusionsPNB effectively reduced PND in older patients with hip fractures and intact cognition. When the study population included patients with intact cognition and those with pre-existing dementia or cognitive impairment, PNB showed no reduction in the incidence of PND. These conclusions should be confirmed with larger, higher-quality RCTs.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-07-04T11:41:03Z
DOI: 10.1177/21514593231186722
Issue No: Vol. 14 (2023)
- Leg Length Discrepancy After Hip Fracture Repair is Associated With
Reduced Gait Speed
Authors: Alexa N. Pearce, Frederick E. Sieber, Nae-Yuh Wang, Jeffrey B. Stambough, Benjamin M. Stronach, Simon C. Mears
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionA negative correlation exists between functional outcomes and leg length discrepancy (LLD) following hip fracture repair. We have assessed the effects of LLD following hip fracture repair in elderly patients on 3-meter walking time, standing time, activities of daily living (ADL), and instrumental activities of daily living (IADL).MethodsOne hundred sixty-nine patients enrolled in the STRIDE trial were identified with femoral neck, intertrochanteric, and subtrochanteric fractures that were treated with partial hip replacement, total hip replacement, cannulated screws, or intramedullary nail. Baseline patient characteristics recorded included age, sex, body mass index Charlson comorbidity index (CCI) score. ADL, IADL, grip strength, sit-to-stand time, 3-meter walking time and return to ambulation status were measured at 1 year after surgery. LLD was measured on final follow-up radiographs by either the sliding screw telescoping distance or the difference from a trans-ischial line to the lesser trochanters, and was analyzed as a continuous variable using regression analysis.ResultsEighty eight patients (52%) had LLD 10 mm. Age, sex, BMI, Charlson score, and ambulation status had no significant impact on LLD occurrence. Type of procedure and fracture type did not correlate with severity of LLD. Having a larger LLD was not found to have a significant impact on post-operative ADL (P = .60), IADL (P = .08), sit-to-stand time (P = .90), grip strength (P = .14) and return to former ambulation status (P = .60), but did have a statistically significant impact on 3-meter walking time (P = .006).DiscussionLLD after hip fracture was associated with reduced gait speed but did not affect many parameters associated with recovery. Continued efforts to restore leg length after hip fracture repair are likely to be beneficial.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-26T11:14:05Z
DOI: 10.1177/21514593231186724
Issue No: Vol. 14 (2023)
- Mid-Term Follow-Up Results After Hemiarthroplasty Using Long Femoral Stem
Prosthesis (Peerless-160) for Intertrochanteric Fractures in Octogenarians
Authors: Qiang Mao, Yi Zhang, Jiang Hua, Bangjian He
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
PurposeTo analyze the clinical effect and imaging data of cementless bipolar hemiarthroplasty employing a long femoral stem (peerless-160) and 2 reconstructed femoral titanium wires to repair intertrochanteric fractures among the octogenarians.MethodsBetween June 2014 and August 2016, 58 octogenarians with femoral intertrochanteric fractures underwent the long femoral stem (peerless-160) cementless bipolar hemiarthroplasty by the same surgeon. We assessed clinical and radiological outcomes such as operative time, bleeding volume, blood transfusion volume, length of hospital stay, full weight-bearing walking time, walking ability calculated by Koval classification and Harris Hip Score (HHS), including fracture healing and greater trochanter fragments subsidence.ResultThe surgery was successfully performed in all patients. The average operation time was 72.8 ± 13.2 min, the average blood loss during surgery was 225.0 ± 91.4 mL, 200 mL of blood was transfused, the mean duration of hospitalization was 11.9 ± 4.0 days, the mean time of full weight bearing was 12.5 ± 3.8 days. Patients were followed up for 24-68 months, averagely 49.4 ± 10.3 months. During follow-up, 4 (6.9%) patients died, and 1 (1.7%) was completely lost to ask about the recent situation. The average Harris Hip Score at the last follow-up was 87.8 ± 6.1, most of the patients recovered walking ability, under radiological examination, the prosthesis showed no signs of loosening. All trochanteric fractures gradually healed, the clinical and radiographic signs of healing occurred at average of 4.0 ± 1.1 months postoperatively.ConclusionFor osteoporotic unstable intertrochanteric fractures in octogenarians, this study confirmed that the Cementless Bipolar Hemiarthroplasty Using a Long Femoral stem (peerless-160) with double cross binding technique is a satisfactory and safe choice for the octogenarians.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-19T04:11:22Z
DOI: 10.1177/21514593231184314
Issue No: Vol. 14 (2023)
- Preoperative Hemoglobin
Authors: Min Li, Chen Chen, Jiang Shen, Linyi Yang
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundPreoperative anemia has been associated with perioperative morbidity and mortality in patients undergoing cardiac and non-cardiac surgery. Preoperative anemia is common in elderly hip fracture patients. The primary objective of the study was to explore the relationship between preoperative hemoglobin levels and postoperative major adverse cardiovascular events (MACEs) in hip fracture patients over 80 years.MethodsThe retrospective study enrolled hip fracture patients over 80 years from January 2015 to December 2021 in our center. The data were collected from the hospital’s electronic database after approval by the ethics committee. The primary objective of the study was to investigate MACEs, and the secondary objectives included in-hospital mortality, delirium, acute renal failure, ICU admission rate, and transfusion (>2 U).Results912 patients were entered for final analysis. Based on the restricted cubic spline, the risk of preoperative hemoglobin (2 U rate [OR 2.002, 95% CI (1.516, 2.65), P < .001] were still higher in the lower hemoglobin level cohort. Moreover, a log-rank test showed increased in-hospital mortality in the cohort with a preoperative hemoglobin level of
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-10T08:41:14Z
DOI: 10.1177/21514593231183611
Issue No: Vol. 14 (2023)
- Tranexamic Acid Treatment Reduces Blood Loss After Elective and
Semi-Urgent Reverse Total Shoulder Arthroplasty
Authors: Shaul Beyth, Gabriel Fraind-Maya, Ori Safran
