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[PMID]:29201302
[Au] Autor:Padegimas EM; Narzikul A; Lawrence C; Hendy BA; Abboud JA; Ramsey ML; Williams GR; Namdari S
[Ad] Endereço:Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
[Ti] Título:Antibiotic Spacers in Shoulder Arthroplasty: Comparison of Stemmed and Stemless Implants.
[So] Source:Clin Orthop Surg;9(4):489-496, 2017 Dec.
[Is] ISSN:2005-4408
[Cp] País de publicação:Korea (South)
[La] Idioma:eng
[Ab] Resumo:Background: Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers. Methods: All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed. Results: There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m vs. stemmed group, 31.5 ± 8.3 kg/m ; = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109° ± 23°. Within the stemmed group, 12 of 15 (80.0%, = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94° ± 43° (range, 30° to 150°; = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation. Conclusions: Stemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers.
[Mh] Termos MeSH primário: Antibacterianos/administração & dosagem
Artroplastia do Ombro/efeitos adversos
Infecções Relacionadas à Prótese/tratamento farmacológico
Prótese de Ombro/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Feminino
Hemiartroplastia/efeitos adversos
Seres Humanos
Masculino
Meia-Idade
Duração da Cirurgia
Infecções Relacionadas à Prótese/microbiologia
Infecções Relacionadas à Prótese/cirurgia
Amplitude de Movimento Articular
Reoperação
Estudos Retrospectivos
Articulação do Ombro/fisiopatologia
Tobramicina/administração & dosagem
Vancomicina/administração & dosagem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 6Q205EH1VU (Vancomycin); VZ8RRZ51VK (Tobramycin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180207
[Lr] Data última revisão:
180207
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171205
[St] Status:MEDLINE
[do] DOI:10.4055/cios.2017.9.4.489


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[PMID]:29305458
[Au] Autor:Stevenson JD; Kumar VS; Cribb GL; Cool P
[Ad] Endereço:Aston University Medical School, Aston Express Way, Birmingham, B4 7ET, UK.
[Ti] Título:Hemiarthroplasty proximal femoral endoprostheses following tumour reconstruction: is acetabular replacement necessary?
[So] Source:Bone Joint J;100-B(1):101-108, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Dislocation rates are reportedly lower in patients requiring proximal femoral hemiarthroplasty than for patients undergoing hip arthroplasty for neoplasia. Without acetabular replacement, pain due to acetabular wear necessitating revision surgery has been described. We aimed to determine whether wear of the native acetabulum following hemiarthroplasty necessitates revision surgery with secondary replacement of the acetabulum after proximal femoral replacement (PFR) for tumour reconstruction. PATIENTS AND METHODS: We reviewed 100 consecutive PFRs performed between January 2003 and January 2013 without acetabular resurfacing. The procedure was undertaken in 74 patients with metastases, for a primary bone tumour in 20 and for myeloma in six. There were 48 male and 52 female patients, with a mean age of 61.4 years (19 to 85) and median follow-up of two years (interquartile range (IQR) 0.5 to 3.7 years). In total, 52 patients presented with a pathological fracture and six presented with failed fixation of a previously instrumented pathological fracture. RESULTS: All patients underwent reconstruction with either a unipolar (n = 64) or bipolar (n = 36) articulation. There were no dislocations and no acetabular resurfacings. Articular wear was graded using the criteria of Baker et al from 0 to 3, where by 0 is normal; grade 1 represents a narrowing of articular cartilage and no bone erosion; grade 2 represents acetabular bone erosion and early migration; and grade 3 represents protrusio acetabuli. Of the 49 patients with radiological follow-up greater than one year, six demonstrated grade 1 acetabular wear and two demonstrated grade 2 acetabular wear. The remainder demonstrated no radiographic evidence of wear. Median medial migration was 0.3 mm (IQR -0.2 to 0.7) and superior migration was 0.3 mm (IQR -0.2 to 0.6). No relationship between unipolar bipolar articulations and wear was evident. CONCLUSION: Hemiarthroplasty PFRs for tumour reconstruction eliminate joint instability and, in the short to medium term, do not lead to native acetabular wear necessitating later acetabular resurfacing. Cite this article: 2018;100B:101-8.