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionPost operative blood loss after reverse shoulder arthroplasty (RSA) is associated with the need for blood transfusion and prolonged hospital stay, among other complications. Tranexamic acid (TXA) reduces perioperative blood loss and is effective when delivered systemically or locally. We compared the effects of TXA on perioperative blood loss between elective and semi-urgent RSA.MethodsWe retrospectively reviewed patients who underwent either elective or semi-urgent RSA for fracture repair, with and without TXA treatment. Demographics, clinical records, and laboratory results were collected and analyzed to compare peripheral blood hemoglobin concentrations before and after surgery, the need for blood transfusion, and length of hospital stay between the 2 groups.ResultsIn a cohort of 158 patients, 91 (58%) underwent elective RSA. TXA was administered in 91 (58%) patients from the entire group. TXA administration was associated with a significant decrease in post operative hemoglobin concentration reduction in both the elective and fracture groups (P = .026 and P = .018, respectively), a significant decrease in post operative blood transfusion rates (P = .004 and P = .003, respectively), and a decrease in the need for prolonged hospitalization (P = .038 and P = .009, respectively).DiscussionThe local application of TXA during RSA yielded a significant reduction in perioperative blood loss. We showed a significant positive effect of local TXA administration during RSA that is comparable for both elective and semi-urgent patients. Due to the baseline characteristics of fracture patients, their clinical benefits may be more notable.ConclusionsThe positive outcomes for surgical patients with the use of TXA during RSA can possibly cause future consideration in clinical practice.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-09T03:32:33Z
DOI: 10.1177/21514593231181992
Issue No: Vol. 14 (2023)
- Implementation of a Multidisciplinary Preoperative Protocol for Geriatric
Hip Fractures Improves Time to Surgery at a Level III Trauma Center
Authors: Jacob R. Meyer, Ryan E. Earnest, Brian M. Johnson, Andrew M. Steffensmeier, Dheer A. Vyas, Richard T. Laughlin
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionHip fractures are common among the elderly, and delays in time to surgery (TTS) and length of stay (LOS) are known to increase mortality risk in these patients. Preoperative multidisciplinary protocols for hip fracture management are effective at larger trauma hospitals. The purpose of this study is to evaluate the effect of a similar multidisciplinary preoperative protocol for geriatric hip fracture patients at our Level III trauma center.Materials and MethodsIn this single-center retrospective study, patients aged 65 and older who were admitted from March 2016 to December 2018 (pre-protocol group, Cohort #1, n = 247) and from August 2021 to September 2022 (post-protocol group, Cohort #2, n = 169) were included. Demographic information, TTS, and LOS were obtained and compared using Student’s t-test and Chi-square testing.ResultsThere was a significant decrease in TTS in Cohort #2 compared to Cohort #1 (P < .001). There was a significant increase in LOS in Cohort #2 compared to Cohort #1 (P < .05), but when comparing a subset of Cohort #2 (Subgroup 2B, patients admitted from May to September 2022 when the effects of COVID-19 were likely dissipated) to Cohort #1, there was no significant difference in LOS (P = .13). For patients admitted to skilled nursing facilities (SNF), LOS in Cohort #2 was significantly longer than in Cohort #1 (P = .001).DiscussionIn general, Level III hospitals have fewer perioperative resources compared to larger Level I hospitals. Despite this fact, this multidisciplinary preoperative protocol effectively reduced TTS which improves mortality risk in elderly patients. LOS is a multifactorial variable, and we believe the COVID-19 pandemic was a significant confounder that reduced available SNF beds in our area which prolonged the average LOS in Cohort #2.ConclusionA multidisciplinary preoperative protocol for geriatric hip fracture management can improve efficiency of getting patients to surgery at Level III trauma centers.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-08T12:11:38Z
DOI: 10.1177/21514593231181991
Issue No: Vol. 14 (2023)
- Percutaneous Curved Vertebroplasty and Bilateral-Pedicle-Approach
Percutaneous Vertebroplasty in the Treatment of Osteoporotic Vertebral
Compression Fracture: A Meta-Analysis
Authors: Yanxing He, Zhentang Yu, Jianjian Yin, Hao Wang, Nanwei Xu, Luming Nong, Yuqing Jiang
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe aim of this study was to evaluate the use of percutaneous curved vertebroplasty procedure (PCVP) and bilateral-pedicle-approach percutaneous vertebroplasty (bPVP) for the treatment of osteoporotic vertebral compression fractures (OVCFs) through a systematic review and meta-analysis of the scientific literature.MethodsA systematic review of the scientific literature in PubMed, China National Knowledge Infrastructure (CNKI), Wanfang and other databases was conducted in conjunction with different keywords. Nine studies were included; all but 3 were randomised controlled studies and all were prospective or retrospective cohort studies.ResultsWe observed statistically significant differences between the PCVP group and the bPCVP group in terms of postoperative visual analogue scale (VAS) scores (mean difference [MD]: −.08; 95% confidence intervals [CI]: −.15 to .00), bone cement leakage rates (OR = .33; 95%CI: .20 to .54), bone cement injection (MD: −1.52; 95%CI: −1.58 to 1.45), operative times (MD: −16.69; 95%CI: −17.40 to −15.99) and intraoperative fluoroscopies (MD: −8.16; 95%CI: −9.56 to −6.67), with the PCVP group being more dominant. There were no statistical differences in postoperative Oswestry Disability Index (ODI) scores (MD: −.72; 95%CI: −2.11 to .67) and overall bone cement distribution rates (MD: 2.14; 95%CI: .99 to 4.65) between the 2 groups.ConclusionsMeta-analysis showed more favourable outcomes in the PCVP group compared to the bPVP group. PCVP might be effective and safe in the treatment of OVCFs because it relieves postoperative patient pain, reduces operative time and cement injection, and decreases the risk of cement leakage and radiation exposure to the surgeon and patient.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-08T08:58:14Z
DOI: 10.1177/21514593231182533
Issue No: Vol. 14 (2023)
- Rehabilitation after Hip Fracture Surgery Improves Physical and Cognitive
Function in Patients with or Without Sarcopenia
Authors: Yuji Kanaya, Hirokazu Inoue, Hideaki Sawamura, Yuichi Hoshino, Katsushi Takeshita
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionSarcopenia is a prevalent risk factor for falls and fractures, and it affects the physical function and mortality of older people. The present study was performed to assess the prevalence of sarcopenia in patients who underwent rehabilitation after hip fracture surgery and to examine the association of sarcopenia with physical and cognitive function outcomes.MethodsThis case–control study involved 132 patients who were admitted to a convalescent rehabilitation ward at a single hospital after surgical treatment of hip fractures from April 2018 to March 2020. The skeletal muscle mass index was examined using whole-body dual-energy X-ray absorptiometry. The Asian Working Group for Sarcopenia 2019 diagnostic criteria were applied on admission. We compared the walking speed, Mini-Mental State Examination (MMSE) score, and Functional Independence Measure (FIM) score between the sarcopenia group and non-sarcopenia group on admission and on discharge.ResultsThe prevalence of sarcopenia was 59.8%. In the non-sarcopenia group, the walking speed, MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly lower on admission than those on discharge (P < .05). In the sarcopenia group, the walking speed, MMSE score, FIM total score, and FIM motor score were significantly lower on admission than those on discharge (P < .05); there was no significant difference in the FIM cognitive score between admission and discharge. On both admission and discharge, the MMSE score, FIM total score, FIM motor score, and FIM cognitive score were significantly better in the non-sarcopenia group than those in the sarcopenia group.ConclusionsAfter postoperative rehabilitation of hip fractures in patients with and without sarcopenia, physical and cognitive function outcomes on discharge were significantly better than those on admission. Patients with sarcopenia had significantly worse physical and cognitive function outcomes than patients without sarcopenia both on admission and on discharge.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-06T07:02:11Z
DOI: 10.1177/21514593231181988
Issue No: Vol. 14 (2023)
- Osteoporosis in the Setting of Shoulder Arthroplasty: A Narrative Review
Authors: Mohammad Daher, Mohamad Y. Fares, Peter Boufadel, Akshay Khanna, Ziad Zalaquett, Joseph A. Abboud
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
Patients who undergo shoulder surgery are frequently affected by osteoporosis and osteopenia, and the prevalence of this association is expected to increase due to the growing number of elderly individuals undergoing these procedures. It may be advisable to conduct a preoperative DXA scan for orthopedic surgical candidates at high risk, to detect those who could benefit from early intervention and avoid any related adverse events. Some of these complications include periprosthetic fractures, infection, subsequent fragility fractures, and have an all-cause revision arthroplasty at 2 years post-op. Some studies analyzed the beneficence of antiresorptive medications pre-operatively but the latter did not show favorable outcomes. Surgical management may include cementing components of the prosthesis as well as modifying the diameter of the shoulder stem. Nevertheless, more studies are needed to evaluate the efficacy of any intervention, whether medical or surgical, to avoid any shoulder arthroplasty related-complication that may be precipitated by the reduced bone mineral density.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-06-05T04:59:40Z
DOI: 10.1177/21514593231182527
Issue No: Vol. 14 (2023)
- Prediction of Non-Home Discharge Following Total Hip Arthroplasty in
Geriatric Patients
Authors: Teja Yeramosu, Jacob Wait, Stephen L. Kates, Gregory J. Golladay, Nirav K. Patel, Jibanananda Satpathy
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe majority of total hip arthroplasty (THA) patients are discharged home postoperatively, however, many still require continued medical care. We aimed to identify important characteristics that predict nonhome discharge in geriatric patients undergoing THA using machine learning. We hypothesize that our analyses will identify variables associated with decreased functional status and overall health to be predictive of non-home discharge.Materials and MethodsElective, unilateral, THA patients above 65 years of age were isolated in the NSQIP database from 2018-2020. Demographic, pre-operative, and intraoperative variables were analyzed. After splitting the data into training (75%) and validation (25%) data sets, various machine learning models were used to predict non-home discharge. The model with the best area under the curve (AUC) was further assessed to identify the most important variables.ResultsIn total, 19,840 geriatric patients undergoing THA were included in the final analyses, of which 5194 (26.2%) were discharged to a non-home setting. The RF model performed the best and identified age above 78 years (OR: 1.08 [1.07, 1.09], P < .0001), as the most important variable when predicting non-home discharge in geriatric patients with THA, followed by severe American Society of Anesthesiologists grade (OR: 1.94 [1.80, 2.10], P < .0001), operation time (OR: 1.01 [1.00, 1.02], P < .0001), anemia (OR: 2.20 [1.87, 2.58], P < .0001), and general anesthesia (OR: 1.64 [1.52, 1.79], P < .0001). Each of these variables was also significant in MLR analysis. The RF model displayed good discrimination with AUC = .831.DiscussionThe RF model revealed clinically important variables for assessing discharge disposition in geriatric patients undergoing THA, with the five most important factors being older age, severe ASA grade, longer operation time, anemia, and general anesthesia.ConclusionsWith the rising emphasis on patient-centered care, incorporating models such as these may allow for preoperative risk factor mitigation and reductions in healthcare expenditure.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-05-26T12:53:21Z
DOI: 10.1177/21514593231179316
Issue No: Vol. 14 (2023)
- Management and Outcome of Elderly Patients With Patellar Fracture Treated
With Novel Modified Cerclage Wiring
Authors: Lin Li, Qing Zhang, Fulin Tao, Dawei Wang, Jinlei Dong, Dongsheng Zhou, Wenhao Song
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe purpose of this study is to assess the efficacy and security of a fixation method for fixing patellar fractures in elderly patients utilizing modified cerclage wire.MethodsFrom January 2015 to December 2020, 31 cases (age≥65 years old) of closed patellar fracture were treated by modified cerclage wiring. Patients in these instances ranged in age from 65 to 87 (73.7 ± 7.2 years), with 15 men and 16 women. 4 instances were type 34-C1 (transverse fracture) according to the AO/OTA classification, 27 cases (87%) were comminuted fractures, including 11 cases that were type 34-C2 (3 fragments), and 16 cases that were type 34-C3 (more than 3 fragments). Postoperative problems such as fragment re-displacement, nonunion, internal fixation loosening, infection, and internal fixation rupture were evaluated. The clinical grading systems of Böstman were used to assess the postoperative clinical outcomes.ResultsThirty one patients in all were monitored for 14 to 31 months (22.2 ± 4.5 months). After the procedure, the fracture took 2.5-3.5 months (2.92 ± .25 months) to heal. There were no postoperative issues like infection, dislocation, implant breakage, uncomfortable hardware, or post-traumatic osteoarthritis. According to the clinical grading scales of Böstman, the average score of the final follow-up was 28.6 ± 1.1 (range 26-30). 29 (94%) of the patients had excellent results, whereas just 2 (6%) had good results. The patient’s knee flexion activity ranged from 110 to 140°, making for a favorable prognosis.ConclusionMost patella fractures in the elderly are comminuted. Elderly patients with patellar fractures may be successfully treated with modified cerclage wire, with good results and no noticeable side effects.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-05-25T04:26:44Z
DOI: 10.1177/21514593231177983
Issue No: Vol. 14 (2023)
- Total Hip Arthroplasty in Nonagenarians – A National In-Patient
Sample-Based Study of Perioperative Complications
Authors: Nikit Venishetty, Michel Toutoungy, Jack Beale, Jack Martinez, Dane K. Wukich, Varatharaj Mounasamy, Michael H. Huo, Senthil Sambandam