[Mh] Termos MeSH primário: Acetábulo/cirurgia
Artroplastia de Quadril/métodos
Neoplasias Femorais/cirurgia
Hemiartroplastia/métodos
Prótese de Quadril
[Mh] Termos MeSH secundário: Acetábulo/diagnóstico por imagem
Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Quadril/efeitos adversos
Feminino
Neoplasias Femorais/secundário
Seguimentos
Hemiartroplastia/efeitos adversos
Luxação do Quadril/etiologia
Seres Humanos
Salvamento de Membro/métodos
Masculino
Meia-Idade
Falha de Prótese
Radiografia
Reoperação/métodos
Reoperação/estatística & dados numéricos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180107
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0005.R1


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[PMID]:29292342
[Au] Autor:Bedard NA; DeMik DE; Dowdle SB; Callaghan JJ
[Ad] Endereço:University of Iowa, 200 Hawkins Drive, Iowa City, IA 52242, USA.
[Ti] Título:Trends and risk factors for prolonged opioid use after unicompartmental knee arthroplasty.
[So] Source:Bone Joint J;100-B(1 Supple A):62-67, 2018 Jan.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: The purpose of this study was to evaluate trends in opioid use after unicompartmental knee arthroplasty (UKA), to identify predictors of prolonged use and to compare the rates of opioid use after UKA, total knee arthroplasty (TKA) and total hip arthroplasty (THA). MATERIALS AND METHODS: We identified 4205 patients who had undergone UKA between 2007 and 2015 from the Humana Inc. administrative claims database. Post-operative opioid use for one year post-operatively was assessed using the rates of monthly repeat prescription. These were then compared between patients with and without a specific variable of interest and with those of patients who had undergone TKA and THA. RESULTS: A total of 4205 UKA patients were analysed. Of these, 1362 patients (32.4%) were users of opioids. Pre-operative opioid use was the strongest predictor of prolonged opioid use after UKA. Opioid users were 1.4 (81.6% 57.7%), 3.7 (49.5% 13.3%) and 5.5 (35.8% 6.5%) times more likely to be taking opioids at one, two and three months post-operatively, respectively (p < 0.05 for all). Younger age and specific comorbidities such as anxiety/depression, smoking, back pain and substance abuse were found to significantly increase the rate of repeat prescription for opioids after UKA. Overall, UKA patients required significantly less opioid prescriptions than patients who had undergone THA and TKA. CONCLUSION: One-third of patients who undergo UKA are given opioids in the three months pre-operatively. Pre-operative opioid use is the best predictor of increased repeat prescriptions after UKA. However, other intrinsic patient characteristics are also predictive. Cite this article: 2018;100-B(1 Supple A):62-7.
[Mh] Termos MeSH primário: Analgésicos Opioides/uso terapêutico
Artroplastia do Joelho
Uso de Medicamentos/tendências
Hemiartroplastia
Dor Pós-Operatória/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Artroplastia de Quadril
Bases de Dados Factuais
Uso de Medicamentos/estatística & dados numéricos
Feminino
Seres Humanos
Masculino
Meia-Idade
Fatores de Risco
Fatores de Tempo
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Analgesics, Opioid)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180104
[Lr] Data última revisão:
180104
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.100B1.BJJ-2017-0547.R1


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[PMID]:28984780
[Au] Autor:Taheriazam A; Saeidinia A
[Ad] Endereço:aDepartment of Orthopedics Surgery, Tehran Medical Sciences Branch, Islamic Azad University, Tehran bMashhad University of Medical Sciences, Mashhad cMedical Practitioner, Guilan University of Medical Sciences, Rasht, Iran.
[Ti] Título:Conversion of failed hemiarthroplasty to total hip arthroplasty: A short-term follow-up study.