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundNonagenarians are a rapidly expanding population in the United States. These patients are met with increasing rates of hip arthritis, necessitating the need for total hip arthroplasty (THA). However, there is currently limited information on hospitalization information and perioperative complications in this population. Methods: In this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016-2019 to analyze the incidence of perioperative complications, length of stay (LOS), and the cost of care (COC) among patients undergoing THAs who were categorized as nonagenarians, and those who were not.ResultsThe NIS database identified 309 100 patients who underwent THAs from 2016-2019. Of those, 1864 patients (.6%) were nonagenarian, while the remaining 307 236 patients were included under the non-nonagenarian category (control). The mean age in the nonagenarian group was 90 years compared to the control group which had a mean age of 65.8 years. There was an increased incidence of mortality rate (nonagenarian group .2%, control group .03%, P < .001), myocardial infarction (MI) (nonagenarian group .1%, control group .02%, P = .01), acute renal failure (ARF) (nonagenarian group 5.4%, control group 1.6%, P < .001), blood anemia post-operatively (nonagenarian group 28.9%, control group 17.2%, P < .001), and deep vein thrombosis (DVT) (nonagenarian group .48%, control group .07%, P < .001) in the nonagenarian group. The COC for the nonagenarian group was higher than that in the control group (P < .001). The mean LOS was longer in the nonagenarian group (3.1 days) in comparison to the control group (1.96 days) (P < .001).ConclusionsNonagenarians had significantly higher rates of both orthopedics and medical complications than the younger patients undergoing THAs. In addition, the nonagenarian group incurred higher COC. This information is useful for the providers to make informed decisions regarding patient care and resource utilization for nonagenarian patients undergoing THAs.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-05-22T11:14:15Z
DOI: 10.1177/21514593231178624
Issue No: Vol. 14 (2023)
- Functional Outcomes of Anterior-Based Muscle Sparing Approach Compared to
Direct Lateral Approach for Total HIP Arthroplasty Following Acute Femoral
Neck Fractures
Authors: Matteo Innocenti, Andrea Cozzi Lepri, Alessandro Civinini, Nicola Mondanelli, Fabrizio Matassi, Davide Stimolo, Simone Cerciello, Roberto Civinini
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionTotal hip arthroplasty (THA) performed for femoral neck fractures (FNFs) is becoming a more frequent treatment in the active elderly population. Since there is limited research available presenting clinical outcomes after THA using the anterior-based muscle sparing (ABMS) approach, the aim of this study was to compare this surgical approach to the direct lateral (DL) approach in patients treated by THA for FNFs.Materials and MethodsWe retrospectively reviewed the data prospectively collected as a part of our “Hip Fracture Unit” and included 163 patients who underwent THA from January 2016 to January 2019 for acute displaced FNFs.ResultsA total of 132 patients who completed a minimum 2-years follow up (69 in the ABMS group and 63 in DL group) were included. The ABMS group demonstrated significantly shorter time to reach milestone for hospital discharge (1.5 Days vs 2.1 days, P = .018), while no statistically significant differences were detected in peri-operative complications. At 3 months, the timed up and go test, the Harris Hip Score (HHS) and the Oxford ip Score (OHS) were significantly better (P = .024, .032 and .034, respectively) in the ABMS group compared to the DL group. No differences were found in functional outcomes (HHS and OHS) nor in complication rate at 6, 12 and 24 months.DiscussionThis is one of the first studies to analyze functional results of THA performed for FNFs through an ABMS approach. Results are in line with those already present in the Literature.ConclusionABMS approach allows earlier mobilization and better early functional outcomes, compared to DL approach, in patients undergoing THA for acute displaced FNF. No differences are found after 6 months in functional results and complications rate.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-05-05T05:02:39Z
DOI: 10.1177/21514593231170844
Issue No: Vol. 14 (2023)
- Fixation of Proximal Third Humeral Shaft Fractures in Older Patients
Authors: Jared Quarcoopome, John Adam, Bence Baljer, Ahmed Nagi, Will Eardley, James L. McVie
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundHumeral shaft fractures occur frequently in older patients. The more proximal end of the shaft is prone to non-union when compared with more distal fractures. We provide an overview of several key features of this significant patient group.MethodOur institutional fracture database was searched for all cases of proximal third humeral shaft fractures in patients over 60 years of age. Retrospective evaluation of patient demographics, management, length of stay and incidence of non-union was performed.Results75 patients (61 female) were analysed. 33 patients were ‘frail’ (Clinical Frailty Scores of>4). Non-union occurred in 19 of 45 non-surgically treated fractures and in 1 of 37 cases treated surgically. Mean length of stay was 5.9 days (non-operative) and 6.6 days (operative). Proximal extension into the humeral head is common.ConclusionNon-surgical management of proximal third humeral shaft fractures is associated with an increased risk of non-union. We detail an operative technique and case example supporting early fixation of displaced proximal third humeral shaft fractures in older patients that can be utilized for both primary and delayed fixation. In view of the significant association of non-union a well-constructed prospective cohort study with outcome assessment would be of value to further characterize this emerging injury population.Level of Evidence: Level IV, retrospective case series
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-21T02:52:21Z
DOI: 10.1177/21514593231164246
Issue No: Vol. 14 (2023)
- Impact of COVID-19 Pandemic on Treatment and Outcome of Fragility Hip
Fractures In Non-COVID Patients: Comparison Between the Lockdown Period, a
Historical Series and the “Pandemic Normality” in a Single Institution
Authors: Elisa Troiano, Alice Giulia De Sensi, Francesco Zanasi, Andrea Facchini, Giulia De Marco, Giovanni Battista Colasanti, Nicola Mondanelli, Stefano Giannotti
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe COVID-19 pandemic has affected and is still deeply affecting all aspects of public life. World governments have been forced to enact restrictive measures to stem the contagion which have led to a decrease in the movement of people within national territory and to a redirection of health care resources with a suspension of non-urgent procedures. In Italy, a lockdown was imposed from March 9th to May 3rd, 2020. As a result, a significant reduction in the overall operative volume of orthopedic trauma was expected, but it was not possible to predict a similar trend regarding fragility fractures of the proximal femur in the elderly.MethodsThe aim of this paper was to examine the impact of COVID-19 on the operating volume for trauma surgeries and to determine how the pandemic affected the management of fragility hip fractures (FHFs) in non-COVID patients at a single Institution.ResultsThe first result was a statistically significant reduction in the overall operative volume of orthopedic trauma during the period of the first lockdown and an increase in the mean age of patients undergoing surgery, as expected. As regard to the second aim, the incidence of FHFs remained almost unchanged during the periods analysed. The population examined were superimposable in terms of demographics, comorbidities, type of fracture, peri-operative complications, percentage of operations performed within 48 hours from hospitalization and 1-year outcome.DiscussionOur results are in line with those already present in the Literature.ConclusionsOur study revealed a significant impact of the restrictive anti-contagion measures on the overall orthopedic surgical volume, but, at the same time, we could affirm that the pandemic did not affect the management of FHFs in non-COVID patients, and their results.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-18T03:07:16Z