[So] Source:Medicine (Baltimore);96(40):e8235, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Purpose of this study was to evaluate the outcomes of patients underwent hemiarthroplasty for proximal femoral fracture converted to total hip arthroplasty (THA).A total of 138 patients from October 2009 till October 2014 had conversion of their failed hemiarthroplasties following a proximal femoral fracture to total hip arthroplasty (THA) in Erfan and Milad hospitals, Tehran. We performed a prospective analysis of the outcome of conversion surgery in patients with failed hemiarthroplasty. The patients had clinical evaluations at 1 month, 6 months, 1 year, and annually thereafter. We used Harris Hip Score (HHS) to evaluate the results of conversion procedure in terms of relief of groin pain and functional improvement.Dislocation occurred in 6 patients (4.34%). The mean period of follow-up was 42 months (range 36-60 months). HHS score improved from mean preoperative score of 44.93 ±â€Š8.40 to 95.41 ±â€Š2.27 at final follow-up. The survivorship analysis with revision of HHS score was 89.1%. Existence of infection (P = .038) and time of primary operation to being symptomatic (P = .009) can predict the postoperative pain significantly.THA is a safe option which can lead to good functional and short-term and mid-term outcomes; and patients should be informed of the possibility of incomplete relief of groin pain or other symptoms postoperatively.
[Mh] Termos MeSH primário: Artroplastia de Quadril/métodos
Fraturas do Fêmur/cirurgia
Hemiartroplastia/efeitos adversos
Reoperação/métodos
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Feminino
Fraturas do Fêmur/fisiopatologia
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Dor Pós-Operatória/etiologia
Dor Pélvica/etiologia
Período Pós-Operatório
Estudos Prospectivos
Recuperação de Função Fisiológica
Resultado do Tratamento
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171012
[Lr] Data última revisão:
171012
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171007
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008235


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[PMID]:28886084
[Au] Autor:Groves D; Fisher J; Williams S
[Ad] Endereço:Institute of Medical and Biological Engineering, School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom.
[Ti] Título:An in vitro simulation method for the tribological assessment of complete natural hip joints.
[So] Source:PLoS One;12(9):e0184226, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The use of hip joint simulators to evaluate the tribological performance of total hip replacements is widely reported in the literature, however, in vitro simulation studies investigating the tribology of the natural hip joint are limited with heterogeneous methodologies reported. An in vitro simulation system for the complete natural hip joint, enabling the acetabulum and femoral head to be positioned with different orientations whilst maintaining the correct joint centre of rotation, was successfully developed for this study. The efficacy of the simulation system was assessed by testing complete, matched natural porcine hip joints and porcine hip hemiarthroplasty joints in a pendulum friction simulator. The results showed evidence of biphasic lubrication, with a non-linear increase in friction being observed in both groups. Lower overall mean friction factor values in the complete natural joint group that increased at a lower rate over time, suggest that the exudation of fluid and transition to solid phase lubrication occurred more slowly in the complete natural hip joint compared to the hip hemiarthroplasty joint. It is envisaged that this methodology will be used to investigate morphological risk factors for developing hip osteoarthritis, as well as the effectiveness of early interventional treatments for degenerative hip disease.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Simulação por Computador
Fricção
Articulação do Quadril/fisiologia
Teste de Materiais
[Mh] Termos MeSH secundário: Acetábulo/fisiologia
Algoritmos
Animais
Cabeça do Fêmur/fisiologia
Hemiartroplastia
Modelos Teóricos
Suínos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171018
[Lr] Data última revisão:
171018
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170909
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0184226


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[PMID]:28768787
[Au] Autor:de Jong L; Klem TMAL; Kuijper TM; Roukema GR
[Ad] Endereço:Maasstad Hospital, Maasstadweg 21, 3079 DZ Rotterdam, The Netherlands.
[Ti] Título:Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur.