DOI: 10.1177/21514593231152420
Issue No: Vol. 14 (2023)
- Atypical Vancouver B1 Periprosthetic Fractures: The Unsolved Problem
Authors: Giovanni Vicenti, Giuseppe Solarino, Guglielmo Ottaviani, Massimiliano Carrozzo, Filippo Simone, Giacomo Zavattini, Domenico Zaccari, Claudio Buono, Davide Bizzoca, Giuseppe Maccagnano, Biagio Moretti
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
Atypical femoral fractures (AFF) are stress or insufficiency fractures induced by low energy trauma or no trauma, frequently correlated with prolonged bisphosphonate therapy. The diagnosis follows major and minor criteria, originally described by the Task Force of the American Society for Bone and Mineral Research in 2010 and updated in 2014. However, the definition of AFFs in the report excluded periprosthetic fractures. When atypical fractures occur close to a prosthetic implant the situation become critical, the surgical treatment is often demolitive and supported by medical treatment. Moreover, acute ORIF as a first line treatment is frequently burdened by a high failure rate , and often a stem revision is required as second line treatment. The healing process is long and difficult with poor functional results and impairing outcomes. We present a case treated at our institution of a 78 year old woman with a history of a femoral atypical periprosthetic fracture, complicated by multiple surgical revisions. Its arduous management reflects all the difficulties that these type of fractures could present to the surgeon, while its good final result may teach us how to approach them in a correct way.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-17T09:52:18Z
DOI: 10.1177/21514593221145884
Issue No: Vol. 14 (2023)
- Reoperation Rate of Internal Fixation for Femoral Neck Fractures in the
Elderly – A Retrospective Follow-Up Study in 116 Patients With an
Exploration of Risk Factors
Authors: Viktor Labmayr, Andrea Borenich, Thomas Pusch, Patrick Reinbacher, Georg Hauer, Patrick Sadoghi, Andreas Leithner, Andrea Berghold, Paul Puchwein
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
AimInternal fixation of femoral neck fractures is a widely used procedure that is comparatively less invasive and faster than hip replacement. While head preserving internal fixation of these fractures are still preferred where feasible, a faster recovery and lower reoperation rates make arthroplasty increasingly more appealing, in spite of being a more invasive option. Our aim was to determine the reoperation rate after internal fixation at our institution and to explore relevant risk factors in a geriatric population.MethodsThis monocentric follow-up study was conducted analyzing 116 patients aged 65 and older with femoral neck fractures who were surgically treated with either cancellous screws or dynamic hip screws between 2010 and 2017. We retrospectively collected longitudinal data from our patient database, supplemented by a telephone survey, with a follow-up period of at least 18 months.ResultsTwenty reoperations, due to either a failure of fixation, avascular necrosis, or posttraumatic osteoarthritis, were identified in our cohort, which constituted a reoperation rate of 17.2% (20/116). Fracture displacement was significantly associated with the reoperation risk (HR 8, CI 3-20; P < .001). The reoperation rate was 52.2% in displaced fractures vs 8.9% in undisplaced fractures. No link was found between the reoperation rate and gender, age, BMI, ASA score, type of implant, quality of internal fixation, type of living accommodation, and pre-fracture mobility.ConclusionInternal fixation has been found to be an effective option in elderly patients with undisplaced fractures regardless of their specific age, cognitive ability or physical condition. In displaced fractures the reoperation rate was found to be high, therefore a primary hip replacement should be recommended.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-11T05:37:20Z
DOI: 10.1177/21514593231164105
Issue No: Vol. 14 (2023)
- Mobility and Hip Function Among Geriatric Patients With Displaced Neck of
Femur Fractures Treated With Arthroplasty
Authors: Jade Pei Yuik Ho, Amy Yoke Foong Wong, Lik Han Ong, Ankimtay Rutel, Sabaruddin Abdullah, Mohd Shahrul Azuan Jaffar, Chun Haw Bong, Kean Tee Tan, Reuben Prashant Rao, Faris Kamaruddin
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundNeck of femur fractures result in impaired function for older people. Despite surgery, many patients experience a decrease in functional level and poorer health status after the injury. The objectives of this study were (1) to determine the short-term mobility and hip function of geriatric patients who underwent hip replacement surgery for a displaced neck of femur fracture in our local population and (2) to identify factors which affect the functional outcome of these patients.MethodsPatients aged 60 years and above, who were admitted for neck of femur fracture from January 2017 to December 2020, and treated surgically with arthroplasty, were included. Information on patient demography, comorbidities, perioperative data, mobility, hip function and complications were retrospectively collected. Outcome measures used were independent ambulation and recovery of pre-fracture mobility at 1 year after surgery while hip function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, pain, stiffness, and physical function scores. Factors associated with these outcomes were analyzed.Results168 patients with a mean age of 75.2 (SD 8.4) years met the inclusion criteria. 32.1% of patients regained their pre-fracture mobility and 59.6% remained independent 1 year after surgery. Logistic regression analysis identified age, gender, surgical procedure, and time to surgery as significant contributors to recovery of pre-fracture mobility. Older age and increasing requirement for postoperative ambulatory aid resulted in worse WOMAC total and physical function scores. No significant differences were observed in patient-reported hip function between those who had a total hip arthroplasty and those who had a hemiarthroplasty.ConclusionMost geriatric patients with displaced neck of femur fractures did not regain pre-fracture mobility despite surgical treatment with arthroplasty.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-10T01:39:04Z
DOI: 10.1177/21514593231164245
Issue No: Vol. 14 (2023)
- Using an Internal Joint Stabilizer Through a Single Posterior Approach for
Elderly Patients With Terrible Triad Injury
Authors: Yen-Chun Chiu, Chin-Hsien Wu, Kun-Ling Tsai, I-Ming Jou, Yuan-Kun Tu, Ching-Hou Ma
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionTreating a terrible triad injury of the elbow remains a challenge for orthopedic surgeons, especially in elderly patients due to the poor quality of the surrounding soft tissue and bony structures. In the present study, we propose a treatment protocol using an internal joint stabilizer through a single posterior approach and analyze the clinical results.Materials and MethodsWe retrospectively reviewed 15 elderly patients with terrible triad injuries of the elbow who underwent our treatment protocol from January 2015 to December 2020. The surgery involved a posterior approach, identification of the ulnar nerve, bone and ligament reconstruction, and the application of the internal joint stabilizer. A rehabilitation program was initiated immediately after the operation. Surgery-related complications, elbow range of motion (ROM), and functional outcomes were evaluated.ResultsThe mean follow-up period was 21.7 months (range, 16-36 months). ROM at the final follow-up was 130° in extension to flexion and 164° in pronation to supination. The mean Mayo Elbow Performance Score was 94 at the final follow-up. Major complications included breaking of the internal joint stabilizer in 2 patients, transient numbness over the ulnar nerve territory in one, and local infection due to irritation of the internal joint stabilizer in one.ConclusionsAlthough the current study involved only a small number of patients and the protocol comprised two stages of operation, we believe that such a technique may be a valuable alternative for the treatment of these difficult cases.Level of Clinical Evidence4.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-06T07:53:20Z
DOI: 10.1177/21514593231162193
Issue No: Vol. 14 (2023)
- Rapidly Progressing Dysphagia After Thoracic Spinal Cord Injury in a
Patient With Ankylosing Spondylitis: A Case Report
Authors: Beom Su Kim, So Young Lee, Jun Hwan Choi, Mina Seok, Su yeon Ko, Hyun Jung Lee
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionAnkylosing spondylitis (AS) is a chronic systemic inflammatory disease affecting the axial skeleton, including the sacroiliac joint, which causes vertebral fusion in the advanced stage. However, reports of anterior cervical osteophytes compressing the esophagus and causing dysphagia in patients with AS are rare. Here, we present the case of a patient with AS and anterior cervical osteophytes who exhibited rapidly progressing dysphagia after thoracic spinal cord injury (SCI).Case PresentationThe patient, a 79-year-old man, was previously diagnosed with AS and had syndesmophytes at C2-C7 without dysphagia for several years. In 2020, he began to experience paraplegia, hypesthesia, and bladder and bowel dysfunction after a fall. He also had T9 SCI American Spinal Injury Association Impairment Scale grade A due to a T10 transverse fracture. Four months after SCI, he developed aspiration pneumonia, and a videofluoroscopic swallowing study indicated dysphagia with epiglottic closing problems due to syndesmophytes at the C2-C3 and C3-C4 levels. He received treatment for dysphagia and VitalStim therapy thrice (once daily); however, the recurrent pneumonia and fever continued. He further underwent bedside physical therapy and functional electrical stimulation once daily. However, he died from atelectasis and exacerbation of sepsis.Discussion and ConclusionGeneral deterioration of the patient’s physical condition due to SCI, sarcopenic dysphagia, and compression of cervical osteophytes seemed to be involved in rapid exacerbation following SCI. Early screening for dysphagia is vital in bedridden patients with AS or SCI. Additionally, assessment and follow-up are important if the number of rehabilitation treatments or the out-of-bed movement activity decreases because of pressure ulcers.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-03-02T09:28:35Z
DOI: 10.1177/21514593231159353
Issue No: Vol. 14 (2023)
- Effect of Postoperative Non-Weight-Bearing in Trochanteric Fracture of the
Femur: A Retrospective Cohort Study Using Propensity Score Matching
Authors: Naoki Takemoto, Junya Yoshitani, Yoshitomo Saiki, Hitoaki Numata, Koshi Nambu
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe effects of postoperative early weight-bearing (WB) on walking ability, muscle mass, and sarcopenia have been investigated. Postoperative WB restriction is also reportedly associated with pneumonia and prolonged hospitalization; however, its effect on surgical failures has not been studied. This study aimed to assess whether WB restriction after surgery for trochanteric fracture of the femur (TFF) is useful in preventing surgical failure, considering the unstable fracture type, quality of intraoperative reduction, and tip-apex distance.Patients and MethodsThis retrospective analysis included 301 patients admitted to a single institution between January 2010 and December 2021, diagnosed with TFF, and who underwent femoral nail surgery. Eight patients were excluded, and finally 293 patients were included in the study. Propensity score (PS) matching yielded 123 cases; 41 patients in the non-WB (NWB) group and 82 patients in the WB group were included in the final analysis. The primary outcome was surgical failure (cutout, nonunion, osteonecrosis, and implant failure). The secondary outcomes were medical complications (pneumonia, urinary tract infection, stroke, and heart failure), change in walking ability, period of hospitalization, and sliding distance of the lag screw.ResultsFive surgical complications occurred in the NWB group and two in the WB group, with significantly more surgical complications in the NWB group (P = .041). Cutout occurred in two cases, each in the NWB and WB groups. Two cases of nonunion and one case of implant failure occurred in the NWB group, but not in the WB group. Osteonecrosis did not occur in both groups. The secondary outcomes were not significantly different between the two groups.ConclusionsThe results of this retrospective cohort study using a PS matching approach showed that WB restriction after TFF surgery could not decrease the incidence of surgical failures.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-02-27T05:33:09Z
DOI: 10.1177/21514593231160916
Issue No: Vol. 14 (2023)
- What Postoperative Nutritional Interventions Lead to Better Outcomes in
Fragility Hip Fractures' A Systematic Review
Authors: Jennifer S. Oberstar, Caitlin J. Bakker, Megan Sorich, Teresa McCarthy
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