[So] Source:Bone Joint J;99-B(8):1088-1094, 2017 Aug.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Surgical site infection can be a devastating complication of hemiarthroplasty of the hip, when performed in elderly patients with a displaced fracture of the femoral neck. It results in a prolonged stay in hospital, a poor outcome and increased costs. Many studies have identified risk and prognostic factors for deep infection. However, most have combined the rates of infection following total hip arthroplasty and internal fixation as well as hemiarthroplasty, despite the fact that they are different entities. The aim of this study was to clarify the risk and prognostic factors causing deep infection after hemiarthroplasty alone. PATIENTS AND METHODS: Data were extracted from a prospective hip fracture database and completed by retrospective review of the hospital records. A total of 916 patients undergoing a hemiarthroplasty in two level II trauma teaching hospitals between 01 January 2011 and 01 May 2016 were included. We analysed the potential peri-operative risk factors with univariable and multivariable logistic regression analysis. RESULTS: A total of 92 patients (10%) had a surgical site infection, and 44 (4.9%) developed a deep infection. After univariable analyses, the multivariable model showed that the level of experience of the surgeon measured by the number of hemiarthroplasties performed per year was a significant prognostic factor (odds ratio (OR) 0.93, p = 0.042) for the development of an infection. Secondly, the development of a haematoma (OR 9.6, p < 0.001), a re-operation (OR 4.7, p = 0.004) and an operating time of < 45 mins (OR 5.1, p = 0.002) or > 90 mins (OR 2.7, p = 0.034) were also significant factors. CONCLUSION: There was a significant association between the experience of the surgeon and the rate of deep infection. Secondly, a haematoma, a re-operation and both shorter and longer operating times were associated with an increased risk of deep infection after hemiarthroplasty. No association was found between deep infection and the anatomical approach, the time when surgery was undertaken and the use of a drain. Cite this article: 2017;99-B:1088-94.
[Mh] Termos MeSH primário: Fraturas do Colo Femoral/cirurgia
Fixação Interna de Fraturas/efeitos adversos
Hemiartroplastia/efeitos adversos
Prótese de Quadril/efeitos adversos
Infecção da Ferida Cirúrgica/epidemiologia
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Seguimentos
Seres Humanos
Incidência
Masculino
Países Baixos/epidemiologia
Estudos Prospectivos
Fatores de Risco
Infecção da Ferida Cirúrgica/etiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170913
[Lr] Data última revisão:
170913
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B8.BJJ-2016-1119.R1


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[PMID]:28691547
[Au] Autor:Hansson S; Nemes S; Kärrholm J; Rogmark C
[Ad] Endereço:a Department of Orthopaedics , Lund University, Skåne University Hospital , Malmö.
[Ti] Título:Reduced risk of reoperation after treatment of femoral neck fractures with total hip arthroplasty.
[So] Source:Acta Orthop;88(5):500-504, 2017 Oct.
[Is] ISSN:1745-3682
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and purpose - Femoral neck fractures (FNFs) are commonly treated with some kind of arthroplasty, but evidence on whether to use hemiarthroplasty (HA) or total hip arthroplasty (THA) is lacking. HA reduces the risk of dislocation, but may lead to acetabular erosion. THA implies longer surgery and increased bleeding. THA may result in better function and health-related quality of life, but evidence is contradictory. We compared HA and THA and in terms of revision, reoperation and death. Patients and methods - Data were extracted from the Swedish Hip Arthroplasty Register for 11,253 patients with acute FNF receiving cemented HA or THA during 2008-2012. 2,902 patients with THA were matched by propensity score matching with as many patients with HA based on age, sex, BMI, and ASA classification. We used competing risks survival regression with reoperation or death and revision or death as endpoints. Results - THA patients had significantly reduced risk of revision (absolute risk reduction 0.51; 95% CI 0.39-0.67) and reoperation (0.58; 0.46-0.74). THA was associated with an almost 50% reduced mortality (risk ratio as competing risk for reoperation 0.51; 0.46-0.57). Interpretation - In our national register study of femoral neck fractures, THA had a lower risk than HA for further surgical procedures related to the hip. The reasons for lower mortality after THA are not known. Despite matching, there might be a selection of more healthy patients for this procedure, and other factors unknown to us, with or without relation to the choice of implant.
[Mh] Termos MeSH primário: Artroplastia de Quadril
Fraturas do Colo Femoral/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia de Quadril/efeitos adversos
Feminino
Hemiartroplastia/efeitos adversos
Seres Humanos
Estimativa de Kaplan-Meier
Masculino
Reoperação/estatística & dados numéricos
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171001
[Lr] Data última revisão:
171001
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170711
[St] Status:MEDLINE
[do] DOI:10.1080/17453674.2017.1348095


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[PMID]:28681677
[Au] Autor:Gjertsen JE; Dybvik E; Furnes O; Fevang JM; Havelin LI; Matre K; Engesæter LB
[Ad] Endereço:a Norwegian Arthroplasty Register, Department of Orthopaedic Surgery , Haukeland University Hospital , Bergen.