BackgroundFragility hip fracture patients are often malnourished. Nutrition supplementation may help, but it is unclear if supplementation is impactful when considering outcomes. A systematic review of literature examining perioperative nutrition status for older adults experiencing a hip fracture was performed.MethodsWe searched Medline, CAB Abstracts and Embase (Ovid); Cochrane Library (Wiley); PubMed; Scopus; Global Index Medicus; Web of Science Core Collection; SPORTDiscus (EBSCO); and clinical trial registries ClinicalTrials.gov and WHO ICTRP from inception to April 2021, incorporating terminology related to nutritional interventions, fragility fractures, and postoperative outcomes. Two investigators reviewed citations for inclusion, extracted nutrition intervention criteria, and categorized hip fragility outcomes.ResultsOf 1792 citations, 90 articles underwent full-text screening, and 14 articles were included in the final sample. We identified nutritional interventions and 4 outcomes of interest. 8 studies (n = 649) demonstrated a mean difference of .78 days (CI .34-1.21) in length of stay (LOS) between the nutritional intervention and control groups. Rehabilitation ward stays were discussed in 2 studies demonstrating a non-statistically significant difference. 7 studies (n = 341) reported mortality rates; when pooled there was no statistically significant difference. 5 studies showed data for postoperative infections and 4 studies reported on postoperative urinary tract infections. Pooling of data found a statistically significant result (Relative Risk: .49 [.32, .75], P = .001) with low heterogeneity (I2 = 27%). 4 studies reported urinary tract infections (n = 140) in the intervention group and (n = 121) in the control group with a non-statistically significant result. Grip strength was only reported in two studies but pooling of the data was non-statistically significant.ConclusionsThis systematic review highlighted the lack of consensus regarding the type of nutrition interventions available and impact on outcomes of interest including mortality, length of stay, infections, and grip strength for fragility hip fractures in older adults.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-02-16T02:19:51Z
DOI: 10.1177/21514593231155828
Issue No: Vol. 14 (2023)
- Psoas Hematoma After Posterior Lumbar Interbody fusion: A Case Report and
Literature Review
Authors: Guan Shi, Liang Zhang, Hao Chen, Tianhao Su, Pu Jia, Fei Feng, Mengmeng Chen, Li Bao
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThis article introduced the management of a case with severe left lower extremity pain and forced hip flexion after posterior lumbar interbody fusion and a final diagnosis of left psoas hematoma.Materials and methodsHere we reported a case of a 65-year-old female received posterior lumbar interbody fusion (PLIF) for L4-L5 spondylolisthesis and L4 instability. On the postoperative day one, the hemoglobin level decreased from 108 g/L to 78 g/L. Meanwhile, the patient presented low back pain and inner thigh radiating pain (VAS pain scale = 8). The pain was so severe that it could be barely relieved by keeping left hip in flexion position. On the postoperative day 6, the pain was still severe even after taking mecobalamin, ankylosaurus, dehydrant agents and central pain relievers(VAS pain scale = 9). Computed Tomography indicated a left intramuscular hematoma image extending down to the left iliac fossa. Active hemorrhage of lumbar segmental arterial was detected by B-ultrasound. The patient then received vascular embolization under angiography on the postoperative day 7.ResultsThe pain in the low back and inner thigh were significantly relieved after the procedure (VAS3-4). On the postoperative day nineteen, the left hip can be fully extended, but the patient was still not able to stand on left leg without a walking stick. On the postoperative day 27, she was able to walk independently.DiscussionThe main reason for the complication was the second conical dilation channel slipped and entered the lateral side of the vertebral body along the transverse process. After timely embolization, pain was significantly relieved and muscle strength was improved.ConclusionsAngiographic embolization is an effective treatment for psoas hematoma after posterior lumbar interbody fusion.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-02-13T06:44:33Z
DOI: 10.1177/21514593231158277
Issue No: Vol. 14 (2023)
- Comparison of Intravenous, Topical, or Combined Routes of Tranexamic Acid
in Primary Total Knee Arthroplasty
Authors: Chunqiang Bi, Damei Wu, Fei Xie, Xue Song, Dawei Yang
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
Introduction: The optimal route and dosing regimen of tranexamic acid (TXA) in primary total knee arthroplasty (TKA) remains unclear. This study aims to explore if there was a synergistic effect of intravenous (IV) and topical TXA on blood loss and risk of complications. Materials and methods: From Jan 2019 to June 2021, medical records of patients aged 65 years or older who underwent primary unilateral TKA for primary osteoarthritis were retrospectively reviewed. The included patients were divided into 3 groups according to the methods of TXA application: Intravenous (IV) group, topical group, or combined group. Propensity-score match was used to reduce the bias and imbalance of confounding variables. The primary outcome was total blood loss. Results: The total blood loss, hidden blood loss, and the reduction of Hb concentration in the combined group were significantly lower than in the IV group and topical group (all P < .01). There is no significant difference in the transfusion rate, length of hospital stay, and incidence of thromboembolic events (both P> .05). Conclusions: Combined administration of IV and topical TXA is the most effective approach to decrease blood loss and postoperative Hb drop in the treatment of TKA without increasing any risk of complications.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-02-11T09:51:55Z
DOI: 10.1177/21514593231152377
Issue No: Vol. 14 (2023)
- Higher Mortality Rate in Patients with Vertebral Compression Fractures is
due to Deteriorated Medical Status Prior to the Fracture Event
Authors: Ariel Zohar, Itamar getzler, Eyal Behrbalk
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionVertebral compression fractures (VCF) are the most common low-energy fractures in older people and are associated with increased mortality. To assess mortality risk in patients suffering from VCF, we conducted a retrospective observational long-term cohort study.Patients and MethodsThe study included 270 patients. 221 patients were treated conservatively, and 49 were treated with vertebroplasty. The study group was compared to a control group of 1641 random individuals age and sex-matched. Electronic healthcare data extracted included monthly chronic medications taken regularly 3 months before hospitalisation, analgesics excluded, and date of death.ResultsPatients who suffer from VCF tend to consume more chronic medications. The mean count of chronic medication prescriptions in the 3 months before hospitalisation was 16.41 (±9.11) in the VCF group and 11.52 (± 7.17) in the control cohort (P < .0001). In univariate analysis, patients with VCF showed decreased long-term survival (P < .00). However, when controlled for age, sex, and chronic medications uptake, no significant difference was observed between the groups in a multivariate model (P = .12).ConclusionsThe study demonstrates that VCF as an independent variable has a marginal effect on mortality. The higher mortality prevalent in these patients is due to the deteriorated health status of the patients before fracture.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-01-31T05:58:56Z
DOI: 10.1177/21514593231153106
Issue No: Vol. 14 (2023)
- Two-Part Intertrochanteric Femur Fractures with Bisection of the Lesser
Trochanter: An Irreducible Fracture Pattern
Authors: Sun-jun Hu, Shi-Min Chang, Shou-chao Du, Li-zhi Zhang, Wen-feng Xiong