[Ti] Título:Improved outcome after hip fracture surgery in Norway.
[So] Source:Acta Orthop;88(5):505-511, 2017 Oct.
[Is] ISSN:1745-3682
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and purpose - The operative treatment of hip fractures in Norway has changed considerably during the last decade. We used data in the Norwegian Hip Fracture Register to investigate possible effects of these changes on reoperations and 1-year mortality. Patients and methods - 72,741 femoral neck (FFN) fractures and trochanteric fractures in patients 60 years or older were analyzed. The fractures were divided into 5 time periods (2005-2006, 2007-2008, 2009-2010, 2011-2012, 2013-2014). Cox regression models were used to calculate unadjusted and adjusted (age group, sex, and ASA class) relative risks (RRs) of reoperation and of 1-year mortality in the different time periods. Results - For undisplaced FFNs treatment with hemiarthroplasty increased from 2.1% to 9.7% during the study period. For displaced FFNs treatment with arthroplasty increased from 56% to 93%. The use of intramedullary nails increased from 9.1% to 26% for stable 2-fragment (AO/OTA A1) trochanteric fractures, from 15% to 33% for multifragment (AO/OTA A2) trochanteric fractures, and from 27% to 61% for intertrochanteric fractures (AO/OTA A3)/subtrochanteric fractures. Compared with the first time period the adjusted 1-year RR for reoperation was 0.43 (95% CI: 0.37-0.49) for displaced FFNs in the last time period. The adjusted 1-year mortality in the last time period was lower for all fractures (RR: 0.87 (0.83-0.91)), displaced FFNs (RR: 0.86 (0.80-0.93)), AO/OTA A1 trochanteric fractures (RR: 0.79 (0.71-0.88)), and AO/OTA A2 trochanteric fractures (RR: 0.87 (0.77-0.98)) when compared with the first study period. Interpretation - Hip fracture treatment in Norway has improved: The risk of reoperation and the 1-year mortality after displaced femoral neck fractures have decreased over a 10-year period. National registration is useful to monitor trends in treatment and outcomes after hip fractures.
[Mh] Termos MeSH primário: Fraturas do Quadril/cirurgia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Artroplastia de Quadril/estatística & dados numéricos
Feminino
Fraturas do Colo Femoral/mortalidade
Fraturas do Colo Femoral/cirurgia
Hemiartroplastia/estatística & dados numéricos
Fraturas do Quadril/mortalidade
Seres Humanos
Masculino
Noruega/epidemiologia
Modelos de Riscos Proporcionais
Melhoria de Qualidade/estatística & dados numéricos
Sistema de Registros
Reoperação/estatística & dados numéricos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:171001
[Lr] Data última revisão:
171001
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1080/17453674.2017.1344456


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[PMID]:28663404
[Au] Autor:Mamarelis G; Key S; Snook J; Aldam C
[Ad] Endereço:Princess Alexandra Hospital NHS Trust, Harlow, Essex CM20 1QX, UK.
[Ti] Título:Outcomes after early return to theatre following hip hemiarthroplasty for intracapsular fracture of the femoral neck.
[So] Source:Bone Joint J;99-B(7):958-963, 2017 Jul.
[Is] ISSN:2049-4408
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:AIMS: Hip hemiarthroplasty is a standard treatment for intracapsular proximal femoral fractures in the frail elderly. In this study we have explored the implications of early return to theatre, within 30 days, on patient outcome following hip hemiarthroplasty. PATIENTS AND METHODS: We retrospectively reviewed the hospital records of all hip hemiarthroplasties performed in our unit between January 2010 and January 2015. Demographic details, medical backround, details of the primary procedure, complications, subsequent procedures requiring return to theatre, re-admissions, discharge destination and death were collected. RESULTS: A total of 705 procedures were included; 428 Austin Moore and 277 Exeter Trauma Stems were used. A total of 34 fractures (in 33 patients) required early return to theatre within 30 days. Age, gender, laterality, time from admission to primary procedure, American Society of Anesthesiologists grade, and implant type were similar for those requiring early return to theatre and those who did not. Early return to theatre was associated with a significantly higher length of stay (mean 33.6 days (7 to 107) 18.6 days (0 to 152), p < 0.001), re-admission rate (38.2% 8.6%, p < 0.001), and subsequent revision rate (17.6% 1.3%, p < 0.001). We found no difference in level of care required on discharge or mortality. CONCLUSION: Proximal femoral fractures are common in the elderly population, with far-reaching medical and economic implications. Factors such as infection or dislocation may require early return to theatre, and this is associated with outcomes which may be both medically and economically detrimental. This illustrates the importance of avoiding early complications to improve longer term outcome. Return to theatre within 30 days is associated with longer length of stay, higher re-admission rate, and higher subsequent revision rate. It may be a useful short-term quality indicator for longer term outcome measures following hip hemiarthroplasty for intracapsular fractures of the proximal femur. Cite this article: 2017;99-B:958-63.