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
ObjectiveTo introduce the clinical features of and surgical techniques for a rare type of irreducible pertrochanteric femur fracture pattern with bisection of the lesser trochanter.MethodsFrom January 2017 to December 2019, 357 patients with per/intertrochanteric femur fractures underwent surgery by closed reduction and internal fixation, of whom 12 patients were identified with rare preoperative imaging features, the lesser trochanter was almost equally bisected. The main fracture pathoanatomy of these cases included: The anterior fracture line passed along the intertrochanteric line to the medial lesser trochanter and bisected it into 2 equal parts from mid-level of the lesser trochanteric protrusion. The proximal part of the lesser trochanter connected to the head-neck fragment and attached by the psoas major tendon, while the distal part of the lesser trochanter connected to the femoral shaft and attached by the tendon of the iliac muscle. These fractures were irreducible by a closed maneuver and were reduced with limited assistance by some devices, and short intramedullary nails were used for fixation of these fractures.ResultsAll patients were followed up for an average of 14.2 ± 2.1 months. Clinical fracture union occurred at an average of 10.8 ± 1.5 weeks, while radiographic union occurred at an average of 12.7 ± 1.2 weeks. No cut out of the helical blade was visible on radiographs. The average Parker-Palmer score was 6.9 ± 1.3 (range, 5-9) at the last follow up, including 8 cases rated as excellent, 2 as good and 2 as fair.ConclusionTwo-part pertrochanteric femur fractures with bisection of the lesser trochanter have an irreducible fracture pattern with cortical locking and soft tissue incarceration. Soft tissue release and short cephalomedullary nail fixation for this fracture pattern provide stable fixation and allow early exercise. This treatment appears to have excellent outcomes in the short and medium terms.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-01-23T04:23:39Z
DOI: 10.1177/21514593231153827
Issue No: Vol. 14 (2023)
- Preoperative Oswestry Disability Index Cannot Reliably Predict Patient
Satisfaction After Single and Double Level Lumbar Transforaminal Interbody
Fusion Surgery
Authors: Bryon Jun Xiong Teo, Tet Sen Howe, Cheri Chan, Joyce SB. Koh, William Yeo, Yeong Huei Ng
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
IntroductionThe role of patient-reported outcomes in preoperative assessment is not well studied. There is recent interest in studying whether Patient-reported outcomes scores can be used either independently, or in conjunction with clinical findings, in the assessment of patients for surgery.AimsTo investigate if improvement in clinically significant scores correlate with post-operative patient satisfaction in 1-2 level transforaminal lumbar interbody fusion (TLIF) surgery. We also aim to define a threshold Oswestry Disability Index (ODI) which correlate with achieving post-operative MCID and patient satisfaction.Methods1001 patients who underwent single or double level TLIF (Minimally invasive and Open) in our institution with at least 2 years follow up were included in this study. We studied self-reported measures including patient satisfaction and ODI score.ResultsAt 2-year follow-up, the overall mean ODI score improved from 49.7 ± 18.3 to 13.9 ± 15.2 (P < 0.001) with 74.6% of patients meeting the MCID. Patient satisfaction was achieved in 95.3% of all patients. In the MIS group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.72 (95% CI 0.65-0.86). In the open group, the preoperative cut-off was determined to be 37.2 at maximal Youden index associated with AUC of 0.70 (95% CI 0.62-0.77). Using the preoperative cut-offs found, there was no significant difference in patient satisfaction in both MIS and open groups.ConclusionsOverall, our patients undergoing TLIF had good 2-year ODI score improvement and patient satisfaction after surgery. While meeting the MCID for ODI score correlates with patients’ satisfaction postoperatively, 75% of patients not meeting the MCID for ODI score remained satisfied with the surgery. We are unable to define a threshold pre-operative ODI which correlates with achieving post-operative MCID and patient satisfaction.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-01-16T07:04:36Z
DOI: 10.1177/21514593231152172
Issue No: Vol. 14 (2023)
- Tranexamic Acid in Hip Hemiarthroplasty Surgery: A Retrospective Analysis
of Perioperative Outcome
Authors: Arne Wilharm, Isabell Wutschke, Philipp Schenk, Gunther Olaf Hofmann
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
Introduction: Implantation of a dual-head hip prosthesis to treat medial femoral neck fractures is often associated with significant blood loss. In elective endoprosthetics procedures, it has already been demonstrated that administration of tranexamic acid (TXA) reduces blood loss and need for postoperative transfusions, as well as reducing the frequency of postoperative complications. The aim of this study is to show whether the administration of TXA also leads to a reduction in perioperative blood loss and haemorrhage-associated complications when applied as part of treatment of femoral neck fractures using a dual-head prosthesis. Methods: In a single-centre retrospective cohort study, 1 g TXA i.v. was administered preoperatively to 93 patients who had suffered from femoral neck fractures. This group was compared to a comparison group of 65 patients who did not receive TXA (nonTXA). Outcomes were evaluated on the basis of perioperative blood loss, frequency of transfusion, and frequency of specific complications occurring. Results: The transfusion rate in the TXA group was 6% lower, whereby the volume of blood transfused was 26.7% lower than in the nonTXA group. However, neither result was significant. The calculated perioperative blood loss remained the same. Similarly, the incidence of postoperative renal failure was not significantly lower in the TXA group, at 6.5%, as compared to the nonTXA group (7.7%). A higher rate of complications or deaths as a result of TXA administration was not observed. The tranexamic acid effect seems to be related to the dose. Conclusion: Preoperative administration of TXA during implantation of a dual-head prosthesis for treatment of a femoral neck fracture does not lead to an increased complication rate. The study revealed a trend towards fewer transfusions required, but a significant reduction in blood loss could not be demonstrated. There should be further investigation of other factors influencing blood loss, in particular the dosing regimen followed for perioperative administration of TXA. Level of Evidence: Level 4: retrospective case-control study
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-01-13T06:27:02Z
DOI: 10.1177/21514593221147817
Issue No: Vol. 14 (2023)
- Commentary on “Risk Factors for Perioperative Hidden Blood Loss After
Intertrochanteric Fracture Surgery in Chinese Patients: A Meta-Analysis”
Authors: Liang-Feng Xu, Zheng-Liang Zhang
Abstract: Geriatric Orthopaedic Surgery & Rehabilitation, Volume 14, Issue , January-December 2023.
Citation: Geriatric Orthopaedic Surgery & Rehabilitation
PubDate: 2023-01-02T08:23:58Z
DOI: 10.1177/21514593221149525
Issue No: Vol. 14 (2023)