[Mh] Termos MeSH primário: Fraturas do Colo Femoral/cirurgia
Hemiartroplastia
Reoperação/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso de 80 Anos ou mais
Feminino
Fraturas do Colo Femoral/epidemiologia
Seres Humanos
Tempo de Internação/estatística & dados numéricos
Masculino
Readmissão do Paciente/estatística & dados numéricos
Complicações Pós-Operatórias
Estudos Retrospectivos
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170828
[Lr] Data última revisão:
170828
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170701
[St] Status:MEDLINE
[do] DOI:10.1302/0301-620X.99B7.BJJ-2016-0890.R1


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[PMID]:28426259
[Au] Autor:Mellner C; Eisler T; Börsbo J; Brodén C; Morberg P; Mukka S
[Ad] Endereço:a Department of Surgical and Perioperative Sciences , Umeå University , Umeå.
[Ti] Título:The Sernbo score predicts 1-year mortality after displaced femoral neck fractures treated with a hip arthroplasty.
[So] Source:Acta Orthop;88(4):402-406, 2017 Aug.
[Is] ISSN:1745-3682
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:Background and purpose - Displaced femoral neck fractures (FNFs) are associated with high rates of mortality during the first postoperative year. The Sernbo score (based on age, habitat, mobility, and mental state) can be used to stratify patients into groups with different 1-year mortality. We assessed this predictive ability in patients with a displaced FNF treated with a hemiarthroplasty or a total hip arthroplasty. Patients and methods - 292 patients (median age 83 (65-99) years, 68% female) with a displaced FNF were included in this prospective cohort study. To predict 1-year mortality, we used a multivariate logistic regression analysis including comorbidities and perioperative management. A receiver operating characteristic (ROC) analysis was used to evaluate the predictive ability of the Sernbo score, which was subsequently divided in a new manner into a low, intermediate, or high risk of death during the first year. Results - At 1-year follow-up, the overall mortality rate was 24%, and in Sernbo's low-, intermediate-, and high-risk groups it was 5%, 22%, and 51%, respectively. The Sernbo score was the only statistically significant predictor of 1-year mortality: odds ratio for the intermediate-risk group was 4.2 (95% Cl: 1.5-12) and for the high-risk group it was 15 (95% CI: 5-40). The ROC analysis showed a fair predictive ability of the Sernbo score, with an area under the curve (AUC) of 0.79 (95% CI: 0.73-0.83). Using a cutoff of less than 11 points on the score gave a sensitivity of 61% and a specificity of 83%. Interpretation - The Sernbo score identifies patients who are at high risk of dying in the first postoperative year. This scoring system could be used to better tailor perioperative care and treatment in patients with displaced FNF.
[Mh] Termos MeSH primário: Artroplastia de Quadril/mortalidade
Fraturas do Colo Femoral/cirurgia
Hemiartroplastia/mortalidade
[Mh] Termos MeSH secundário: Atividades Cotidianas
Fatores Etários
Idoso
Idoso de 80 Anos ou mais
Feminino
Fraturas do Colo Femoral/mortalidade
Seres Humanos
Estimativa de Kaplan-Meier
Modelos Logísticos
Masculino
Estudos Prospectivos
Medição de Risco
Fatores de Risco
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170421
[St] Status:MEDLINE
[do] DOI:10.1080/17453674.2017.1318628



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